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We examined the effect of aging and cortical stroke on the rate of motor adaptation (adaptation rate) and amount of performance gains (adaptation plateau) in balance skills. Fourteen older (≥60 years) and fifteen younger ( 0.05). However, both stroke groups demonstrated a smaller adaptation plateau for the majority of reactive variables compared to healthy older adults (p < 0.05). The rate of adaptation to gait-slips does not slow with aging and cortical stroke; however, cortical stroke, age notwithstanding, may reduce performance gains in reactive balance skills, possibly hindering retention and transfer to real-life scenarios. People with stroke may need adjunctive therapies/supplemental agents to apply laboratory-acquired balance skills to daily life.

Background: Community pharmacists are in the position to contribute to fall prevention, but this is not yet common practice. Objective: The aim of this study was to evaluate the implementation of a community pharmacy-based fall prevention service. Methods: A fall prevention service, consisting of a fall risk screening and assessment including a medication review, was implemented in pharmacies during three months. A preparative online training was provided to the pharmacy team to enhance adoption of the service. Included patients were aged ≥70 years, using ≥5 drugs of which ≥1 fall risk-increasing drug. The implementation process was quantitively assessed by registering medication adaptations, recommendations, and referrals. Changes in patient scores on the Short Fall Efficacy Scale-International (FES-I) and a fall prevention knowledge test were documented at one month follow-up. Implementation was qualitatively evaluated by conducting semi-structured interviews with pharmacists before and after the project, based on the consolidated framework of implementation research. Results: The service was implemented in nine pharmacies and 91 consultations were performed. Medication was adapted of 32 patients. Patients' short FES-I scores were significantly higher at follow-up (p = 0.047) and patients’ knowledge test scores did not differ (p = 0.86). Pharmacists experienced the following barriers: lack of time, absence of staff, and limited multidisciplinary collaboration. Facilitators were training, motivated staff, patient engagement, and project scheduling. Conclusion: The service resulted in a substantial number of medication adaptations and lifestyle recommendations, but many barriers were identified that hamper the sustained implementation of the service.

Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal. This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement. The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%-96%) prioritized them (involvement), fewer participants (33%-55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR=2.33 [95% CI, 2.06-2.64]), were ≥80 years old (OR=1.83 [95% CI, 1.51-2.23]), and had fewer fall risk factors (OR=0.90 [95% CI, 0.83-0.99]). The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.

According to the World Health Organisation, falling is a major health problem with potentially fatal implications. Each year, thousands of people die as a result of falls, with seniors making up 80% of these fatalities. The automatic detection of falls may reduce the severity of the consequences. Our study focuses on developing a vision-based fall detection system. Our work proposes a new feature descriptor that results in a new fall detection framework. The body geometry of the subject is analyzed and patterns that help to distinguish falls from non-fall activities are identified in our proposed method. An AlphaPose network is employed to identify 17 keypoints on the human skeleton. Thirteen keypoints are used in our study, and we compute two additional keypoints. These 15 keypoints are divided into five segments, each of which consists of a group of three non-collinear points. These five segments represent the left hand, right hand, left leg, right leg and craniocaudal section. A novel feature descriptor is generated by extracting the distances from the segmented parts, angles within the segmented parts and the angle of inclination for every segmented part. As a result, we may extract three features from each segment, giving us 15 features per frame that preserve spatial information. To capture temporal dynamics, the extracted spatial features are arranged in the temporal sequence. As a result, the feature descriptor in the proposed approach preserves the spatio-temporal dynamics. Thus, a feature descriptor of size [m×15] is formed where m is the number of frames. To recognize fall patterns, machine learning approaches such as decision trees, random forests, and gradient boost are applied to the feature descriptor. Our system was evaluated on the UPfall dataset, which is a benchmark dataset. It has shown very good performance compared to the state-of-the-art approaches.

Diamond step (DS) exercises are associated with multiple components of postural control and, thus, have the potential to efficiently improve balance ability. This study aimed to verify whether DS exercises contribute to improving balance ability. This study included 35 healthy young people and 29 older adults. DS exercises were performed continuously for 3 min, four times a week, for 1 month. Balance ability was assessed at baseline and after 1 and 2 months; eight items in total were examined: 30 s chair stand test, functional reach test, standing on one leg with eyes closed, time required for five rounds of DS, left–right DS, Y balance test, open–close stepping test, and finger-to-floor distance. The difficulty, achievement, and lightness/enjoyment of DS exercises were measured after the first practice and 1 month after beginning the exercises as subjective evaluations. Older adults showed improvement in seven of the eight items, with the exception being the one-legged stance with closed eyes. The subjective evaluation showed a decrease in the level of difficulty of DS exercises for older adults. DS exercises may improve balance by effectively utilizing various postural control strategies. These exercises can be effective and easy to implement, given their moderate difficulty level and self-efficacy.

When walking with wearable robotic exoskeletons (WRE) in people with spinal cord injury, the distance between the user and the walker is one of the most important perspectives for ensuring safety. The purpose of this study was to clarify the distance between WRE users and four-wheeled walkers (4WW) while walking on level and sloping surfaces. To eliminate the effects of variation in neurological conditions, 12 healthy subjects participated. All participants ambulated using the WRE and the 4WW on level and sloping surfaces. The outcomes were the mean distances between the WRE users and the 4WWs in the level and slope conditions. To examine the influence of uphill and downhill slopes on distance, comparisons were conducted between the uphill or downhill conditions and the respective transitional periods. In the uphill condition, the mean distances were significantly greater than that in the level condition. Conversely, the mean distance moving downhill was significantly shorter than that in the level condition. Changes in the distance between the WRE user and the 4WW might increase the risk of falling forward on an uphill slope and backward on a downhill slope. This study’s results will assist in developing a new feedback system to prevent falls.

Background: Falls are a primary cause of mortality and morbidity in older adults. In an effort to assess falls, a number of studies have measured neurological, biomechanical, and neuromuscular function in relation to fall risk. Despite efforts, falls continue to affect the older adult population leading to subsequent impaired mobility and function. Multiple factors contribute to fall risk among older adults, however, a factor that has shown a consistent relationship with the prevalence of future falls is reduced muscle characteristics. Moreover, the ability to rapidly accelerate a limb, as captured by rate of power development (RPD), rate of velocity development (RVD), and peak power (PP) could have important role in balance recovery. When stepping to avoid a fall, the ability to move a limb is critical, therefore and step time provide insight into these relationships. Our overarching purpose was to determine how time to peak values, not solely peak values, were associated with reactive balance performance. Research Question: Will RPD, RVD, and PP have a strong, positive relationship with maximal lean angle as well as strong, negative relationship with step time following a temporally unpredictable perturbation? We hypothesized that older adults would have a strong, positive relationships among RPD, RVD, PP and maximal lean angle as well as strong, negative relationships with step time when compared to young adults. Methods: Females and males between 18 and 35 years old, and those between 55 and 85 years old were recruited to complete a cross-sectional design. Subjects reported for two visits to the Neuromuscular Research Laboratory and the Movement Analysis Laboratory. After a dynamic warm-up, subjects performed the stretches by alternating limbs and performed experimental strength testing and balance (rapid step) protocols. The strength testing protocol involved three maximal vertical jumps while standing on a jump mat and a seated isometric, isokinetic, and isotonic dynamometer test was used to assess leg extension/flexion and hip extension/flexion in which peak torque (PT), RPD, RVD, and PP were measured. The rapid step protocol involved temporally unpredictable perturbations, in which each trial began at a lean angle of 10° and progressed by 5° increments with successful completion. Trials consisted of three attempts to regain balance following a postural perturbation, and two successful completions were required. Outcome measures maximal lean angle and step time were expected to have a strong, positive correlation with, RPD, RVD muscle characteristics. Results: A total of 35 participants completed the two visits including young (n = 26) and older adults (n = 9). Young adults did have significant associations between isometric, knee extension PT (e.g., step time r = .407, p = .024), older adults did have a significant, positive association between maximal lean angle and PT (r = .607, p = .042). Among young adults, no significant associations were present between step outcomes (maximal lean angle and step time) and PP, RVD, or RPD variables. However, among older adults, maximal lean angle, and PP (r = .640, p = .032), RVD (r = .608, p = .041), and RPD (r = .751, p = .010) all reported significant, positive associations. Significance: Our results suggest older adults’ muscle characteristics (e.g., PP, PT, RVD, RPD) have strong, positive relationships with the achieved maximal lean angle. While young adults did have significant associations between isometric, knee extension PT (e.g., step time r = .407, p = .024). When stepping to avoid a fall, the ability to rapidly move a limb is critical and time- dependent muscle capacities (e.g., RPD, RVD, and PP) are important determinants of limb movement.

