Falls in elderly

Falls are a major health problem among the elderly and an estimated 6% of falls by elderly result in fractures. Early identification of fall risk is likely to result in earlier implementation of intervention and to minimise development of secondary problems such as reduced confidence and activity levels. A comprehensive falls risk factor assessment should be performed for older people who present for medical attention after a fall, those who had more than one fall in the preceding year or those who have abnormalities of gait or balance. Falls are as a result of extrinsic risk factors, intrinsic risk factor or a combination of both. Syncope is defined as a transient, self limited loss of consciousness usually leading to a fall. Syncope and falls are often considered two separate entities with different aetiologies. Disorders affecting balance in the elderly are cerebral, cerebellar, spinal cord disorders; dementia; arrhythmias; postural hypotension; cerebrovascular disease; musculoskeletal/orthopaedic disorders; intervertebral disc disorders; psychological factors; visual impairment. Effective interventions include: (1) Health promotion and falls prevention. (2) Single interventions. (3) Medication review. (4) Exercise. (5) Home modifications. (6) To improve safety in the home. (7) To improve safety outside the home. Effective preventive strategies require better understanding of the causes of and risk factors for falling among elderly.     

Development and validation of fall risk screening tools for use in residential aged care facilities

OBJECTIVE: To develop screening tools for predicting falls in nursing home and intermediate-care hostel residents who can and cannot stand unaided. DESIGN AND SETTING: Prospective cohort study in residential aged care facilities in northern Sydney, New South Wales, June 1999 - June 2003. PARTICIPANTS: 2005 people aged 65-104 years (mean +/- SD, 85.7 +/- 7.1 years). MAIN OUTCOME MEASURES: Demographic, health, and physical function assessment measures; number of falls over a 6-month period; validity of the screening models. RESULTS: Ability to stand unaided was identified as a significant event modifier for falls. In people who could stand unaided, having either poor balance or two of three other risk factors (previous falls, nursing home residence, and urinary incontinence) increased the risk of falling in the next 6 months threefold (sensitivity, 73%; specificity, 55%). In people who could not stand unaided, having any one of three risk factors (previous falls, hostel residence, and using nine or more medications) increased the risk of falling twofold (sensitivity, 87%; specificity, 29%). CONCLUSIONS: These two screening models are useful for identifying older people living in residential aged care facilities who are at increased risk of falls. The screens are easy to administer and contain items that are routinely collected in residential aged care facilities in Australia.     

Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital: a retrospective

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics. Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group： Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident Information Management System （IIMS）. Further details about the particular admission（s） were obtained from patients＇ medical records, e.g., patients＇ characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-railers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients＇ room and 18.9% in patients＇ bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9：00-11：00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination （MMSE） score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall. Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.     

Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital: a retrospective case-control study

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics.Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group: Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident information Management System (IIMS). Further details about the particular admission(s) were obtained from patients' medical records, e.g., patients' characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-fallers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients' room and 18.9% in patients' bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9:00-11:00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination (MMSE) score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall.Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.     

Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital: a retrospective case-control study

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics.Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group: Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident information Management System (IIMS). Further details about the particular admission(s) were obtained from patients' medical records, e.g., patients' characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-fallers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients' room and 18.9% in patients' bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9:00-11:00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination (MMSE) score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall.Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.     

Risk factors for recurrent nonsyncopal falls. A prospective study

Falls are a major threat to the health of older persons. We evaluated potential risk factors for falls in 325 community-dwelling persons aged 60 years or older who had fallen during the previous year, then followed up weekly for 1 year to ascertain nonsyncopal falls and their consequences. Risk factors for having a single fall were few and relatively weak, but multiple falls were more predictable. In multivariate analyses, we found increased odds of two or more falls for persons who had difficulty standing up from a chair, difficulty performing a tandem walk, arthritis, Parkinson's disease, three or more falls during the previous year, and a fall with injury during the previous year, and for whites. The proportion of subjects with two or more falls per year increased from 0.10 for those with none or one of these risk factors to 0.69 for those with four or more risk factors. Among older persons with a history of a recent fall, the risk of multiple nonsyncopal falls can be predicted from a few simple questions and examinations.     

