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Abstacts 7 Recent abstracts from the research literature.

CAREX 2012 3

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FALLS LINKSVolume 7, Issue 4, 2012 Newsletter of the NSW Falls Prevention Network

This issue includes:

• LiFE Program• Report on CAREX 2012• New Resources and Conferences information• Abstracts - the latest abstracts from the research

literature

The 5th Biennial Australian and New Zealand Falls Prevention Society (ANZFPS) Conference will be held in Adelaide at the Convention Centre from the 28-30th October 2012, further information is available at

www.anzfpsconference.com.au/

fallsnetwork.neura.edu.au

Inside this IssueLiFE Program 2

New Resources and Conferences 5 New resources, websites and upcoming meetings.

Network Information 26How to join and communicate through the network.

WelcomeCAREX 2012

“Falls Prevention is Everyone’s Business”

Maree Connolly at the Falls Network Stand

www.anzfpsconference.com.au

http://fallsnetwork.neura.edu.au

Falls Links Vol 7, Issue 4, 2012 NSW Falls Prevention Network

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The LiFE (Lifestyle Integrated Functional Exercise) ProgramBalance and strength training integrated into everyday routines could reduce falls in older people by almost a third, according to a new University of Sydney study.

The research, published online in the British Medical Journal by researchers in the University’s Ageing, Work & Health Research Unit, Faculty of Health Sciences, led by Professor Lindy Clemson, found balance and strength tasks integrated into everydayactivitieswereeffectiveinreducingtherateoffallsinolder,high-riskpeople living at home.

Professor Clemson and her team developed the Lifestyle integrated Functional Exercise (LiFE) to reduce falls program, which involves embedding balance and lower limb strength training into daily routines such as walking, stepping over objects, and moving from sitting to standing.

TheLiFEprogramisthefirstintheworldtoinvestigatewhetherintegratingexercise into everyday activities could prevent falls in older people.

The LiFE program provides an alternative for older people at risk of falls to traditional exercise programs. Rather than a prescribed set of exercises conducted several times a week, participants were encouraged to complete LiFE activities, such as walking sideways or bending knees, whenever the opportunity arose during their day.

Participants might shift their weight from foot to foot while standing at the kitchen bench, or bend their knees to close a drawer instead of bending at the waist. They can then upgrade these everyday activities as they increase their strength and balance, for example once they’ve mastered closing drawers with bended knees, they could bend atthekneestopicksomethingupfromthefloor.

The study recruited 317 men and women over the age of 70 living in the community who had experienced two or more falls, or one injurious fall, in the past year.

The researchers compared their own lifestyle intervention with a structured exercise program performed three timesaweekusinganklecuffweightsandwithgentle‘sham’exercisesthatactedasthestudycontrol.Theyfoundasignificant31percentreductionintherateoffallsforparticipantsintheLiFEprogramcomparedwiththecontrolgroup.Therewasanon-significantreductionintherateoffallsforthoseinthestructuredprogrammecomparedtothe control group.

Compared with control patients LiFE participants showed improvements in both static and dynamic balance, ankle strength and in function and participation in daily life, suggesting the program improves both fall risk and frailty.

AdherencewassignificantlybetterintheLiFEprogrammeandcontrolgroupcomparedwiththestructuredexerciseprogramme.

Theprogramwastaughtonfivehomevisitsbyanoccupationaltherapistoraphysiotherapist.Thereweretwofollowup phone calls and two booster visits.

The article is freely available online at BMJ (http://www.bmj.com/content/345/bmj.e4547).

The participant and therapist manuals, with feedback sheets, will soon be available from Sydney University Press. The manuals are detailed with many photographs to show examples of activities. They can be contacted at: [email protected]. You may leave an expression of interest.

Lindy Clemson Professor, Occupational Therapy & Ageing NHMRC CD Research Fellow Ageing, Work & Health Research Unit Faculty of Health Sciences, The University of Sydney

Professor Lindy Clemson

http://www.bmj.com/content/345/bmj.e4547

[email protected]

NSW Falls Prevention Network Falls Links Vol 7, Issue 4, 2012

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CAREX 2012 REPORT

Background

CAREX is an expo of products, services, programs and initiatives for acute, residential, retirement or disability care organisations providers to older people, and was held at Rosehill Racecourse on the 8th and 9th August, 2012. Entry to CAREX for attendees is free. The Falls Network had been invited to have a stall (this year for a small fee) at thelastfiveCAREXexposandthiswasoursixthattendance.

Attendance

Lorraine Lovitt (Leader, NSW Falls Prevention Program, Clinical Excellence Commission [CEC]), Maree Connolly (ProjectOfficer,NSWFallsPreventionProgram,CEC)andEstherVance(ProjectOfficer,NSWFallsPreventionProgram, Neuroscience Research Australia) attended the 2 day expo. We spoke to 540 participants over the 2 days (266onthefirstdayand274onthesecondday);thiswasanincreaseof39%overlastyear.

This year there was a range of professionals attending including Nursing Home Managers, Directors of Nursing (DON), nurses, physiotherapists and physiotherapy aides, occupational therapists, and AINs and Catering Managers from the aged care sector and an Aged Care Accreditation Agency Assessor.

Stafffromcommunitycareandhospitalsectorsalsoattended,includingCommunityServicecoordinators,HACCstaff,careworkers,SafetyandQualityManagers,NursingUnitManagers,NurseEducatorsandAgedCareCNCs,PalliativeCareStaff,aswellasCouncilAgedCareServicesworkers,SteppingOncoordinators,DADHCcaseworkersandapodiatrist.TherewerealsoanumberofstudentsstudyingeitherforCertificateIIIinAgedCare,AssistantsinNursingorAlliedHealthTAFECoursesandtheirteachingstaffandaUniversityLecturerteachingnursing and allied health students. We also spoke to 2 GPs and a Practice Nurse from rural NSW and an Architect.

Attendees came mostly from the Sydney area however there were attendees from Albury, Blainey, Blue Mountains, Orange, Cowra, Wollongong, Nowra, Narromine and Newcastle. All attendees we spoke to were aware of the problemsoffallsandveryinterestedinfallspreventioninformationespeciallytheACSQHCFallsPreventionBestPractice guidelines Active and healthy website and the Staying active and on your feet booklets, with at least 30 enquiries about this booklet being available in CALD languages .

Esther Vance at the Falls Network Stand


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We also engaged with members of Diversional Therapy Australia, Macular Degeneration Foundation, Mental Health Association of NSW and discussed the relevance of falls prevention for their respective organisations.

Mini workshop Presentation

The NSW Falls Prevention Program and NSW Falls Prevention Network were invited to present a mini-workshop oneachofthedayson‘What’s new in Falls Prevention? Improving care based on best practice’. This presentation provided an update of the latest falls prevention research and discussed falls risk factors as well as providing examples of interventions to improve good practice in falls prevention by use of a case study. The presentation wasgivenbyLorraineLovittonthefirstdayandwasattendedby100participantsandEstherVanceonthesecondday and was attended by 25 participants (this was the last session of the day). Feedback on the presentation was verypositivewiththoseattendingfindingtheinformationusefulfortheirpractice.

Resources

A number of resources were handed out over the 2 days including CDs (50) with the Australian Commission on SafetyandQualityinHealthcare,(ACSQHC)Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Hospitals, Residential Aged Care Facilities and Community Care 2009. CDs of presentations supporting these guidelines were also distributed. Resource summaries for each of the care settings were provided to participants.

Other resources distributed included copies of the Staying active and on your feet booklet (300 copies) as well as information on the NSW Falls Prevention Network, NSW Falls Prevention Program, NSW Ministry of Health Active and Healthy website (www.activeandhealthy.nsw.gov.au),QuickScreen®FallsRiskassessmenttool,BasicStepsresource(NorthernSydneyCentralCoast)andCECFallsPreventionandBoneHealthflyer.

Future

CAREX provides an opportunity to promote best practice in falls prevention with external organisations and providers of care to older and disabled clients.

Maree Connolly providing information to participants at the Falls Network Stand

http://www.activeandhealthy.nsw.gov.au


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Resources and WebsitesRoyal College of Physicians - Falls Prevention Resources

Falls Prevention resources for clinical hospital wards developed by UK Royal College of Physicians, and overseen by key stakeholders including the National Patient Safety Agency (NPSA), Royal College of Nursing (RCN), British Geriatrics Society (BGS) and the patient support group Action against Medical Accidents (AvMA).

Access at http://www.rcplondon.ac.uk/resources/falls-prevention-resources (scroll down to access PDFs).

Western Australian Centre for Healthy Ageing

This site includes a range of e learning modules on issues in the ageing population that health professionals can complete including one on falls.

go to http://e-ageing.wacha.org.au/index.php?id=828

Conferences/Meetings5th Biennial Australian and New Zealand Falls Prevention Society Conference, 28th - 30th October, Adelaide Convention CentreThe main theme for this years conference is Translating Research into practice. Go to www.anzfpsconference.com.au

This conference will be of interest and relevance to health professionals and others who provide care and support to older people, and who are interested in reducing the rate of falls and harm from falls. The conference showcases Australasian and international research.

The Program is now available, register now for the conference and preconference workshops being held on Sunday 28th October.

http://www.rcplondon.ac.uk/resources/falls-prevention-resources

http://e-ageing.wacha.org.au/index.php?id=828

http://www.anzfpsconference.com.au

http://www.anzfpsconference.com.au/


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ReviewsAdherence to and efficacy of home exercise programs to prevent falls: a systematic review and meta-analysis of the impact of exercise program characteristics

Simek EM, McPhate L, Haines TP.

Prev. Med.2012;ePub(ePub):ePub.

Affiliation:MonashUniversity,PhysiotherapyDepartment,McMahonsRoad,Frankston,Victoria,Australia,3199.DOI: 10.1016/j.ypmed.2012.07.007 PMID: 22813920 (Copyright © 2012, Elsevier Publishing).

Abstract

OBJECTIVE: To determine whether adherence to home exercise interventions for the prevention of falls in older adultsrelatestohomeexerciseprogramcharacteristicsandinterventionefficacy.

METHOD: In Australia (2011) a systematic literature search of four databases was conducted. Randomized controlledtrialswereincluded.Random-effectsmeta-analysisofparticipantadherencerateswasperformed.Meta-regression analyses were used to determine the relationship between intervention program characteristics, interventionefficacyandadherence.

