Screening,education, and associated behavioral responses to reduce risk for falls among people over age 65 years attending a community health fair

BACKGROUND AND PURPOSE: Because of the high risk of falling and the recognition that falling is a "geriatric syndrome," screening for risk of falls has become popular at community health fairs. The purposes of this study were to determine whether health fair screening and educational intervention would result in behaviors that could reduce the risk of falls and to determine whether adoption of risk-reduction behaviors differed between people over age 65 years screened as being at high risk for falls and those screened as being at lower risk for falls. SUBJECTS AND METHODS: The Berg Balance Test was used to classify fall risk in 68 individuals aged 57 to 89 years who were attending a community health fair. A score of 45 or lower led to a categorization of the person being at high risk for falls. All subjects were provided recommendations intended to reduce fall risk. Participants were interviewed by telephone 30 days after the screening to assess implementation of these recommendations. RESULTS: Seventy-two percent of the participants reported implementing at least one risk-reduction behavior. The high-risk group was more likely to implement risk-reduction behaviors than the low-risk group. DISCUSSION AND CONCLUSION: Screening and education in a health fair setting appear to promote behaviors that could reduce fall risk among elderly people. Future study with a control group that does not receive an educational intervention is needed to draw more definite conclusions about the value of this health promotion activity for fall prevention.     

Older people's experience of falls: understanding, interpretation and autonomy

Title. Older people’s experience of falls: understanding, interpretation and autonomy Aim. This paper is a report of a study to explore the experiences of older people who suffered a recent fall and identify possible factors that could contribute to service development. Background. Falls in older people are prevalent and are associated with morbidity, hospitalization and mortality, personal costs to individuals and financial costs to health services. Method. A convenience sample of 27 older people (mean age 84 years; range 65–98) participated in semi‐structured taped interviews. Follow‐up interviews during 2003–2004 were undertaken to detect changes over time. Data were collected about experience of the fall, use of services, health and well‐being, activities of daily living, informal care, support networks and prevention. Thematic content analysis was undertaken. Findings. Twenty‐seven initial interviews and 18 follow‐up interviews were conducted. The majority of people fell indoors (n = 23) and were alone (n = 15). The majority of falls were repeat falls (n = 22) and five were a first‐ever fall. People who reflected on their fall and sought to understand why and how it occurred developed strategies to prevent future falls, face their fear, maintain control and choice and continue with activities of daily living. Those who did not reflect on their fall and did not know why it occurred restricted their activities and environments and remained in fear of falling. Conclusion. Assisting people to reflect on their falls and to understand why they happened could help with preventing future falls, allay fear, boost confidence and aid rehabilitation relating to their activities of daily living.     

Prospective study of fall risk assessment among institutionalized elderly in Japan

Abstract The purpose of the present study was to identify risk factors for falls among institutionalized elderly, using the standardized risk assessment tool developed by Izumi. We examined 746 patients from three types of facilities: rehabilitation wards in four general hospitals, three long-term care facilities, and three nursing homes, for up to three months. The incidence of falls within all facilities was 12.5%. Patterns of relative risks of falling differed among types of facilities. The highest relative risk of fall in long-term care facilities and nursing homes was nurses' prediction, followed by history of fall and altered mentation. In contrast, that in general hospitals was mobility. In long-term care facilities, history of falls (odds 3.68, 95CI: 1.47–9.23) and interaction (history of falls and assistance with toileting) (odds 3.13, 95CI: 1.48–6.64) showed significance on adjusted-odds ratios for fall. History of falls, altered mentation, and assistance with toileting may be used to screen patients at a high risk for fall at admission.     

