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Abstract Injurious falls pose a significant threat to the safety of stroke patients, particularly among older adults. While the influence of activities of daily living (ADL) on falls is acknowledged, the precise connection between ADL ability and fall-related injuries in older stroke patients undergoing rehabilitation, particularly those with varying mobility levels, remains unclear. This multicenter cross-sectional study in China recruited 741 stroke patients aged 65 years and above, categorized into bedridden, domestic, and community groups based on their mobility levels using the Longshi Scale. ADL ability was assessed using the Barthel Index. Logistic regression models, generalized additive models, smoothed curve-fitting, and threshold effect analysis were employed to explore the relationship between ADL ability and injurious falls across the three mobility groups. Results revealed an inverted U-shaped relationship between ADL ability and injurious falls among patients in the domestic group (p = 0.011). Below the inflection point of 35 on the Barthel Index, the likelihood of injurious falls increased by 14% with each unit increase in ADL ability (OR = 1.14, 95% CI 1.010–1.29, p = 0.0331), while above the inflection point, it decreased by 3% per unit increase (OR = 0.97, 95% CI 0.95–0.99, p = 0.0013). However, no significant association between ADL ability and injurious falls was observed in either the bedridden or community groups (p > 0.05). These findings suggest that only older stroke patients capable of engaging in activities at home demonstrate a correlation between ADL ability and injurious falls. The identified inverted U-shaped relationship may aid in identifying fall injury risk in this population.

Injurious falls pose a significant threat to the safety of stroke patients, particularly among older adults. While the influence of activities of daily living (ADL) on falls is acknowledged, the precise connection between ADL ability and fall-related injuries in older stroke patients undergoing rehabilitation, particularly those with varying mobility levels, remains unclear. This multicenter cross-sectional study in China recruited 741 stroke patients aged 65 years and above, categorized into bedridden, domestic, and community groups based on their mobility levels using the Longshi Scale. ADL ability was assessed using the Barthel Index. Logistic regression models, generalized additive models, smoothed curve-fitting, and threshold effect analysis were employed to explore the relationship between ADL ability and injurious falls across the three mobility groups. Results revealed an inverted U-shaped relationship between ADL ability and injurious falls among patients in the domestic group (p = 0.011). Below the inflection point of 35 on the Barthel Index, the likelihood of injurious falls increased by 14% with each unit increase in ADL ability (OR = 1.14, 95% CI 1.010–1.29, p = 0.0331), while above the inflection point, it decreased by 3% per unit increase (OR = 0.97, 95% CI 0.95–0.99, p = 0.0013). However, no significant association between ADL ability and injurious falls was observed in either the bedridden or community groups (p > 0.05). These findings suggest that only older stroke patients capable of engaging in activities at home demonstrate a correlation between ADL ability and injurious falls. The identified inverted U-shaped relationship may aid in identifying fall injury risk in this population. [ABSTRACT FROM AUTHOR]