INTRODUCTION: Disabling gait symptoms, especially freezing of gait (FoG), represents a milestone in the progression of Parkinson's disease (PD). This systematic review and network meta-analysis assessed and ranked interventions according to their effectiveness in treating gait symptoms in people with PD across four different groups of gait measures.METHODS: A systematic search was carried out across PubMed, EMBASE, PubMed Central (PMC), and Cochrane Central Library from January 2000 to April 2021. All interventions, or combinations, were included. The primary outcome was changes in objective gait measures, before and after intervention. Outcome measures in the included studies were stratified into four different types of gait outcome measures; dynamic gait, fitness, balance, and freezing of gait. For the statistical analysis, five direct head-to-head comparisons of interventions, as well as indirect comparisons were performed. Corresponding forest plots ranking the interventions were generated.RESULTS: The search returned 6288 articles. From these, 148 articles could be included. Of the four different groups of measurement, three were consistent, meaning that there was agreement between direct and indirect evidence. The groups with consistent evidence were dynamic gait, fitness, and freezing of gait. For dynamic gait measures, treatments with the largest observed effect were Aquatic Therapy with dual task exercising (SMD 1.99 [- 1.00; 4.98]) and strength and balance training (SMD 1.95 [- 0.20; 4.11]). For measures of fitness, treatments with the largest observed effects were aquatic therapy (SMD 3.41 [2.11; 4.71] and high-frequency repetitive transcranial magnetic stimulation (SMD 2.51 [1.48; 3.55]). For FoG measures, none of the included interventions yielded significant results.CONCLUSION: Some interventions can ameliorate gait impairment in people with PD. No recommendations on a superior intervention can be made. None of the studied interventions proved to be efficacious in the treatment of FoG. PROSPERO (registration ID CRD42021264076).

The aim of this study was to compare the current fall prevention nursing practices with the evidence-based practices recommended in clinical practice guidelines according to the risk of falling and specific risk factors.The standardized nursing statements of 12,277 patients were extracted from electronic nursing records and classified into groups according to the risk of falling and individual patients' specific risk factors. The mean frequencies of the fall prevention practices in 10 categories derived from clinical practice guidelines were compared among the groups. We additionally analyzed the differences in the mean frequencies of tailored fall prevention practices according to individual patients' specific risk factors.The nurses documented more fall prevention practices for patients at a high risk of falling and nonfallers than for patients at a low risk of falling and fallers. Specifically, the difference in nursing practices related to environmental modifications was largest between patients at a high risk of falling and those at a low risk of falling. There were also large differences in the nursing practices related to mental status, dizziness/vertigo, and mobility limitations between fallers and nonfallers. There was more documentation of tailored fall prevention practices related to mobility limitations for patient with mild lower limb weakness than for those with good power and balance. In contrast, patients with severe lower limb weakness had received fewer fall prevention practices related to mobility limitations.The present findings emphasize that individual risk-specific nursing interventions in addition to universal precautions are crucial for preventing falls among patients.

《目的》6か月間日常生活に腹臥位を取り入れた高齢者の体幹柔軟性・バランス機能の変化について明らかにする。《方法》関東近郊のシルバー人材センターに登録している高齢者19名を対象に、1群事前事後テストを実施した。各自が自宅で週3回以上1日1回15～30分腹臥位を実施し、月1回同センター内の活動室で長座位体幹前屈とファンクショナルリーチテストを測定後、15分間腹臥位を実施し終了後再度測定した。腹臥位開始時と6か月後の腹臥位前後のデータをSPSS Ver20を用いてWilcoxon符号付順位検定を行い比較した。《結果》腹臥位開始時と6か月後ともに、腹臥位前後の比較では長座位体幹前屈とファンクショナルリーチテストともに有意な増加がみられた。6か月の比較では統計学的な有意差はみられなかったが減少傾向はみられなかった。《結論》高齢者の日常生活に腹臥位を継続的に組み込むことは、体幹柔軟性やバランス機能の維持・改善につながる可能性があることが示唆された。, Objective：This study aimed to identify changes in the trunk flexibility and balance function of elderly individuals who have integrated the prone position into their daily lives for six months.Methods：A pretest and posttest were conducted on one group of 19 elderly people registered at the Silver Human Resources Center in the Kanto area. Each person performed the prone position at home at least three times a week or more once daily for 15–30 min. The long seated forward bend and the Functional Reach Test score were measured in the activity room of the center once a month; then, the prone position was performed for 15 min, and measurements were obtained again. The data collected in the prone position at the initiation and after six months were compared by Wilcoxon’s signed rank test using SPSS version 20.Results：The comparison before and after performing the prone position showed a significant increase in the long seated forward bend and the Functional Reach Test score when the prone position was initiated and after six months. The scores between the start of the prone position and after 6 months did not show statistically significant difference, and there was also no decreasing tendency.Conclusion：The continuous integration of the prone position into the daily lives of elderly people may lead to the maintenance and improvement of trunk flexibility and balance function.

〔目的〕 簡便に測定できるレーザー距離計を用いた Functional reach test（ 以下，レーザー距離計法） の信頼性・妥当性を検討すること。〔方法〕 健常成人67名を対象とした。レーザー距離計法は，直立位で肩関節を90°屈曲した開始肢位にて壁までの距離を測定したのち，前方に手を伸ばした終了肢位にて再度距離を測定し，前者から後者を差し引いて測定値とした。壁までの距離を 2 m，3 m，4 m とし，各3 回ずつ測定した。基準尺度として，最初にFunctional reach test が提唱された方法に近い計測機器法，既存の方法として指示棒を用いた指示棒法を各2 回ずつ測定した。3 方法の信頼性は級内相関係数を用いて検討した。レーザー距離計法と基準尺度との関連の強さを示す基準関連妥当性をPearson の積率相関係数を用いて検討した。3 方法の測定値の差は反復測定の分散分析および事後検定としてShaffer 法を用いて検討した。〔結果〕 レーザー距離計法の級内相関係数は0.86であり，計測機器法の0.89に比べやや低かったが，指示棒法の0.79と比べて高かった。レーザー距離計法と計測機器法とは0.71と有意な強い正の相関があり，基準関連妥当性が高かった。レーザー距離計法は計測機器法および指示棒法に比べ有意に短かった。〔結語〕 レーザー距離計法は，信頼性および妥当性が高く，姿勢の安定化に寄与する要因を排除して測定できる尺度であった。また，レーザー距離計法は場所を選ばずに測定できることから病棟や訪問業務での再現が可能であると考えられた。, [Objective] The functional reach test has been developed to evaluate dynamic balance in the elderly. The aim of this study was to evaluate the validity and reliability of a new measuring method using laser range finder for functional reach test.[Methods] The functional reach distance was measured in three ways, namely, the laser range finder method (LRF), the measuring instrument method (MI), and the telescoping rod method (TR) for 67 subjects. When the LRF method was performed, subjects were asked to stand for 2 m, 3 m, or 4 m from a wall. The association between the LRF, MI, and TR methods was tested using Pearson's correlation coefficient. Inter-observer reliability was evaluated using the intraclass correlation coefficient. Repeated measures analysis of variance (rANOVA) was used to analyze the averages of the reach distances from each measurement method.[Results] The intraclass correlation for the LRF method was 0.86, that of the MI method was 0.89, and that of the TR method was 0.79. The LRF method and TR method were both strongly associated with the MI method, in wherein the reach distance using the MI method strongly correlated with the distances measured using the LRF and TR methods ( r=0.71, r=0.75 respectively). The reach distance using the LRF method was significantly shorter than those of two methods, and that of the TR method was longest of the three methods.[Conclusions] The LRF method has good validity and reliability; thus, the LRF method could be performed for rehabilitation in the wards or during home visits.

