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.     

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.     

Falls in the elderly--clinician's approach

Fall is an involuntary event producing a change in posture resulting in the individual adopting an unplanned supine position. Globally more than one-third of persons 65 years of age or older fall each year and in half of such cases the falls are recurrent. Several predisposing factors for such falls have been recognised like age related changes in posture control, reduced visual acuity, anxiety, drugs, environmental hazards and underlying neurological diseases. It is the interplay of predisposing and precipitating factors that really matter and not exactly a single cause. Evidence based interventions have been suggested from recent clinical trials and certain preventive guidelines are present to reduce the rate of falling, provided a periodic targeted approach is followed.     

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.     

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.     

Iatrogenic causes of falls in hospitalised elderly patients: a case-control study

Objective: To explore risk factors associated with falls and to evaluate a strategy used by nurses to predict and prevent falls in a hospitalised cohort of elderly patients. Design: A case-control study of risk factors for falls in hospital. Setting: A district general hospital in the UK. Subjects: Altogether 181 patients in an acute integrated medical unit who had fallen were matched for age with 181 patients in the next bed who had not fallen. Results: It was found that 46% (84 of 181) of the fallers were taking one or more benzodiazepines compared with 27% (48 of 181) of the control patients (p<0.001). More fallers 20% (34 of 181) had their benzodiazepines prescribed during their current admission compared with 7% (13 of 181) of the control patients (p<0.001). Temazepam was the main benzodiazepine used by over 95% of cases and controls. Overall 25% (45 of 181) of the fallers had fallen before during the current admission. The logistic regression analysis showed that only a previous fall, benzodiazepine intake, and the need for maximum assistance were significant predictors of falling in hospital, odds ratios were 5.6 (95% confidence interval (CI) 2.7 to 11.6), 2.3 (95% CI 1.4 to 3.7), and 3.1 (95% CI 1.9 to 5.2) respectively. Most fallers had been identified at risk of falling (125; 69%) by ward staff and in 113 (90%) of those preventive measures had been undertaken. Falls were least likely to occur during visiting hours with a peak incidence during night-time. Conclusion: There is a need for evidenced based successful fall prevention strategies but our study also reinforces an urgent public health message that an alternative to benzodiazepines should be sought for night sedation for older patients.     

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.     

Approach to falls among the elderly in the community

One in three community-dwelling elderly aged ≥ 65 years and one in two aged > 80 years will have at least one fall within a year. Many elderly people are ‘silent fallers’ who do not report the fall nor seek medical assistance unless they are injured. In Singapore, falls account for 40% of injury-related deaths. Unaddressed risk factors for falls lead to recurrent falls and poor quality of life. Elderly people who have experienced falls and near falls can have a fear of falling, post-fall anxiety syndrome, depression and reduction in activities, with a negative impact on their well-being. Primary care doctors can screen and optimise modifiable risk factors such as poor vision, balance, poor gait, motor weakness, joint disorders, psychotropic drugs, sedatives, anti-hypertension medications, choice of footwear and environment factors. Timely referrals for cataract operations, balance and strengthening exercises, and osteoporosis treatment can reduce the risk of falls and injurious outcomes.     

Prevalence and risk factors for falls in urban and rural older adults in Ekiti State,Nigeria

ObjectivesThis study assessed and compared the risk factors for falls among older adults in rural and urban communities.DesignA comparative cross-sectional approach was used.SettingThe study was conducted among community-living older adults in the rural and urban communities of the most populated Local Government Area (Ado-Ekiti LGA) in Ekiti State.ParticipantsThe study population consisted of 624 persons aged 65 years and above recruited into rural and urban groups using multi-stage random sampling.Main outcome measuresData collected using validated tools and physical measurements were subjected to binary logistic regression to determine the odds of falls with relevant predictor variables among older adults in both groups.ResultsA significantly higher proportion of participants in the urban than the rural group had experienced a fall , and the associated risks include low visual acuity, increasing age, arthritis, hearing impairment, hyperglycaemia and high BMI. Physical activity was a protective factor.ConclusionThis study revealed a high risk of falls among older adults in the urban community. Early diagnosis and management of chronic conditions that increase fall risk and promote physical activity, especially among urban-dwelling older adults, are vital measures to be considered in fall prevention programmes.FundingSelf-funded research     

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.     

Will my patient fall?

David A. Ganz, MD, MPH; Yeran Bao, MD; Paul G. Shekelle, MD, PhD; Laurence Z. Rubenstein, MD, MPH

JAMA. 2007;297:77-86.

Context  Effective multifactorial interventions reduce the frequent falling rate of older patients by 30% to 40%. However, clinical consensus suggests reserving these interventions for high-risk patients. Limiting fall prevention programs to high-risk patients implies that clinicians must recognize features that predict future falls.

Objective  To identify the prognostic value of risk factors for future falls among older patients.

Data Sources and Study Selection  Search of MEDLINE (1966-September 2004), CINAHL (1982-September 2004), and authors' own files to identify prospective cohort studies of risk factors for falls that performed a multivariate analysis of such factors.