Apolipoprotein ɛ4 (APOE ɛ4) may be a genetic risk factor for reduced bone mineral density (BMD) and muscle function, which could have implications for fall and fracture risk. We examined the association between APOE ɛ4 status and long-term fall- and fracture-related hospitalization risk in older women. A total of 1 276 community-dwelling women from the Perth Longitudinal Study of Aging Women (mean age ±  SD  = 75.2 ± 2.7 years) were included. At baseline, women underwent APOE genotyping and detailed phenotyping for covariates including prevalent falls and fractures, as well as health and lifestyle factors. The association between APOE ɛ4 and fall-, any fracture-, and hip fracture-related hospitalizations, obtained over 14.5 years from linked health records, was examined using multivariable-adjusted Cox-proportional hazard models. Over 14.5 years, 507 (39.7%) women experienced a fall-related hospitalization and 360 (28.2%) women experienced a fracture-related hospitalization, including 143 (11.2%) attributed to a hip fracture. In multivariable-adjusted models, compared to noncarriers, APOE ɛ4 carriers (n  = 297, 23.3%) had greater risk for a fall- (hazard ratio [HR] 1.48, 95% CI: 1.22–1.81), fracture- (HR 1.28, 95% CI: 1.01–1.63), or hip fracture-related hospitalization (HR 1.83, 95% CI: 1.29–2.61). The estimates remained similar when specific fall and fracture risk factors (fear of falling, plasma 25-hydroxyvitamin D, grip strength, timed up-and-go, hip BMD, vitamin K status, prevalent diabetes, HbA1c, cholesterol, and abbreviated mental test score) were added to the multivariable model. In conclusion, APOE ɛ4 is a potential risk factor for fall- and fracture-related hospitalization in community-dwelling older women. Screening for APOE ɛ4 could provide clinicians an opportunity to direct higher-risk individuals to appropriate intervention strategies. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: Our objective was to study the predictive value of the Short Physical Performance Battery (SPPB) in the cohort of the SCOPE project on falls, injurious falls, and possible difference of prediction between indoors and outdoors falls. Findings: No association of SPPB and falls was found in models adjusted for age, sex, marital status, number of medications, quality of life, handgrip strength, and muscle mass. While SPPB fails to differentiate between injurious and non-injurious falls (p = 0.48), a lower SPPB score was associated with falls at home (p < 0.01) after 24 months. Message: SBPP was not able to significantly predict the risk of falling as well as experiencing an injurious fall. Introduction: Falls and fall-related injuries in older persons are a major public health problem. Our objective was to study the predictive value of the Short Physical Performance Battery (SPPB) in the cohort of the SCOPE project on falls, injurious falls, and possible difference of prediction between indoors and outdoors falls. Methods: For this sub-study of the SCOPE project participants reporting no falls at baseline, and survey data on falls at the 12-month and 24-month follow-up were included. Participant´s characteristics were assessed during the baseline interview and medical examinations. Falls as well as injurious falls and fall circumstances were obtained self-reported. SPPB and its association with fallers vs. no fallers at 12 and at 24 months were studied with logistic regression models. Results: The 1198 participants had a median age of 79 years (77–82), and a median SPPB of 10 (8–11), with a 52.5% of female. A total of 227 and 277 falls (12- and 24- month visits, respectively) were reported. In the crude model, the SPPB sum scores (p < 0.001) as well as most single item scores were significant different between fallers and non-fallers over time. However, the association was attenuated in models adjusted for age, sex, marital status, number of medications, quality of life, handgrip strength, and muscle mass [e.g., 12 months; OR 0.94 (0.87–1.02)]. While SPPB fails to differentiate between injurious and non-injurious falls (p = 0.48), a lower SPPB score was associated with falls at home (p < 0.01) after 24 months. Conclusion: SBPP was not able to significantly predict the risk of falling as well as experiencing an injurious fall. Trial registration: This study was registered prospectively on 25th February 2016 at clinicaltrials.gov (NCT02691546). [ABSTRACT FROM AUTHOR]

Falls are one of the most common adverse events in hospitals, and patient mobility is a key risk factor. In hospitals, risk assessment tools are used to identify patient-centered fall risk factors and guide care plans, but these tools have limitations. To address these issues, we examined daily patient mobility levels before injurious falls using the Johns Hopkins Highest Level of Mobility, which quantifies key patient mobility milestones from low-level to community distances of walking. We aimed to identify longitudinal characteristics of patient mobility before a fall to help identify fallers before the event. Conducting a retrospective matched case-control analysis, we compared mobility levels in the days leading up to an injurious fall between fallers and nonfallers. We observed that patients who experienced an injurious fall, on average, spent 28% of their time prefall at a low mobility level (Johns Hopkins Highest Level of Mobility levels 1–4), compared with nonfallers who spent 19% of their time at a low mobility level (mean absolute difference, 9%; 95% confidence interval, 1%–16%; P = 0.026; relative difference, 44%). This suggests that assessing a patient's mobility levels over time can help identify those at an increased risk for falls and enable hospitals to manage mobility problems more effectively. [ABSTRACT FROM AUTHOR]

