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Recurrent Falls (recurrent + fall)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

FIVE TIMES SIT TO STAND TEST IS A PREDICTOR OF RECURRENT FALLS IN HEALTHY COMMUNITY-LIVING SUBJECTS AGED 65 AND OLDER

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2008
Severine Buatois PhD
No abstract is available for this article. [source]

Multitasking: Association Between Poorer Performance and a History of Recurrent Falls

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2007
Kimberly A. Faulkner PhD
OBJECTIVES: To examine the association between poorer performance on concurrent walking and reaction time and recurrent falls. DESIGN: Cross-sectional analysis. SETTING: Community. PARTICIPANTS: Three hundred seventy-seven older community-dwelling adults (mean age±standard deviation 78±3). MEASUREMENTS: Reaction times on push-button and visual-spatial decision tasks were assessed while seated and while walking a 20-m course (straight walk) and a 20-m course with a turn at 10 m (turn walk). Walking times were recorded while walking only and while performing a reaction-time response. Dual-task performance was calculated as the percentage change in task times when done in dual-task versus single-task conditions. A history of recurrent falls (,2 vs ,1 falls) in the prior 12 months was self-reported. Multivariate logistic regression models were used to predict the standardized odds ratios (ORs) of recurrent falls history. The standardized unit for dual-task performance ORs was interquartile range/2. RESULTS: On the push-button task during the turn walk, poorer reaction time response (slower) was associated with 28% lower (P=.04) odds of recurrent fall history. On the visual-spatial task, poorer walking-time response (slower) was associated with 34% (P=.02) and 42% (P=.01) higher odds of recurrent falls history on the straight and turn walks, respectively. CONCLUSION: These findings suggest that walking more slowly in response to a visual-spatial decision task may identify individuals at risk for multiple falls. Prospective studies are needed to confirm the prognostic value of poor walking responses in a dual-task setting for multiple falls. [source]

Validation and Comparison of Two Frailty Indexes: The MOBILIZE Boston Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2009
Dan K. Kiely MPH
OBJECTIVES: To validate two established frailty indexes and compare their ability to predict adverse outcomes in a diverse, elderly, community-dwelling sample of men and women. DESIGN: Prospective observational study. SETTING: A diverse defined geographic area of Boston. PARTICIPANTS: Seven hundred sixty-five community-dwelling participants in the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study. MEASUREMENTS: Two published frailty indexes, recurrent falls, disability, overnight hospitalization, emergency department (ED) visits, chronic medical conditions, self-reported health, physical function, cognitive ability (including executive function), and depression. One index was developed from the Study of Osteoporotic Fractures (SOF) and the other from the Cardiovascular Health Study (CHS). RESULTS: The SOF frailty index classified 77.1% as robust, 18.7% as prefrail, and 4.2% as frail. The CHS frailty index classified 51.2% as robust, 38.8% as prefrail, and 10.0% as frail. Both frailty indexes (SOF; CHS) were similar in their ability to predict key geriatric outcomes such as recurrent falls (hazard ratio (HR)frail=2.2, 95% confidence interval (CI)=1.2,4.0; HRfrail=1.9, 95% CI=1.2,3.1), overnight hospitalization (odds ratio (OR)frail=3.5, 95% CI=1.5,8.0; ORfrail=4.4, 95% CI=2.4,8.2), ED visits (ORfrail=3.5, 95% CI=1.4,8.8; ORfrail=3.1, 95% CI=1.6,5.9), and disability (ORfrail=5.4, 95% CI=2.3,12.3; ORfrail=7.7, 95% CI=4.0,14.7), as well as chronic medical conditions, physical function, cognitive ability, and depression. CONCLUSION: Two established frailty indexes were validated using an independent elderly sample of diverse men and women; both indexes were good at distinguishing geriatric conditions and predicting recurrent falls, overnight hospitalization, and ED visits according to level of frailty. Although both indexes are good measures of frailty, the simpler SOF index may be easier and more practical in a clinical setting. [source]

Multitasking: Association Between Poorer Performance and a History of Recurrent Falls

Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta-Analysis

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2004
Julie D. Moreland MSc
Objectives: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults. Design: Random-effects meta-analysis. Setting: English-language studies indexed in MEDLINE and CINAHL (1985,2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers. Participants: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community-dwelling subjects were included. Measurements: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow-up for occurrence of falls. Methods: Sample size, population, setting, measure of muscle strength, and length of follow-up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement. Results: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31,2.37) for any fall and 3.06 (95% CI=1.86,5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01,2.32) for any fall and 1.41 (95% CI=1.25,1.59) for recurrent falls. Conclusion: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls. [source]

Musculoskeletal Pain and Risk for Falls in Older Disabled Women Living in the Community

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002
Suzanne G. Leveille PhD
OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities. DESIGN: Prospective population-based cohort study. SETTING: The city and county of the eastern area of Baltimore. PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991. MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region (, 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview. RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.25,2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.02,1.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain. CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons. J Am Geriatr Soc 50:671,678, 2002. [source]

Development of a simple scoring tool in the primary care setting for prediction of recurrent falls in men and women aged 65 years and over living in the community

JOURNAL OF CLINICAL NURSING, Issue 7 2009
Jean Woo
Aim., We documented the number of falls and falls risk profile over two years to derive a falls risks prediction score. Background., Simple falls risk assessment tools not requiring equipment or trained personnel may be used as a first step in the primary care setting to identify older people at risk who may be referred for further falls risk assessment in special clinics. Design., Survey. Method., Men (n = 1941) and 1949 women aged 65 years and over living in the community were followed up for two years to document the number of falls. Information was collected regarding demography, socioeconomic status, medical history, functional limitations, lifestyle factors and psychosocial functioning. Measurements include body mass index, grip strength and stride length. Logistic regression was used to determine significant predictions of falls and to calculate predictive scores. Result., Twelve factors in men and nine factors in women were used to construct a risk score. The AUC of the receiver operating characteristic curve was >0·70 for both men and women and a cut off score of ,8 gave sensitivity and specificity values between 60,78%. The factors included chronic disease, drugs, functional limitation, lifestyle, education and psychosocial factors. When applied to future predictions, only low energy level and clumsiness in both hands in men and feeling downhearted in women, were significant factors. Conclusions., A risk assessment tool with a cut off score of ,8 developed from a two-year prospective study of falls may be used in the community setting as an initial first step for screening out those at low risk of falls. Relevance to clinical practice., A simple tool may be used in the community to screen out those at risk for falls, concentrating trained healthcare professionals' time on detailed falls assessment and intervention for those classified as being at risk. [source]

Identification of Fall Risk Factors in Older Adult Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 3 2009
Christopher R. Carpenter MD
Abstract Objectives:, Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED). Methods:, This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence. Results:, A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one's own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55). Conclusions:, Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non,fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one's own toenails, and previous falls are all associated with falls after ED discharge. [source]

LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults

AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2010
Lindy Clemson
Background:,Exercise as a falls prevention strategy is more complex with people at risk than with the general population. The Lifestyle approach to reducing Falls through Exercise (LiFE) involves embedding balance and lower limb strength training in habitual daily routines. Methods:,A total of 34 community-residing people aged ,70 years were randomised either into the LiFE programme or into a no-intervention control group and followed up for six months. Inclusion criteria were two or more falls or an injurious fall in the past year. Results:,There were 12 falls in the intervention group and 35 in the control group. Therelative risk (RR) analysis demonstrated a significant reduction in falls (RR = 0.23; 0.07,0.83). There were indications that dynamic balance (P = 0.04 at three months) and efficacy beliefs (P = 0.04 at six months) improved for the LiFE programme participants. In general, secondary physical and health status outcomes, which were hypothesised as potential mediators of fall risk, improved minimally and inconsistently. Conclusions:,LiFE was effective in reducing recurrent falls in this at-risk sample. However, there were minimal changes in secondary measures. The study was feasible in terms of recruitment, randomisation, blinding and data collection. A larger randomised trial is needed to investigate long-term efficacy, mechanisms of benefit and clinical significance of this new intervention. [source]