RESULTS: Twenty-three studies met the inclusion criteria. The pooled estimate of participants who were fully adherentwas21%(95%ConfidenceInterval:15%-29%,range:0%-68%).Higherlevelsoffulladherencewere found in interventions containing balance or walking exercise, moderate home visit support, physiotherapist leddeliveryandnoflexibilitytraining.Higherlevelsofpartialadherencewerefoundininterventionscontaininghome visit or telephone support, a participant health service recruitment approach and no group exercise training. Neither full nor partial adherence to prescribed home exercise program dosages were associated with intervention efficacy.

CONCLUSION:Adherencetohomeexerciseforthepreventionoffallsinolderadultsislowandmaybeaffectedbyhomeexerciseprogramcharacteristics.Thereisanabsenceofevidencetolinkadherencetointerventionefficacy.

Can falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis

da Costa BR, Rutjes AW, Mendy A, Freund-Heritage R, Vieira ER.

PLoS ONE2012;7(7):e41061.

Affiliation:DivisionofClinicalEpidemiologyandBiostatistics,InstituteofSocialandPreventiveMedicine,University of Bern, Bern, Switzerland. DOI: 10.1371/journal.pone.0041061 PMID: 22815914 PMCID: PMC3398864 (Copyright © 2012, Public Library of Science).

Abstract

BACKGROUND: Falls of elderly people may cause permanent disability or death. Particularly susceptible are elderly patients in rehabilitation hospitals. We systematically reviewed the literature to identify falls prediction tools available for assessing elderly inpatients in rehabilitation hospitals.

METHODS AND FINDINGS: We searched six electronic databases using comprehensive search strategies developed foreachdatabase.EstimatesofsensitivityandspecificitywereplottedinROCspacegraphsandpooledacrossstudies.Oursearchidentifiedthreestudieswhichassessedthepredictionpropertiesoffallspredictiontoolsin a total of 754 elderly inpatients in rehabilitation hospitals. Only the STRATIFY tool was assessed in all three studies;theotheridentifiedtools(PJC-FRATandDOWNTON)wereassessedbyasinglestudy.ForaSTRATIFYcut-scoreoftwo,pooledsensitivitywas73%(95%CI63to81%)andpooledspecificitywas42%(95%CI34to51%).AnindirectcomparisonofthetoolsacrossstudiesindicatedthattheDOWNTONtoolhasthehighestsensitivity(92%),whilethePJC-FRAToffersthebestbalancebetweensensitivityandspecificity(73%and75%,respectively). All studies presented major methodological limitations.

CONCLUSIONS:Wedidnotidentifyanytoolwhichhadanoptimalbalancebetweensensitivityandspecificity,orwhichwereclearlybetterthanasimpleclinicaljudgmentofriskoffalling.Thelimitednumberofidentifiedstudies with major methodological limitations impairs sound conclusions on the usefulness of falls risk prediction tools in geriatric rehabilitation hospitals.

AbstractsRecent abstracts from the research literature


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Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis

Billington J, Galvin R, Fahey T.

BMC Fam. Pract.2012;13(1):76.

(Copyright © 2012, BioMed Central) DOI 10.1186/1471-2296-13-76 PMID 22870921

Abstract

BACKGROUND: The STRATIFY score is a clinical prediction rule (CPR) derived to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall diagnostic accuracy of the STRATIFY rule across a variety of clinical settings.

METHODS: A literature search was performed to identify all studies that validated the STRATIFY rule. The methodologicalqualityofthestudieswasassessedusingtheQualityAssessmentofDiagnosticAccuracyStudiestool. A STRATIFY score of greater than or equal to 2 points was used to identify individuals at higher risk of falling. AllincludedstudieswerecombinedusingabivariaterandomeffectsmodeltogeneratepooledsensitivityandspecificityofSTRATIFYatacutpointofgreaterthanorequalto2points.Heterogeneitywasassessedusingthevarianceoflogittransformedsensitivityandspecificity.

RESULTS: Seventeen studies were included in our meta-analysis, incorporating 11,378 patients. At a score greater than or equal to 2 points, the STRATIFY rule is more useful at ruling out falls, with a greater pooled sensitivity estimate(0.67,95%CI0.52-0.80)thanspecificity(0.57,95%CI0.45-0.69).Thesensitivityanalysiswhichexaminedtheperformanceoftheruleindifferentsettingsandsubgroupsalsoshowedbroadlycomparableresults,indicatingthattheSTRATIFYruleperformsinasimilarmanneracrossavarietyofdifferent‘atrisk’patientgroupsindifferentclinicalsettings.

CONCLUSION: This systematic review shows that the diagnostic accuracy of the STRATIFY rule is limited and should not be used in isolation for identifying individuals at high risk of falls in clinical practice.

Epidemiology and risk factorsAssociation between nocturia and falls-related long-term mortality risk in the elderly

Galizia G, Langellotto A, Cacciatore F, Mazzella F, Testa G, Della-Morte D, Gargiulo G, Ungar A, Ferrara N, Rengo F, Abete P.

J. Am. Med. Dir. Assoc.2012;ePub(ePub):ePub.

Affiliation:IstitutoScientificodiVeruno(Novara),DivisionediRecuperoeRieducazioneFunzionale,FondazioneSalvatore Maugeri, IRCCS, Veruno (Novara). DOI: 10.1016/j.jamda.2012.05.016 What is this? PMID: 22763143 (Copyright © 2012, Lippincott Williams and Wilkins).

Abstract

OBJECTIVES: A high falls-related mortality rate in the elderly is not exclusively related to injuries. Moreover, the risk of falls increases with urinary disorders such as nocturia. The aim of this study was to investigate the role of nocturia in falls-related long-term mortality in elderly subjects.

DESIGN: Longitudinal study.

SETTING AND PARTICIPANTS: The “Osservatorio Geriatrico Regione Campania” was a cross-sectional study performed in 1992 in Campania, a region of Southern Italy.

MAIN MEASUREMENTS: Long-term mortality (12 years’ follow-up) in 178 elderly subjects (mean age 74.0 ± 6.3 years) with falls and 1110 elderly subjects (mean age 75.2 ± 6.4 years) without falls at baseline was measured. Subjectswerethenstratifiedforthepresence/absenceofnocturia.

KEYRESULTS:Inoursample,theprevalenceoffallswas13.8%andtheprevalenceofnocturiawas45.7%.Long-termmortalitywas51.3%innonfallersand62.9%infallers(P<.05).Intheabsenceofnocturia,long-termmortalitywassimilarinnonfallersandfallers(49.0%vs46.7%;P=.514,NS).Incontrast,inthepresenceofnocturia,long-termmortalitywashigherinfallersthaninnonfallers(74.5%vs53.6%;P<.05).Coxregressionanalysisconfirmedthepredictiveroleoffallsonlong-termmortalityinthepresenceofnocturia(hazardratio60;95%confidenceinterval1.01-2.57;P<.05)butnotintheabsenceofnocturia(hazardratio=1.27;95%

Abstracts ContinuedRecent abstracts from the research literature


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confidenceinterval0.81-1.99;P=.28).

CONCLUSIONS: Our data suggest that falls are related to an increased risk of long-term mortality in the elderly much more in the presence of nocturia. This phenomenon is probably related to the high comorbidity that usually affectselderlysubjectswithnocturia.

Depressive symptoms and motor performance in the elderly: a population based study

Santos KT, Fernandes MH, Reis LA, Coqueiro RS, Rocha SV.

Rev. Bras. Fisioter. 2012;ePub(ePub):ePub.

Affiliation:CenterforEpidemiologicStudiesofAging,DepartmentofHealth,UniversidadeEstadualdoSudoesteda Bahia (UESB). DOI: unavailable PMID: 22760089 (Copyright © 2012, Departamento de Fisioterapia da Universidade Federal de São Carlos).

Abstract

BACKGROUND: There is a growing incidence of depression in the elderly, and this impairment interferes directly in the reduction of motor skills.

OBJECTVE: This study aims to examine the association between depressive symptoms and motor performance in community-dwelling elderly.

METHOD: This is a cross-sectional study that analyzed data from 316 elders of a home and population-based epidemiologicalsurvey.Theinformationusedwas:socio-demographiccharacteristics;motorperformancetests;physicalactivity;andGeriatricDepressionScale.ThedatawereanalyzedusingtheStatisticalPackageforSocialSciences.Mann-WhitneyUtest,chi-square,SpearmancorrelationandPoissonregression,withaconfidenceintervalof95%,werecalculated.

RESULTS: For all motor tests, motor performance was negatively associated with depressive symptoms, regardless of gender, age, literacy and illiteracy, per capita income and physical activity. Elderly people with depressive symptomshavebetween58%and82%morefunctionallimitation,dependingonthemotorperformancetestcompared to those who were not depressed.

CONCLUSIONS: There is an inverse relationship between depressive symptoms and motor performance in the elderly.

Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes

Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, McLachlan AJ, Cumming RG, Handelsman DJ, Le Couteur DG.

J. Clin. Epidemiol.2012;ePub(ePub):ePub.

Affiliation:DepartmentofClinicalPharmacology,11CMainBuilding,RoyalNorthShoreHospital,StLeonards,NSW2065,Australia;DepartmentofAgedCare,11CMainBuilding,RoyalNorthShoreHospital,StLeonards,NSW2065,Australia;SydneyMedicalSchool,UniversityofSydney,Camperdown,NSW2006,Australia;CentreforEducationandResearchonAgeing,ConcordHospital,Concord,NSW2139,Australia;FacultyofPharmacy,UniversityofSydney, Camperdown, NSW 2006, Australia. DOI: 10.1016/j.jclinepi.2012.02.018 PMID: 22742913 (Copyright © 2012, Elsevier Publishing).

Abstract

OBJECTIVE: This study aimed to determine an optimal discriminating number of concomitant medications associated with geriatric syndromes, functional outcomes, and mortality in community-dwelling older men.

STUDYDESIGNANDSETTING:Oldermenaged≥70years(n=1,705),enrolledintheConcordHealthandAginginMen Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome.