Frailty is associated with declines in physiological capacity across sensory, neurological, and musculoskeletal systems. An underlying assumption is that the frailer an individual, the more likely they are to experience falls and fractures. We examined whether grades of frailty can assess the long-term risk of hospitalized falls, fractures, and all-cause mortality in 1261 community-dwelling older women (mean age [SD] of 75.1 [2.7] yr) over 14.5 yr. Frailty was operationalized using a frailty index (FI) of cumulative deficits from 33 variables across multiple health domains (physical, mental, comorbidities) at baseline. The total score across these variables was summed and divided by 33 to obtain the FI. Participants were graded as fit (FI ≤ 0.12), mildly frail (FI > 0.12–0.24), moderately frail (FI > 0.24–0.36), or severely frail (FI > 0.36). Fall-related (n  = 498), any fracture-related (n  = 347), and hip fracture–related hospitalizations (n  = 137) and deaths (n  = 482) were obtained from linked health records. Associations between FI grades and clinical outcomes were analyzed using multivariable-adjusted Cox-proportional hazard models including age, treatment (calcium/placebo), BMI, smoking history, socioeconomic status, plasma vitamin D (25OHD) status plus season obtained, physical activity, self-reported prevalent falls in the last 3 mo, and self-reported fractures since the age of 50 yr. At baseline, 713 (56.5%), 350 (27.8%), 163 (12.9%), and 35 (2.8%) of women were classified as fit, mildly frail, moderately frail, and severely frail, respectively. Women with mild, moderate, and severe frailty had significantly higher hazards (all P  < .05) for a fall-related (46%, 104%, 168%), any fracture-related (88% for moderate, 193% for severe frailty), hip fracture–related hospitalizations (93%, 127%, 129%), and all-cause mortality (47%, 126%, 242%). The FI identified community-dwelling older women at risk for the most serious falls and fractures and may be incorporated into risk assessment tools to identify individuals with poorer clinical prognosis. [ABSTRACT FROM AUTHOR]

Objective To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48 h after hospital admission. Design and setting Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet. Participants (i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period. Outcomes (i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility. Results 541 patients participated (median age 81 years); 270 control group and 271 experimental group. Allied health assistants (n  = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24 h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P  = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention. Conclusions It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants. [ABSTRACT FROM AUTHOR]

Abdominal aortic calcification (AAC), a recognized measure of advanced vascular disease, is associated with higher cardiovascular risk and poorer long‐term prognosis. AAC can be assessed on dual‐energy X‐ray absorptiometry (DXA)‐derived lateral spine images used for vertebral fracture assessment at the time of bone density screening using a validated 24‐point scoring method (AAC‐24). Previous studies have identified robust associations between AAC‐24 score, incident falls, and fractures. However, a major limitation of manual AAC assessment is that it requires a trained expert. Hence, we have developed an automated machine‐learning algorithm for assessing AAC‐24 scores (ML‐AAC24). In this prospective study, we evaluated the association between ML‐AAC24 and long‐term incident falls and fractures in 1023 community‐dwelling older women (mean age, 75 ± 3 years) from the Perth Longitudinal Study of Ageing Women. Over 10 years of follow‐up, 253 (24.7%) women experienced a clinical fracture identified via self‐report every 4–6 months and verified by X‐ray, and 169 (16.5%) women had a fracture hospitalization identified from linked hospital discharge data. Over 14.5 years, 393 (38.4%) women experienced an injurious fall requiring hospitalization identified from linked hospital discharge data. After adjusting for baseline fracture risk, women with moderate to extensive AAC (ML‐AAC24 ≥ 2) had a greater risk of clinical fractures (hazard ratio [HR] 1.42; 95% confidence interval [CI], 1.10–1.85) and fall‐related hospitalization (HR 1.35; 95% CI, 1.09–1.66), compared to those with low AAC (ML‐AAC24 ≤ 1). Similar to manually assessed AAC‐24, ML‐AAC24 was not associated with fracture hospitalizations. The relative hazard estimates obtained using machine learning were similar to those using manually assessed AAC‐24 scores. In conclusion, this novel automated method for assessing AAC, that can be easily and seamlessly captured at the time of bone density testing, has robust associations with long‐term incident clinical fractures and injurious falls. However, the performance of the ML‐AAC24 algorithm needs to be verified in independent cohorts. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). [ABSTRACT FROM AUTHOR]

