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 ( &#85 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.     

A comparison of four functional tests in discriminating fallers from non-fallers in older people

Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear. This study aims to compare the Berg Balance Scale (BBS), Tinetti Mobility Score (TMS), Elderly Mobility Scale (EMS) and Timed Up and Go test (TUG) in discriminating fallers from non-fallers in older people.

Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in random sequence. Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic, and 39 community-dwellers without fall history and whose age, sex and BMI matched those of the fallers. All subjects underwent the mobility and balance assessment within one day.

Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS, TMS and TUG. The BBS demonstrated the best discriminating ability, with high sensitivity and specificity. The BBS item 'pick up an object from the floor' was the best at screening fallers.

Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller.     

Sensorimotor,Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study

ObjectiveTo determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations.DesignWe pooled data from 5 studies for this observational analysis of prospective falls.SettingCommunity or low-level care facility.ParticipantsOlder people (N=1090; 74.0±9.4y; 579 female); 500 neurologically intact (NI) older people and 3 groups with neurologic disorders (cognitive impairment, n=174; multiple sclerosis (MS), n=111; Parkinson disease, n=305).InterventionsNone.Main Outcome MeasuresSensorimotor function was assessed with the Physiological Profile Assessment, cognitive function with tests of executive function, affect with questionnaires of depression, and concern about falling with falls efficacy questionnaires.These variables were associated with fall incidence rates, obtained prospectively over 6-12 months.ResultsPoorer sensorimotor function was associated with falls (incidence rate ratio [95% CI], 1.46 [1.28-1.66]). Impaired executive function was the strongest predictor of falls overall (2.91 [2.27-3.73]), followed by depressive symptoms (2.07 [1.56-2.75]) and concern about falling (2.02 [1.61-2.55]). Associations were similar among groups, except for a weaker relationship with executive impairment in NI persons and a stronger relationship with concern about falling in persons with MS. Multivariable analyses showed that executive impairment, poorer sensorimotor performance, depressive symptoms, and concern about falling were independently associated with falls.ConclusionsDeficits in cognition (executive function) and affect (depressive symptoms) and concern about falling are as important as sensorimotor function for fall prediction. These domains should be included in fall risk assessments for older people and clinical groups.     

Activity limitation, coping efficacy and self-perceived physical independence in people with disability

Objective: This study examines whether the relationships between activity limitations and independence are mediated by coping efficacy.

Method: Data come from a cross-sectional survey of 286 adults, aged 55 or older, with osteoarthritis (OA) and/or osteoporosis (OP). Physical independence was assessed by asking to what extent respondents' OA/OP had affected their independence on a 5-point scale from 'not at all' to 'a great deal'. Activity limitations were examined in three domains: personal care, community mobility, and household activity. A coping efficacy scale was derived from three items scored on a 5-point Likert-type scale from strongly disagree to strongly agree. Structural equation modelling was used to test the model.

Results: Activity limitation in household activities was directly associated with perceptions of independence, with a statistically significant standardized path coefficients of - 0.32. The effect of activity limitation in personal care was partially mediated by coping efficacy with a direct effect of - 0.41 which was partially offset by coping efficacy to give a net effect of - 0.308. The effect of community mobility on independence was completely mediated through coping efficacy with significant standardized path coefficients of - 0.85 (community mobility to coping efficacy) and - 0.14 (coping efficacy to independence). The overall model's goodness of fit was excellent (R² = 0.59, ch-square/df = 1.4, CFI = 0.97, and NNFI = 0.97).

Conclusion: Activity limitation had a detrimental effect on the level of self-perceived independence. Coping efficacy showed a significant mediating effect between activity limitation and self-perceived independence for the domains of personal care and community mobility, but not household tasks. This study suggests that how activity limitation affects perceptions of independence varies across activity limitation domains, and indicates the importance of incorporating activity limitation domains in future studies.     

Incidence of and risk factors for falls following hip fracture in community-dwelling older adults

BACKGROUND AND PURPOSE: Hip fracture is a major medical problem among older adults, leading to impaired balance and gait and loss of functional independence. The purpose of this study was to determine the incidence of and risk factors for falls 6 months following hospital discharge for a fall-related hip fracture in older adults. SUBJECTS: Ninety of 100 community-dwelling older adults (> or =65 years of age) hospitalized for a fall-related hip fracture provided data for this study. METHODS: An observational cohort study used interviews and medical records to obtain information on demographics, prefracture health, falls, and functional status. Self-report of falls and performance-based measures of balance and mobility were completed 6 months after discharge. RESULTS: A total of 53.3% of patients (48/90) reported 1 or more falls in the 6 months after hospitalization. Older adults who fell following discharge had greater declines in independence in activities of daily living and lower performance on balance and mobility measures. Prefracture fall history and use of a gait device predicted postdischarge falls. DISCUSSION AND CONCLUSION: Falls following hip fracture can be predicted by premorbid functional status.     