RESULTS:ThehighestvalueoftheYoudenIndexforfrailtywasobtainedforacutoffpointof6.5medicationscomparedwithacutoffof5.5fordisabilityand3.5forcognitiveimpairment.Formortalityandincidentfalls,thehighestvalueofYoudenIndexwasobtainedforacutoffof4.5medications.Foreveryoneincreaseinnumberof


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medications,theadjustedoddsratioswere1.13(95%confidenceinterval[CI]=1.06-1.21)forfrailty,1.08(95%CI=1.00-1.15)fordisability,1.09(95%CI=1.04-1.15)formortality,and1.07(95%CI=1.03-1.12)forincidentfalls.There was no association between increasing number of medications and cognitive impairment.

CONCLUSION:Thestudysupportstheuseoffiveormoremedicationsinthecurrentdefinitionofpolypharmacytoestimatethemedication-relatedadverseeffectsforfrailty,disability,mortality,andfalls.

Is there an increased risk of hip fracture in Parkinson’s disease? A nationwide inpatient sample

Bhattacharya RK, Dubinsky RM, Lai SM, Dubinsky H.

Mov. Disord.2012;ePub(ePub):ePub.Affiliation:DepartmentofInternalMedicine,DivisionofEndocrinology,Metabolism, and Genetics, University of Kansas Medical Center, Kansas City, Kansas, USA. [email protected]. DOI: 10.1002/mds.25073 PMID: 22744727 (Copyright © 2012, Movement Disorders Society, Publisher John Wiley and Sons).

Abstract

OBJECTIVE: The aim of this study was to determine whether people with Parkinson’s disease (PD) are overrepresented in a national cohort of hip-fracture admissions.

BACKGROUND: Frequent falls, combined with a higher rate of osteoporosis in people with PD, should lead to an increased risk of hip fracture.

METHODS: This work was a retrospective cohort analysis from the Nationwide Inpatient Sample from 1988 to 2007,astratifiedsampleof20%ofU.S.hospitaladmissions.Admissionswithaprimarydiagnosisofacutehipfracturewereidentified,aswasasubsetwithasecondarydiagnosisofPD.RESULTS:Atotalof3.63%of1,066,404hip-fracture admissions had PD. When compared to the population of prevalence among patients with hip fracture, theprevalenceofPDwasupto4.48times(95%confidenceinterval[CI]:4.46,4.49)morethanpredicted,andwhenadjustedforgenderandage,itwas4.02(95%CI:4.00,4.03).

CONCLUSIONS: In this 20-year nationwide sample of hip fractures, patients with PD were overrepresented by a factor of 4. © 2012 Movement Disorder Society.

A structural equation model relating physical function, pain, impaired mobility (IM), and falls in older adults

Dai B, Ware WB, Giuliani CA.

Arch. Gerontol. Geriatr.2012;ePub(ePub):ePub.

Affiliation:DivisionofPhysicalTherapy,DepartmentofAlliedHealthSciences,UniversityofNorthCarolinaatChapel Hill, Chapel Hill, NC 27599, USA. DOI: 10.1016/j.archger.2012.06.005 PMID: 22766209 (Copyright © 2012, Elsevier Publishing).

Abstract

The current study used a structural equation model to investigate the interrelationships among physical function, pain, IM, and falls in 511 American older adults. The model included 11 measurement variables (tandem stance, single leg stance, 360° turn, chair stand, arm curl, sit and reach, back scratch, normative score of 6-min walk or 2-minstep,timedupandgo,pain,andfall)andfourlatentvariables(balance,strength,flexibility,andIM).Thefinalmodelwiththecombinedsampledemonstratedgoodfitwiththeparticipantdata(χ(2)(31)=30.0,N=499,p=0.52;GoodnessofFitIndex(GFI)=0.99).BalancehadasignificantandthelargesteffectonIM(standardizedregressionweights=-1.05,p<0.001).Strength,endurance,flexibility,andpainhadsmalleffectsonIM(standardizedregressionweights<0.2).Thefindingssuggestthatbalanceandmobilitytestingshouldbeapriorityin fall screening and prevention programs.

Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition

MirelmanA,HermanT,BrozgolM,DorfmanM,SprecherE,SchweigerA,GiladiN,HausdorffJM.

PLoS ONE2012;7(6):e40297.

Affiliation:MovementDisordersUnit,DepartmentofNeurology,Tel-AvivSouraskyMedicalCenter,Tel-Aviv,Israel.DOI: 10.1371/journal.pone.0040297 PMID: 22768271 PMCID: PMC3386974 (Copyright © 2012, Public Library of



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Science).

Abstract

BACKGROUND:Recentfindingssuggestthatexecutivefunction(EF)playsacriticalroleintheregulationofgaitinolderadults,especiallyundercomplexandchallengingconditions,andthatEFdeficitsmay,therefore,contributeto fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk.

METHODOLOGY/MAIN RESULTS: We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs;61%women)whoweredementiafreeandhadgoodmobilityuponentranceintothestudy.Atbaseline,acomputerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthlycalendars.Negativebinomialregressionquantifiedriskratios(RR).Afteradjustingforage,genderandthenumberoffallsintheyearpriortothestudy,onlytheEFindex(RR:.85;CI:.74-.98,p=.021),theattentionindex(RR:.84;CI:.75-.94,p=.002)anddualtaskinggaitvariability(RR:1.11;CI:1.01-1.23;p=.027)wereassociatedwith future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls duringthe66monthsoffollow-up(p<0.02).

CONCLUSIONS/SIGNIFICANCE:Thesefindingsdemonstratethatamongcommunity-livingolderadults,theriskoffuture falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screenin

Poor health, but not fracture and fall risk, is associated with nonattendance at bone mineral density screening

Ryder KM, Bush A, Womack C, Pitts W.

South Med J2012;105(7):325-328.

Affiliation:DepartmentsofMedicineandPreventiveMedicine,UniversityofTennesseeHealthScienceCenter,the Department of Medicine, VA Medical Center at Memphis, and the University of Memphis Mid-South Survey ResearchCenter,Memphis,Tennessee.DOI:10.1097/SMJ.0b013e318258ffcaPMID:22766656(Copyright©2012,Southern Medical Association).

Abstract

BACKGROUND:Bonemineraldensityscreeningidentifieswomenatriskforfracture.Nonattendanceatscreeningis associated with subsequent hip fracture. Determining reasons for nonattendance may help in the designing of methods to improve screening.

METHODS: We hypothesize that nonattenders may report poorer health and have a higher risk of fracture and fall. Women were randomly chosen from a list of people scheduled for a screening dual x-ray absorptiometry (DXA) scan. We used a validated telephone survey to calculate osteoporosis, fracture, and fall risk scores. Women answeredquestionsabouttheirhealthandmedicalconditions.RESULTS:Of263womencontacted,226(86%)womenagreedtoparticipate;145participantscompletedadual-energyx-rayabsorptiometryscanand81womenfailed to attend. Women who did not attend screening were more likely to report a serious medical condition (59.3%vs46.9%;P=0.09).Nonattendersweremorelikelytoreporttheirhealthasfairorpoor(51.9%vs33.8%;P=0.01).Therewerenodifferencesforosteoporosis,fall,andfracturerisks.

CONCLUSIONS:Failuretoattendosteoporosisscreeningisassociatedwithsignificanthealthproblemsandpoorself-rated health. Improving point of care access may increase the amount of osteoporosis screening among women with multiple comorbidities.

Physical impairments in cognitively impaired older people: implications for risk of falls

Taylor ME, Delbaere K, Lord SR, Mikolaizak AS, Close JC.

Int. Psychogeriatr. 2012;ePub(ePub):1-9.Affiliation:FallsandBalanceResearchGroup,NeuroscienceResearchAustralia, University of New South Wales, Sydney, Australia. DOI: 10.1017/S1041610212001184 PMID: 22831907 (Copyright © 2012, Cambridge University Press).


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Abstract

Background: Cognitively impaired older people fall twice as often as their cognitively intact counterparts. There is, however, limited information on factors that increase the risk of falls in this population. This study aimed to determine whether a group of cognitively impaired older people (CIG) perform worse than a matched group of cognitivelyintactolderpeople(NCIG)onaprofileofphysicalperformanceandmobilitytests.

Methods: One hundred and thirty-eight cognitively impaired and 276 age and gender matched cognitively intact community-dwelling older adults (>60 years) took part in the study. Participants completed a detailed physical performance battery from which composite fall risk scores were derived. Falls were measured prospectively for 12 months with monthly falls diaries, telephone calls, and by regularly contacting participants’ “person responsible.”

Results: The CIG performed worse than the NCIG in tests of reaction time, muscle strength (grip and quadriceps), balance(swayonfloor,swayonfoam,controlledleaningbalanceandneartandemstandingability),andmobility(sittostand,timedupandgo(TUG)andstepsrequiredtoturn180degrees).TheCIGhadsignificantlyhighercompositefallriskscoresthantheNCIGandfellsignificantlymoreduringfollow-up(Multiplefalls(2+):CIG43%;NCIG21%).

Conclusions:FallriskintheCIGwassignificantlyincreasedduetomultiplephysicalimpairments.Physicalprofilesprovide a means of quantifying the extent of impairment in older people with cognitive impairment and potential direction for targeting interventions for reducing fall risk.

Frequencies of falls and associated features at different stages of Parkinson’s disease

Hiorth YH, Lode K, Larsen JP.

Eur. J. Neurol. 2012;ePub(ePub):ePub.Affiliation:NorwegianCentreforMovementDisorders,StavangerUniversityHospital, Stavanger, Norway. DOI: 10.1111/j.1468-1331.2012.03821.x PMID: 22816560 (Copyright © 2012, European Federation of Neurological Societies, Publisher John Wiley and Sons).

Abstract

OBJECTIVE:Toexaminethefrequenciesandclinicalcharacteristicsoffallersandnon-fallersatdifferentstagesofParkinson’s disease (PD).

METHODS: The sample consisted of 232 patients in an unselected cross-sectional cohort of patients with PD, 207 newlydiagnosedanddrugnaivepatientsand175controls.TheexaminationsincludedtheUnifiedParkinson’sDisease Rating Scale (UPDRS), Hoehn and Yahr, Schwab and England, and Mini-Mental State Examination. Accordingtoitem13oftheUPDRS,theparticipantswereclassifiedasfallers,rare-fallersandnon-fallers.