Incidence and Associated Factors for Single and Recurrent Falls among the Elderly in an Urban Community of Beijing

Objective To investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing. Methods A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews. Results The incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age(χ2for trend=21.06, 19.20, P=0.001, 0.002). Binary logistic stepwise regression analysis showed that age(OR=2.20), living alone(OR=4.67) and gait disturbance(OR=1.27) were risk factors, while housing with elevators(OR=0.35), appropriate width/height of stair steps(OR=0.78), sufficient lighting for stairway(OR=0.45) and regular exercise(OR=0.12) could lower the risk for single fall; factors such as low monthly family income(OR=1.39), poor vision(OR=1.83), low physical ability(OR=4.47), abnormal static balance(OR=2.48), and fear of falls(OR=2.23) were risk factors, while appropriate width/height of stair steps(OR=0.49) and easiness of access to daily supplies(OR=0.41) were protective factors for recurrent falls. Conclusion The incidence of falls in community-dwelling elderly people in Beijing is common, and falls and their related injuries have been associated with both intrinsic and extrinsic factors.     

农村社区老年高血压患者跌倒风险评估

对农村社区426例老年高血压患者（观察组）和436名非高血压老年人（对照组）应用修订版跌倒效能量表评价其跌倒风险,并比较老年高血压患者有跌倒史组与无跌倒史组的跌倒风险差异。结果显示,观察组评估条目平均得分（8．62±2．15）分,对照组评估条目平均得分（9．35±1．35）分,P〈0．01。老年高血压患者426例中既往有跌倒史的112例评估条目平均得分（6．94±1．85）分,无跌倒史的314例评估条目平均得分（9．22±1．42）分,P〈0．01。提示农村社区老年高血压者跌倒风险高于非高血压者,用评估量表进行风险评估和预测有利于防范老年人意外伤害事件的发生。     

Falls and fall prevention in the elderly: the Jamaican perspective

Falls in the elderly may precipitate adverse physical, medical, psychological, social and economic consequences and are an issue of concern in both developed and developing countries. In Jamaica, there are no epidemiological studies on falls in the elderly though there is evidence to suggest that it is an issue that warrants some attention. This paper, through the use of quantitative and qualitative methods, provides insights on falls in the elderly in Jamaica. Through literature reviews, review of medicals records, and conducting focus group interviews, perspectives were gleaned on falls in elderly persons in Jamaica. Contributory risk factors and perceptions, and costs were explored, as were any existing fall prevention policies or policy thrusts. The emerging picture is that falls are not a rare occurrence among older persons in Jamaica and extrinsic factors such as poor road surfaces, poorly constructed steps and poor design of public transportation vehicles are factors that contribute to falls. Similarly, intrinsic factors related to co-morbid conditions such as hypertension, diabetes mellitus and sensory impairment appear to also contribute to increased risk of falling.     

老年人跌倒的危险因素

老年人跌倒是严重的公共卫生事件。跌倒严重影响老年人的生存质量,给整个社会及家庭带来沉重经济负担。影响跌倒的危险因素是多方面的,随着年龄的增长,老年人会出现中枢和周围神经系统退变、感觉功能衰退、肌肉力量下降、平衡能力下降、步态稳定性下降。这些变化是导致老年人跌倒的危险因素,而心脑血管类疾病、神经系统疾病、药物不良反应、环境因素和跌倒恐惧症也使老年人跌倒风险增加。     

