Risk factors for falls and for serious injuries on falling among older Japanese women in Hawaii.

OBJECTIVES: To evaluate if similar constellations of factors underlie the risks of falls and injuries on falling for Japanese women as reported for predominately white populations. DESIGN: A prospective cohort study SETTING: The island of Oahu PARTICIPANTS: The older Japanese women who participated in the Hawaii Osteoporosis Study (mean age = 74 +/- 5 (SD) years). MEASUREMENTS: As outcomes: falls and serious injuries on falling. As predictors: anthropometric measurements, measurements of neuromuscular performance, activities of daily living (ADLs), past falls, and other suspected risk factors for falls and serious injuries. RESULTS: In multivariable models, four subject characteristics were positively associated with having a fall (having a fall in the past year (RR = 2.0 (95% CI, 1.5-2.8)), slow chair stands (RR = 1.4 (95% CI, 1.0-1.9), a short height (RR = 1.5 (95% CI, 1.1-2.1)), difficulties with five or more ADLs (RR = 1.5 (95% CI, 1.1-2.1))). Two subject characteristics were negatively associated with having a fall (ability to perform a full tandem balance with eyes closed (RR = .7 (95% CI, .5-1.0)) and having a long functional reach (RR = .7 (95% CI, .5-1.0))). The RRs represent as nearly as possible comparisons of the upper (or lower) quartile and the remaining quartiles. In multivariable models, long times for chair stands (odds ratio (OR) = 3.0 (95% CI, 1.5-6.1)) and a low BMI (OR = 3.1 (95% CI, 1.5-6.4)) were positively associated with having a serious injury among women who had a fall. Among the same women, taking part in an activity they did frequently (OR = .3 (95% CI, .1-.8)) and slow foot reaction times (OR = .3 (95% CI, .1-.8)) were associated negatively with having a serious injury. CONCLUSIONS: The results from this Japanese cohort support the conclusion that women at high risk of falling and serious fall injuries can be identified using a questionnaire and simple, performance-based tests of neuromuscular function. The risk factors for falling overlapped, but were distinct from, those for suffering a serious injury once a fall had occurred.     

Association of physical performance and falls among the community elderly in Japan in a five year follow-up study]

Since falling is one of the main causes of morbidity and mortality among the elderly, attention should be paid to prevention. The purpose of the present study was to investigate the risk factors for falls among the elderly by a 5-year longitudinal observation. The subjects were the elderly aged 65 years and over living in a rural community in the eastern part of Honshu, Japan. Of the 852 eligible subjects, 685 persons (278 males and 407 females) received the multidimensional medical examination including physical performance as the baseline of TMIG-LISA (Tokyo Metropolitan Institute of Gerontology, Longitudinal and Interdisciplinary Study on Aging) in 1992. From baseline medical examinations, the following variables were adopted to investigate risk factors for falls (2 or more times during the 5-year follow-up): self-rated health, experience of falling, TMIG-index of competence, visual deficit, anthropometric measurements (height, weight, BML total skinfold thickness), lumbar bone mineral density, and physical performance tests (grip strength, finger-tapping rate, one leg standing time with eyes open or closed, preferred and maximum speed walking for 5 meters). A total of 108 subjects experienced falls two or more times during the 5-year follow-up period (43 men and 65 women). There were significant differences in grip strength, preferred and maximum walking speeds between those who fell and those who did not. Multiple logistic regression analysis controlled for age, sex and other variables adopted in this study revealed the following variables were significantly and independently related to falling: experience of falling within one year preceding the baseline survey (directly, p < 0.0001), preferred walking speed (inversely, p < 0.005) and total skinfold thickness (inversely, p < 0.01). These results suggest that the walking test as well as the experience of falling have discriminant and predictive validity for assessing the future occurrence of falls among the elderly.     