RESULTS:Inthecross-sectionalstudycohort,19%ofthepatientswereclassifiedasfallersand25%asrare-fallers. Higher scores on activity of daily living (UPDRS ADL score) and motor complications (UPDRS complication oftherapyscore)weresignificantlyandindependentlyassociatedwithfalling.InthecohortofnewlydiagnosedpatientswithPD2%wereclassifiedasfallersand15%asrare-fallers.Intheage-andsex-matchedcontrolgroup,nonewerefallers,andonly2%wererare-fallers.Patientswithtremor-dominatedPDsubtypeinbothstudypopulations did not fall.

CONCLUSIONS: Falls are a markedly increasing problem in patients with PD as the disease progresses. Healthcare workers should ask patients about falling, and specially focus on patients with motor complications or postural instability and gait disability (PIGD)-dominated subtype of parkinsonism.

A study to investigate the walking speed of elderly adults with relation to pedestrian crossings

Bollard E, Fleming H.

Physiother. Theory Pract. 2012;ePub(ePub):ePub.

School of Public Health, Physiotherapy and Population Science, University College Dublin , Dublin , Ireland. (Copyright © 2012, Informa - Taylor and Francis Group).DOI 10.3109/09593985.2012.703760, PMID 22844989

Abstract

Elderly pedestrians are particularly at risk on the roads. The objective of this study was to investigate the walking speed of elderly adults and determine if it allows the safe clearance of pedestrian crossings. The increasing elderly population and high fatality rates of this age group on Irish roads necessitate this investigation. Fifty-two



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community-dwelling adults over the age of 65 years completed a 10-meter walk test. Acceleration and steady-statewalkingspeedwereaccountedfor.Twentytraffic-light-controlledpedestriancrossingswereanalyzedwithin a 1 kilometer radius of 4 day care centers in Kilkenny, Ireland. Values were recorded for the distance of the crossings and time of the light signals. The mean acceleration of the 52 participants was 0.20 ± 0.15 ms(-2) (mean±SD)andthemeansteady-statewalkingspeedwas0.82±0.27ms(-1).Intotal,30%ofthepedestriancrossings investigated would not have permitted this sample of participants enough time to safely cross the road giventhetimeofthegreenandamberlightsignals.Over96%ofparticipantswouldhavebeenunabletocrossaroad of average distance on the amber signal alone. A substantial number of elderly adults walked slower than the speed required to safely cross the road.

Dental status and incident falls among older Japanese: a prospective cohort study

Yamamoto T, Kondo K, Misawa J, Hirai H, Nakade M, Aida J, Kondo N, Kawachi I, Hirata Y.

BMJ Open2012;2(4):ePub.

Division of Sociological Approach in Dentistry, Department of Dental Sociology, Kanagawa Dental College, Yokosuka-shi, Kanagawa, Japan. (Copyright © 2012, BMJ Publishing Group)

DOI 10.1136/bmjopen-2012-001262, PMID 22855628

Abstract

OBJECTIVE: To examine if self-reported number of teeth, denture use and chewing ability are associated with incident falls.

DESIGN: Longitudinal cohort study (the Aichi Gerontological Evaluation Study).

SETTING: 5 Japanese municipalities.

PARTICIPANTS: 1763 community-dwelling individuals aged 65 years and older without experience of falls within the previous year at baseline.

MAIN OUTCOME MEASURES: Self-reported history of multiple falls during the past year at the follow-up survey about 3 years later. Baseline data on the number of teeth present and/or denture use and chewing ability were collected using self-administered questionnaires. Logistic regression analyses controlled for sex, age, functional disability during follow-up period, depression, self-rated health and educational attainment.

RESULTS:86(4.9%)subjectsreportedfallsatthefollow-upsurvey.Logisticregressionmodelsfullyadjustedforallcovariatesshowedthatsubjectshaving19orfewerteethbutnotusingdentureshadasignificantlyincreasedriskforincidentfalls(OR2.50,95%CI1.21to5.17,p=0.013)comparedwiththosehaving20ormoreteeth.Amongsubjectswith19orfewerteeth,theirriskoffallswasnotsignificantlyelevatedsolongastheyworedentures(OR1.36,95%CI0.76to2.45,p=0.299).Nosignificantassociationwasobservedbetweenchewingability and incident falls in the fully adjusted model.

CONCLUSIONS: Having 19 or fewer teeth but not using dentures was associated with higher risk for the incident falls in older Japanese even after adjustment for multiple covariates. Dental care to prevent tooth loss and denture treatment for older people might prevent falls, although the authors cannot exclude the possibility that the association is due to residual confounding.

Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility

Meijers JM, Halfens RJ, Neyens JC, Luiking YC, Verlaan G, Schols JM.

J. Nutr. Health Aging 2012;16(7):654-658.

J.M.M. Meijers, Post Doc researcher, Maastricht University, Health Services Research, CAPHRI, Maastricht, 6200 MD,Netherlands,+31433881707,FAX:+31433884162,[email protected].(Copyright©2012,Springer), DOI unavailable, PMID 22836709

Abstract

To investigate the role of malnutrition, impaired mobility and care dependency in predicting fallers in older Dutch home care clients.

Design: This study is a secondary analysis of data of the annual independent National Prevalence Measurement


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of Care Problems of Maastricht University. The design involves a cross-sectional, multicentre point prevalence measurement (malnutrition, mobility), and a 30 days incidence measurement (falls). Setting: Dutch home care organisations.

Participants: 2971 clients (older than 65 years) from 22 home care organizations participated. Measurements: A standardized questionnaire was used to register amongst others data of weight, height, number and type of diseases (like for example neurologic diseases, dementia, CVA, COPD, eye/ear disorders, musculoskeletal disorders), nutritional intake, use of psychopharmaca, undesired weight loss, fall history, mobility, and care dependency.

Results: The study was able to show that fallers are more often malnourished than non-fallers in the univariate analysis. Most importantly the study indicated by multivariate analysis that fallers could be predicted by the risk factorsimmobility((OR2.51695%CI1.144-5.532),highcaredependency(OR1.68495%CI1.121-2.532)andmalnutrition(OR1.97895%CI1.340-2.920).

Conclusion:Thefindingsofthisstudystressthatmalnutrition,impairedmobilityandcaredependencyarepotentialreversiblefactorsrelatedtofalls.Thereforeearlyidentificationandmanagementofnutritionalstatus,impaired mobility and care dependency are important aspects for a possible fall prevention strategy.

Slipping and tripping: fall injuries in adults associated with rugs and carpets

Rosen T, Mack KA, Noonan R.

J. Inj. Violence Res.2012;5(1):ePub.

National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. [email protected].

(Copyright © 2012, Kermanshah University of Medical Sciences). DOI 10.5249/jivr.v5i1.177 PMID 22868399

Abstract

BACKGROUND: Falls are a leading cause of unintentional injury among adults age 65 years and older. Loose, unsecured rugs and damaged carpets with curled edges, are recognized environmental hazards that may contribute to falls. To characterize nonfatal, unintentional fall-related injuries associated with rugs and carpets in adults aged 65 years and older.

METHODS: We conducted a retrospective analysis of surveillance data of injuries treated in hospital emergency departments (EDs) during 2001-2008. We used the National Electronic Injury Surveillance System-All Injury Program,whichcollectsdatafromanationallyrepresentativestratifiedprobabilitysampleof66U.S.hospitalEDs.Sample weights were used to make national estimates.

RESULTS: Annually, an estimated 37,991 adults age 65 years or older were treated in U.S. EDs for falls associated withcarpets(54.2%)andrugs(45.8%).Mostfalls(72.8%)occurredathome.Womenrepresented80.2%offallinjuries.Themostcommonlocationforfallinjuriesinthehomewasthebathroom(35.7%).Frequentfallinjuriesoccurred at the transition between carpet/rug and non-carpet/rug, on wet carpets or rugs, and while hurrying to the bathroom.

CONCLUSION: Fall injuries associated with rugs and carpets are common and may cause potentially severe injuries. Olderadults,theircaregivers,andemergencyandprimarycarephysiciansshouldbeawareofthesignificantriskforfallinjuriesandofenvironmentalmodificationsthatmayreducethatrisk.©2012KUMS,Allrightreserved.

Fear of FallingParticipation restriction, not fear of falling, predicts actual balance and mobility abilities in rural community-dwelling older adults

Allison LK, Painter JA, Emory A, Whitehurst P, Raby A.

J. Geriatr. Phys. Ther. 2012;ePub(ePub):ePub.

Affiliation:1PhysicalTherapyDepartment,CollegeofAlliedHealthSciences,EastCarolinaUniversity,Greenville,North Carolina. 2Occupational Therapy Department, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina. DOI: 10.1519/JPT.0b013e3182493d20 PMID: 22790588 (Copyright © 2012, American



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Physical Therapy Association).

Abstract

BACKGROUND AND PURPOSE: Fear of falling (FOF) has been correlated with an increased risk for falls, self-restriction of physical activity, and subsequent decrease in quality of life in older adults. The relationship between perceived FOF, participation restriction, and balance and mobility abilities is unclear, as results from prior studies are inconsistent. Few studies have used the Survey of Activities and Fear of Falling in the Elderly (SAFE) as a standard measure of FOF, although this survey provides both a measure of FOF and participation restriction. Only one study has explored the relationship of individual items from the SAFE with balance and mobility tests that predict fall risk. The primary purpose of this study was to investigate the relationships between FOF and participation restriction as measured by the SAFE and actual balance and mobility abilities in a diverse group of older adults.

PARTICIPANTS::Eighty-twocommunity-dwellingolderadults(17men)withameanageof74(SD=8.8;range=55-91)participatedinthisstudy.Thesamplecomprised45%AfricanAmericansand54%whites.

METHODS: Fear of falling and participation restriction were assessed using the SAFE, a self-assessment survey. The SAFE assesses information about participation in 11 functional activities as well as the extent to which fear is a source of participation restriction. Balance and functional mobility were measured using the Berg Balance Scale (BBS)andTimedGetUp&GoTest(TUG),respectively.Participantswerecategorizedaslow(N=36),mixed(N=19),orhigh(N=24)riskforfuturefallsbasedontheirpastfallhistoryandresultsontheBBSandtheTUG.DataanalysisincludedχandSpearmancorrelationand2regressionanalyses.