Using the Care Dependency Scale for fall risk screening

AIM: This paper is a report of a study conducted to estimate the sensitivity and specificity of the Care Dependency Scale as a measure of risk of falling for individuals in hospital and nursing home settings. BACKGROUND: Falls and their consequences are common problems in hospitals and nursing homes and nurses should assess the potential risks of their patients. Items in fall risk scales resemble a general nursing assessment, which leads to redundant assessment procedures. It would be beneficial to have a single generic instrument for general assessment and fall risk screening. METHODS: Standardized questionnaires were used in a cross-sectional study in 2004 and data were gathered from 9943 German nursing home residents and hospital patients (response rate 77.1%). Sensitivity and specificity of all Care Dependency Scale scores were calculated for fall risk. Relationships between the 15 scale items and falls were described using odds ratios and logistic regression analysis. FINDINGS: Patients with falls in hospitals were more care dependent than those without falls. Sensitivity and specificity values showed that with the Care Dependency Scale a differentiation is possible between the falls group and the no-falls group. High odds ratios and logistic regression analysis suggest that the Care Dependency Scale item 'Avoidance of danger' indicated fall risk. Nursing home residents with and without falls had similar care dependency scores. CONCLUSION: Nursing assessment in hospitals could be simplified by using the Care Dependency Scale for fall risk screening. Its value in fall risk screening in nursing homes requires further testing.     

Assessment of postural stability disorders in older adults treated at a health resort

Background. Falls are a common and often devastating occurrence for the elderly in both home and institutional settings. The main purpose of our study was to assess disorders of postural stability in elderly patients undergoing health resort treatment, recruited at the sanatorium in Swieradów Zdrój, Poland. Material and methods. Thirty two older adults between the ages of 67 and 84 years were enrolled. All subjects completed a questionnaire pertaining to their fall history, subjective feeling of unsteadiness, activity level, medical status and use of assistive devices and/or medications. The Berg Balance Test (BBT), consisting of 14 functional subtests, was used to measure balance abilities and identify individuals with a higher risk of falling. Results. The mean score on the BBT for all these older adults was 42. The lowest number of points was obtained by those persons who showed all the risk factors for falls: postural instability, previous falls, and no physical activity (26 +/- 15.5). The highest number of points was obtained by persons who had only one risk factor (45.3 +/- 4.5) or no risk factors (49.5 +/- 5.8). 41% of our study group had a higher risk of falling (score 40), while in 19% of the patients the risk of incurring a fall was 100% (score 36). Conclusions. Among health resort patients over the age of 65, there is a decline in balance abilities and more propensity to fall. Testing of balance and fall prevention programs should become a standard part of the treatment program at health resorts for the elderly.     

Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET)

Objectives: The prevention of falls in the elderly trial (PROFET) provides evidence of the benefits of structured interdisciplinary assessment of older people presenting to the accident and emergency department with a fall. However, the service implications of implementing this effective intervention are significant. This study therefore examined risk factors from PROFET and used these to devise a practical approach to streamlining referrals from accident and emergency departments to specialist falls services.

Methods: Logistic regression analysis was used in the control group to identify patients with an increased risk of falling in the absence of any intervention. The derived predictors were investigated to see whether they also predicted loss to follow up. A second regression analysis was undertaken to test for interaction with intervention.

Results: Significant positive predictors of further falls were; history of falls in the previous year (OR 1.5 (95%CI 1.1 to 1.9)), falling indoors (OR 2.4 (95%CI 1.1 to 5.2)), and inability to get up after a fall (OR 5.5 (95%CI 2.3 to 13.0)). Negative predictors were moderate alcohol consumption (OR 0.55 (95%CI 0.28 to 1.1)), a reduced abbreviated mental test score (OR 0.7 (95%CI 0.53 to 0.93)), and admission to hospital as a result of the fall (OR 0.26 (95%CI 0.11 to 0.61)). A history of falls (OR 1.2 (95%CI 1.0 to 1.3)), falling indoors (OR 3.2 (95%CI 1.5 to 6.6)) and a reduced abbreviated mental test score (OR 1.3 (95%CI 1.0 to 1.6)) were found to predict loss to follow up.

Conclusions: The study has focused on a readily identifiable high risk group of people presenting at a key interface between the primary and secondary health care sectors. Analysis of derived predictors offers a practical risk based approach to streamlining referrals that is consistent with an attainable level of service commitment.