静安区社区老人跌倒现状和自身及环境危险因素研究

目的调研卜海市静安Ⅸ社区老人的跌倒现状、相关的危险因素，探讨针对性的干预方法。方法对静安区5个社区人选的253位老人进行跌倒现状和相关危险因素调查，并对上述老人中的111位上门进行环境危险因素调查。结果253位老人平均年龄为（69．8±8．2）岁，独居占13．4％，87．4％老人患与跌倒相关慢性疾病；69．6％老人定时服药，但仅有7．1％老人了解药物可能引起跌倒。1年跌倒发生率为19．4％，跌倒后16．3％老人发生骨折。19．8％老人对跌倒有恐惧感而减少活动。多数老人居室内外环境和随行物（鞋、服装、眼镜）的跌倒危险因素评分下降。结论静安区社区老人丧偶和独腭比例较高，多数老人患有与跌倒相关的慢性病及服用易导致跌倒药物，仅有少数老人了解药物和跌倒相关；跌倒发生率与北京岽文区、上海长宁区相似；跌倒多发生在户外公共场所，最多是绊例；老人居室内外环境安全性存存隐患。     

Sensory interaction on static balance: A comparison concerning the history of falls of community-dwelling elderly

Aim:   To determine whether elderly subjects with distinct histories of falls presented differences concerning the influence of sensory interaction on balance.
Methods:   Cross-sectional research. Ninety-six community-dwelling elderly subjects were divided into three groups, according to the history of falls within the past year (group 1, no falls; group 2, one fall; and group 3, recurrent falls). The Clinical Test of Sensory Interaction and Balance was used to evaluate the influence of sensory inputs on standing balance. The test required the subject to maintain stability during 30 s, under six conditions: (i) firm surface with eyes open; (ii) firm surface with eyes closed; (iii) firm surface with visual conflict; (iv) unstable surface with eyes open; (v) unstable surface with eyes closed; and (vi) unstable surface with visual conflict. The time expended on conditions and the number of abnormal cases were compared between groups. Each group was evaluated in relation to its performance in the progression of conditions.
Results:   More abnormal cases occurred in group 3 compared to group 1 for conditions (iv) and (v); and compared to group 2 for condition (iv). Group 3 remained less time than group 1 under conditions (iv), (v) and (vi). Groups 1, 2 and 3 presented relevant decrements in trial duration from conditions (iv) to (v). For group 3, a significant decay was also noted from condition (i) to (ii).
Conclusion:   Sensorial interaction in the elderly varies according to their history of falls. Thus, it is possible to correctly guide the rehabilitation process and to prevent sensorial decays according to an individual's history of falls.     

Differing risk factors for falls in nursing home and intermediate-care residents who can and cannot stand unaided

OBJECTIVES: To determine fall risk factors in nursing home and intermediate-care residents who can and cannot stand unaided. DESIGN: Prospective cohort study. SETTING: Residential elderly care facilities in Sydney, Australia. PARTICIPANTS: One thousand people aged 65 to 103 (mean age +/- standard deviation: 85.0 +/- 7.4). MEASUREMENTS: Accidental falls. RESULTS: Fall rates were highest in those with fair standing balance, intermediate in those with the best standing balance, and lowest in those with the worst standing balance. This nonlinear pattern was even more striking when subjects were categorized according to their standing balance and ability to rise from a chair. Using this dual classification, fall rates were highest in those who could rise from a chair but could not stand unaided (81%) and lowest in those who could neither rise from a chair nor stand unaided (48%). In residents who could stand unaided, risk factors included increased age, male sex, higher care classifications, incontinence, psychoactive medication use, previous falls, and slow reaction times. In contrast, quite different risk factors were evident in residents who could not stand unaided, with a number of known fall risk factors (previous stroke, reduced ability to rise from a chair, slow reaction times) being associated with fewer falls. In this group, risk factors were intermediate versus nursing home care, poor health status, psychoactive medication use, Parkinson's disease, previous falls, and being able to get out of a chair. CONCLUSION: The findings indicate that there are different risk factors for falls for people living in residential aged care facilities who can and cannot stand unaided. These findings provide important information for developing fall-prevention strategies and suggest that those who can stand unaided but have multiple falls risk factors constitute the highest priority group for such interventions.     