RESULTS:BothSAFEFOFandparticipationrestrictionscoresweresignificantlycorrelatedwithBBSandTUGscores. However, SAFE participation restriction scores, but not SAFE FOF scores, predicted BBS and TUG scores. SAFE FOF scores could discriminate older adults at high risk for falls from those at mixed and low risk but could not discriminate between the mixed- and low-risk groups.

DISCUSSION/CONCLUSION: The relationship between self-reported participation restriction and objectively measured balance and mobility abilities is stronger than the relationship between self- reported FOF and objectivelymeasuredbalanceandmobilityabilities.Thesefindingslendsupporttotheargumentthatparticipation restriction may be the critical mediating factor between FOF, balance and mobility limitations, and fallrisk.EvaluationofandinterventionforFOFandfallriskwithoutdirectandspecificattentiontoparticipationrestriction may not yield optimal results. Older adults whose goals include both reduction in fall risk and increase in participation level may need combined treatment approaches.

Differences in fear of falling in the elderly with or without dizzines

Perez-Jara J, Olmos P, Abad MA, Heslop P, Walker D, Reyes-Ortiz CA.

Maturitas2012;ePub(ePub):ePub.

MusculoskeletalUnit,FreemanHospital,HighHeaton,NewcastleuponTyne,NE77DN,UK;UnidaddeValoraciónGeriátrica,HospitalElBierzo,C/MédicossinFronteras7Ponferrada,León24411,Spain.(Copyright©2012,Elsevier Publishing), DOI 10.1016/j.maturitas.2012.07.005, PMID 22853871

Abstract

To compare prevalence and risk factors associated with fear of falling (FoF) in two groups of elderly people, 109 patientswithrecurrentdizzinessand109controlswithoutdizziness.FoFwasdefinedasapositiveresponsetothesinglequestionandwithFallsEfficacyScaleof>50.TheprevalenceofFoFwasgreater(71.6%)inthedizzygroup(control,31.2%;p<0.001).FactorsassociatedwithFoFinthedizzy-groupwerediabetes,highGeneralHealthQuestionnaire(GHQ-28)scoreandpoorbalancescore.Inthenon-dizzygroup,femalegender,highGHQ,andpoorgait score in Tinetti’s scale were the association. Further research is needed to explore the relationship between dizziness and FoF.

Participating in a virtual reality balance exercise program can reduce risk and fear of falls

Singh DK, Rajaratnam BS, Palaniswamy V, Pearson H, Raman VP, Bong PS.

Maturitas 2012;ePub(ePub):ePub.


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Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia. (Copyright © 2012, Elsevier Publishing)

DOI 10.1016/j.maturitas.2012.07.011 PMID 22884437

Abstract

OBJECTIVE:Theobjectiveofthisstudywastoquantifytheeffectivenessofvirtualrealitybalancegames(VRBG)todecrease risk and fear of falls among women.

METHODS: Thirty six community dwelling women aged 56 and above were randomly divided into experimental (exercises using VRBG focus on improving balance) and control (conventional balance exercises) groups. Both groups attended a twice 6 weekly exercise session for an hour. Risk and fear of falls were measured with PhysiologicalProfileApproach(PPA)andActivitySpecificBalanceScale(ABC-6).PreandpostinterventiondifferencesbetweenthegroupswereexaminedusingtwowayrepeatedmeasuresANOVA.

RESULTS:BothVRBGandconventionalbalanceexercisegroupshadsignificantdecreaseinPPA(p<0.001)andABC-6(p<0.01)aftertheinterventions.However,nosignificanteffectsweredemonstratedbetweenthegroupsinPPA(p=0.18)andABC-6(p=0.25)postintervention.TimeandgroupinteractioneffectwerenotsignificantforPPA(p=0.18)andABC-6(p=0.45).

CONCLUSIONS:PractisingVRBGcanincreasebalanceconfidenceanddecreaseriskoffallsamongcommunitydwelling women.

Risk AssessmentPerception of the postural vertical and falls in older people

Menant JC, St George RJ, Fitzpatrick RC, Lord SR.

Gerontology 2012;ePub(ePub):ePub.

Affiliation:NeuroscienceResearchAustralia,UniversityofNewSouthWales,Sydney,N.S.W.,Australia.DOI: 10.1159/000339295 PMID: 22759640 (Copyright © 2012, Karger Publishers).

Abstract

Background: Research on the relationship between vestibular function and falls in older people is sparse. The perception of the postural vertical (PPV) provides an indicator measure of vestibular (otolith) function in the absence of visual input and diminished somatosensory feedback.

Objective: This study examined whether impaired PPV is associated with falls in this group.

Methods:Onehundredandninety-fivepeopleaged70plusyearsstoodblindfoldedonamotorisedplatformthat could be tilted in the roll plane and attempted to adjust it so that their bodies were aligned to the vertical. Somatosensory feedback was minimised as the base and vertical support surfaces on the tilting platform were covered in thick soft foam rubber. PPV error from true vertical and PPV variability (°) were calculated. Participants alsounderwentanassessmentofdistaltactilesensitivityandthephysiologicalprofileassessment(PPA);fallersweredefinedasthosewhohadoneormorefallsduringaprospective12-monthfollow-upperiod.

Results:Eighty-eightparticipants(45%)reportedfallinginthefollow-upyear.IncreasedPPVerrorandvariabilitywere correlated with increased lateral sway in a condition of absent visual input and reduced foot somatosensory feedback(eyesclosed/foam;rrange=0.16-0.20,p<0.05)andwithcompositePPAfallriskscores(rrange=0.22-0.26,p<0.05).PPVvariabilitywasasignificantandindependentpredictoroffallsafteradjustingforthecompositePPAscores,ageandgender[adjustedRR=1.42(1.01-1.98)].Conclusions:OlderpeoplewithincreasedPPVvariabilityareatincreasedriskoffalls.ThesefindingsindicatethatassessmentofPPVmayaugmentfallriskassessment in older people.

Identification of high risk fallers among older people living in residential care facilities: A simple screen based on easily collectable measures

Whitney J, Close JC, Lord SR, Jackson SH.

Arch. Gerontol. Geriatr. 2012;ePub(ePub):ePub.



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Affiliation:KingsHealthPartners,KingsCollegeHospital,LondonSE59RS,UK.DOI:10.1016/j.archger.2012.05.010PMID: 22770712 (Copyright © 2012, Elsevier Publishing).

Abstract

PURPOSE: To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls.

METHODS: This prospective study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated. Demographics, medical history, medication use, cognition (mini mental state examination (MMSE)), function (Barthel, balance and sit-to-stand ability) and behavior (neuro-psychiatric inventory (NPI) and impulsivity) were recorded at baseline. Falls and injuries were prospectively recordedover6months.Datawereanalyzedfordifferencesbetweenfallersandnon-fallersandsignificantvariables entered into logistic regression analysis.

RESULTS:Twohundredandfortyresidentscompletedthestudy.Inthefollow-upperiod,50%fell≥1times.Fallershad worse function, cognition, behavior and balance and took more medications. Falling in the past year, walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood offalling.LogisticregressionidentifiedMMSE<17,impulsivityscore≥2,standingbalancescore<6,requiringawalking frame, falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent andsignificantpredictorsoffalls.Theareaunderthereceiveroperatingcurve(ROC)forthismodelwas0.79(95%CI 0.73-0.84). CONCLUSIONS: This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period. The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group.

Exergames for the elderly: Towards an embedded Kinect-based clinical test of falls risk

Garcia JA, Felix Navarro K, Schoene D, Smith ST, Pisan Y.

Stud. Health Technol. Inform. 2012;178:51-57.

Affiliation:UniversityofTechnologySydney,FEIT,Sydney,Australia.DOI:unavailablePMID:22797019(Copyright© 2012, IOS Press).

Abstract

Falls are the leading cause of disability, injuries or even death among older adults. Exercise programmes that includeabalancecomponentreducetheriskoffallingby40%.However,suchinterventionsareoftenperceivedas boring and drop-out rates are high. The characteristics of videogames may overcome this weakness and increaseexerciseadherence.Theuseofmoderninputdevices,suchastheMicrosoftKinect,enablesquantificationof player performance in terms of motor function while engaging with games. This capability has just started to be explored. The work presented in this paper focuses on the development of a Kinect-based system to deliver step training while simultaneously measuring parameters of stepping performance that have shown to predict falls in older people.

A simple question about falls to distinguish balance and gait difficulties in Parkinson’s disease

Lieberman A, Krishnamurthi N, Dhall R, Santiago A, Moguel-Cobos G, Sadreddin A, Husain S, Salins N, Pan D.

Int. J. Neurosci. 2012;ePub(ePub):ePub.Affiliation:MuhammadAliParkinsonCenter(MAPC)atBarrow Neurological Institute, St. Joseph’s Hospital and Medical Center , Phoenix, AZ 85013. DOI: 10.3109/00207454.2012.711399 PMID: 22784291 (Copyright © 2012, Informa - Taylor and Francis Group).

Abstract

AlthoughgaitandbalancedifficultiesoftenoccurtogetherinParkinson’sdisease(PD)patients,itisbelievedthat they are actually two separate symptoms. However, there are no simple tests to distinguish them. We have developed the self-administered Barrow Neurological Institute (BNI) question to distinguish between gait and balance issues in PD and it was tested in 102 consecutive PD patients. The responses were compared with those of the walking and balance question (item # 2.12) of the Movement Disorder Society-sponsored revision of the UnifiedParkinson’sDiseaseRatingScale(MDS-UPDRS),andtheMDS-UPDRSmotorexaminationanditssubsetssuchasgaitandposturalstability(PS).Fifty-fivepatientsreportedbalancedifficultyontheBNIquestionand64reportedwalkingandbalancedifficultyontheMDS-UPDRSquestion.Ofthepatientswhoreportedbalance


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difficultyontheBNIquestion,74.5%hadaPSscore≥2and25.4%fellatleast3timespermonth.OfthepatientswhoreportedwalkingandbalancedifficultyontheMDS-UPDRSquestion,only59.4%hadaPSscore≥2andonly10.9%fell3ormoretimespermonth.ThesestatisticallysignificantresultssuggestthattheBNIquestionisbetterabletodetectbalancedifficultyanditsassociatedfallsinPDandcanbeasupplementtotheMDS-UPDRSorastand-alonequestiontoevaluatebalancedifficultyanditsassociatedfallsinPD.