健康的な生活には，身体活動の継続が重要である．本研究の目的は，恵庭市在住高齢者を対象に，北海道文教大学で考案されたじぇじぇじぇ体操実施による心理的効果と，高齢者健康づくり教室において有用であるかについて検討することである． 方法：大学主催の高齢者健康づくり教室に参加したのべ 94 名（男 36，女 58）に対して，生活習慣記録機による活動度記録及び Mood Check List - Short Form2（MCL-S.2）による体操実施前後の気分調査を行った．また教室参加者に対して健康づくり教室利用に関するアンケート調査を実施した． 結果：MCL-S.2 の快感情得点やリラックス感得点の有意な向上，不安感得点の有意な低下が認められ，体操実施による気分状態改善が示唆された．また，聴き慣れた曲を使いストーリー性のある振付構成体操であったことで雰囲気が盛り上がり，さらに運動強度も適切範囲内であったことで高齢者にも受け入れやすいとの評価が多かった． 結論：健康づくり教室におけるじぇじぇじぇ体操の実施は，参加者の気分を改善し，教室全体の雰囲気を盛り上げることから，有用な運動プログラムであることが示唆された．

BACKGROUND AND PURPOSE: With an aging population, falls have become an increasing public health concern. While face-to-face exercise programs have demonstrated efficacy in reducing falls, their effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programs to older adults. In addition, they may increase the reach, uptake, and sustainability of fall prevention programs. Therefore, understanding older adults' experiences of using technology-driven methods is essential. This study explored the user experience of StandingTall, a home-based fall prevention program delivered through a tablet computer.METHODS: Fifty participants were recruited using purposive sampling, from a larger randomized controlled trial. Participants were selected to ensure maximum variability with respect to age, gender, experience with technology, and adherence to the program. Participants undertook a one-on-one structured interview. We followed an iterative approach to develop themes.RESULTS AND DISCUSSION: Eight themes were identified. These fall under 2 categories: user experience and program design. Participants found StandingTall enjoyable, and while its flexible delivery facilitated exercise, some participants found the technology challenging. Some participants expressed frustration with technological literacy, but most demonstrated an ability to overcome these challenges, and learn a new skill. Older adults who engaged in a technology-driven fall prevention program found it enjoyable, with the flexibility provided by the online delivery central to this experience. While the overall experience was positive, participants expressed mixed feelings about key design features. The embedded behavior change strategies were not considered motivating by most participants. Furthermore, some older adults associated the program characters with gender-based stereotypes and negative views of aging, which can impact on motivation and preventive behavior.CONCLUSION: This study found digital technologies are an effective and enjoyable method for delivering a fall prevention program. This study highlights that older adults are interested in learning how to engage successfully with novel technologies.

In the geriatric population, falls are a prevalent issue and can entail severe physical and psychological consequences. Fall risk assessment can provide early information in order to adopt prevention measures. However, there are many different reasons why a person might fall ranging from muscolosceletal deficits to cognitive, mental or sensory impairments, and cardiovascular diseases. While the majority of the approaches on fall risk assessment are based on gait analyses, other methods have shown that including considerations of other possible causes can significantly improve the prediction. Thus, for the development of an effective fall risk assessment and to choose the appropriate interventions, the underlying causes need to be identified. This review provides an overview of fall risk factors in the elderly population outlining the correlations between the causes, symptoms and fall risk. Moreover, the state of the art of assessment methods for the identified risk factors as well as for fall risk in general is presented.

Standing up from a chair is a mechanically demanding daily motion, and its biomechanics represent motor performance. In older adults with locomotive syndrome (LS), sit-to-stand (STS) movement with adequate postural control is essential to prevent falls. This study evaluated the characteristics of dynamic balance during STS movement on older adults with LS. A total of 116 participants aged ≥65 years were divided into Non-LS, LS stage 1, and LS stage 2 groups using the LS risk test. The participants were instructed to stand on the Nintendo Wii Balance Board as quickly as possible, and the STS movement was quantified using the vertical ground reaction force (VGRF) and center of pressure (CoP). The STS score, which represented dynamic balance, was significantly different among the groups (p < 0.001). The rate of VGRF development was significantly lower in the LS stages 1 and 2 than in the Non-LS group (p < 0.001). On the other hand, the total distance of the CoP path did not differ among the groups (p = 0.211). These findings indicated a reduction of postural control in older adults with LS. The STS score emphasized the importance of balance training to prevent falls in older adults with LS.

(1) Background: Inpatient falls are a major cause of hospital-acquired complications (HAC) and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study uses existing implementation theory to develop an implementation enhancement plan to improve the uptake of a digital fall prevention workflow. (2) Methods: A qualitative approach using focus groups/interview included 12 participants across four inpatient wards, from a newly built, 300-bed rural referral hospital. Interviews were coded to the Consolidated Framework for Implementation Research (CFIR) and then converted to barrier and enabler statements using consensus agreement. Barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) tool to develop an implementation enhancement plan. (3) Results: The most prevalent CFIR enablers included: relative advantage (n = 12), access to knowledge and information (n = 11), leadership engagement (n = 9), patient needs and resources (n = 8), cosmopolitanism (n = 5), knowledge and beliefs about the intervention (n = 5), self-efficacy (n = 5) and formally appointed internal implementation leaders (n = 5). Commonly mentioned CFIR barriers included: access to knowledge and information (n = 11), available resources (n = 8), compatibility (n = 8), patient needs and resources (n = 8), design quality and packaging (n = 10), adaptability (n = 7) and executing (n = 7). After mapping the CFIR enablers and barriers to the ERIC tool, six clusters of interventions were revealed: train and educate stakeholders, utilize financial strategies, adapt and tailor to context, engage consumers, use evaluative and iterative strategies and develop stakeholder interrelations. (4) Conclusions: The enablers and barriers identified are similar to those described in the literature. Given there is close agreement between the ERIC consensus framework recommendations and the evidence, this approach will likely assist in enhancing the implementation of Rauland’s Concentric Care fall prevention platform and other similar workflow technologies that have the potential to disrupt team and organisational routines. The results of this study will provide a blueprint to enhance implementation that will be tested for effectiveness at a later stage.

The recent increase in sedentary lifestyles has highlighted the importance of physical activity in our daily lives. Although fall accidents are a common cause of injuries among the elderly, walking is one of the simplest physical activities available. Therefore, walking route selection and identification of walking behavior in different scenarios remains a widely researched area. This paper is about developing a walking-route recommender system that proposes a safe route to the user and reduces the probability of fall accidents. We determine route candidates after the start and endpoints are fed to the system. Then the tripping risk involved in each route candidate is identified by performing several walking simulations of a digital human model on a three-dimensional laser-scanned point cloud. Finally, a safe route is determined after considering the user’s age and the tripping risk. It was confirmed that tripping risk could be competently estimated according to the considered age group.

Balance and gait impairments increase fall rate and injury in people with neurological disorders(PwND). The modified Dynamic Gait Index(mDGI) is a scale assessing dynamic balance during walking, however its ability in identifying Fallers and Recurrent Fallers has not been studied.To evaluate mDGI's ability in identifying retrospective Fallers and Recurrent Fallers establishing cut-off scores for its use in clinical practice.In this cross-sectional study, the number of retrospective falls and mDGI scores were collected. PwND were categorised as Non-Fallers or Fallers (falls≥1) and as Recurrent Fallers(falls≥2) or Non-Recurrent/Non-Fallers(falls2) according to their number of retrospective falls over two months. Two generalised linear logistic models were developed using a machine learning method to detect Fallers (Model 1) and Recurrent Fallers (Model 2) based on mDGI scores. ROC curves were used to identify mDGI cut-off scores to distinguish between different fall categories.58 PwND (mean ± standard deviation age: 63.4 ± 12 years) including 28 people with Multiple Sclerosis, 15 people with Parkinson's disease and 15 people with Stroke were analysed. The mDGI score(median (IQR)) for Non-Fallers, Fallers, Recurrent Fallers and Non-Recurrent/Non-Fallers was respectively 50(22), 37(22), 26.5(20.25) and 46.5(20.5)points. The cut-off to identify Fallers from Non-Fallers was 49 points(sensitivity:100 %, specificity:50 %, post-test probability with mDGI ≤ cut-off: 53.2 %, post-test probability with mDGIcut-off: 0%, AUC:0.68), while 29 points(sensitivity:60 %, specificity:79 %, post-test probability with mDGI ≤ cut-off:52.1 %, post-test probability with mDGIcut-off:16.1 %, AUC:0.70) was the best cut-off to identify Recurrent Fallers.People with mDGI score49 points have low or minimal fall risk, while people with mDGI score≤49 points should be further investigated with other scales before starting a balance-focused rehabilitation intervention. People scoring ≤29 points on the mDGI scale may need a fall prevention intervention, regardless of the results of other balance clinical measures.