Background: Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study. Methods: This was a non‐randomized trial (pilot study) including NH staff and residents from five facilities. Long‐stay residents at high‐risk for injurious falls were identified using a validated risk calculator and staff referral. A remote team reviewed the electronic health record (EHR) and provided recommendations as Injury Prevention Plans (IPP). A research nurse served as a care coordinator focused on resident engagement and shared decision‐making. Outcomes included implementation measures, as identified in the EHR, and surveys and interviews with staff. Results: Across five facilities, 274 residents were screened for eligibility, and 46 residents (16.8%) were enrolled. Most residents were female (73.9%) and had dementia (63.0%). An IPP was completed for 45 residents (97.8%). The nurse made a total of 93 deprescribing recommendations in 36 residents (80% of residents had one or more deprescribing recommendation; mean 2.2 recommendations/resident). Twenty of 45 residents (44.4%) had a recommendation for osteoporosis treatment. Among residents with recommendations, 21/36 (58.3%) had one or more deprescribing orders written and 6/20 (30.0%) had an osteoporosis medication prescribed. At 4 months, most medication changes persisted. Adverse side effects were rare. Staff members identified several areas for program refinement, including aligning recommendations with provider workflow and engaging consultant psychiatrists. Conclusions: A remote injury prevention service is safe and feasible to enhance deprescribing and osteoporosis treatment in long‐stay NH residents at risk for injury. Additional investigation is needed to determine if this model could reduce injurious falls when deployed across NH chains. [ABSTRACT FROM AUTHOR]

Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making. [ABSTRACT FROM AUTHOR]

Approximately 40–60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient’s cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making.

Abstract Background Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF. Methods Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported “not at all” at baseline and “somewhat/fairly/very concerned” at follow-up, or “not at all” at follow-up, and “somewhat/fairly/very concerned” at baseline, and P-FoF was defined as participants answered “somewhat/fairly/very concerned” in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis. Results The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03–4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12–5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31–5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23–10.1) and living alone (OR = 2.44, 95%CI = 1.17–5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16–3.27), BMI (OR = 1.08, 95%CI = 1.02–1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02–1.13) and depression (OR = 2.55, 95%CI = 1.33–4.88) were significant predictors of P-FoF. Conclusions T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls. Trial registration The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).

Abstract Background Falls are a major public health problem affecting millions of older adults each year. Little is known about FRID prescribing behaviors after injurious falls occur. The primary objective of this study was to investigate whether an injurious fall is associated with being prescribed a new FRID. Methods We conducted a cross-sectional analysis using data from the National Ambulatory Medical Care Survey (2016). We included visits from patients age ≥ 65 years and classified visits based on presence of an injurious fall. The outcome of interest was prescription of new FRID between those with and without an injurious fall. Multivariable logistic regression weighted for sampling and adjusted for demographics, health history and other medications was used. Age and Alzheimer’s disease were examined as potential effect measure modifiers. Odds ratios and 95% confidence intervals were reported. Bayes factor upper bounds were also reported to quantify whether the data were better predicted by the null hypothesis or the alternative hypothesis. Results The sample included 239,016,482 ambulatory care visits. 5,095,734 (2.1%) of the visits were related to an injurious fall. An injurious fall was associated with a non-statistically significant increase in odds of at least one new FRID prescription: adjusted OR = 1.6 (95% CI 0.6, 4.0). However, there was non-statistically significant evidence that the association depended on patient age, with OR = 2.6 (95% CI 0.9, 7.4) for ages 65–74 versus OR = 0.4 (95% CI 0.1, 1.6) for ages ≥ 75. In addition to age, Alzheimer’s disease was also identified as a statistically significant effect measure modifier, but stratum specific estimates were not determined due to small sample sizes. Conclusions Ambulatory care visits involving an injurious fall showed a non-statistically significant increase in odds of generating a new FRID prescription, but this association may depend on age.