The efficacy of a work-station intervention programme to improve functional ability and flexibility in ageing clients with Cerebral Palsy: a pilot study

Purpose: Health care workers associated with the long-term care of ageing clients with Cerebral Palsy have reported on the adverse effects of less active daily activity programmes with resultant decreased functional mobility. While the negative effects of ageing have been reported in these clients, programmes have not been implemented to determine whether these adverse changes can be reversed or prevented. The efficacy of a work-station intervention programme to improve functional ability and flexibility in ageing clients with cerebral palsy was investigated.

Method: A clinical intervention study using repeated measures (pre/post-intervention and at follow-up) to evaluate efficacy was undertaken. Twenty-two clients with Cerebral Palsy participated in a twice-weekly work-station programme delivered over 8 weeks. The Physical Mobility Scale items, two upper limb function measures, range limitation of hip and knee extension and gleno-humeral movement were assessed.

Results: Results showed a significant improvement that was retained at follow-up in functional but not flexibility measures.

Conclusion: The efficacy of a work-station exercise programme for ageing clients with Cerebral Palsy was demonstrated. Evidence was provided that the PMS is effective in showing level of dependency for these clients.     

Diagnosis of the risk of accidental falls in the elderly

The steep increase in the incidence of hip fractures and other fall-related fractures with advancing age is caused by an age-associated combination of increased fall frequency, typical fall mechanisms and reduced bone strength. This article reviews the current knowledge related to fall risk factors and fall mechanisms. Non-syncopal falls during normal daily activities are predominantly age-associated occurrences with serious consequences. 5% of all falls cause fractures, another 10 to 15% lead to a variety of further injuries. The most serious consequences of the geriatric fall syndrome are fractures of hip, humerus, wrist and pelvis. Fear of falling and self limitation of physical activity are self imposed psychological impairments. There is a pathological cascade from age-associated gait and balance disorders to locomotor falls and further to fall-related fractures. Significantly increased fall risk caused by gait and balance disorders can be considered as a distinct chronic pathological condition. It is strongly age-related and definitely has a multifactorial origin. The term "age-associated multifactorial gait disorder" has been coined for this condition. Assessing fracture risk requires evaluating fall risk, fall mechanisms and bone strength. Older people with gait and balance disorders fall mostly sideways, and the impact of such a fall from standing height generates enough force to break an older non-osteoporotic femur. Osteoporosis can decrease bone strength beyond the age-related grade, and is one of the several most important risk factors for fractures. Prospective studies have consistently found the following independent risk factors for non-syncopal falls: 1. Muscle power of lower extremities, 2. Lateral postural stability, 3. Clinical evaluation of gait, 4. Visual impairment, 5. Four or more different medications or certain psychotropic drugs, 6. Cognitive impairment, and 7. History of falling. The fall-related neuromuscular status can be adequately assessed by three diagnostic procedures: The chair rising test represents muscle power, and has proven its relevance for both fall risk and deterioration of mobility and functional independence. Measurement of lateral postural stability can be done by tandem manoeuvres. Clinical evaluation of gait should focus on the regularity of gait as a cyclic event. The fall risk status of an individual depends strongly on the number of the independent risk factors that one accumulates. Both prevention and therapy must focus on each of these individual risk factors. Preventing falls and its consequences is imperative for successful aging.     

Foot and leg problems are important determinants of functional status in community dwelling older people

Purpose. To determine whether foot and leg problems are independently associated with functional status in a community sample of older people after adjusting for the influence of socio-demographic, physical and medical factors.

Method. Data were analysed from the Health Status of Older People project, a population-based study involving a random sample of 1000 community-dwelling people aged 65 - 94 years (533 females, 467 males, mean age 73.4 years ± 5.87). A structured interview and brief physical examination were used to investigate the associations between self-reported foot and leg problems and functional status. Functional status was assessed using: (i) timed 'Up & Go' test, (ii) self-reported difficulty climbing stairs, (iii) self-reported difficulty walking one kilometer, (iv) self-reported difficulty performing instrumental activities of daily living (IADLs), and (v) self-reported history of one or more falls in the previous 12 months. These associations were then explored after adjusting for socio-demographic, physical and medical factors.