OBJECTIVE To investigate sociodemographic characteristics and physical and mental health indicators between participants and nonparticipants of a large-scale 2-year exercise RCT including noninvited women living in nearby rural area in Finland. STUDY DESIGN AND SETTING From a previous OSTPRE study cohort, 914 women (aged 72-84) participated in Kuopio Fall Prevention Study in 2016-2019. The participants were compared to non-participants (n = 4,536) and noninvited OSTPRE women (n = 7,119) living outside the urban recruitment area. RESULTS Participants were younger (P< 0.001) with higher education (P< 0.001) and had more often regular hobbies (P< 0.001) and physical exercising (P< 0.001) than nonparticipants or noninvited. They reported better functional capability (P< 0.001), mental (P< 0.001) and subjective health (P< 0.001), lower number of medications (P< 0.001), less fear of falls (P< 0.001), but more frequent falls (P= 0.002) and more often musculoskeletal diseases (P= 0.006). Participants also showed better functional capacity in the clinical measurements. In register analysis, urban-rural differences in the prevalence of diseases were detected. CONCLUSION In population-based exercise interventions, participants are more likely to be better off in respect to physical and mental wellbeing, functional capability and sociodemographic status. Recruiting participants only from cities increases unavoidable selection bias due to urban-rural differences which should be noticed when interpreting and generalizing RCT results. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT02665169.

OBJECTIVE The aim of this study was to compare the efficacy of a modified Dionne's Egress Test (Egress) as a predictor of falls with the Morse Fall Scale (MFS) in adult medical and surgical patients in an acute care setting. BACKGROUND Nurses must identify fall risk while balancing fall prevention and early mobility in their care delivery. Fall risk screening tools alone are not enough to assist nurses in predicting patients at risk of falling. METHODS A retrospective observational study design was used to compare the Egress as a predictor of falls to the MFS. The sample included data abstracted from 197 electronic health records and internal falls data. RESULTS The Egress and the MFS are moderately and negatively correlated; however, only Egress was a significant predictor of falls. Passing the Egress, not being on benzodiazepines, and having a longer length of stay (LOS) results were associated with being less likely to fall. CONCLUSION Egress is a better predictor of falls than MFS when benzodiazepines and LOS are controlled in the model.

Introduction: In the United States, fall-related emergency department (ED) visits among older adults (age 65 and older) have increased over the past decade. Studies document seasonal variation in fall injuries in other countries, while research in the United States is inconclusive. The objectives of this study were to examine seasonal variation in older adult fall-related ED visits and explore if seasonal variation differs by the location of the fall (indoors vs. outdoors), age group, and sex of the faller. Methods: Fall-related ED visit data from the National Electronic Injury Surveillance System-All Injury Program were analyzed by season of the ED visit, location of the fall, and demographics for adults aged 65 years and older. Results: Total fall-related ED visits were higher during winter compared with other seasons. This seasonal variation was found only for falls occurring outdoors. Among outdoor falls, the variation was found among males and adults aged 65 to 74 years. The percentages of visits for weather-related outdoor falls were also higher among males and the 65–74 year age group. Conclusions: In 2015, there was a seasonal variation in fall-related ED visits in the United States. Weather-related slips and trips in winter may partially account for the seasonal variation. Practical Implications: These results can inform healthcare providers about the importance of screening all older adults for fall risk and help to identify specific patients at increased risk during winter. They may encourage community-based organizations serving older adults to increase fall prevention messaging during winter.

BACKGROUND: Falls are one of the most common syndromes in old age. An estimated 646,000 deaths from falls occur each year worldwide. Moreover, most fatal falls occur in people over 65 years of age. Most falls are the result of the interaction of several factors. AIMS: To examine the long-term effectiveness of multifactorial interventions in preventing falls in elderly and senile patients. MATERIALS AND METHODS: A sample of patients territorially attached to the Family Medicine Center of the North-Western State Medical University named after I.I. Mechnikov was established four years ago. Individual fall prevention programs were developed for all study participants (n = 260) because they had different falls risk factors. Patient follow-up was continued for 12 months. The results of the multifactorial intervention were evaluated after 12 months and after 3 years, 2 times in total, the last study in a random subsample of patients (n = 84). Aging asthenia screening, questionnaires, assessment of emotional status, and presence of sleep disturbances were performed to assess the risk of falls. The effectiveness of multifactorial interventions was assessed based on repeated assessment of risk factors for falls. RESULTS: Participants with a history of falls were significantly more likely to have symptoms of depression, anxiety, symptoms of frailty, visual and hearing impairment (p 0.05). On average, each participant in the group with falls had 6.1 2.1 risk factors for falls and 3.8 2.3 in the group without falls (p = 0.000). During the follow-up period after the interventions, the incidence of falls decreased 9-fold after one year (from 28.5% to 3.1%) and then increased to 23.8%. All patients who fell after the multifactorial intervention had a history of cognitive impairment and falls. In addition, in the group of patients with falls, fall risk factors such as low levels of physical activity, hearing impairment, and the presence of a traumatic environment at home were not eliminated. As a result of the interventions, fear of falls disappeared in 9 patients, 95% CI (2.35-65.89), p = 0.039. CONCLUSIONS: The study demonstrated a decrease in the effectiveness of multifactorial interventions to prevent falls at three years. A less persistent effect was seen in patients with a history of falls. A history of falls, symptoms of frailty, complaints of fear of falls, sleep disturbances, and anxiety symptoms were factors that increased the risk of falls. Individualized fall prevention programs resulted in decreased fear of falls.

BACKGROUND Physiotherapy plays an important role in fall prevention, and is a science- and evidence-based profession that is constantly undergoing development. Currently, the possibility of digital fall prevention is being explored; however, the perception of physiotherapists (PTs) toward a digital approach is still a sparsely investigated topic. PURPOSE This study aimed to explore the PT's experiences with a fall prevention exercise program used in their daily work and their thoughts regarding the use of digital support in this context. METHODS Discussions were held in two focus groups with seven PTs (age: 26-48 years). A qualitative content analysis was performed. RESULTS We identified two main categories: 1) The importance of evidence-based fall prevention exercise; and 2) Transition toward a digital fall prevention exercise approach. The participants expressed that they had time- and resource-related limitations affecting evidence-based work and adherence to fall prevention exercise programs. They stated that education and management support were required. CONCLUSION There is a need for fall prevention exercise to be evidence-based and prioritized in physiotherapy. The study results provide insights into the lack of adherence to fall prevention exercise programs and highlighted the need for a transition toward working digitally in the future.

Aims and objectives The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. Background Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. Design An integrative review. Methods An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. Results Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. Conclusions Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. Relevance to clinical practice Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.

Background Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals. Methods Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers. Results The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p p Conclusions The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.

Objective Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has emerged to prevent falls by enhancing both physical and cognitive functions in older adults. Therefore, we aim to quantitatively assess and compare the effects of PT and EI on the performance of balance control and fall prevention in healthy older adults via meta-analysis. Methods A search strategy based on the PICOS principle was used to find the publication in the databases of PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE. The quality and risk of bias in the studies were independently assessed by two researchers. Results Twenty studies consisting of 845 participants were included. Results suggested that as compared to PT, EI induced greater improvement in postural control (sway path length, SMD = − 0.66, 95% CI − 0.91 to − 0.41, P I2 = 0%; sway speed, SMD = − 0.49, 95% CI − 0.71 to − 0.27, P I2 = 42%) and dynamic balance (SMD = − 0.19, 95% CI − 0.35 to − 0.03, P = 0.02, I2 = 0%) in healthy older adults. The EI with 90–119 min/week for more than 8-week significantly reduced falls. Subgroup analyses revealed that exergames, which were designed by the two principles of repeatedly performing diversified tasks and gradually increase the difficulty of the task, induced significant effects in improving balance control and falls prevention respectively (P = 0.03, P = 0.009). In addition, intervention that combines EI and PT induced significant improvement in postural control (P = 0.003). Conclusion The exergame intervention, especially the combination of EI and PT, is a promising strategy to improve balance control and reduce falls in healthy older adults. Future studies with rigorous design, larger sample size, and follow-up assessments are needed to further assess the effectiveness of diverse exergame interventions in fall prevention and to quantify the “dose-effect” relationship, as well as the carry-over effect of such intervention, which will ultimately help optimize the rehabilitative strategies to improve balance control and prevent falls.