Evaluation of risk of falls in patients at a memory impairment outpatient clinic

Aim: We investigated the usefulness of the fall‐predicting score, a simple screening test to identify patients at high risk of falls in outpatients with cognitive impairment. Methods: This was a 1‐year prospective study. Seventy‐nine patients (28 men and 51 women, 78.1 ± 5.9 years old) in the Memory Impairment Outpatient Clinic of Kyorin University Hospital. History of falls in the past year, record of falls in the follow‐up period (1 year), fall‐predicting score, time of standing on one foot, timed Up & Go test, tandem gait, functional reach, grip strength, maximum circumference of the legs and blood laboratory tests were measured. Results: Of the 79 subjects, 38 (48.1%) had experienced falls in the past year, and 29 (36.7%) experienced falls during the follow‐up period. Comparing the two groups with and without a history of falls during the follow‐up period, a significant difference was observed in fall‐predicting score, timed Up & Go test, tandem gait and functional reach. Logistic regression analysis revealed that fall‐predicting score was the only significant determinant for predicting future falls. Furthermore, fall‐predicting score correlated with timed Up & Go, duration of standing on one foot, functional reach, grip strength and tandem gait. When the χ²‐test was performed to investigate the correlation between individual items of the fall‐predicting questions and falls during the follow‐up period, “Do you use a stick when you walk?” and “Are there any obstacles in your house?” showed a significant difference (P < 0.05). Conclusion: Fall‐predicting score is useful as a screening test to predict future falls in patients with cognitive decline.     

The association between orthostatic hypotension and recurrent falls in nursing home residents

PURPOSE: Orthostatic hypotension is common among the elderly, but its relation to falls is not certain. We determined whether orthostatic hypotension, including its timing and frequency, was associated with falls in elderly nursing home residents. SUBJECTS AND METHODS: We conducted a prospective study of 844 elderly (60 years of age and older), long-stay residents at 40 facilities that were part of a multistate nursing home chain. All subjects were able to maintain weight-bearing for at least 1 minute. Orthostatic hypotension was defined as a 20 mm Hg or greater decrease in systolic blood pressure from supine to standing, as measured after 1 or 3 minutes of standing on four occasions (before or after breakfast, or before or after lunch). The outcome was any subsequent fall during a mean of 1.2 years of follow-up. RESULTS: Orthostatic hypotension was present (at least on one measurement) in 50% of the subjects but was not associated with subsequent falls. However, among subjects with a history of previous falls in the past 6 months, those with orthostatic hypotension had an increased risk of recurrent falls [adjusted relative risk (RR) = 2.1; 95% confidence interval (CI), 1.4 to 3.1 ]. The risk of subsequent falls was greatest in previous fallers who had orthostatic hypotension at two or more measurements (RR = 2.6; 95% CI, 1.7 to 4.6). The association between orthostatic hypotension and recurrent falls was independent of measured demographic or clinical risk factors for falls. The timing of orthostatic hypotension (before or after meals) did not affect the risk of falls. CONCLUSIONS: Orthostatic hypotension is an independent risk factor for recurrent falls among elderly nursing home residents. Although the benefit of treating orthostatic hypotension will require further study, it may be prudent to identify high-risk residents and institute precautionary measures.     

Force platform measurements as predictors of falls among older people - a review

BACKGROUND: Poor postural balance is one of the major risk factors for falling. A great number of reports have analyzed the risk factors and predictors of falls but the results have for the most part been unclear and partly contradictory. Objective data on these matters are thus urgently needed. The force platform technique has widely been used as a tool to assess balance. However, the ability of force platform measures to predict falls remains unknown. OBJECTIVE: The purpose of this systematic review was to extract and critically review the findings of prospective studies where force platform measurements have been used as predictors of falls among elderly populations. METHODS: The study was done as a systematic literature review. PubMed, the Cochrane Central Register of Controlled Trials, and CINAHL databases from 1950 to April 2005 were used. The review includes prospective follow-up studies using the force platform as a tool to measure postural balance. Results: Nine original prospective studies were included in the final analyses. In five studies fall-related outcomes were associated with some force platform measures and in the remaining four studies associations were not found. For the various parameters derived on the basis of the force platform data, the mean speed of the mediolateral (ML) movement of the center of pressure (COP) during normal standing with the eyes open and closed, the mean amplitude of the ML movement of the COP with the eyes open and closed, and the root-mean-square value of the ML displacement of COP were the indicators that showed significant associations with future falls. Measures related to dynamic posturography (moving platforms) were not predictive of falls. CONCLUSION: Despite a wide search only a few prospective follow-up studies using the force platform technique to measure postural balance and a reliable registration of subsequent falls were found. The results suggest that certain aspects of force platform data may have predictive value for subsequent falls, especially various indicators of the lateral control of posture. However, the small number of studies available makes it difficult to draw definitive conclusions.     