社区老年人跌倒恐惧与健康自评的关系研究

背景　老年人跌倒恐惧是非常常见的现象，由此造成的肢体功能受限、生活质量下降、跌倒风险增加、医疗经济负担增加等不容忽视。健康状况自我评价是反映一个人健康状况以及死亡率的重要指标，其简单易行，可用于快速筛查和评估。国外已有一些健康自评和疾病关系的研究。但是目前我国关于此类的研究并不多见。目的　研究社区老年人跌倒恐惧的情况及其与健康自评的关系。方法　采用横断面设计，于2017年3-5月选取在北京市西城区牛街社区卫生服务站门诊就诊的老年人（年龄≥60岁），通过面对面问卷调查的形式进行数据收集。调查其过去1年跌倒发生情况，以及跌倒恐惧情况。采用世界卫生组织生存质量测定量表（WHOQOL），针对总体生活质量、健康状况、睡眠情况、日常生活能力、自我满意度、人际关系、朋友支持、居住地、卫生保健、交通情况以及消极情绪等进行自我评价。结果　共发放问卷410例，其中拒访2人，回收有效问卷408份。408名社区老年人中，267例（65.4%）存在跌倒恐惧，151例（37.0%）过去1年发生跌倒，发生跌倒的老年人中131例（86.8%）存在跌倒恐惧。跌倒恐惧者总体生活质量好、健康状况、睡眠情况、日常生活能力、自我满意度、人际关系、朋友支持、居住地、卫生保健、交通情况满意率低于无跌倒恐惧者，经常消极情绪发生率高于无跌倒恐惧者（P<0.05）。多因素Logistic回归分析结果显示，总体生活质量、健康状况、睡眠情况、日常生活能力、自我满意度、人际关系、朋友支持、居住地、卫生保健、交通情况自我评价不满意是老年人跌倒恐惧发生的危险因素（P<0.05），消极情绪自我评价偶尔出现是老年人跌倒发生的保护因素（P<0.05）。结论　跌倒恐惧与健康相关自我评价有关，有助于筛查跌倒恐惧高风险人群，以进一步采取相应的干预措施，以减少老年人跌倒恐惧，促进健康老龄化社会的建设。     

Falls amongst institutionalised psycho-geriatric patients

Falls are common among the elderly patients in the psycho-geriatric wards and yet they have been understudied. A fall is a multi-factorial syndrome involving the patient and the environment. Psycho-geriatric patients who fall may suffer serious physical injuries that result in morbidity, further institutionalisation or even mortality. This study aims to examine the contributing factors to, and morbidity and outcome of falls among institutionalised psycho-geriatric patients so that preventive strategies can be refined. Data of patients who fell over a year's period in four psycho-geriatric wards were collected retrospectively and compared with those who had not fallen within the same period. The general profile of the psycho-geriatric patient who falls is one who is: above seventy-five years old; on three or more medications; and having recent changes in medication and mental status. About one in three fallers fell repeatedly. The rate of serious injury and mortality was low. In conclusion, while many factors are attributable to the common effects of aging and physical illnesses; psychotropic medication, change in mental state and specific environmental factors also play significant contributory roles to falls in this group of patients.     

高龄脑梗死患者跌倒的危险因素分析及护理管理策略

目的探讨老年脑卒中患者意外跌倒的风险因素,分析并制订有效的护理对策,以防止老年脑卒中患者意外跌倒的发生。方法选取我院2007年1月～2011年6月收治的老年脑卒中患者84例,将其随机分为对照组（42例）和观察组（42例）。对照组仅进行常规教育,观察组进行跌倒风险评估同时采取防跌倒知识宣传,分析比较两组患者意外跌倒情况。结果晚22：00～早8：00为患者意外跌倒高发时段,跌倒地点多发生于病床边,受伤部位多为头部,60～70岁患者的跌倒频率最高,观察组意外跌倒发生率明显低于对照组,差异有统计学意义（P〈0.05）。结论全面评估老年脑卒中患者意外跌倒的风险因素,增加配套的安全设施,加强患者的安全教育和用药护理,制订科学、合理的护理对策和康复训练计划可以有效防止老年脑卒中患者意外跌倒的发生,是一种安全有效的治疗方法,值得临床推广使用。     

Risk factors for accidental falls in the elderly and intervention strategy

As the population ages, older people's health and quality of life are becoming a matter of public concern increasingly. Through review of the literatures and analysis of the reasons for falls in older people, we worked out some measures to cope with such a situation, provided the self-care knowledge of falls prevention for older people and improved the quality life of older persons. The recovery process is long, if the old people fall down, which brings a lot of inconvenience to individuals and families, and it can also cause a lot of complications. If wary of fall risk factors, the quality of life of older persons can be improved. According to the different conditions of the elderly, we should take effective measures to create suitable living environment for senior citizens, and propagandize the knowledge of the old people's health care, which has the great significance in preventing the elderly's fall, and improving their living quality.     

