Home About us Contact
|
Home About us Contact | ||
|
|
||
Fall Risk Factors (fall + risk_factor)
Selected AbstractsIdentification of Fall Risk Factors in Older Adult Emergency Department PatientsACADEMIC EMERGENCY MEDICINE, Issue 3 2009Christopher 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] Fall risk factors in older people with dementia or cognitive impairment: a systematic reviewJOURNAL OF ADVANCED NURSING, Issue 5 2009Jürgen Härlein Abstract Title.,Fall risk factors in older people with dementia or cognitive impairment: a systematic review. Aim., This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case,control studies. Background., People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies. Data sources., The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007. Review methods., A systematic review was conducted. Cohort or case,control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality. Results., Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density. Conclusion., There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed. [source] The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studiesAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2010Lori Letts Background/aim:,Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. Methods:,Eight databases (1985,2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. Results:,Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. Cohort:,Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97,1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03,1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59,2.71) and institutional (OR = 1.77; 95% CI: 1.66,1.89) settings. Conclusions:,Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls. [source] Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Cindy Stern BHS(Hons) Abstract Aim, Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods, A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results, Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: ,,A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days ,,A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ,,A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion, There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities. [source] Fall risk factors in older people with dementia or cognitive impairment: a systematic reviewJOURNAL OF ADVANCED NURSING, Issue 5 2009Jürgen Härlein Abstract Title.,Fall risk factors in older people with dementia or cognitive impairment: a systematic review. Aim., This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case,control studies. Background., People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies. Data sources., The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007. Review methods., A systematic review was conducted. Cohort or case,control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality. Results., Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density. Conclusion., There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed. [source] Footwear Style and Risk of Falls in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004Thomas D. Koepsell MD Objectives: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn. Design: Nested case-control study. Setting: Group Health Cooperative, a large health maintenance organization in Washington state. Participants: A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex. Measurements: Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall. Results: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4,51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9,1.9), varying somewhat by style. Conclusion: Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes. [source] Selected As the Best Paper in the 1990s: Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance TrainingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2003FAPTA, Steven L. Wolf PhD Objectives: To evaluate the effects of two exercise approaches, tai chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrences of fall). Design: The Atlanta Frailty and Injuries: Cooperative Studies and Intervention Techniques, a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education (ED)). Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4-month follow-up. Falls were monitored continuously throughout the study. Setting: Persons aged 70 and older living in the community. Participants: A total of 200 participants, 162 women and 38 men; mean age was 76.2. Measurements: Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional instrumental activities of daily living (IADL), and psychosocial well-being (Center for Epidemiological Studies for Depression scale, fear of falling questionnaire, self-perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables. Results: Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12-minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group (P=.046 and P=.058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%. Conclusion: A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. TC warrants further study as an exercise treatment to improve the health of older people. [source] Differing Risk Factors for Falls in Nursing Home and Intermediate-Care Residents Who Can and Cannot Stand UnaidedJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2003Stephen R. Lord PhD Objectives: To determine fall risk factors in nursing home and intermediate-care residents who can and cannot stand unaided. Design: Prospective cohort study. Setting: Residential elderly care facilities in Sydney, Australia. Participants: One thousand people aged 65 to 103 (mean age ± standard deviation: 85.0 ± 7.4). Measurements: Accidental falls. Results: Fall rates were highest in those with fair standing balance, intermediate in those with the best standing balance, and lowest in those with the worst standing balance. This nonlinear pattern was even more striking when subjects were categorized according to their standing balance and ability to rise from a chair. Using this dual classification, fall rates were highest in those who could rise from a chair but could not stand unaided (81%) and lowest in those who could neither rise from a chair nor stand unaided (48%). In residents who could stand unaided, risk factors included increased age, male sex, higher care classifications, incontinence, psychoactive medication use, previous falls, and slow reaction times. In contrast, quite different risk factors were evident in residents who could not stand unaided, with a number of known fall risk factors (previous stroke, reduced ability to rise from a chair, slow reaction times) being associated with fewer falls. In this group, risk factors were intermediate versus nursing home care, poor health status, psychoactive medication use, Parkinson's disease, previous falls, and being able to get out of a chair. Conclusion: The findings indicate that there are different risk factors for falls for people living in residential aged care facilities who can and cannot stand unaided. These findings provide important information for developing fall-prevention strategies and suggest that those who can stand unaided but have multiple falls risk factors constitute the highest priority group for such interventions. [source] Prevention of elderly fallsNURSING & HEALTH SCIENCES, Issue 2 2004Akihiro Fujii Falling is a leading cause of morbidity and immobil-ity in people over 65 years of age in Japan. Many researchers have studied the relationship of physical decline and falls in older adults. However, only a few studies have focused on describing the Japanese living environment and lifestyle as potential risk factors for falls. The purpose of this study is to describe situational factors contributing to falls among community dwelling elderly people in Japan. After analyzing traditional Japanese housing characteristics and daily living behaviors of older Japanese adults, possible interventions to reduce situational fall risk factors are discussed. The results from this study are important as they suggest strategies to prevent falls in community dwelling elderly in Japan as well as providing a foundation for future cross-cultural research. [source] Identification of Fall Risk Factors in Older Adult Emergency Department PatientsACADEMIC EMERGENCY MEDICINE, Issue 3 2009Christopher 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] The Contribution of Foot Problems to Mobility Impairment and Falls in Community-Dwelling Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2001Hylton B. Menz B Pod (Hons) OBJECTIVES: To investigate the relationship between foot problems, balance, and functional ability in community-dwelling older people and to determine whether older people with a history of multiple falls exhibit greater foot impairment than those who have not fallen or who have fallen once only. DESIGN: A cross-sectional, retrospective study. SETTING: Falls and Balance Laboratory, Royal North Shore Hospital, Sydney, Australia. PARTICIPANTS: One hundred thirty-five community-dwelling men and women age 75 to 93 (mean age ± standard deviation, 79.8 ± 4.1). MEASURES: Foot problem score; postural sway; coordinated stability; stair ascent and descent; an alternate stepping test; timed 6-meter walk; and tests of vision, sensation, strength, and reaction time. RESULTS: Eighty-seven percent of the sample had at least one foot problem. Women had a significantly higher foot problem score than did men. The foot problem score was significantly associated with performance on the coordinated stability test, stair ascent and descent, alternate stepping test, and timed 6-meter walk. Multiple regression analyses revealed that the foot problem score was a significant independent predictor of performance in the coordinated stability test, stair ascent and descent, and the alternate stepping test. Subjects with a history of multiple falls had a significantly higher foot problem score than did those who had not fallen or who had fallen once only, but the prevalence of individual foot conditions or the presence of foot pain did not differ between these groups. CONCLUSIONS: Foot problems are common in older people and are associated with impaired balance and performance in functional tests. Furthermore, older people with a history of multiple falls have greater foot impairment than non- or once-only fallers. These findings provide further evidence that foot problems are a falls risk factor and suggest that the cumulative effect of multiple foot problems is more important in increasing falls risk than the presence or absence of individual foot conditions. [source] | ||||||||||