Intervention in lifestyle factors for the prevention of osteoporosis and osteoporotic fractures

According that osteoporosis is the common condition in an aging society such as in Japan, much progress has been made in understanding the treatment and prevention of osteoporosis. Among potential risk factors, exercise, smoking, and alcohol consumption have been recognised as important lifestyle factors that might influence the risk of osteoporosis and osteoporotic fractures. To assess the relationship between these lifestyle factors and the risk for low bone mass and osteoporosis-related fractures, a systematic literature search over past 13 years was conducted. Accumulating evidence indicates that exercises decrease the risk for hip fractures among middle aged and older men and women. Exercises also help to maintain muscle strength, muscle volume, balance, and joint flexibility, which might prevent falls and fall-related fractures. One randomised controlled trial indicates that high-impact and/or weight-bearing exercise might increase the bone density in the elderly and the peak bone mass among young women. The literature search also address that there is an association between cigarette smoking and the risk of osteoporosis. Smoking cessation is effective to decrease the risk for both osteoporosis and osteoporotic fractures. Future research should be required to evaluate the alcohol consumption and osteoporosis.     

Severity of injuries associated with falls in the community dwelling elderly are not affected by fall characteristics and physical function level

Many elderly people experience difficulty with independent living after injuries associated with falls. This study aimed to examine the influence of fall characteristics and physical function level on the severity of fall related injuries. The surveys were conducted in 1955 community dwelling elderly. The questions regarded the following: fall experience within the past year, fall direction, fall cause, injured parts and degree of injury, and an activity of daily living (ADL) questionnaire from the Ministry of Education, Culture, Sports, Science and Technology Japan. Data of 1850 subjects with available and complete responses were used for analysis. Three hundred and eighty-six (20.9%) elderly people experienced a fall within the past year and 257 (66.7%) were injured. ADL score was significantly higher in the elderly without fall experience than the elderly with fall experience. No significant difference was found in frequency of fall cause and fall direction between the elderly with and without injuries caused by falling. Significant correlations were found between fall direction and fall cause and injured parts (φ=0.49 and 0.32). ADL score of the elderly who fell by leg backlash was significantly lower than that of the elderly who fell by tripping, slipping and staggering. A decrease of ADL affects the rate of falls in the elderly, but not the degree of injury. Fall characteristics may not be related to the extent of fall injury.     

Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data

OBJECTIVES: Our falls prevention research group has conducted four controlled trials of a home exercise program to prevent falls in older people. The objectives of this meta-analysis of these trials were to estimate the overall effect of the exercise program on the numbers of falls and fall-related injuries and to identify subgroups that would benefit most from the program. DESIGN: We pooled individual-level data from the four trials to investigate the effect of the program in those aged 80 and older, in those with a previous fall, and in men and women. SETTING: Nine cities and towns in New Zealand. PARTICIPANTS: One thousand sixteen community dwelling women and men aged 65 to 97. INTERVENTION: A program of muscle strengthening and balance retraining exercises designed specifically to prevent falls and individually prescribed and delivered at home by trained health professionals. MEASUREMENTS: Main outcomes were number of falls and number of injuries resulting from falls during the trials. RESULTS: The overall effect of the program was to reduce the number of falls and the number of fall-related injuries by 35% (incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI) = 0.57-0.75; and, respectively IRR = 0.65, 95% CI = 0.53-0.81.) In injury prevention, participants aged 80 and older benefited significantly more from the program than those aged 65 to 79. The program was equally effective in reducing fall rates in those with and without a previous fall, but participants reporting a fall in the previous year had a higher fall rate (IRR = 2.34, 95% CI = 1.64-3.34). The program was equally effective in men and women. CONCLUSION: This exercise program was most effective in reducing fall-related injuries in those aged 80 and older and resulted in a higher absolute reduction in injurious falls when offered to those with a history of a previous fall.     