Vitamin D deficiency

Vitamin D deficiency is common and may contribute to osteopenia, osteoporosis and falls risk in the elderly. Screening for vitamin D deficiency is important in high-risk patients, especially for patients who suffered minimal trauma fractures. Vitamin D deficiency should be treated according to the severity of the deficiency. In high-risk adults, follow-up serum 25-hydroxyvitamin D concentration should be measured 3–4 months after initiating maintenance therapy to confirm that the target level has been achieved. All patients should maintain a calcium intake of at least 1,000 mg for women aged ≤ 50 years and men ≤ 70 years, and 1,300 mg for women > 50 years and men > 70 years.     

The overlap between syncope and falls in the elderly.

Syncope and falls are often considered to be two separate diagnoses with two separate sets of aetiologies. However, although it remains controversial, the existence of an overlap between syncope and falls is becoming increasingly acknowledged. In the elderly, determining the cause of a fall can be difficult. Approximately 30% of cognitively normal elderly people are unable to recall documented falls three months later and a witness account for syncopal events is unavailable in about 50% of patients. We have found that in almost 40% of patients in whom an attributable diagnosis of carotid sinus syndrome was made, the only presenting symptoms were falls alone or falls with dizziness; syncope was denied. Amnesia for loss of consciousness can be demonstrated in over 20% of all patients with a diagnosis of carotid sinus syndrome and in 50% of those patients who present only with falls or falls and dizziness. There is a suggestion from studies in postprandial hypotension and orthostatic hypotension, where similar haemodynamic changes are found in patients complaining of either syncope or falls, that this phenomenon may be generalisable. The importance of the presence of an overlap between syndrome and falls in the elderly lies in the healthcare implications of missed diagnoses of cardiovascular syncope for which there are established effective treatments. Consideration of syncope in the differential diagnosis of unexplained falls should reduce the numbers of falls for which no attributable diagnosis is found and result in an improved standard of health care for elderly patients who fall.     

足底感知训练对有跌倒史老年人平衡能力和跌倒风险的影响研究

背景　跌倒已经成为我国65岁以上老年人因伤致死的首位原因。因受伤到医疗机构就诊的老年人中,一半以上是因为跌倒。足底感知训练能够改善平衡功能,可能会对减少跌倒有一定价值。目的　探讨足底感知训练对有跌倒史老年人平衡能力和跌倒风险的影响,以期为减少老年人群跌倒提供依据。方法　2017年5月-2018年5月,从海南省人民医院老年医学中心招募在2018-06-01前6个月中至少经历过1次跌倒的60岁以上老年人。最终选择62名老年人为研究对象,依据随机数字表法将其分为试验组和对照组,各31例。收集患者一般资料,试验组在康复医学科进行足底感知训练,对照组以与试验组相同的方式和时间进行训练,但是不要求区分5个海绵垫的硬度水平。比较两组平衡检测〔干预前后睁眼、闭眼时压力中心（COP）移动路径长度,起立行走计时测试（TUG）结果〕、跌倒风险评估〔跌倒效能量表（FES）得分〕结果。结果　试验组第7、8、9、10天足底感知训练得分均低于第1天（P<0.05）。干预方法与时间在睁眼时COP移动路径长度上不存在交互作用（P>0.05）;干预方法在睁眼时COP移动路径长度上主效应不显著（P>0.05）;时间在睁眼时COP移动路径长度上主效应显著（P<0.05）。干预方法与时间在闭眼时COP移动路径长度、TUG结果上存在交互作用（P<0.05）;干预方法、时间在睁眼时COP移动路径长度、TUG结果上主效应显著（P<0.05）。对照组、试验组干预后睁眼时COP移动路径长度分别短于本组干预前（P<0.05）。试验组干预前闭眼时COP移动路径长度长于对照组,干预后闭眼时COP移动路径长度短于对照组（P<0.05）;对照组、试验组干预后前闭眼时COP移动路径长度分别短于本组干预前（P<0.05）。试验组干预前、干预后TUG结果均短于对照组（P<0.05）;对照组、试验组干预后TUG结果分别短于本组干预前（P<0.05）。干预方法与时间在FES得分上存在交互作用（P<0.05）;干预方法、时间在FES得分上主效应显著（P<0.05）。试验组干预前FES得分低于对照组,干预后FES得分高于对照组（P<0.05）;对照组、试验组干预后FES得分分别高于本组干预前（P<0.05）。结论　足底感知训练有利于提高老年人的平衡能力,从而减少跌倒。     