Development and validation of a falls-grading scale

Davalos-Bichara M, Lin FR, Carey JP, Walston JD, Fairman JE, Schubert MC, Barron JS, Hughes J, Millar JL, Spar A, Weber KL, Ying HS, Zackowski KM, Zee D, Agrawal Y.

J. Geriatr. Phys. Ther.2012;ePub(ePub):ePub.

Affiliation:1DepartmentofOtolaryngology-HeadandNeckSurgery,2DivisionofGeriatricsandGerontology,3Department of Arts as Applied to Medicine, 4Department of Physical Medicine and Rehabilitation, 5Department of Orthopaedic Surgery, 6Department of Ophthalmology, 7Department of Neurology, The Johns Hopkins UniversitySchoolofMedicine,Baltimore,USA.8EscueladeMedicinaIgnacioA.SantosdelTecnológicodeMonterrey, Monterrey, México. 9Kennedy Krieger Institute, The Johns Hopkins Medical Institutions, Baltimore, USA. DOI: 10.1519/JPT.0b013e31825f6777 PMID: 22810170 (Copyright © 2012, American Physical Therapy Association).

Abstract

BACKGROUND AND PURPOSE:: The recording of fall events is usually subjective and imprecise, which limits clinical practice and falls-related research. We sought to develop and validate a scale to grade near-fall and fall events on the basis of their severity represented by the use of health care resources, with the goal of standardizing fall reporting in the clinical and research settings.

METHODS::Qualitativeinstrumentdevelopmentwasbasedonaliteraturereviewandsemistructuredinterviewstoassess face and content validity. We queried older individuals and health care professionals with expertise in the careofpatientsatriskoffallingaboutclinicallyimportantdifferencestodetectandhowtooptimizethescale’sease of use. To assess the scale’s interrater reliability, we created 30 video-vignettes of falls and compared how health care professionals and volunteers rated each of the falls according to our grading scale.

RESULTS:: We developed the illustrated 4-point Hopkins Falls Grading Scale (HFGS). The grades distinguish a near-fall (grade 1) from a fall for which an individual did not receive medical attention (grade 2), a fall associated with medical attention but not hospital admission (grade 3), and a fall associated with hospital admission (grade 4). Overall,theHFGSexhibitedgoodfaceandcontentvalidityandhadanintraclasscorrelationcoefficientof0.998.

CONCLUSION:: The 4-point HFGS demonstrates good face and content validity and high interrater reliability. We predict that this tool will facilitate the standardization of falls reporting in both the clinical and research settings.

Diagnostic accuracy of fall risk assessment tools in people with diabetic peripheral neuropathy

Jernigan SD, Pohl PS, Mahnken JD, Kluding PM.

Phys. Ther.2012;ePub(ePub):ePub.

S.D. Jernigan, PT, PhD, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Mail Stop 2002, 3901 Rainbow Blvd, Kansas City, KS 66160 (USA). (Copyright © 2012, American Physical Therapy Association), DOI 10.2522/ptj.20120070, PMID 22836004.

Abstract

Background:Diabeticperipheralneuropathyaffectsnearlyhalfofindividualswithdiabetesandleadstoincreasedfall risk. Evidence addressing fall risk assessment for these individuals is lacking.

Objective: The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent fallers and those who are not recurrent fallers.

Design: A cross-sectional study.

Setting: A medical research university setting.



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Participants: A convenience sample of 36 participants between 40 and 65 years old with diabetic peripheral neuropathy.

Measurements: Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, Timed Up and Go, Berg Balance Scale and Dynamic Gait Index. Sensitivity, specificity,positiveandnegativelikelihoodratios,andoveralldiagnosticaccuracywerecalculatedforeachfallriskassessmenttool.Receiveroperatingcharacteristiccurveswereusedtoestimatemodifiedcut-offscoresforeachfallriskassessmenttool;indiceswerethenrecalculated.

Results:Tenofthe36participantswereclassifiedasrecurrentfallers.Whentraditionalcut-offscoreswereused,theDynamicGaitIndexandFunctionalReachTestdemonstratedthehighestsensitivityatonly30%;theDynamicGaitIndexalsodemonstratedthehighestoveralldiagnosticaccuracy.Whenmodifiedcut-offscoreswereused,alltoolsdemonstratedimprovedsensitivity(80%or90%).OveralldiagnosticaccuracyimprovedforalltestsbuttheFunctionalReachTest;theTimedUpandGodemonstratedthehighestdiagnosticaccuracyat88.9%.LimitationsSmall sample size and retrospective fall history assessment.

Conclusions:Modifiedcut-offscoresimproveddiagnosticaccuracyfor3of4fallriskassessmenttoolswhentesting people with diabetic peripheral neuropathy.

Accuracy of Timed Up and Go Test for screening risk of falls among community-dwelling elderly

Alexandre TS, Meira DM, Rico NC, Mizuta SK.

Rev. Bras. Fisioter. 2012;ePub(ePub):ePub.UniversidadedeSãoPaulo,SãoPaulo,SP,Brazil.

(Copyright © 2012, Departamento de Fisioterapia da Universidade Federal de São Carlos) DOI unavailable, PMID 22858735

Abstract

OBJECTIVE: To determine the accuracy of the Timed Up and Go Test (TUGT) for screening the risk of falls among community-dwelling elderly individuals.

METHOD:Thisisaprospectivecohortstudywitharandomlybylotswithoutrepositionsamplestratifiedbyproportional partition in relation to gender involving 63 community-dwelling elderly individuals. Elderly individuals who reported having Parkinson’s disease, a history of transitory ischemic attack, stroke and with a Mini Mental State Exam lower than the expected for the education level, were on a wheelchair and that reported a single fall in the previous six months were excluded. The TUGT, a mobility test, was the measure of interested and the occurrence of falls was the outcome. The performance of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) was determined through the Older American Resources and Services, and the socio-demographic and clinical data were determined through the use of additional questionnaires. Receiver Operating CharacteristicCurveswereusedtoanalyzethesensitivityandspecificityoftheTUGT.

RESULTS:ElderlyindividualswhofellhadgreaterdifficultiesinADLandIADL(p<0.01)andaslowerperformanceontheTUGT(p=0.02).Nodifferenceswerefoundinsocio-demographicandclinicalcharacteristicsbetweenfallersandnon-fallers.Consideringthedifferentsensitivityandspecificity,thebestpredictivevaluefordiscriminatingelderlyindividualswhofellwas12.47seconds[(RR=3.2)95%CI:1.3-7.7].

CONCLUSIONS: The TUGT proved to be an accurate measure for screening the risk of falls among elderly individuals.Althoughdifferentfromthatreportedintheinternationalliterature,the12.47secondcutoffpointseems to be a better predictive value for Brazilian elderly individuals.

Intervention StudiesEfficacy of simple home-based technologies combined with a monitoring assistive center in decreasing falls in a frail elderly population (results of the Esoppe study).

TchallaAE,LachalF,CardinaudN,SaulnierI,BhallaD,RoquejoffreA,RialleV,PreuxPM,DantoineT.

Arch. Gerontol. Geriatr. 2012;ePub(ePub):ePub.

Affiliation:CHULimoges,HôpitalDupuytren,PôledePersonnesâgéesetSoinsàdomicile,F-87042Limoges,2AvenueMartin-LutherKing,CentreHospitalierUniversitairedeLimoges,France;UniversitédeLimoges,EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, F-87025, France.


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DOI: 10.1016/j.archger.2012.05.011 PMID: 22743136 (Copyright © 2012, Elsevier Publishing).

Abstract

BACKGROUND: Increasing age often implies increasing frailty, and the oldest old are often described as a frail group with a high risk of developing functional impairments and multi-morbidities like falls at home, which often resultindependenceindailyactivities.Thispreliminarystudyevaluatetheefficacyoflightpathcoupledwithtele-assistance service for preventing unintentional falls at home in a frail elderly population.

METHODS: Study design is a longitudinal prospective cohort study from 1st July 2009 to 30 June 2010. The program included 194 adults aged 65 and over living at home and registered on a list of frail elderly people. Participants were uniformly asked about their history of falls during the year prior to their most recent health examination. The recall period was one year.

RESULTS:Weobservedthat77(40.5%)elderlyfellathome,29(30.9%)intheexposedgroupand48(50.0%)intheunexposedgroup.Theuseoflightpathcoupledwithtele-assistancewassignificantlyassociatedwiththereductioninfallsathome,oddratio=0.3395%CI[0.17-0.65]pvalue=0.0012.Therewasalsoagreaterreductioninpost-fallhospitalizationrateamongexposedgroupwithoddratio=0.3095%CI[0.12-0.74]pvalue=0.0091.

CONCLUSIONS: This preliminary study showed that the use of light path coupled with tele-assistance service significantlyreducedtheincidenceofunintentionalfallingathomeamongfrailelderlypopulation.Thisresultshouldbeconfirmedbyarandomizedtrial.

The influence of protection, palliation and costs on mobility optimization of residents in nursing homes: A thematic analysis of discourse

Taylor J, Sims J, Haines TP.

Int. J. Nurs. Stud.2012;ePub(ePub):ePub.

Affiliation:MonashUniversity,Melbourne,FacultyofMedicine,NursingandHealthSciences,Building1,270Ferntree Gully Rd, Notting Hill, Victoria 3168, Australia. DOI: 10.1016/j.ijnurstu.2012.06.008 PMID: 22771161 (Copyright © 2012, Elsevier Publishing).

Abstract

BACKGROUND: With the aging of the population, increasing numbers of older people live in nursing homes. Discourse such as policies and standards highlight the need to optimize the mobility independence of residents. Thisisexpectedtooccurinawaythatissafeforresidentsandstaffwhilstmeetingtheresidents’needs.Theinfluenceofdiscourseonhealthcaredeliverycanbepoorlyunderstood,beingattimeshiddenortakenforgranted. The aim of this study was to uncover discourse relevant to resident mobility optimization to enable the origins and reasoning behind existing and intersecting policy and practice to be critically appraised.