Background: Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF.Methods: Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported "not at all" at baseline and "somewhat/fairly/very concerned" at follow-up, or "not at all" at follow-up, and "somewhat/fairly/very concerned" at baseline, and P-FoF was defined as participants answered "somewhat/fairly/very concerned" in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis.Results: The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03-4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12-5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31-5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23-10.1) and living alone (OR = 2.44, 95%CI = 1.17-5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16-3.27), BMI (OR = 1.08, 95%CI = 1.02-1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02-1.13) and depression (OR = 2.55, 95%CI = 1.33-4.88) were significant predictors of P-FoF.Conclusions: T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls.Trial Registration: The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016). [ABSTRACT FROM AUTHOR]

Purpose: This study is to explore the risk factors of injurious falls among hospitalized patients at psychiatric units in a medical center of southern Taiwan. Methods: This retrospective matched case-control study selected patients who were hospitalized in psychiatric units and had at least one fall event from 2010 to 2015. A total of 352 cases were reviewed using chart audit and data were analyzed using a logistic regression. Results: The risk factors of injurious falls among psychiatric inpatients were as follow: the number of falls during hospitalization (OR=1.58 - 95% CI = 1.22-2.03), non-cancer diagnosis (OR=9.12 - 95% CI = 2.72-30.60), having an acute infection (OR=2.11 - 95% CI=1.12-3.97), sleep disturbance in nursing record (OR=3.29 - 95% CI=1.98-5.46), without providing fall-preventive education (OR=17.35 - 95% CI=1.55-194.60), and case in handover report (OR=4.34 - 95% CI=1.49-12.59). Conclusion: The results suggested that nurses should give an individualized nursing care for preventing the occurrences of injurious falls for the following conditions: fall history, having acute infections, having sleep disorders and case in handover report. [ABSTRACT FROM AUTHOR]

Background: Only 2% of falls in older adults result in serious injuries (i.e., hip fracture). Therefore, it is important to differentiate injurious versus non-injurious falls, which is critical to develop effective interventions for injury prevention. Objects: The purpose of this study was to a. extract the best features of surface electromyography (sEMG) for classification of injurious falls, and b. find a best model provided by data mining techniques using the extracted features. Methods: Twenty young adults self-initiated falls and landed sideways. Falling trials were consisted of three initial fall directions (forward, sideways, or backward) and three knee positions at the time of hip impact (the impacting-side knee contacted the other knee (“knee together”) or the mat (“knee on mat”), or neither the other knee nor the mat was contacted by the impacting-side knee (“free knee”). Falls involved “backward initial fall direction” or “free knee” were defined as “injurious falls” as suggested from previous studies. Nine features were extracted from sEMG signals of four hip muscles during a fall, including integral of absolute value (IAV), Wilson amplitude (WAMP), zero crossing (ZC), number of turns (NT), mean of amplitude (MA), root mean square (RMS), average amplitude change (AAC), difference absolute standard deviation value (DASDV). The decision tree and support vector machine (SVM) were used to classify the injurious falls. Results: For the initial fall direction, accuracy of the best model (SVM with a DASDV) was 48%. For the knee position, accuracy of the best model (SVM with an AAC) was 49%. Furthermore, there was no model that has sensitivity and specificity of 80% or greater. Conclusion: Our results suggest that the classification model built upon the sEMG features of the four hip muscles are not effective to classify injurious falls. Future studies should consider other data mining techniques with different muscles.