老年综合征对老年2型糖尿病患者的躯体功能和跌倒风险的影响

  目的  探讨老年综合征对老年2型糖尿病患者的躯体功能以及跌倒风险的影响。  方法  选取2019年2月—2020年2月在浙江医院门诊就诊和住院治疗的老年2型糖尿病患者165例为研究对象，根据患者老年综合征的种类和数量分为0~1种组(36例)、2~3种组(73例)、4~6种组(56例)。比较和分析老年综合征对老年2型糖尿病患者的躯体功能以及跌倒风险的影响。  结果  4~6种组年龄、离异/丧偶比例、害怕跌倒比例、辅具使用率、近1年出现跌倒史发生率、跌倒高风险率以及日常生活能力缺陷和平衡步态功能下降的比例均明显高于0~1种组和2~3种组患者(均P＜0.05)；经单因素及多因素logistic回归分析显示衰弱是老年2型糖尿病患者日常生活能力缺陷、平衡与步态功能下降、近1年出现跌倒的独危险因素(均P＜0.01)；认知功能下降是跌倒风险增高、平衡与步态功能下降、近1年出现跌倒的独立危险因素(均P＜0.01)；营养不良是日常生活能力缺陷、跌倒风险增高、平衡与步态功能降低、近1年出现跌倒的独立危险因素(均P＜0.01)。  结论  衰弱、营养不良以及认知功能下降等老年综合征会引起老年2型糖尿病患者躯体功能下降和跌倒风险增高，临床应对老年2型糖尿病患者进行老年综合评估并采取干预措施以提高其生活质量。      

Menopausal osteoporosis: screening,prevention and treatment

Screening for osteoporosis in women can be based on age and weight, using the Osteoporosis Screening Tool for Asians and assessment for other risk factors such as early menopause, Chinese ethnicity and other secondary factors. Based on the resulting risk profile, women can be triaged to dual-energy X-ray absorptiometry (DEXA) scanning for definite diagnosis of osteoporosis. Treatment should be considered in women with previous fragility fractures, DEXA-diagnosed osteoporosis and high risk of fracture. Exercise improves muscle function, can help prevent falls and has moderate effects on improvements in bone mass. Women should ensure adequate calcium intake and vitamin D. Menopausal hormone therapy (MHT) effectively prevents osteoporosis and fractures, and should be encouraged in those aged < 50 years. For women aged < 60 years, MHT or tibolone can be considered, especially if they have vasomotor or genitourinary symptoms. Risedronate or bisphosphonates may then be reserved for those aged over 60 years.     

Carers’ concern for older people falling at home: an integrative review

Falls, the leading cause of injury and death among older people, can have a significant psychosocial impact on carers. Carers play a crucial role in caring for older persons at home and in fall prevention. This review, which included 15 studies, aimed to identify carers’ concern about older people falling and its impact. We identified that most carers had concerns about repeated falls in older people, unknown consequences of falls and care recipients’ non-adherence to fall prevention advice. These concerns, in turn, affect carers’ physical and psychological health, lifestyle, caregiving burden and use of fall prevention strategies. This paper highlights the importance of recognising carers’ fall concern so as to identify carers’ needs and awareness of fall prevention in older people living at home. Greater insight into carers’ fall concern could facilitate the implementation of new strategies to manage older people’s fall risk as well as improve carers’ well-being.