     

Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation

OBJECTIVE: To investigate predictors of recurrent falls in adults who return to community dwelling after stroke rehabilitation. DESIGN: Prospective observational study. SETTING: Community. PARTICIPANTS: Fifty-five adults with stroke (mean age +/- standard deviation, 68.1+/-12.8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Baseline measures included balance, gait speed, muscle strength and tone, activity level, hemianopia, visual contrast sensitivity, hemineglect, medication use, fear of falling, and depression. Participants kept a 6-month prospective falls diary after discharge from rehabilitation. RESULTS: Twenty-five (45%) participants reported falling, 12 had recurrent falls (> or =2 falls), and 13 fell once. Participants who fell recurrently had histories of falling during hospitalization or rehabilitation, poorer physical function measures, were taking more medications, and were more likely to have hemineglect than participants who fell once or did not fall (P<.05). A history of falling in the hospital or during rehabilitation, combined with poor balance (either Berg Balance Scale score <49 or step test score <7), predicted recurrent falls with sensitivity and specificity values greater than 80%. CONCLUSIONS: Falls are a common occurrence after stroke. The predictive model developed can be used to identify people who are likely to have recurrent falls in the 6 months after stroke rehabilitation.     

HumptyDumpty儿童跌倒风险量表的初步评价

[目的]识别住院患儿跌倒的高危因素,评价HumptyDumpty跌倒量表（HDFS）识别跌倒高风险患儿的能力。[方法]运用回顾性配对病例对照设计,通过匹配年龄、性别和诊断,按照1：1配对,对81例跌倒病例以及8l例配对的未跌倒的病例进行病史回顾,运用HDFS进行各风险因素的评估。[结果]男性、年龄≤3岁及消化系统、循环系统疾病等是引发跌倒的高危因素;高危患儿（HDFS≥12分）发生跌倒的风险是低危患儿（HDFS〈12分）的3．25倍,需预防人数（NNT）为3．70人。[结论]HDFS是一个能识别跌倒高风险住院患儿的有效工具。在惠儿入院时、每班以及病情发生变化时运用HDFS,可以提升护士对跌倒高风险患儿的认识,这个过程可促进护士对患儿家长进行预防跌倒的教育。     

Patient falls in the acute care setting: identifying risk factors

A retrospective comparative chart audit was conducted to identify patient characteristics associated with falls in the acute care setting, to examine the extent to which the significant characteristics explained if falls occurred, and to test the ability of variables believed to be risk factors to predict falls. Patients aged 60 and older who fell during hospitalization (n = 331) were compared with a random sample of patients aged 60 and older who were hospitalized during the same time period but did not fall (n = 300). Two days of documentation were sampled: admission day and day preceding the fall for the fall group, and admission day and a random day of hospital stay for the no-fall group. Findings supported the idea that fall-prone patients can be identified and that significant differences between those who do and do not fall are evident at hospital admission. The findings also suggested an alteration in the constellation of characteristics nurses use to identify fall-prone patients. Of 11 variables representing standard risk factors, only 6 were significantly related to fall status; 5 entered the regression equation as significantly contributing to the 22% explained variance. When potential predictor variables were expanded to include additional patient characteristics, the explained variances for fall status were 31% from the admission day data and 34.5% from the fall/random day data.     

Preventing falls in acute care: an innovative approach

Falls among elderly individuals have been significant sources of disability and death. Falls have affected as many as 10% of older adults during an acute care inpatient stay. The acute care environment has contributed to elderly patient falls. Additionally, manifestations of acute illness, polypharmacy, and medication side effects have been risk factors for falls in the acute care setting. Individualized fall prevention strategies, initial patient assessments, and ongoing patient reassessments have been linked to a decrease in falls in the acute care setting. Approaches to fall prevention have included identification of high-risk patients, communication among staff and family members about an individual's risk of falls, and both case-specific and universal interventions for fall prevention. The purpose of this article is to describe a fall prevention program instituted in an acute care setting in southern Arizona that has produced encouraging results. Moreover, this article addresses individualizing interventions through a continuous clinical feedback loop, which provides patient care areas with relevant information about their patients who fell and recommendations for improving fall prevention.     

Falls and injury prevention should be part of every stroke rehabilitation plan

OBJECTIVE: To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed. DESIGN: Prospective cohort study. SETTING: Community. SUBJECTS: Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study. MAIN MEASURES: Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM). RESULTS: Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People required assistance to get up after 25 falls (38%) and 36 falls (55%) resulted in an injury. People sought professional health care after only 16 falls, and activity was restricted after 29 falls (44%). The Berg Balance Scale and Functional Independence Measure scores were lower in people who had longer lies after a fall, and who restricted their activity after a fall (p < 0.05). Lower physical function scores were also associated with falling in the morning, wearing multifocal glasses at the time of a fall, and injurious falls (p < 0.05). CONCLUSION: Falls are common when people return home after stroke. Of concern are the small number seeking health professionals' assistance after a fall, the high proportion restricting their activity as a result of a fall and the number of falls occurring towards the paretic side.     