Data Extraction  Two reviewers independently determined inclusion of articles and assessed study quality. Disagreements were resolved by consensus. Included studies were those identifying the prognostic value of risk factors for future falls among community-dwelling persons 65 years and older. Clinically identifiable risk factors were identified across 6 domains: orthostatic hypotension, visual impairment, impairment of gait or balance, medication use, limitations in basic or instrumental activities of daily living, and cognitive impairment.

Data Synthesis  Eighteen studies met inclusion criteria and provided a multivariate analysis including at least 1 of the risk factor domains. The estimated pretest probability of falling at least once in any given year for individuals 65 years and older was 27% (95% confidence interval, 19%-36%). Patients who have fallen in the past year are more likely to fall again [likelihood ratio range, 2.3-2.8]. The most consistent predictors of future falls are clinically detected abnormalities of gait or balance (likelihood ratio range, 1.7-2.4). Visual impairment, medication variables, decreased activities of daily living, and impaired cognition did not consistently predict falls across studies. Orthostatic hypotension did not predict falls after controlling for other factors.

Conclusions  Screening for risk of falling during the clinical examination begins with determining if the patient has fallen in the past year. For patients who have not previously fallen, screening consists of an assessment of gait and balance. Patients who have fallen or who have a gait or balance problem are at higher risk of future falls.

     

帕金森病患者跌倒的危险因素-多中心、回顾性的横断面研究

目的 回顾性研究帕金森病（PD）患者跌倒的危险因素。方法 133例来自香港3所医院的神经科专科门诊的PD患者纳入研究。收集患者的人口学及临床资料，并进行躯体功能、精神、智能及跌倒方面的评估。应用logistic多元回归分析研究PD患者跌倒的危险因素。结果 44例(33.1%)患者在最近一年内有1次以上的跌倒。44例跌倒者平均跌倒的次数为1.9±0.7次。Logistic多元回归显示，婚姻状况（丧偶、离异或未婚）(OR=1.965，95%CI=1.203-3.208, P=0.007)、Schwab和England 日常生活能力评分（OR=0.973, 95%CI=0.955-0.991, P=0.003）及服用三种以上抗PD药物（OR=0.973, 95%CI=0.955-0.991，P=0.026）是跌倒的独立危险因素。 结论 跌倒是PD患者的一个很常见的问题。服用多种抗PD药物、日常生活能力及婚姻状况对跌倒均有明显的的影响，提示了在跌倒的预防与评估中，疾患内在因素和社会因素均需考虑。     

社区宣教对跌倒后要求急救的老年人的影响

目的 了解本地区老年人跌倒在老年人院前急救中所占比例及跌倒后受伤情况,探讨老年人常见病与跌倒之间的关系及社区宣教在降低老年人跌倒致创伤方面的作用。 方法 采用回顾性对照研究的方法,研究对象为2013年1月—2014年12月南昌市青云谱区内所有因跌倒相关问题呼救“120”的老年人,按时间段将其分为2组,对照组:2013年1月1日—12月31日;实验组:2014年1月1日—12月31日,2014年在青云谱区所辖50个社区进行了老年人跌倒危险因素及跌倒后救护相关知识的宣教,收集2组跌倒老年人院前急救病例,并对其在医院内检查、诊断、住院、手术情况继续进行追踪。 结果 2014年与2013年相比,青云谱区老年人增加了0.64%,呼救“120”的老年人增加了8.45%,然而经过社区宣教,因跌倒相关问题呼救“120”的老年人减少了14.75%;2组呼救“120”时间对比,差异有统计学意义(χ2=10.444,P=0.034),老年人跌倒至呼救“120”的时间明显提前;2组创伤人数对比,差异有统计学意义(χ2=6.162,P=0.046),社区宣教后跌倒致颅脑伤及骨折人数显著减少,但扭伤及肌肉拉伤有所增加;2组患病情况对比,差异无统计学意义(χ2=11.15,P=0.266),社区宣教不能改变跌倒老年人所患基础病种类;但某些疾病与跌倒关系密切。 结论 社区宣教可以降低跌倒致创伤率,尽早的专业救护和治疗可以减少不必要的二次损伤及合并症的发生。跌倒老年人患多有心脑血管疾病、骨关节疾病、神经疾病、糖尿病、肺部感染疾病,特别是高血压,宣教时应把这些老年人作为重点,这样社区宣教才能达到预期效果。宣教内容除跌倒高危因素外,还应有跌倒致创伤的常用救护措施,其中要包括骨折、颅脑伤、颈髓伤的救护。      

Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study

CONTEXT: Atrial fibrillation is the most common arrhythmia in elderly persons and a potent risk factor for stroke. However, recent prevalence and projected future numbers of persons with atrial fibrillation are not well described. OBJECTIVE: To estimate prevalence of atrial fibrillation and US national projections of the numbers of persons with atrial fibrillation through the year 2050. DESIGN, SETTING, AND PATIENTS: Cross-sectional study of adults aged 20 years or older who were enrolled in a large health maintenance organization in California and who had atrial fibrillation diagnosed between July 1, 1996, and December 31, 1997. MAIN OUTCOME MEASURES: Prevalence of atrial fibrillation in the study population of 1.89 million; projected number of persons in the United States with atrial fibrillation between 1995-2050. RESULTS: A total of 17 974 adults with diagnosed atrial fibrillation were identified during the study period; 45% were aged 75 years or older. The prevalence of atrial fibrillation was 0.95% (95% confidence interval, 0.94%-0.96%). Atrial fibrillation was more common in men than in women (1.1% vs 0.8%; P<.001). Prevalence increased from 0.1% among adults younger than 55 years to 9.0% in persons aged 80 years or older. Among persons aged 50 years or older, prevalence of atrial fibrillation was higher in whites than in blacks (2.2% vs 1.5%; P<.001). We estimate approximately 2.3 million US adults currently have atrial fibrillation. We project that this will increase to more than 5.6 million (lower bound, 5.0; upper bound, 6.3) by the year 2050, with more than 50% of affected individuals aged 80 years or older. CONCLUSIONS: Our study confirms that atrial fibrillation is common among older adults and provides a contemporary basis for estimates of prevalence in the United States. The number of patients with atrial fibrillation is likely to increase 2.5-fold during the next 50 years, reflecting the growing proportion of elderly individuals. Coordinated efforts are needed to face the increasing challenge of optimal stroke prevention and rhythm management in patients with atrial fibrillation.     

家庭医生团队服务模式对预防社区脑卒中患者跌倒的效果研究

背景　据文献报道47%的社区脑卒中患者有超过1次的跌倒，跌倒被认为是脑血管疾病的一种严重并发症。为此，加强社区脑卒中防跌倒管理已迫在眉睫。目的　探索家庭医生团队服务模式对社区脑卒中患者防跌倒的影响。方法　选取2016年在彭浦新村街道社区卫生服务中心登记的163例脑卒中患者为研究对象。采用家庭医生团队服务模式对居家脑卒中患者及照顾者进行防跌倒干预，干预时间1年。比较首次、第6个月、第12个月入户随访时脑卒中患者及其家庭照顾者防跌倒相关知识认知度、跌倒风险评估得分及2016年与2017年跌倒发生率等指标。结果　首次、第6个月、第12个月入户随访时，患者及照顾者防跌倒相关知识认知度、跌倒风险评估得分比较，差异均有统计学意义（P<0.001）；其中，第6个月、第12个月入户随访时患者及照顾者防跌倒相关知识认知度、跌倒风险评估得分均高于首次入户时，第12个月入户随访时患者及照顾者防跌倒相关知识认知度、跌倒风险评估得分均高于第6个月入户随访时（P<0.05）。2017年研究对象跌倒发生率为14.9%（24/161），低于2016年的32.5%（53/163）（χ2=13.86，P<0.01）。结论　运用家庭医生团队服务模式能有效控制社区脑卒中患者跌倒发生的风险因素，提高患者及照顾者防跌倒相关知识认知度，减少跌倒的发生率。     

Comparison between elderly inpatient fallers with and without dementia

INTRODUCTION

This study aimed to examine the various factors associated with inpatient falls among patients with and without dementia in a hospital setting.

METHODS

This was a retrospective one-year study using data collected from Singapore General Hospital''s electronic reporting system for inpatient falls.

RESULTS

In the study period, 298 patients aged ≥ 65 years fell during their hospital stay. The majority of the patients (n = 248) did not have dementia. In our study, fallers with dementia were more likely to use ambulatory aids, be visually impaired and have urinary incontinence. More patients with dementia than those without had a history of previous falls, and were placed on fall precaution with restricted freedom of movement, which at times, included restraints. However, the difference between patients who were put on restraints and those who were allowed to move freely was not statistically significant. The majority of falls in both groups occurred at the bedside. We found that fallers without dementia were more likely to fall during the morning shift, whereas fallers with dementia were more likely to fall during the night shift. Fallers with dementia were more likely to be confused at the time of the fall.

CONCLUSION

In our study, we found that fallers with dementia were more likely to have visual impairment, have urinary incontinence, use walking aids, and to be confused and physically restrained at the time of the fall. The fallers without dementia in our study may have undiagnosed dementia.     

Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.     

Head injuries related to the use of baby walkers.

To determine what proportion of head injuries in children under 24 months of age who presented to an emergency department were related to the use of baby walkers, we reviewed the charts of 52 such children. Walkers were involved in 42% of the head injuries in the children under 12 months of age and in none of those in the children aged 12 to 24 months. All walker-related injuries, including skull fractures in three children, involved stairs (p less than 0.001). Questionnaires were also sent to all families with children aged 3 to 18 months attending a private pediatric practice to determine the prevalence of falls involving baby walkers among these children and the factors associated with such falls. Of the 152 responding families 82% reported using or having used a walker. Thirty-six percent of the families reported that their child had a fall while in a walker, with 8.8% of the falls resulting in contact with a doctor. Walker-related falls were directly associated with time spent in the walker (p less than 0.001) and with a previous fall from the walker by an older sibling (p less than 0.03). Since there is no demonstrated benefit of walkers, their use should not be encouraged, and parents should be advised of their potential danger.