Background: Falls are a major public health problem affecting millions of older adults each year. Little is known about FRID prescribing behaviors after injurious falls occur. The primary objective of this study was to investigate whether an injurious fall is associated with being prescribed a new FRID.Methods: We conducted a cross-sectional analysis using data from the National Ambulatory Medical Care Survey (2016). We included visits from patients age ≥ 65 years and classified visits based on presence of an injurious fall. The outcome of interest was prescription of new FRID between those with and without an injurious fall. Multivariable logistic regression weighted for sampling and adjusted for demographics, health history and other medications was used. Age and Alzheimer's disease were examined as potential effect measure modifiers. Odds ratios and 95% confidence intervals were reported. Bayes factor upper bounds were also reported to quantify whether the data were better predicted by the null hypothesis or the alternative hypothesis.Results: The sample included 239,016,482 ambulatory care visits. 5,095,734 (2.1%) of the visits were related to an injurious fall. An injurious fall was associated with a non-statistically significant increase in odds of at least one new FRID prescription: adjusted OR = 1.6 (95% CI 0.6, 4.0). However, there was non-statistically significant evidence that the association depended on patient age, with OR = 2.6 (95% CI 0.9, 7.4) for ages 65-74 versus OR = 0.4 (95% CI 0.1, 1.6) for ages ≥ 75. In addition to age, Alzheimer's disease was also identified as a statistically significant effect measure modifier, but stratum specific estimates were not determined due to small sample sizes.Conclusions: Ambulatory care visits involving an injurious fall showed a non-statistically significant increase in odds of generating a new FRID prescription, but this association may depend on age. [ABSTRACT FROM AUTHOR]

Abstract Background Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls. Methods The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving community-dwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment. The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUTS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects. Results Our series consisted of 2256 SCOPE participants (median age = 79.5 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment. CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79–1.14 for eGFR

Min Zhao,1– 3,* Shuguang Li,2,* Yun Xu,2 Xiaoxia Su,1,2 Hong Jiang2 1School of Nursing, Fudan University, Shanghai, People’s Republic of China; 2Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 3Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hong JiangDepartment of Nursing, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Jing’an District, Shanghai 200040, People’s Republic of ChinaTel +86-182177161812Email hlbjiang0@163.comPurpose: Injurious falls seriously threaten the safety of elderly patients. Identifying risk factors for predicting the probability of injurious falls is an important issue that still needs to be solved urgently. We aimed to identify predictors and develop a nomogram for distinguishing populations at high risk of injurious falls from older adults in acute settings.Patients and Methods: A retrospective case–control study was conducted at three hospitals in Shanghai, China. Elderly patients with injurious falls from January 2014 to December 2018 were taken as cases, and control patients who did not have falls were randomly matched based on the admission date and the department. The data were collected through a medical record review and adverse events system. The original data set was randomly divided into a training set and a validation set at a 7:3 ratio. A nomogram was established based on the results of the univariate analysis and multivariate logistic regression analysis, and its discrimination and calibration were verified to confirm the accuracy of the prediction. The cut-off value of risk stratification was determined to help medical staff identify the high-risk groups.Results: A total of 115 elderly patients with injurious falls and 230 controls were identified. History of fractures, orthostatic hypotension, functional status, sedative-hypnotics and level of serum albumin were independent risk factors for injurious falls in elderly patients. The C-indexes of the training and validation sets were 0.874 (95% CI: 0.784− 0.964) and 0.847 (95% CI: 0.771– 0.924), respectively. Calibration curves were drawn and showed acceptable predictive performance. The cut-off values of the training and validation sets were 146.3 points (sensitivity: 73.7%; specificity: 87.5%) and 157.2 points (sensitivity: 69.2%; specificity: 85.5%), respectively.Conclusion: The established nomogram facilitates the identification of high-risk populations among elderly patients, providing a new assessment tool to forecast the individual risk of injurious falls.Keywords: acute hospitalization, elderly adults, injurious falls, nomogram, prediction tool