Background Falls in older adults are considered a major public health problem. Declines in cognitive and physical functions, as measured by parameters including reaction time, mobility, and dual-task performance, have been reported to be important risk factors for falls. The aim of this study was to investigate the effects of two multimodal programs on reaction time, mobility, and dual-task performance in community-dwelling older adults at risk of falling. Methods In this randomized controlled trial, fifty-one participants (75.4 ± 5.6 years) were allocated into two experimental groups (EGs) (with sessions 3 times per week for 24 weeks), and a control group: EG1 was enrolled in a psychomotor intervention program, EG2 was enrolled in a combined exercise program (psychomotor intervention program + whole-body vibration program), and the control group maintained their usual daily activities. The participants were assessed at baseline, after the intervention, and after a 12-week no-intervention follow-up period. Results The comparisons revealed significant improvements in mobility and dual-task performance after the intervention in EG1, while there were improvements in reaction time, mobility, and dual-task performance in EG2 (p ≤ 0.05). The size of the interventions’ clinical effect was medium in EG1 and ranged from medium to large in EG2. The comparisons also showed a reduction in the fall rate in both EGs (EG1: -44.2%; EG2: − 63.0%, p ≤ 0.05) from baseline to post-intervention. The interventions’ effects on reaction time, mobility, and dual-task performance were no longer evident after the 12-week no-intervention follow-up period. Conclusions The results suggest that multimodal psychomotor programs were well tolerated by community-dwelling older adults and were effective for fall prevention, as well as for the prevention of cognitive and physical functional decline, particularly if the programs are combined with whole-body vibration exercise. The discontinuation of these programs could lead to the fast reversal of the positive outcomes achieved. Trial registration ClinicalTrials.gov Identifier: NCT03446352. Date of registration: February 07, 2018.

The aim of this systematic review (SR) and meta-analysis was to assess what type of exercise is associated with fall risk reduction among apparently healthy adults aged 50 and older. We conducted a SR by searching for randomized controlled trials (RCTs) included in Cochrane SRs published until October 2019. Five SRs that compared exercise versus any type of control included 32 RCTs. The outcomes examined were falls, fallers, fractures, and fear of falling. A random effects-based meta-analysis by type of exercise was performed. Almost all the interventions were effective for fall rate reduction, with a major effect for three-dimensional exercise, strength/resistance exercises, and mixed exercises. The number of fallers was reduced by three-dimensional exercise and mixed exercises. Fall-related fractures were generally reduced by all types of exercises considered all together, but none singly resulted in statistically effective fracture prevention. Fear of falling was slightly decreased with endurance exercises.

Objectives: To assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall. Design: Longitudinal study. Setting and Participants: The subjects (n = 561) were participants in fall prevention conducted in western Finland. Methods: Blood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. Results: The prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment. Conclusions and Implications: OH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.

This is a two-pronged feasibility study with two primary objectives, representing part one and two of the study, respectively (13). The primary objectives are to evaluate the feasibility of the WFG2022 case-finding algorithm and an implementation plan for fall prevention in home health care services. Study start is set to the beginning of January 2023 with a duration of ten weeks. The feasibility study is considered a preparation for a full-scale cluster-randomised trial in the FALLPREVENT project aiming to implement evidence-based fall prevention programmes in municipalities in Norway

This is a two-pronged feasibility study with two primary objectives, representing part one and two of the study, respectively (13). The primary objectives are to evaluate the feasibility of the WFG2022 case-finding algorithm and an implementation plan for fall prevention in home health care services. Study start is set to the beginning of January 2023 with a duration of ten weeks. The feasibility study is considered a preparation for a full-scale cluster-randomised trial in the FALLPREVENT project aiming to implement evidence-based fall prevention programmes in municipalities in Norway

El programa de intervención de Actividad Física (AF) en el adulto mayor, está enfocado en el contexto del mejoramiento del equilibrio por medio de sesiones de actividad física de manera sistemática y funcional, donde se evalúan 61 adultos mayores, pero en su totalidad el grupo está conformado por 96 adultos mayores quienes participan como población intervenida. El objetivo principal de este programa fue diseñar y aplicar sesiones de actividad física para el adulto mayor pertenecientes al Centro de Proyección Social (CPS) de Suba Gaitana para mejorar el nivel de equilibrio. Los resultados obtenidos exponen que las intervenciones de actividad física, en un 90%, mejoraron en la población, lo que quiere decir que el riesgo de caídas y/o fragilidad ha disminuido por el alto impacto que tuvieron las sesiones de Actividad Física (AF) para la salud en el Adulto Mayor (AM). También se pudo observar que muchos de estos no obtuvieron buenos resultados, pero estos fueron concluidos por la falta de asistencia a las sesiones lo que hace que el rendimiento no sea igual. Los resultados finales concluyen la importancia que tiene la actividad física para la salud en el adulto mayor, ya que existen beneficios a nivel de salud y en general para obtener un “envejecimiento más activo”. The Physical Activity (PA) intervention program for the elderly is focused on the context of improving balance through physical activity sessions in a systematic and functional way, where 61 elderly adults are evaluated, but the group as a whole is made up of 96 elderly adults who participate as the intervention population. The main objective of this program was to design and apply physical activity sessions for older adults belonging to the Centro de Proyección Social (CPS) of Suba Gaitana to improve the level of balance. The results obtained show that 90% of the physical activity interventions improved in the population, which means that the risk of falls and/or fragility has decreased due to the high impact that the Physical Activity (PA) sessions had on the health of the Older Adult (MA). It could also be observed that many of these did not obtain good results, but these were concluded by the lack of attendance to the sessions which makes the performance not equal. The final results conclude the importance of physical activity for the health of the older adult, since there are benefits at the level of health and in general to obtain a more "active aging". Profesional en Cultura Física, Deporte y Recreación Pregrado

Einleitung: Die demographische Entwicklung führt zu steigendem (Lang-zeit)Pflegebedarf. Menschen in Langzeitpflegeeinrichtungen stürzen häufiger als in Gemeinschaft lebende Menschen. Fortschreitendes Alter ist einer von vielen Faktoren, die das Risiko von Verletzungen als Folge von Stürzen erhöhen. Die Vermeidung von Stürzen und ihren Folgen ist demgemäß für Langzeitpflegeeinrichtungen von großem Interesse. Diese Bachelorarbeit ging daher der Frage nach, welche pflegerischen Maßnahmen für die Sturzprävention in der Langzeitpflege effektiv sind und welche Rahmenbedingungen dafür notwendig sind. Methodik: Die Bachelorarbeit beruht auf einer systematischen Literaturrecherche in den Datenbanken PubMed und CINAHL, die anhand der festgelegten Ein- und Ausschlusskriterien zur Einbeziehung von 13 Studien geführt hat. Ergebnisse: Übungsinterventionen sind jedenfalls in Verbindung mit kognitiv-verhaltenstherapeutischen Elementen bei nicht-gebrechlichen Bewohner*innen von Langzeitpflegeeinrichtungen geeignete Maßnahmen zur Reduktion der Sturzrate. Die Überprüfung und Reduktion der Medikation wird bevorzugt in Verbindung mit anderen Interventionen als effektiv für die Sturzprävention beschrieben und in klinischen Leitlinien zur Sturzprävention stark empfohlen. Die Verabreichung von Vitamin D wird über-wiegend befürwortet. Die Effektivität des Tragens von Hüftprotektoren ist strittig, Empfehlungen in Richtlinien sind seltener. Dokumentation ist für die Bewertung des Sturzrisikos, der Sturzursachen, der Sturzrate und der Sturzfolgen unbedingt erforderlich. Aufklärung/Schulung der Bewohner*innen von Langzeitpflegeeinrichtungen verringert die Zahl der Stürze nur insignifikant. Die Schulung des Personals ist wesentlich, kann jedoch die Sturzrate nicht verringern. Umgebungsanpassungen gehören auch zu den häufigsten übereinstimmenden Empfehlungen in klinischen Leitlinien zur Sturzprävention. Stoßdämpfende Bodenbeläge beeinflussen die Sturzrate weder positiv noch negativ, haben aber zumindest positive Auswirkungen auf die Verletzungsfolgen. Schlussfolgerung: Effektive Sturzprävention kann durch Übungsinterventionen abgestimmt auf die Gebrechlichkeit in Verbindung mit regelmäßiger Medikationsprüfung und Verabreichung von Vitamin D sowie Aufklärung durch ausreichend geschultes Personal in angepasster, möglichst sicherer Umgebung erzielt werden. Leitlinien für die Sturzprävention in Langzeitpflegeeinrichtungen sollten dies entsprechend sicherstellen. Schlüsselbegriffe: Langzeitpflege, Langzeitpflegeeinrichtung, Stürze, Sturzprävention, (Übungs-)Interventionen, Medikamentenprüfung, Vitamin D, Umgebung(sanpassung), Implementierung, Richtlinien Introduction: Demographic developments are leading to an increasing need for (long-term) care. People in long-term care facilities fall more often than people living in the community. Advancing age is one of many factors that increase the risk of injuries due to falls. The prevention of falls and their consequences is accordingly of great interest for long-term care facilities. This bachelor thesis therefore explored the question of which nursing measures are effective for fall prevention in LTCF and which framework conditions are necessary for this. Methodology: The bachelor thesis is based on a systematic literature search in the PubMed and CINAHL databases, which led to the inclusion of 13 studies based on the defined inclusion and exclusion criteria. Results: Exercise interventions, in combination with cognitive-behavioral therapy, are appropriate measures to reduce the rate of falls in non-frail residents of long-term care facilities. Medication review and reduction, preferably in conjunction with other inter¬ventions, is described as effective for fall prevention and is strongly recommended in clinical guidelines on fall prevention. Vitamin D administration is overwhelmingly advocated. The effectiveness of wearing hip protectors is controversial, recommen-dations in guidelines are less frequent. Documentation is essential for assessing fall risk, causes of falls, rate of falls and consequences of falls. Education/training of residents in long-term care facilities only insignificantly reduces the number of falls. Staff training is essential but cannot reduce the rate of falls. Environmental adaptations are also among the most common consistent recommendations in clinical guidelines for fall prevention. Shock-absorbing flooring has neither a positive nor a negative effect on the rate of falls, but at least has a positive effect on the injury consequences. Conclusion: Effective fall prevention can be achieved through exercise interventions tailored to frailty, combined with regular medication review and administration of vitamin D, as well as education by adequately trained staff in appropriate settings that are as safe as possible. Guidelines for falls prevention in long-term care facilities should ensure this accordingly. Keywords: long-term care, long-term care facility, falls, fall prevention, (exercise) interventions, medication review, vitamin D, environment(adaptation), implementation, guidelines