Humpty Dumpty儿童跌倒风险量表的初步评价

[目的]识别住院患儿跌倒的高危因素,评价Humpty Dumpty跌倒量表(HDFS)识别跌倒高风险患儿的能力。[方法]运用回顾性配对病例对照设计,通过匹配年龄、性别和诊断,按照1∶1配对,对81例跌倒病例以及81例配对的未跌倒的病例进行病史回顾,运用HDFS进行各风险因素的评估。[结果]男性、年龄≤3岁及消化系统、循环系统疾病等是引发跌倒的高危因素;高危患儿(HDFS≥12分)发生跌倒的风险是低危患儿(HDFS<12分)的3.25倍,需预防人数(NNT)为3.70人。[结论]HDFS是一个能识别跌倒高风险住院患儿的有效工具。在患儿入院时、每班以及病情发生变化时运用HDFS,可以提升护士对跌倒高风险患儿的认识,这个过程可促进护士对患儿家长进行预防跌倒的教育。     

Psychosocial consequences of falling: the perspective of older Hong Kong Chinese who had experienced recent falls

AIM OF THE STUDY: The study's aim was to explore the psychosocial consequences of falling with a group of older Chinese who had recently fallen. BACKGROUND: Older people fall more frequently. Thus, the consequences of these falls and their influence on health outcomes need to be determined. One important outcome, namely the psychosocial consequence of falling, has not been extensively studied. As a result, this study explored the psychosocial consequences of falling with a group of older Chinese who had recently experienced a fall. RESEARCH APPROACH: An explorative qualitative approach with semi-structured interviews was used in this study. SAMPLE: Twenty informants, with recent fall experiences either in the community or hospital setting, were interviewed in two elder care wards in an acute care hospital. FINDINGS: Three major categories of psychosocial consequences of falling emerged from the interview data: powerlessness, fear and seeking care. Powerlessness was also exemplified in three subcategories: lack of control, self-comforting and lack of emotion. Informants perceived falls as unpredictable and not preventable, expressing fears that falling could result in dependence on others and becoming a care burden. The interview data also showed that there is a need by older Chinese to seek care and advice from relatives and health care professionals. CONCLUSIONS: Findings from this study have provided insights into the psychosocial consequences of falling for older Chinese. These insights suggest nursing interventions should promote a sense of mastery in prevention of falls, facilitate supportive social interactions with relatives and give empathetic responses to those who have fallen.     

Stability and Falls Evaluations in AMPutees (SAFE-AMP 2): Reduced functional mobility is associated with a history of injurious falls in lower limb prosthesis users

BackgroundInjurious falls have a high cost and economic impact on an individual and the health system. Several studies have assessed performance-based functional mobility in lower limb prosthesis (LLP) users and fall risk including fall history. However, limited data exist regarding the relationship between functional mobility and a history of injurious falls in individuals who use a LLP. Such information could inform clinical practice and decision making from prosthesis design to policy. The purpose of this study was to identify factors associated with a history of injurious falls among LLP users using a clinical outcomes database.MethodsRetrospective (2016-2018) observational study. Logistic regression applied.ResultsA final sample of 12,044 LLP users was included for analysis. Within the sample, 1,529 individuals reported a history of an injurious fall within the previous 6 months. Self-reported functional mobility was stratified into low, middle, and high levels: differences were found between levels for history of an injurious fall. The lowest mobility level was associated with 2.29 higher odds of a history of an injurious fall (95% CI: 1.96-2.69) indicating a potentially greater serious fall risk compared to those with higher mobility levels while controlling for covariates (sex, cause of amputation and level of amputation).Conclusion(s)Self-reported functional mobility was associated with a history of injurious falls in LLP users. The Prosthetic Limb Users Survey of Mobility is an accessible tool that prosthetists could use to identify individuals with a high risk of falls; this can inform care planning. Rehabilitation plans and prosthesis designs that target LLP users who report low functional mobility may positively impact health outcomes.     