DESIGN: Narrative literature review and thematic analysis with a focus on discourse were employed for this study.

DATA SOURCES: Databases (CINAHL and Ovid Medline) and websites of relevant professional and governmental bodies were accessed.

METHOD:Aliteraturesearchcenteredonretrievaloftextsfocusedondiscoursesthatinfluencedgoalstooptimizeresident mobility. Database searches for texts covered the period from 1994 to 2011. Iterative thematic analysis focussedonthetexts’socio-culturalcontextandinfluence.

FINDINGS:Fourdiscoursesemergedthatpotentiallyinfluencegoalstooptimizeresidentmobility:safemanualhandling;fallsprevention;palliativecare;andcostsandfundingconstraintstoindividualizedcare.Thesediscoursesmayinfluencemobilitycareinthedirectionofmoreroutinized,passiveanddependencysupportapproaches. A common overarching theme was that of collaboration and communication.

CONCLUSION: Discourses such as safe manual handling, falls prevention, palliative care and cost constraints to individualized care can negatively impact on the goal to optimize the mobility of residents in nursing homes. Inter-professionalapproacheswherestaffworkcollaborativelyandcommunicatewellmaycountersuchinfluencesandensureindividualizedcarethatfocusesmoreeffectivelyonresidentmobility.



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Cost-effectiveness of a multifactorial fall prevention program in nursing homes

Heinrich S, Rapp K, Stuhldreher N, Rissmann U, Becker C, König HH.

Osteoporos. Int.2012;ePub(ePub):ePub.

Affiliation:DepartmentofMedicalSociologyandHealthEconomics,HamburgCenterforHealthEconomics,University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany, [email protected]:10.1007/s00198-012-2075-xPMID:22806557(Copyright©2012,SpringerScience+BusinessMedia).

Abstract

Thepurposeofthisstudywastoanalyzethecost-effectivenessofamultifactorialfallpreventionprograminnursing home residents. Given a willingness-to-pay (WTP) of 50,000 EUR per year free of femoral fracture, the probabilitythattheinterventioniscost-effectiveis83%.

INTRODUCTION: Despite their increased risk of falls and fractures, nursing home residents have been neglected ineconomicevaluationsoffallpreventionprogramssofar.Thepurposeofthisstudywastoanalyze,forthefirsttime,thecost-effectivenessofamultifactorialfallpreventionprograminnursinghomeresidents.

METHODS: This study is part of a prospective, unblinded, cluster, nonrandomized, controlled study focusing on thetransferofanefficaciousfallpreventionprogramintoareal-worldsetting.Theanalyzedsubsamplewasderivedfromclaimsdataandconsistedofdataonintervention(n=256,residentsn=10,178)andcontrolhomes(n=893,residentsn=22,974),representingallinsurantsofasicknessfund(AOKBavaria,Germany)whowere65yearsorolder,residinginanursinghomeonthe31stofMarch2007andhadalevelofcareof≥1accordingtotheclassificationofthestatutorylong-termcareinsurance.Timefreeoffemoralfracture(ICD-10,S72)wasusedasmeasureofhealtheffects.Femoralfracture-relatedcostsandinterventioncostsweremeasuredfromapayer perspective. Multivariate regression models were applied. Sensitivity analyses were performed and cost-effectivenessacceptabilitycurvescomputed.

RESULTS:Withinthefirstyearoftheintervention,femoralfractureratewassignificantlyreduced,resultinginanonsignificantincrementalmeantimeof1.41daysfreeoffemoralfracture.Incrementalmeantotaldirectcostswere29EURperresident,whichwasnotsignificant.Theincrementalcost-effectivenessratio(ICER)was7,481EURperyearfreeoffemoralfracture.TheprobabilityofanICER<50,000EURperyearfreeoffemoralfracturewas83%.

CONCLUSION:Dependingontheamountthedecision-makeriswillingtopayfortheincrementaleffect,thefallpreventionprogrammightbecost-effectivewithinthefirstyear.Futurestudiesshouldexpandtherangeofcostsandeffectsmeasured.

A randomized controlled trial of Tai chi for balance, sleep quality and cognitive performance in elderly Vietnamese

Nguyen MH, Kruse A.

Clin. Interv. Aging 2012;7(online):185-190.

Affiliation:InstituteofGerontology,HeidelbergUniversity,Heidelberg,Germany.DOI:10.2147/CIA.S32600PMID:22807627 (Copyright © 2012, Dove Medical Press).

Abstract

OBJECTIVE:ToevaluatetheeffectsofTaichiexerciseonbalance,sleepquality,andcognitiveperformanceincommunity-dwelling elderly in Vinh city, Vietnam.

DESIGN: A randomized controlled trial.

PARTICIPANTS: One hundred two subjects were recruited.

INTERVENTION: Subjects were divided randomly into two groups. The Tai chi group was assigned 6 months’ Tai chi training. The control group was instructed to maintain their routine daily activities. OUTCOME MEASURES: The FallsEfficacyScale(FES),PittsburghSleepQualityIndex(PSQI),andTrailMakingTest(TMT)wereusedasprimaryoutcome measures.


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RESULTS:ParticipantsintheTaichigroupreportedsignificantimprovementinTMT(partA)(F[1,71]=78.37,P<0.001)andinTMT(partB),(F[1,71]=175.00,P<0.001)incomparisonwiththecontrolgroup.TaichiparticipantsalsoreportedbetterscoresinFES(F[1,71]=96.90,P<0.001)andinPSQI(F[1,71]=43.69,P=0.001)thanthecontrol group.

CONCLUSION:Taichiisbeneficialtoimprovebalance,sleepquality,andcognitiveperformanceoftheelderly.

Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease

Morris MM, Martin C, McGinley JL, Huxham FE, Menz HB, Taylor NF, Danoudis M, Watts JJ, Soh SE, Evans AH, Horne M, Kempster P.

BMC Neurol. 2012;12(1):54. DOI: 10.1186/1471-2377-12-54 PMID: 22799601 (Copyright © 2012, BioMed Central)

Abstract

BACKGROUND: The high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown somebenefitinhealthyolderpeople,theabilityofphysicaltherapyinterventionsinhomesettingstoreducefallsand improve mobility in people with Parkinson’s has not been convincingly demonstrated.

METHODS / DESIGN: 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention willestablishboththeimmediateandlong-termbenefitsofhome-basedrehabilitation.Thenumberoffalls,numberofrepeatfalls,fallsrateandtimetofirstfallwillbetheprimarymeasuresusedtoquantifyoutcome.Theeconomic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from ahealthsystemperspectivewillbeestablished.Theeffectsofinterventiononmotorandglobaldisabilityandonquality of life will also be examined.

DISCUSSION:Thisstudywillprovidenewevidenceontheoutcomesandcosteffectivenessofhome-basedmovement rehabilitation programs for people living with PD.

Trial registration: The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381

High-risk geriatric protocol: Improving mortality in the elderly

Bradburn E, Rogers FB, Krasne M, Rogers A, Horst MA, Belan MJ, Miller JA.

J. Trauma Acute Care Surg. 2012;73(2):435-440.

From the Department of Trauma, Critical Care and Acute Care Surgery, Lancaster General Hospital, Lancaster, Pennsylvania. (Copyright © 2012, Lippincott Williams and Wilkins). DOI 10.1097/TA.0b013e31825c7cf4, PMID 22846952

Abstract

BACKGROUND: Injured geriatric patients pose unique challenges to the trauma team because of their abnormal responses to shock and injury. We have developed the high-risk geriatric protocol (GP) that seeks to identify high-risk geriatric patients. We hypothesized that a high-risk GP would improve outcome in this select group of patients.

METHODS: Patients from 2000 to 2010 were included. Patients 65 years or older who met high-risk GP based on comorbidities and/or physiologic parameters were compared with those patients who had not received GP before its implementation as well as other non-GP patients. This protocol includes a geriatric consultation, as well as a lactate levels, arterial blood gas levels, and echo test to assess for occult shock. Age, trauma activation, preexisting conditions, Injury Severity Score, Revised Trauma Score, and mortality were reviewed. Univariate and multivariate analyses were conducted to identify factors predictive of mortality.



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RESULTS: A total of 3,902 patients were evaluated. Patients receiving GP were less likely to die (odds ratio, 0.63 [0.39-0.99],p=0.046).Forallpatients,therewasadramaticincreaseinmortalityforthosepatientsolderthan75years.

CONCLUSION:TheGP,adjustedforothercovariates,significantlyreducedmortalityinourpatientpopulation.Thus,thisstudyconfirmstheoveralleffectivenessofourGP,whichishallmarkedbypromptidentificationofthosepatients with occult shock and a multidisciplinary care of the aged population.

LEVEL OF EVIDENCE: Therapeutic study, level IV.

Improving balance control and self-reported lower extremity function in community-dwelling older adults: a randomized control trial

Melzer I, Oddsson LI.

Clin. Rehabil.2012;ePub(ePub):ePub.

1NeuroMuscular Research Center, Boston University, Boston, MA, USA. (Copyright © 2012, Sage Publications), DOI 10.1177/0269215512450295, PMID 22837541

Abstract

Objectives:Toevaluatetheeffectofagroup-basedfunctionalandspecificbalancetrainingprogrammethatincluded dual-task exercises on balance function in healthy older adults.

Design: A single-blind randomized controlled trial.

Setting: General community.

Participants: Sixty-six community-dwelling older adults (age 77.0 ± 6.5 years), without functional balance impairmentwererecruitedandallocatedatrandomtoaninterventiongroup(n=33)orareferencegroup(n=33).

Intervention: The intervention group received 24 training sessions over three months that included perturbation as well as dual-task exercises. The reference group received no intervention.

Outcome measures: The voluntary step execution times during single- and dual-task conditions, stabilogram-diffusionanalysisinuprightstanding,andself-reportedphysicalfunction;allweremeasuredassessedatbaselineand at the end of intervention. The intervention group was retested after six months.