Abstract Background Whether exercise prevents fall-related injuries in different health conditions and with different training protocols is still unclear. This study aimed to determine the effect of exercise on fall-related injuries by participant characteristics and divergent exercise protocols. The safety and compliance of exercise were also examined. Methods Electronic database searches were conducted in PubMed, Web of Science, and EMBASE for randomised controlled trials that evaluated the influence of exercise on fall-induced injuries in older people. Results Twenty-five trials met the inclusion criteria. Exercise significantly reduced the risk of fall-related injuries in older adults, risk ratio (RR) 0.879 [95% confidence interval (CI) 0.832–0.928]. Among the injuries, events needing medical care or resulting fractures were also decreased by exercise intervention, with RR 0.681 (0.562–0.825) and 0.561 (0.366–0.860), respectively. When analysis was stratified by participant characteristics and exercise protocols, we found that participants at high risk of falling, or with osteoporosis, were sensitive to exercise intervention. Combined exercise protocols and balance training were the most effective exercise types in reducing fall-related injuries. Exercise-associated beneficial effects were even significant in very old people (≥80 years) and across the duration of interventions (

Background: The dose–response relationship of vitamin D status and the risk of serious falls requiring hospitalization in older women is unclear. We examined the association between plasma 25‐hydroxyvitamin D (25OHD) with falls‐related hospitalizations over 14.5 years in a large cohort of older women. Methods: In 1348 community‐dwelling Australian women aged ≥70 years, plasma 25OHD concentrations were assessed at baseline (1998) using LC–MS/MS. Fall‐related hospitalizations were obtained from linked data systems. Baseline grip strength and timed‐up‐and‐go (TUG) were assessed as measures of muscle strength and physical function, respectively. Results: Mean plasma 25OHD was 66.9 ± 28.2 nmol/L. The number of women in the low (LOW; <50 nmol/L), medium (MED; 50 to <75 nmol/L), and higher 25OHD (HIGH; ≥75 nmol/L) categories were 384 (28.5%), 491 (36.4%), and 473 (35.1%), respectively. In the multivariable‐adjusted analysis, compared to LOW, women in HIGH had significantly lower hazards for a falls‐related hospitalization (HR 0.76 95%CI 0.61–0.95). Restricted cubic spline regression models highlight increasing gradient of risk for a falls‐related hospitalization with decreasing 25OHD levels. Generalized additive modeling highlighted higher 25OHD to be associated with better TUG performance. Including TUG into the multivariable‐adjusted models did not alter the relationship between 25OHD and injurious falls (HIGH vs. LOW HR 0.76 95%CI 0.60–0.95). Conclusions: In community‐dwelling older Australian women, maintaining plasma 25OHD at 75 nmol/L or above may confer benefits to muscle function and long‐term prevention of injurious falls requiring hospitalization. This relationship appears to be independent of better physical function observed in women with higher 25OHD levels. [ABSTRACT FROM AUTHOR]

Injurious falls remain among the most common, dangerous, and costly adverse events in hospitals, despite the widespread implementation of fall prevention programs. Many current health care system policies and nursing practices oversimplify fall prevention by focusing on limiting the person's mobility and making the environment safer, or simply documenting a fall risk score. But most falls are caused by factors intrinsic to that individual; merely limiting their mobility can increase preventable hospital complications and readmissions, and still leaves them at risk for falls. This article proposes a new approach to reducing injurious falls in older adults--one grounded in evidence-based protocols known to positively impact the health of older adults. The approach, called by the acronym ERA--Electronic health record integration, Risk factors that matter, Assessment and care plans--allows nurses to use a validated fall risk assessment tool to reframe fall risk factors as part of the comprehensive care plan, and to map modifiable risk factors to interventions that address the underlying causes of falls and promote safer mobility. The ERA approach can help nurses use their time more effectively by focusing on targeted actions that improve patient outcomes, working in coordination with an interprofessional, cross-continuum care team. [ABSTRACT FROM AUTHOR]