Factors associated with falls in active older adults in Japan and Brazil

Background/PurposeAging populations are a global public health concern. The risk of falls increases with age, so fall prevention is becoming an important health issue. However, few studies have focused on cross-cultural analyses of falls. Therefore, we aimed to compare the incidence of falls and compare anthropometric measures and physical function between active Japanese and Brazilian older adults.Materials and methodsWe measured the incidence of falls (investigated by self-reported questionnaire), body mass index (BMI), waist circumference (WC), grip strength (GS), one-legged stance (BALANCE), frequency of physical activity (PA), medication use (MU), and hospitalization history in 114 physically active community-dwelling adults 65 years of age and older in Japan (73.9 ± 4.0 years, n = 40) and Brazil (70.7 ± 4.5 years, n = 74).ResultsThe Japanese elderly were older (p < 0.01), but had a better BALANCE score (p < 0.05) than the Brazilian elderly. Nevertheless, Brazilian elderly showed higher engagement in PA and had higher BMI and WC (p < 0.01). Despite the lack of a difference in the incidence of falls between the two cohorts, Japanese elderly who fell had decreased GS compared to Japanese elderly who did not fall [odds ratio (OR): 0.83, 95% confidence interval (CI) 0.72–0.97, p < 0.05]. In Brazil, those who fell had larger WC than those who did not fall (OR: 1.07, 95% CI 1.01 – 1.13, p < 0.01).ConclusionOur results indicate that physical function (i.e., grip strength) is a more important predictor of falls in Japanese elderly. However, increasing waist size is a predictor of falls in Brazilian elderly. These findings suggest that risk factors for falls are multifactorial and vary according to setting.     

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.     

Fall Risk Index predicts functional decline regardless of fall experiences among community‐dwelling elderly

Aim: The 21‐item Fall Risk Index (FRI‐21) has been used to detect elderly persons at risk for falls. The aim of this longitudinal study was to evaluate the FRI‐21 as a predictor of decline in basic activities of daily living (BADL) among Japanese community‐dwelling elderly persons independent of fall risk. Methods: The study population consisted of 518 elderly participants aged 65 years and older who were BADL independent at baseline in Tosa, Japan. We examined risk factors for BADL decline from 2008 to 2009 by multiple logistic regression analysis on the FRI‐21 and other functional status measures in all participants. We carried out the same analysis in selected participants who had no experience of falls to remove the effect of falls. Results: A total of 45 of 518 participants showed decline in BADL within 1 year. Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05–1.20), FRI‐21 ≥ 10 (OR 3.81, 95% CI 1.49–9.27), intellectual activity dependence (OR 3.25, 95% CI 1.42–7.44) and history of osteoarthropathy (OR 3.17, 95% CI 1.40–7.21) were significant independent risk factors for BADL decline within 1 year. FRI‐21 ≥ 10 and intellectual activity dependence (≤3) remained significant predictors, even in selected non‐fallers. Conclusion: FRI‐21 ≥ 10 and intellectual activity dependence were significant predictive factors of BADL decline, regardless of fall experience, after adjustment for confounding variables. The FRI‐21 is a brief, useful tool not only for predicting falls, but also future decline in functional ability in community‐dwelling elderly persons. Geriatr Gerontol Int 2012; ??: ??–?? .     

Fall-related risk factors and osteoporosis in older women referred to an open access bone densitometry service