BackgroundSuccessful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in community-dwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community.MethodsA scoping review was performed using the Arksey and O'Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research.ResultsFourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as “networks and communications”, “formally appointed internal implementation leaders”, “available resources” and “patient needs and resources”. The other constructs (n = 14) were identified only in the .DiscussionFindings in this review show that a wide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.

Effectiveness of tailored implementation of fall prevention in municipalities in Norway - the FALLPREVENT cluster-randomised trial

Hintergrund/Ziel: Die Sturzprävention ist für Senior*innen ein zentrales Thema, da Stürze einer der Hauptgründe für Verletzungen und damit einhergehend auch für Krankenhausaufenthalte und im Extremfall, Grund für ein verfrühtes Ableben sein können. Daher hat es sich diese Arbeit zum Ziel gesetzt den Einfluss der beiden sturzpräventiven Übungsprogramme Otago und HIFE in Bezug auf das Sturzrisiko im direkten Vergleich zu determinieren, um so eine Intervention für einen möglichst hohen positiven Benefit für sturzgefährdete Senior*innen zu evaluieren. Methode: Im Zuge dieser Arbeit wurde eine systematische Literaturrecherche in ausgewählten medizinischen Datenbanken durchgeführt. Am Ende dieser Recherche konnten sechs RCTs, je drei pro Übungsprogramm, in die Arbeit aufgenommen werden. Anhand der Messparameter, welche laut Literatur eine Sturzrisikominimierung reflektieren, konnten vier Kategorien zum Vergleich geschaffen werden, nämlich Kraft, Mobilität, Gleichgewicht und funktionelle Unabhängigkeit. Ergebnisse: Hinsichtlich des Otago-Übungsprogramms konnte in den ausgewählten Studien in jeder der definierten Überkategorien eine signifikante Verbesserung gemessen werden. In der Studie von Kocic et al. (2018) konnte bei allen Messparametern eine signifikante Verbesserung der EG im Gruppenvergleich festgestellt werden. Die Ergebnisse der Studie von Garcia-Gollarte et al. (2023) und Arkkukangas et al. (2019) konnten nur eine teilweise Verbesserung der EG im Gruppenvergleich evaluieren. In Bezug auf die Studien, welche das mit dem HIFE-Übungsprogramm als Interventionsmittelpunkt haben konnte in großen Teilen in der Studie von Kastner et al. (2017) eine signifikante Verbesserung der EG gemessen werden. Bei der Studie von Lindelöf et al. (2013) konnte ausschließlich hinsichtlich der BBS eine signifikante Verbesserung der EG erreicht werden, wohingegen in der Studie von Toots et al. (2016) in großen Teilen keine signifikante Verbesserung der EG festgestellt werden. Schlussfolgerung: Sowohl das Otago-Übungsprogramm als auch das HIFE-Übungsprogramm haben einen positiven Einfluss auf die Sturzrisikominimierung. Wobei in diesem Vergleich die Studien des Otago-Übungsprogramms eindeutigere Ergebnisse präsentiert haben. Somit kann gesagt werden, dass das Otago-Übungsprogramm eine adäquate wissenschaftliche Evidenz aufweist, um als sturzrisikominimierendes Übungsprogramm eingesetzt werden zu können. Das HIFE-Übungsprogramm benötigt noch weitere Forschungsschritte, um einen eindeutigen positiven Effekt zu untermauern. Background/Aim: Fall prevention is a central issue for seniors, as falls can be one of the main reasons for injuries, hospitalizations and, in extreme cases, premature death. Therefore, the aim of this study is to determine the influence of the two fall prevention exercise programs Otago and HIFE in relation to the risk of falls in direct comparison, in order to evaluate an intervention for the highest possible benefit for seniors at risk of falling. Methods: In the course of this work, a systematic literature search was conducted in selected medical databases. At the end of this search, six RCTs, three per exercise program, could be included in the work. Based on the outcome parameters, which according to the literature reflect fall risk reduction, four categories could be created for comparison: strength, mobility, balance and functional independence. Results: Regarding the Otago exercise program, significant improvement was measured in each of the defined excess categories in the selected studies. In the study by Kocic et al. (2018), significant improvement in the EG was found in all outcome parameters when compared between groups. The results of the study by Garcia-Gollarte et al. (2023) and Arkkukangas et al. (2019) could only show a partial improvement of the EG in the between group comparison. Regarding the studies that contain the HIFE exercise program as the main intervention, a significant improvement of the EG could be measured in large parts in the study by Kastner et al. (2017). In the study of Lindelöf et al. (2013), a significant improvement of the EG could be achieved exclusively regarding the BBS, whereas in the study of Toots et al. (2016), a lack of significant improvement of the EG was found in large parts. Conclusion: Both the Otago exercise program and the HIFE exercise program have a positive impact on fall risk reduction. Whereby in this comparison, the studies of the Otago exercise program presented clearer results. Thus, it can be said that the Otago exercise program has an adequate scientific background to be used as a fall risk minimizing exercise program. The HIFE exercise program still needs further RCTs to support a clearer positive effect.

Fall injuries are affecting many individuals' physical and psychological well-being, especially among older adults. Moreover, fall accidents are found to be the most common type of work-related accident in various industries. Thus, there is a need for fall prevention exercises supported by a gamified system to ensure user engagement and motivation. The system's usability is also highly relevant to guarantee the acceptance and satisfaction of the users. This study examined the characteristics regarding usability required within such a system with the goal of preventing falls among adults between 45 to 69 years old. The intention was to implement and design a web-based system that incorporates usability and gamification features. The system was developed through an iterative user-centered design approach utilizing user tests in each iteration and conducted in collaboration with Atea and a research team at Mälardalens University. The study revealed that among the user group, simplicity, consistency, and motivation through gamification were all key characteristics of the system. Furthermore, personalization was found to be an important characteristic to ensure a satisfactory user experience. Overall, the thesis contributed to the development of a gamified web-based system for fall injury prevention, focusing on usability.

The bachelor thesis focuses on fall prevention from the perspective of the general nurse. General nurses encounter falls very frequently with health care providers and should be able to act on this issue in both the prevention and management of a fall. This thesis consists of a theoretical and a research part. The theoretical part deals with the characteristics of falls and risk groups of patients and other internal and external risk factors that occupy an important role in this issue. It also discusses the role of the general nurse in fall prevention as an integral part of the practice of the profession. The thesis also deals with selected aspects of fall prevention and follow-up of fall occurrence and consequences in patients. It was also important to mention the scales used to assess falls or to reduce the risk of falls. For the research part of this bachelor's thesis, a qualitative data collection method was chosen by using the technique of semi-structured interviews conducted with general nurses of selected wards of internal type of health care providers. The aim of the research part was to find out how general nurses identify patient groups at risk for falls. Also, whether general nurses implement preventive measures for fall occurrence and how they proceed when a fall occurs. Last but not least, it was important to find out how general nurses proceed when a patient is discharged to home care.

Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients’ perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient’s understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent.

Doctoral Thesis (Doctorate in Leaders for Technical Industries / Engineering Design and Advanced Manufacturing LTI/EDAM - MIT Portugal), The phenomenon of falls has become a global public health concern due to their prevalence in a projected constantly ageing population (≥ 65 years), as well as its effects on mortality, lower Quality of Life (QoL) (annually: 684.000 deaths; 37,3 millions of accidents with injury) and higher costs. On the other hand, the lack of real-world fall data makes it difficult to develop and implement different technological solutions on a daily basis. This research solution aims, in a first phase, to collect data on falls and dynamic gait, both in institutions and in safe laboratory environments. Several protocols were developed and conducted to serve the development of algorithms and devices to further contribute to minimise or reduce the incidence of falls among the elderly. A conventional wood cane was instrumented to detect falls (>99%; lead time of 373ms) and 4 cane events (>85% per event). A cane-type robot prototype was designed, following a design and product development approach, to detect falls and act to prevent them. So far, the cane has a hardware and software architecture capable of recognising the user’s motion intention and gait phases. A Multifactorial Fall Risk Assessment (FRA) Strategy with 3 modules was initiated during this thesis, starting with the recognition of 16 daily activities and 4 types of fall (96.53%) using a waistband equipped with an inertial sensor. Bio-inspired Central Pattern Generator (CPG) controllers are the basis of a fall prevention strategy for a knee orthosis, where the objective is to detect slips using the knee angle information (80%, mean detection time of 250 ms). Finally, a realistic virtual environment (VE) that closely resembles the typical home setting was created to apply fall-related visual disturbances while using a Head-Mounted Display (HMD), following the concepts of place illusion, plausibility and ecological validity, in order to collect data on compensatory postural reactions., O fenómeno das quedas tornou-se uma preocupação de saúde pública global devido à sua prevalência numa população projetada em constante envelhecimento (≥ 65 anos), bem como os seus efeitos na mortalidade, menor Qualidade de Vida (QoL) (anualmente: 684.000 mortes; 37,3 milhões de acidentes com lesão) e maiores custos. Por outro lado, o desenvolvimento e a aplicação diária de várias soluções tecnológicas são travados pela escassez de dados de quedas do mundo-real. Esta solução de investigação visa, numa primeira fase, recolher dados sobre quedas e marcha dinâmica, tanto em instituições como em ambientes laboratoriais seguros. Diversos protocolos foram desenvolvidos e conduzidos para servir o desenvolvimento de algoritmos e dispositivos para posteriormente contribuírem para minimizar ou reduzir a incidência de quedas entre os idosos. Uma bengala de madeira convencional foi instrumentada para detetar quedas (>99%; lead time de 373ms) e 4 eventos da bengala (>85% por evento). Um protótipo de uma bengala robot foi projetado, seguindo uma abordagem de design e desenvolvimento de produto, para detetar quedas e atuar para as evitar. Até ao momento, a bengala possui uma arquitetura de hardware e software capaz de reconhecer a intenção de movimento do utilizador e as fases da marcha. Uma Estratégia Multifactorial de Avaliação de Risco de Queda (FRA) com 3 módulos foi iniciada nesta tese, tendo começado pelo reconhecimento de 16 atividades diárias e 4 tipos de queda (96,53%) a partir de uma waistband equipada com um sensor inercial. Controladores Central Pattern Generator (CPG) bioinspirados estão na base de uma estratégia de prevenção de queda para uma ortótese do joelho, onde o objetivo é detetar escorregões usando a informação do ângulo do joelho (80%, tempo médio de deteção de 250 ms). Finalmente, um ambiente virtual (VE) realista que se assemelha ao ambiente doméstico típico foi criado para aplicar perturbações visuais relacionadas a quedas ao usar um Head-Mounted Display (HMD), seguindo conceitos de ilusão de lugar, plausibilidade e validade ecológica, por forma a recolher dados de reações posturais compensatórias., Thank all the partner institutions for providing facilities, equipment and access to volunteers. I would also like to thank Fundação para a Ciência e Tecnologia for the scholarship PD/BD/141515/2018.

We studied the use of a millimeter-wave frequency-modulated continuous wave radar for gait analysis in a real-life environment, with a focus on the measurement of the step time. A method was developed for the successful extraction of gait patterns for different test cases. The quantitative investigation carried out in a lab corridor showed the excellent reliability of the proposed method for the step time measurement, with an average accuracy of 96%. In addition, a comparison test between the millimeter-wave radar and a continuous-wave radar working at 2.45 GHz was performed, and the results suggest that the millimeter-wave radar is more capable of capturing instantaneous gait features, which enables the timely detection of small gait changes appearing at the early stage of cognitive disorders.

Background: The aging society worldwide carries public and inevitable issues. Aging is accompanied by multiple diseases, and the health impacts challenge healthcare and social systems. In addition to medical treatment, exercise has been recognized as an effective strategy not only for disease prevention and alleviation, but also for multiple health benefits on health promotion. The purpose of this study was to investigate the effects of a suitable Pilates exercise intervention program on health maintenance and benefits in community-dwelling middle-aged women with a quasi-experimental design. Methods: We recruited healthy middle-aged community-dwelling women who had not regularly exercised in the previous three months. The participants were assigned to the experimental (n = 22) and control (n = 23) groups based on a quasi-experimental design. The experimental group participated in a mat-based Pilates exercise class twice a week (1 h/session) throughout the 12-week intervention, whereas there was no intervention for the control group. Body composition, basal metabolic rate, and functional physical fitness—comprising cardiovascular capacity, flexibility, muscular strength of upper limbs, muscular strength of lower limbs, core strength, agility, static balance, and dynamic balance—were assessed as primary outcomes in both groups before and after the intervention. Results: There were no significant differences in any of the dependent variables between the two groups before the exercise intervention. After the 12-week intervention, body composition, including body mass index, body fat (−1.5 to 3%), and basal metabolic rate (+10.6%), and functional fitness, including flexibility (+3.5%), core strength (+31.5%), lower-limb strength (+13.5%), agility (+7.3%), and balance (+4.2%), improved significantly in the experimental group relative to the control group (p < 0.05). Moreover, the improvement in physical fitness in lower-limb strength, agility, and balance for fall prevention also demonstrated higher clinical significance than the control. Conclusions: This 12-week mat-based Pilates exercise program significantly improved body composition, basal metabolic rate, and functional physical fitness in community-dwelling middle-aged women. The beneficial effects of Pilates exercise programs may thus promote improved health in the middle-aged female population, with practical implications for communities.