Facteurs prédictifs de la chute chez l''hémiplégique vasculaire en centre de médecine physique

OBJECTIVES: To determine factors predicting falls by patients with vascular hemiplegia to establish a program aimed at preventing falls in this population. METHODS: A comparative prospective study performed over 19 months with 44 patients older than 16 years who had had a cerebral vascular accident (CVA, stroke) and were consequently admitted to the Centre Richelie. The exclusion criteria were represented by CVA history, evidence of another form of encephalic lesion, and subsequent admission to hospital after hemiplegia or for follow-up. Assessment consisted of taking note of the mechanism of the fall, possible lesions, and number of falls and analyzing follow-up after the return home. Also included for all patients was information on 20 variables that could be risk factors for fall. RESULTS: The patients' average age was 60.43+/-13.43 years and 20 had had at least one fall (mean 2.2), which allowed us to determine a "falling" group and a control group. Statistical analysis revealed the following factors considered to predict falls: large amount of time prior to hospitalization and lengthy hospitalization, low functional independence measure for entering and leaving, the existence of sensitivity disorders, spatial neglect, failed seated and standing equilibrium, and sedative treatment. In most cases, whatever their nature, falls occurred during transfers (68% of cases). Most often, the post-fall lesions were minor. However, in one case, a femur neck fracture necessitated osteosynthesis. One-third of the patients had a fall at home (as opposed to 5% of the control group). CONCLUSION: Our results confirm those in the literature. The predictive factors for falls in patients with hemiplegia are therefore well established and essentially correlate with the CVA. This consideration must lead to implementation of a prevention program including material-based as well as human measures.     

Fear of falling,falls efficacy,and health outcomes in older people following hip fracture

Purpose : This study sought to determine whether fear of falling and falls efficacy independently contribute to the prediction of health outcomes after a fall, controlling for length of stay in hospital, prefall activity problems, and history of falls.

Method : Eighty-two older people ( ≥65 years) admitted to hospital as a result of a fall, with proximal femoral fracture, were interviewed to assess variables of interest. At two months after initial interview, participants ( n =57) were re-interviewed in their own home, and their functional limitation and further fall events were assessed. Regression analyses were carried out to determine the ability of the variables assessed in hospital to predict functional limitation and further falls post discharge.

Results : Perceived risk of falling and falls efficacy did not explain variance in functional limitation when added to a model containing biomedical factors. In the prediction of further falls, addition of falls efficacy and worry over further falls to a model containing biomedical factors resulted in a statistically reliable improvement, although falls efficacy was not independently associated with outcome.

Conclusions : Assessing worry over further falls in hospital may help to identify older people with hip fracture at risk of poor health outcomes.     

Use of clinical and impairment-based tests to predict falls by community-dwelling older adults

BACKGROUND AND PURPOSE: Few tests have been found to be strongly predictive of falls in community-dwelling older adults. The purpose of this study was to determine whether data from 5 balance tests-combined with data regarding fall history, number of medications, dizziness, visual problems, use of an assistive device, physical activity level, sex, and age-could predict falls in community-dwelling older adults who were independent. SUBJECTS: Ninety-nine community-dwelling older adults aged 65 to 90 years (X =74.02, SD=5.64) were tested. METHODS: Subjects were tracked for falls over a 1-year period following testing. Impairment-based tests, which are tests that attempt to specifically identify which sensory systems are impaired or how motor control is impaired (eg, speed, accuracy of movement), were the Modified Clinical Tests of Sensory Interaction for Balance (Modified CTSIB) and the 100% Limits of Stability Test, both of which were done on the Balance Master 6.1. Performance-based tests, which are functional tests that identify functional limitations without necessarily identifying their causes, were the Berg Balance Scale, the Timed "Up Go" Test, and the Dynamic Gait Index. Demographic and health data included age, sex, number of medications, physical activity level, presence of dizziness, vision problems, and history of falls over the previous year. Logistic regression was used to determine which combinations of data from balance tests, demographics, and health factors were predictive of falls. RESULTS: Two models-(1) the "standing on a firm surface with eyes closed" (FEC) condition of the Modified CTSIB and (2) the FEC combined with age and sex-were predictive of falls, but predicted only 1 and 2 subjects who were at risk for falling, respectively, out of 20 people who were at risk for falling. DISCUSSION AND CONCLUSION: Five balance tests combined with health and demographic factors did not predict falls in a sample of community-dwelling older adults who were active and independent.