Results:Comparedwiththereferencegroup,participationingroup-basedfunctionalandspecificbalancetrainingledtofastervoluntarystepexecutiontimesundersingle-task(P=0.02;effectsize(ES)=0.34)anddual-task(P=0.036;ES=0.55)conditions;lowertransitiondisplacementandshortertransitiontimeofthestabilogram-diffusionanalysisundereyes-closedconditions(P=0.007,ES=0.30andP=0.08,ES=0.44,respectively);andimprovedself-reportedlowerextremityfunction(P=0.006,ES=0.37).Effectswerelostatsix-monthfollow-up.

Conclusions:Functionalandspecificbalancetrainingcanimprovevoluntarysteppingandbalancecontrolinhealthy older non-fallers, parameters previously found to be related to increased risk of falls and injury in older adults.

Vibrotactile neurofeedback balance training in patients with Parkinson’s disease: Reducing the number of falls

Rossi-Izquierdo M, Ernst A, Soto-Varela A, Santos-Pérez S, Faraldo-García A, Sesar-Ignacio A, Basta D.

Gait Posture 2012;ePub(ePub):ePub.

Department of Otolaryngology, University Hospital Lucus Augusti, Spain. (Copyright © 2012, Elsevier Publishing).DOI 10.1016/j.gaitpost.2012.07.002, PMID 22841586

Abstract

Theaimofthisstudywastoassesseffectivenessofbalancetrainingwithavibrotactileneuro-feedbacksystemin improving overall stability in patients with Parkinson’s disease (PD). Ten patients diagnosed with idiopathic PD were included. Individualization of the rehabilitation program started with a body sway analysis of stance and gaittasks(StandardBalanceDeficitTest,SBDT)byusingthediagnostictooloftheapplieddevice(Vertiguard(®)-RT). Those tasks with the poorest outcome as related to age- and gender-related controls were included in the


24

training program (not more than six tasks). Improvement of postural stability was assessed by performing SBDT, Sensory Organization Test (SOT) of Computerized Dynamic Posturography (CDP), Dizziness Handicap Inventory (DHI),activity-specificbalanceconfidencescaleandrecordingthenumberoffallsoverthepastthreemonths.Furthermore, scores of SOT and DHI of 10 PD patients previously trained in an earlier study (by using CDP) were compared with results of those in the present study. After neuro feedback training (NFT), there was a statistically significantimprovementinbodysway(calculatedoveralltrainingtasks),numberoffalls,andscoresofSOT,DHIandABC.IncomparisonwithCDP-training,astatisticallysignificanthigherincreaseofSOTscorewasobservedforpatientsafterNFTwiththeVertiguard-RTdevicecomparedtoCDPtraining.Ourresultsshowedthatafree-fieldvibrotactileNFTwithVertiguard(®)-RTdevicecanimprovebalanceinPDpatientsineverydaylifeconditionsveryeffectively,whichmightledinturntoareductionoffalls.

A randomized controlled pilot study assessing the feasibility of combined motor-cognitive training and its effect on gait characteristics in the elderly

de Bruin ED, van Het Reve E, Murer K.

Clin. Rehabil. 2012;ePub(ePub):ePub.InstituteofHumanMovementSciencesandSport,DepartmentHealth Sciences and Technology, ETH Zurich, CH, Switzerland. (Copyright © 2012, Sage Publications). DOI 10.1177/0269215512453352 PMID 22865831

Abstract

Objective:(1)Todevelopamotor-cognitiontrainingprogramme;(2)toevaluatetheabilitytorecruitandretainelderlypeople;(3)toassesstheeffectsoftheinterventions.

Design: Pilot randomized controlled trial.

Setting: Assisted living facility.

Participants: Sixteen subjects (11 female) living in an assisted living facility were randomized to a motor or motor-cognition group.

Interventions: Both groups received machine-driven strength training and balance exercises for 45 minutes, twice weekly, for 12 weeks. In addition, the motor-cognition group received computerized training for attention 3-5 times per week for 10 weeks.

Main outcome measures: Baseline and post-intervention (12 weeks) assessments focused on recruitment, attrition and adherence. Secondary outcome measures assessed dual-task costs of gait (velocity, cadence, step time, step length),expandedtimedget-up-and-go,fallsefficacyandreactiontime.

Results:Of35subjectsinitiallyapproached,16startedand14completedthestudy,resultingin46%recruitment,19%attritionand>80%adherencerates.Thereismoreevidenceofalteredlevelsinthemotor-cognitivetreatmentgroupwithsignificantdifferencesinaveragechangeforfearoffalling(P=0.017)andfootreactiontime(P=0.046).Nostatisticalsignificancewasreachedforgaitparameters.

Conclusions: Motor-cognition training is feasible and shows trends to stronger improvement in walking and reaction time. The application in a main study is deemed feasible. A minimum of ±55 subjects per group are requiredtoachieveapowerof80%atthe5%levelofsignificancebasedonsteplengthandconsideringtheexpectable attrition rate in a required larger scale study.

Use of mobility aids reduces attentional demand in challenging walking conditions

Miyasike-Dasilva V, Tung JY, Zabukovec JR, McIlroy WE.

Gait Posture 2012;ePub(ePub):ePub.

Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.

(Copyright © 2012, Elsevier Publishing), DOI 10.1016/j.gaitpost.2012.06.026, PMID 22840321

Abstract

While mobility aids (e.g., four-wheeled walkers) are designed to facilitate walking and prevent falls in individuals with gait and balance impairments, there is evidence indicating that walkers may increase attentional demands during walking. We propose that walkers may reduce attentional demands under conditions that challenge



25

balancecontrol.Thisstudyinvestigatedtheeffectofwalkeruseonwalkingperformanceandattentionaldemandunder a challenged walking condition. Young healthy subjects walked along a straight pathway, or a narrow beam. Attentional demand was assessed with a concurrent voice reaction time (RT) task. Slower RTs, reduced gait speed, andincreasednumberofmissteps(>92%ofallmissteps)wereobservedduringbeam-walking.However,walkeruse reduced attentional demand (faster RTs) and was linked to improved walking performance (increased gait speed, reduced missteps). Data from two healthy older adult cases reveal similar trends. In conclusion, mobility aids canbebeneficialbyreducingattentionaldemandsandincreasinggaitstabilitywhenbalanceischallenged.Thisfindinghasimplicationsonthepotentialbenefitofmobilityaidsforpersonswhorelyonwalkerstoaddressbalanceimpairments.

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial

Clemson L, Fiatarone Singh MA, Bundy A, Cumming RG, Manollaras K, O’Loughlin P, Black D.

BMJ (Compact Ed.)2012;345(online):e4547.

Ageing, Work, and Health Research Unit and the Centre for Excellence in Population Ageing Research, Faculty of Health Sciences, University of Sydney, Lidcombe, 2141 New South Wales, Australia. (Copyright © 2012, BMJ Publishing Group). DOI 10.1136/bmj.e4547 PMID 22872695

Abstract

OBJECTIVES:Todeterminewhetheralifestyleintegratedapproachtobalanceandstrengthtrainingiseffectiveinreducing the rate of falls in older, high risk people living at home.

DESIGN:Threearm,randomisedparalleltrial;assessmentsatbaselineandaftersixand12months.Randomisationdonebycomputergeneratedrandomblocks,stratifiedbysexandfallhistoryandconcealedbyanindependentsecure website.

SETTING: Residents in metropolitan Sydney, Australia.

PARTICIPANTS: Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months, recruitedfromVeteran’sAffairsdatabasesandgeneralpracticedatabases.Exclusioncriteriaweremoderatetoseverecognitiveproblems,inabilitytoambulateindependently,neurologicalconditionsthatseverelyinfluencedgaitandmobility,residentinanursinghomeorhostel,oranyunstableorterminalillnessthatwouldaffectabilitytodoexercises.

INTERVENTIONS:Threehomebasedinterventions:LifestyleintegratedFunctionalExercise(LiFE)approach(n=107;taught principles of balance and strength training and integrated selected activities into everyday routines), structuredprogramme(n=105;exercisesforbalanceandlowerlimbstrength,donethreetimesaweek),shamcontrolprogramme(n=105;gentleexercise).LiFEandstructuredgroupsreceivedfivesessionswithtwoboostervisitsandtwophonecalls;controlsreceivedthreehomevisitsandsixphonecalls.Assessmentsmadeatbaselineandaftersixand 12 months.

MAIN OUTCOME MEASURES: Primary measure: rate of falls over 12 months, collected by self report. Secondary measures:staticanddynamicbalance;ankle,kneeandhipstrength;balanceselfefficacy;dailylivingactivities;participation;habitualphysicalactivity;qualityoflife;energyexpenditure;bodymassindex;andfatfreemass.

RESULTS: After 12 months’ follow-up, we recorded 172, 193, and 224 falls in the LiFE, structured exercise, and control groups, respectively. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90inthestructuredprogrammeand2.28inthecontrolgroup.Wesawasignificantreductionof31%intherateoffallsfortheLiFEprogrammecomparedwithcontrols(incidencerateratio0.69(95%confidenceinterval0.48to0.99));thecorrespondingdifferencebetweenthestructuredgroupandcontrolswasnon-significant(0.81(0.56to1.17)).Staticbalanceonaneightlevelhierarchyscale,anklestrength,function,andparticipationweresignificantlybetterintheLiFEgroupthanincontrols.LiFEandstructuredgroupshadasignificantandmoderateimprovementindynamic balance, compared with controls.

CONCLUSIONS: The LiFE programme provides an alternative to traditional exercise to consider for fall prevention. Functional based exercise should be a focus for interventions to protect older, high risk people from falling and to improve and maintain functional capacity. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry 12606000025538.


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NSW Falls Prevention Network BackgroundThe NSW Falls Prevention Network was established in 1993. The role of this network has grown since its inception and now includes:

• Meetingsfordiscussionoffallsrelatedissues;• Disseminationofresearchfindingsbothlocalandinternational;

• Sharing resources developed and exploration of opportunities to combine resources in joint initiatives;

• Encouragement of collaborative projects and research;

• Toactasagrouptoinfluencepolicy;• To liaise with NSW Ministry of Health to provide

information on current State/Commonwealth issues in relation to falls and

• Maintenanceofresourcespertinenttothefield.

The main purpose of the network is to share knowledge, expertise and resources on falls prevention for older people.

The NSW Falls Prevention Network activities are part of the implementation of the NSW Falls Prevention Policy funded by the NSW Ministry of Health.

“Falls Prevention is Everyone’s Business”

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