Results. Thirty-six percent of the sample reported having foot or leg problems. Univariate analyses revealed that people with foot and leg problems were significantly more likely to exhibit poorer functional status in all parameters measured. After adjusting for socio-demographic, physical and medical factors, foot and leg problems remained significantly associated with impaired timed 'Up & Go' performance (OR = 2.15, 95%CI 1.55 - 2.97), difficulty climbing stairs (OR = 3.33, 95%CI 1.98 - 5.61), difficulty walking one kilometer (OR = 3.13, 95%CI 2.09 - 4.69), and history of falling (OR = 1.73, 95%CI 1.26 - 2.37).

Conclusions. Foot and leg problems are reported by one in three community-dwelling people aged 65 years and older. Independent of the influence of age, gender, common medical conditions and other socio-demographic factors, foot and leg problems have a significant impact on the ability to perform functional tasks integral to independent living.     

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.     

Disability in an urban black community in Zimbabwe

Purpose : This study was undertaken to establish which health conditions are primarily responsible for disability and morbidity in a high-density area in Harare, Zimbabwe.

Method : House-to-house screening visits were followed up by medical examination and interview of those identified as having a functional limitation.

Results : Information was obtained during screening on 10 839 residents. Of these, 608 were examined by medical professionals. The rate of disability/morbidity was 5.6% for the whole sample. Headaches and migraine were the most common problem. These were followed by back pain, hypertension and osteoarthritis. HIV/AIDS was the fifth most common condition. Depression, based on responses to a screening tool, was evident in one-third of the subjects. Common activity limitations included difficulty with the performance of housework activities and with walking. HIV/AIDS resulted in the most severe activity limitation, in that cognitive functions were also affected.

Conclusion : The middle-aged and elderly with osteoarthritis and young women with depression constitute vulnerable groups who are not in a position to demand services. The older women particularly need assistance as they are bearing the double burden of their own degenerative conditions and the results of the HIV/AIDS pandemic.     

Audit, guidelines and standards: Clinical governance for hip fracture care in Scotland

Purpose: To report on experience of national-level audit, guidelines and standards for hip fracture care in Scotland.

Methods: Scottish Hip Fracture Audit (from 1993) documents case-mix, process and outcomes of hip fracture care in Scotland. Evidence-based national guidelines on hip fracture care are available (1997, updated 2002). Hip fracture serves as a tracer condition by the health quality assurance authority for its work on older people, which reported in 2004.

Results: Audit data are used locally to document care and support and monitor service developments. Synergy between the guidelines and the audit provides a means of improving care locally and monitoring care nationally. External review by the quality assurance body shows to what extent guideline-based standards relating to A&E care, pre-operative delay, multidisciplinary care and audit participation are met

Conclusion: Three national-level initiatives on hip fracture care have delivered: Reliable and large-scale comparative information on case-mix, care and outcomes; evidence-based recommendations on care; and nationally accountable standards inspected and reported by the national health quality assurance authority. These developments are linked and synergistic, and enjoy both clinical and managerial support. They provide an evolving framework for clinical governance, with casemix-adjusted outcome assessment for hip fracture care as a next step.     

Care and services for spinal injured people with,and without,neurological deficit

Purpose : To describe the care and service usage characteristics of the spinal injured (SI) population of New South Wales (NSW), Australia, including people without significant permanent neurological deficits.

Method : A cross-sectional mailed survey was undertaken with all persons admitted to the two spinal injury hospital units in NSW following traumatic spinal injury in the period 1977 - 1992 who were not known to be deceased ( n =2432). Response was gained from 75.8% of the 932 persons whose address was able to be confirmed ( n =706).

Results : SI persons were primarily males who incurred a motor related trauma at a young age. Over one third had minimal or no permanent neurological impairment. Over half of the respondents received assistance with everyday living (59.5%), including older persons with minimal or no motor or sensory problems, and a large number made use of professional services (40.5%). People with lower-level incomplete lesions were more likely to use paramedical services than some groups of people with quadriplegia.

Conclusions : The relatively high use of care and paramedical services by some persons with minimal physical functional limitations indicates the importance of including such persons when considering the provision of long-term care and rehabilitation services for people with spinal injury.     

Rehabilitation following hip fracture surgery: a comparative study of females and males

Purpose: To compare patient, fracture and rehabilitation variables between male and female patients during the rehabilitation period immediately following surgical repair of hip fracture (HF).