Dissertação de mestrado integrado em Engenharia Biomédica (especialização em Biomateriais, Reabilitação e Biomecânica), De acordo com a OMS, um total de 684 000 quedas fatais ocorrem todos os anos, fazendo deste evento a segunda causa mais frequente de morte, por lesão. De entre as possíveis causas de uma queda, as quedas por escorregamento evidenciam-se. De forma a limitar a sua incidência, surge a necessidade do desenvolvimento de soluções tecnológicas orientadas especificamente para esta problemática. Estas devem ser capazes de prever, detetar e responder a uma situação iminente de queda. A presente dissertação procurou identificar as especificações alvo para o desenvolvimento de um dispositivo robótico wearable através da análise de dados experimentais, onde os indivíduos foram induzidos a escorregar, em laboratório. A análise dos dados recolhidos permitiu uma compreensão da globalidade da resposta biomecânica humana da perna perturbada bem como da perna não perturbada. Neste estudo foram consideradas diversas variáveis externas nomeadamente a velocidade da marcha, o pé (esquerdo ou direito) que foi perturbado, a inclinação da superfície e a intensidade da perturbação. Variáveis cinemáticas, cinéticas, espaço temporais e EMG foram analisadas de forma a proceder-se a uma investigação completa da resposta biomecânica. A partir desta análise foram definidos torques, RoM, rpm e tempos de atuação e deteção para o dispositivo a desenvolver. A resposta biomecânica da anca, joelho e tornozelos da perna perturbada foi caracterizada, respetivamente, por momentos extensores, fletores e de flexão plantar. Por sua vez, a resposta biomecânica da perna não perturbada foi caracterizada por flexão da anca, extensão do joelho e flexão plantar do tornozelo. Estas respostas foram influenciadas pela velocidade da marcha, inclinação da superfície e intensidade da perturbação. As especificações alvo determinadas relativas ao RoM foram de 85.90°, 106.34°, e 95.23°, respetivamente, para a anca, joelho e tornozelo. Relativamente aos rpm, foram definidas as gamas de [17.85 - 51.10] para a anca, [21.73 - 63.80] para o joelho e [17.52 - 57.14] para o tornozelo. Por fim, os valores de torque definidos foram de [-3.05 a 3.22], [-1.70 a 2.34] e [-2.21 a 0.90] em Nm/kg, respetivamente para as articulações da anca, joelho e tornozelo., According to WHO, 684 000 fatal falls occur every year, making them the second leading cause of death by injury. Slip is the most common cause of a fall among the many possible reasons. As a result, because it is critical to limit the occurrence of these incidents, there is a need to focus on the development of purpose-oriented technological solutions capable of predicting, detecting, and responding to an imminent fall situation. The current dissertation sought to identify the target specifications for the development of a wearable robotic system for slip-like fall prevention based on the analysis of experimental data in which individuals were asked to handle induced slip-like perturbations. The statistical analysis of experimental data allowed a full understanding of the natural human biomechanical response to slip perturbations of both perturbed and unperturbed legs. The research considered a wide variety of external characteristics such as gait speed, perturbed foot, surface inclination, and perturbation intensity. Kinematic, kinetic, spatiotemporal, and EMG data were analysed to complete the investigation of this natural reaction. Based on the experimental data analysis, torques, RoM, rpm, detection and actuation times were established. The biomechanical response to slip-like perturbations by the hips, knees, and ankles' of the perturbed limb were defined by extension, flexion, and plantarflexion moments, respectively. Biomechanical response in the unperturbed limb was characterised by hip flexion, knee extension, and ankle plantarflexion. These responses were also affected by gait speed, surface inclination, and perturbation intensity. The RoM goal parameters for hips, knees, and ankle joints were 85.19°, 106.34°, and 95.23°, respectively. For the hip, knee, and ankle joints, rpm values of [17.85 - 51.10], [21.73 - 63.80], and [17.52 - 57.14] were found, respectively. Finally, for the hip, knee, and ankle joints, flexion/extension torque values of [-3.05 to 3.22], [- 1.70 to 2.34], and [-2.21 to 0.90] in Nm/kg were estimated.

Humans’ balance recovery responses to gait perturbations are negatively impacted with ageing. Slip and trip events, the main causes preceding falls during walking, are likely to produce severe injuries in older adults. While traditional exercise-based interventions produce inconsistent results in reducing patients’ fall rates, perturbation-based balance training (PBT) emerges as a promising task-specific solution towards fall prevention. PBT improves patients’ reactive stability and fall-resisting skills through the delivery of unexpected balance perturbations. The adopted perturbation conditions play an important role towards PBT’s effectiveness and the acquisition of meaningful sensor data for studying human biomechanical reactions to loss of balance (LOB) events. Hence, this narrative review aims to survey the different methods employed in the scientific literature to provoke artificial slips and trips in healthy adults during treadmill and overground walking. For each type of perturbation, a comprehensive analysis was conducted to identify trends regarding the most adopted perturbation methods, gait phase perturbed, gait speed, perturbed leg, and sensor systems used for data collection. The reliable application of artificial perturbations to mimic real-life LOB events may reduce the gap between laboratory and real-life falls and potentially lead to fall-rate reduction among the elderly community., This work was supported by the FCT—Fundação para a Ciência e Tecnologia—national funds, under the scholarship references UMINHO-VC/BII/2021/02, POCI-01-0247-FEDER-039868_ BI_02_2022_CMEMS and PD/BD/141515/2018, and the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, and under Stimulus of Scientific Employment with the grant 2020.03393.CEECIND.

Background: The importance of physical activity for the elderly is undeniable. Specific forms of exercise that are able to engage practitioners, both cognitively and physically, may provide more positive consequences for health and quality of life. Juggling is one of these activities that has both of these characteristics. Methods: Twenty elderly people (70.55 ± 4.91) were included in a juggling-based motor learning protocol for twelve training units during one month of exercising. An evaluation of the proposed exercises (five-point Likert scale) and a subjective assessment of well-being (WHO-5) were conducted during the protocol. Results: All participants learned to perform a three-ball flash cascade. Exercises were rated as very attractive (4.85 ± 0.31) by the practitioners, and a statistically significant improvement in well-being in participants was shown (p < 0.01; d = 0.76). Additionally, in the participating group, the number of people at risk of depression decreased significantly after the intervention with juggling classes (p < 0.01; g = 0.5). Conclusions: The proposed protocol could be an interesting physical activity for the elderly. It can be assumed that this activity, especially when performed in a group form, can improve the well-being of participants in a short period of time.

Background Falls are the leading cause of traumatic injury in older adults. Multidisciplinary approaches between trauma surgeons and primary care providers can powerfully advocate for fall prevention. This study explores current fall prevention practices and barriers to falls screening and prevention in the primary care setting and proposes pertinent recommendations to address the deficiencies. Methods A questionnaire was adapted from a previous survey study to explore the beliefs, knowledge, attitudes, and clinical practice regarding falls by primary care providers. The questionnaire was distributed by e-mail to primary care providers at a tertiary urban medical center. Results The survey achieved a response rate of 58%. All respondents agreed that older adult patients should be assessed for fall risks and that evidence-based fall prevention programs can reduce the risk of falls. However, 43% of respondents did not agree that they had the expertise to perform fall risk assessments, and similarly 43% did not agree they have the time to perform fall risk assessments in the office. Furthermore, although 52% of respondents were aware of the Medicare reimbursement for fall risk screening, only 24% had billed for fall risk screening and only 5% agreed that they were adequately reimbursed. Conclusion Several barriers to performing fall prevention care in the primary care setting were identified: unfamiliarity with resources, perceived lack of time, and perceived insufficient reimbursement. We implemented a set of interventions which include an educational series and workflow optimization to overcome barriers identified.

The study aims were to identify factors related to incident falls in community-dwelling older adults by sex and to determine whether these factors were modifiable. A 1-year retrospective longitudinal cohort survey was used. Study participants were community-dwelling older adults. Data were analyzed for 4255 individuals. A sex-based multivariate logistic regression analysis was performed to examine the relationship between item responses and incident falls. Incident fall risk was associated with physical function, depression, and cognitive function in men and with pain and physical function in women. The findings suggest the need for fall prevention strategies that reflect sex differences.

Patient safety attendants (PSAs) provide constant direct observation to patients who have cognitive impairments or thoughts. Some estimates report that an acute care hospital in the United States may spend more than $1 million annually on PSAs, an expenditure often not reimbursed. With no national defined standards to regulate or monitor PSA use, this study sought to determine the impact of COVID-19 on a PSA reduction program in a large Midwestern healthcare system., In this article, the authors present the findings of a study conducted to determine the impact of COVID-19 on the patient safety attendant (PSA) reduction program at their facility and analyze the use of video monitoring and other alternatives to PSA.

Stimulating the usability and acceptability of canes within the geriatric community is crucial for fall prevention. Clinical evidences support the use of canes to increase the user's balance and reduce the fall risk. Its nonuse is correlated with a higher number of falls. This fateful event draws tragic consequences such as death or injuries that might affect the victim's psychology, reducing their confidence and mobility. However, users tend to put aside canes and canes’ acceptability is reduced. To increase their usability and acceptability, appellative and time-effective technology-based strategies, such as automatic fall detection systems, should be incorporated. First, steps toward a fall-related approach demand the ability to identify that a fall event is eminent relying only on information derived from the device. This study proposes and compares two fall event approaches. A machine learning framework determines the best models and features for three classification problems: fall event, fall phase, and fall category. The long short-term memory (LSTM) is the most suitable classifier for fall event and phase classification problems, requiring the first 32 and 17 features, respectively, ranked by the Relief-F and minimum-redundancy maximum-relevancy methods (accuracy >99 $\%$ and >95 $\%$ ). K-nearest neighbors with the first 40 features ranked by the Relief-F method presented the best performance for fall category classification (accuracy >74 $\%$ ). A finite-state machine (FSM) combined accelerometer and gyroscope's data to detect the cane's fall with a clear proximity to the LSTM performance (accuracy >99 $\%$ ). Both approaches detect a fall before its occurrence with mean lead times higher than 373 (LSTM) and 266 ms (FSM).