OBJECTIVE: Both falls and low bone density are important in the pathogenesis of osteoporotic fractures. Whilst bone density is routinely measured to assess fracture risk, little attention is given to the assessment of fall risk. In this study we have determined the prevalence and explored relationships between fall-related risk factors and osteoporosis in women referred to our open access bone densitometry service. DESIGN: Cross-sectional study. SETTING: Teaching hospital in south-west London, UK. SUBJECTS: Older women referred for open access bone densitometry. MEASUREMENTS: Bone densitometry by dual-energy X-ray absorptiometry and fall risk assessment (visual acuity, ability to do five stand-ups without arm use and ability to perform heel-toe walking). RESULTS: Data for 558 women seen over an 18 month period were examined. Their mean age was 74.8 years (range 65-93). Fall risk and femoral neck (FN) osteoporosis increased with age, with fall-related risk factors being more prevalent than FN osteoporosis at each tertile of age. Women with both FN osteoporosis and fall-related risk factors ranged from 7% in the youngest tertile to 22% in the oldest tertile. In women with FN osteoporosis, increased fall risk was found in 37% in the youngest tertile, increasing to 63% in the oldest tertile. CONCLUSIONS: Fall-related risk factors are common in older women referred for open access bone densitometry. We recommend that both bone density and fall risk assessment, using simple screening tests for falls, are essential to determine fracture risk in older people referred for bone densitometry. Subsequent management to reduce fracture risk should be individualised for each patient.     

Risk factors for falls and fall-related injuries in adults 85 years of age and older

Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs.     

Proposal for a multiphase fall model based on real-world fall recordings with body-fixed sensors

Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses. The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals.     

Older patients with distal forearm fracture. A challenge to future fall and fracture prevention

BACKGROUND AND AIMS: Falls and fractures in older people are a common health problem. Patients with distal forearm fracture are at risk of sustaining new fractures. The aim of this work was to describe the characteristics of this patient group. METHODS: Sixty women and six men, mean age 68 years (50-86), with a recent fall-related distal forearm fracture, filled in a questionnaire about medical history, previous falls and fractures. Handgrip strength on the non-fractured side, one-leg standing, walking tests, and test of vibration sensation were measured and a video-nystagmoscopy was performed. RESULTS: One-third of the subjects had fallen during the last year, and one-third had had previous fall-related fractures during the last 10 years. Half of the patients took medication and were examined for chronic ailments regularly. Handgrip strength, balance and walking capacity declined with age and were similar to reference values. In three patients, the vibration sensation value was above the threshold value. Fifty patients (76%) had nystagmus, but no relationship between fall direction, physical performance and nystagmus was found. CONCLUSIONS: Although apparently healthy, many patients exhibited risk factors for new falls and fractures. Our recommendation is that these patients should be screened for fall and fracture risk and be targeted for preventive measures, besides fracture treatment. Physical therapists must play a major role in increasing and maintaining general physical functions in this patient group.     

Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial

OBJECTIVES: To determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls. DESIGN: Randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care. SETTING: Accident & Emergency departments in a university teaching hospital and associated district general hospital. SUBJECTS: 313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care. Outcome measures: primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling. RESULTS: There were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46-0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81-1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1-7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72-14.2). CONCLUSION: Multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.     

A systematic review and meta-analysis of fall incidence and risk factors in elderly patients after total joint arthroplasty

Background:Falls in the elderly have become a serious social problem worldwide. Approximately a third of persons fall at least once in the year after total joint arthroplasty (TJA), but preventing and treating falls is still challenging in clinical practice. Until now, no formal systematic review or meta-analysis was performed to summarize the risk factors of falls after TJA. The present study aimed to quantitatively and comprehensively conclude the risk factors of falls after TJA in elderly patients.Methods:The electronic databases to be searched include CNKI, Embase, Medline, and Cochrane central database (all up to November 2018). All studies on the risk factors of falls after TJA in elderly patients without language restriction were reviewed. Process of evaluation of identified studies and extraction of data were independently conducted by 2 reviewers, qualities of included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled and a meta-analysis completed. All analyses were performed by the software Stata 11.0.Results:A total of 14 studies were included, which altogether included 1284456 patients with TJA, of them 12879 cases of falls occurred after surgery, suggesting the accumulated incidence of 13.1% and the prevalence of in-hospital falls was 1.0%. This study has provided evidence for the preventing of falls in the elderly patients who were underwent TJA. Outcome measures include advanced age, female, Overweight (BMI≥25 kg/m²), falls history, use of walking aid, diabetes, cardiac disease, hypertension, COPD and depressive symptoms. The ABC Scale was significantly negatively correlated with falls after lower extremity joint replacement.Conclusions:Related prophylaxis strategies should be implemented in elderly patients involved with above-mentioned risk factors to prevent falls after TJA.