Methods: A prospective cohort study was conducted in a rehabilitation geriatric ward in a tertiary university hospital in southern Israel. The study group consisted of 808 elderly patients, 65 years of age or older, selected for hospitalized rehabilitation following surgery for HF. The measurements included functional studies by the Functional Independence Measure (FIM™) scale, mental status by Folstein Minimental Test and Clock Drawing Test, Geriatric Depression Screening Scale (GDS), demographic and social parameters, laboratory tests, length of rehabilitation, complications and mortality during rehabilitation.

Results: Six hundred and fourteen patients (76%) were women and 194 (24%) were men. The mean age ( ± SD) of the women was 78.4 ± 7.1 years and of the men was 77.8 ± 7.5 (NS). There were no significant differences between women and men in terms of the anatomic site of the fracture or the type of surgery, the complication rate or mortality during rehabilitation, the length of time needed for rehabilitation, the framework to which the patient was discharged, FIM values before the HF, on admission and at the end of rehabilitation, or the difference between FIM scores at these last two points in time.

Conclusions: In selected elderly patients with HF gender does not affect variables associated with hip fracture, the rehabilitation process immediately following the fracture, or the results of rehabilitation.     

The risk factors related to falling in elderly females

The purpose of this study was to explore the relationship between muscle strength and functional mobility and falls in women aged 65 and over. Thirty-one female subjects with a mean age of 69.57 +/- 4.89 years (65-78) were enrolled in the study. Demographic properties, body mass index, comorbid medical conditions, smoking, the number of medications taken, and fall characteristics were recorded. Knee flexor and extensor strength of the dominant extremity was measured by Biodex isokinetic system, and physical capacity was assessed with a 6-minute walk test. Cognitive status was evaluated by the Mini-Mental State Examination, and disability in daily activities was determined with the Barthel Index. Twelve subjects (38.7%) reported experiencing a fall in the previous year. Eight (25.8%) had experienced a fall outside the home and 4 (12.9%) inside the home. Nine subjects had fallen once, 2 subjects twice, and 1 subject had fallen 3 times. Six (19.4%) subjects reported a fracture after falling. Muscle strength of the knee extensors and flexors and work capacity was similar between those who had fallen and those who had not. The risk factors related to falling were evaluated, but no related factor was determined. Fear of falling was found to be high in patients who had fallen in the previous year. In conclusion, knee extensor and flexor strength are not significant factors in falls or the risk of falling for elderly women, particularly those who are able to function independently. Balance tests in current use are not effective predictors of falls in older adults who live independently and who do not have any significant health problem. These results suggest that there may be a significant interactive effect of the many causal factors that we need to address. Further study is needed to develop new assessment tools for active elderly people to help prevent falls and fall-related injuries.     

Associations of objectively measured physical activity and sedentary behaviour with fall-related outcomes in older adults: A systematic review

BackgroundHigher physical activity (PA) and lower sedentary behaviour (SB) are associated with better muscle strength, balance, and functional ability, which are imperative for avoiding falls. This systematic review aimed to describe the association between objectively measured PA and SB with falls, fear of falling, and fractures.MethodsSix databases were searched from inception to July 21, 2020 for articles reporting the association of objectively measured PA/SB with falls, fear of falling, and/or fractures in community-dwelling older adults ≥60 years old. Results were synthesized in effect-direction heat maps and albatross plots expressed as Pearson's correlation coefficients (R).ResultsA total of 43 articles were included, representing 27,629 (range 26–5545) community-dwelling older adults (mean [SD] age 76.6 [8.4] years, 47% female). Longitudinal associations were reported in 13 articles and cross-sectional associations in 30. Falls were reported in 11 articles, fear of falling in 18 and fractures in 2. Higher PA and lower SB were associated with less fear of falling (median [interquartile range] Rs = steps: -0.214 [0.249; -0.148], total PA: -0.240 [0.267; -0.144], and moderate-to-vigorous PA: -0.180 [0.382; -0.121]), but these associations did not extend to falls or fractures, which showed inconsistent effect directions.ConclusionFear of falling is associated with less engagement in PA and more SB, thus indicating that it is a psychological barrier to an active lifestyle. Varying effect directions for associations between PA and SB with falls and fractures may provide evidence for non-linear associations and require further research considering details of the fall or fracture incident.PROSPERO registration numberCRD42018103910     

Simultaneous distal radius and hip fractures in elderly patients--implications to rehabilitation

Purpose : The reasons for fractures in the elderly patients are multifactorial. Osteoporosis is considered to be the main pathology. Other reasons are the increase in fall frequency and the protective response to trauma. The most common sites at which these fractures occur are the hip, vertebra and distal radius. A combination of these is uncommon.

Methods : All patients who were treated between January 1990 and December 2000 with a combination of distal radius and hip fractures and were older than 65-years were retrospectively evaluated. The following parameters were evaluated: age; sex; pre fall function; use of drugs; chronic and acute comorbidity; circumstance of the fall; hospitalization length of stay; treatment procedure; complications; and post-hospitalization rehabilitation.

Results : Forty-six patients met the study's criteria. Group I consisted of 16 patients between 65-80 years, and group II consisted of the remaining 30 patients older than 80 years. All patients suffered low energy trauma. Ten out of the 16 patients in group I, and eight out of the 30 patients in group II were totally independent, while the remaining patients needed some help with activity of daily living (ADL). In all patients the simultaneous fractures were ipsilaterally. For 45 patients hospital stay ranged from 5-23 days. Twenty-eight patients were transferred to a geriatric rehabilitation centre. Twenty-six of them returned to their previous ADL after a period of 60 days on average. Among the 18 remaining patients, 11 gained full recovery (6 from group I and 5 from group II) and seven patients (5 from group II) had a slight reduction in ADL.

Conclusions : A combination of these fractures is probably more traumatic and occurs in the higher-age group. It is always located in the ipsilateral side. The double trauma represents a better pre-morbid condition relative to patients in the same age group, and thus it may serve as a prognostic indicator for success in rehabilitation.     

Costs and consequences of hip fracture occurrence in old age: An economic perspective

Purpose: To summarize the reported short- and long-term costs associated with hip fracture occurrence in old age, based on a systematic literature review of published studies. A further aim is to provide a clinician-oriented discussion of the different types of economic evaluations, with an emphasis on studies that examined potential determinants of the costs of care after hip fracture.

Method: Literature review.

Main results: Even after the initial hospitalization, hip fractures continue to generate significant costs throughout the one-year period after discharge, but particularly during the first three months. Cost estimates based on data obtained prospectively from hip-fracture patients and matched controls showed that the costs associated with the treatment of hip-fracture patients are about three times greater than those resulting from the treatment of age and residence-matched controls without a fracture. Two-fifths of these excess costs are incurred during the first three months following hospital discharge. Increasing age at the time of injury and living in an institution before the fracture are among the most important determinants of an increased cost of care after hospital discharge. Programs that focus on continuity of care, adopt a multidisciplinary approach, and accelerate rehabilitation have shown to be able to reduce the cost of care after hip fracture.

Conclusions: This review emphasizes the importance of current and future interventions to decrease the incidence of hip fracture. While the current review cannot provide definite answers to the questions of cost containment, our review provides critically important evidence about the need to base health policy decisions on empirical observations. Comprehensive economic analyses of financial costs and health outcomes are needed to develop cost-effective strategies.     

Selecting a theoretical framework to guide a research study of older adults' perceptions and experiences of falling in the hospital

A paucity of research has explored the older adult's experience of falling in the hospital. Understanding the central concepts associated with a fall while hospitalized is essential for further fall prevention research and practice. The purpose of this paper is to describe the process of selecting a theoretical framework to guide a qualitative study exploring the older adult's experience of falling while hospitalized. An analysis of six established illness self-management theories and models from nursing and psychology was conducted using Walker and Avant's framework for theory analysis. The Health Belief Model was selected as the most appropriate theoretical framework, as it entails concepts applicable to the experience of falling and captures the complexity of the phenomenon of inpatient falls, which is important for nursing.     

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.     

A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a single home visit by an occupational therapist in the reduction of fall risk after hip fracture in elderly women. DESIGN: Quasi-randomized controlled trial. PARTICIPANTS: Ninety-five women aged 60 years or older, living in the community, who sustained a fall-related hip fracture. METHODS: The women were allocated alternately to intervention or control groups. All the women underwent a multidisciplinary programme targeted at fall prevention during in-patient rehabilitation. Additionally, the intervention group received a home visit by an occupational therapist a median of 20 days after discharge. Falls were recorded at a 6-month follow-up. RESULTS: Thirteen of the 50 women in the control group sustained 20 falls during 9231 days, whereas 6 of the 45 women in the intervention group sustained 9 falls during 8970 days. After adjustment for observation periods, Barthel Index scores, and body height, a significantly lower proportion of fallers was found in the intervention group: the odds ratio was 0.275 (95% confidence interval 0.081-0.937, p=0.039). CONCLUSION: A single home visit by an occupational therapist after discharge from a rehabilitation hospital significantly reduced the risk of falling in a sample of elderly women following hip fracture.