Although aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults. Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. The numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids. Among the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P =.003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P =.007). Our findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults. [ABSTRACT FROM AUTHOR]

Objectives: To investigate a 4-year longitudinal relationship between falls, recurrent falls, and injurious falls, according to different levels of life-space mobility (LSM). Methods: Longitudinal analysis of an international cohort study. The participants were older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline. Three waves of data (2012, 2014, 2016) were used. Fall history during the past year was recorded. Recurrent fallers were identified as those who fell at least twice and injurious fallers as participants who required medical attention. LSM measurements included Total Life-Space (LS-C), Maximal Life-Space (LS-M), Assisted Life-Space (LS-A), Independent Life-Space (LS-I) and Restricted Life-space (LS-ID) scores. Generalized estimation equation (GEE) models were used to determine whether life-space mobility measures and their change over time differed between recurrence of falls and injurious falls. Results: At baseline, the prevalence of falls in the last year was 28%. 11.8% reported recurrent falls and 2.6% had serious injurious falls in the last year preceding the assessments. Recurrent fallers were more likely to be female, with insufficient income and, with comorbidities. GEE models showed that life-space mobility was lower among those with recurrent falls or serious injurious falls compared to those who never fell, but the rate of change did not differ over the 4-year follow-up except for the LS-A and LS-I scores, where some improvements were observed over time. Conclusions and implications: Falls were independently associated with a decrease in LSM over 4 years. Targeting older adults with recurrent and injurious falls with appropriate interventions may improve community mobility and social participation. [ABSTRACT FROM AUTHOR]

Background: Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls.Methods: The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving community-dwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment. The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUTS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects.Results: Our series consisted of 2256 SCOPE participants (median age = 79.5 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment. CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79-1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81-1.28 for eGFR< 45; OR = 1.08, 95%CI = 0.74-1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67-1.24 for eGFR< 60; OR = 0.93, 95%CI = 0.63-1.37 for eGFR< 45; OR = 1.19, 95%CI = 0.62-2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 1.56, 95%CI = 1.29-1.89) and injurious falls (OR = 1.58, 95%CI = 1.14-2.19), and such associations were confirmed in all multivariable models.Conclusions: Cross-sectional data suggest that CKD may not be associated with history of falls or injurious falls, whereas LUTS is significantly associated with the outcomes.Trial Registration: This study was registered on 25th February 2016 at clinicaltrials.gov ( NCT02691546 ). [ABSTRACT FROM AUTHOR]

The primary objective was to determine the prevalence and characteristics of older adults concurrently using opioids and other central nervous system (CNS)-active medications, and the specialties of providers who ordered the medications. A secondary objective was to document medication-related adverse effects associated with such concurrent drug use. Study populations were identified as older adults aged ≥65 years with 1 year continuous medical and drug plan enrollment during 2017 and opioid use of ≥2 prescriptions for ≥15 days' supply. CNS-active medications included benzodiazepines, non-benzodiazepine hypnotics, muscle relaxants, antipsychotics, and gabapentinoids. Provider specialties were identified from the National Provider Identification database. Characteristics associated with opioids only, opioids plus 1, and opioids plus ≥2 additional CNS-active medications were determined using multinomial logistic regression. Outcome measures during 2017 included injurious falls/fractures and ≥3 emergency room (ER) visits. Among eligible insureds (N = 209,947), 57% used opioids only, 28% used opioids plus 1 additional CNS medication, and 15% used ≥2 additional medications. About 60% of opioids and other concurrent CNS medications were prescribed by the same provider, generally a primary care provider. Benzodiazepines and gabapentinoids were most often used concurrently with opioids. Health status, insomnia, anxiety, depression, and low back pain had the strongest associations with concurrent medication use. Overall, concurrent use with ≥2 CNS medications increased the likelihood of injurious falls/fractures or ≥3 ER visits in this population by about 18% and 21%, respectively. Both patients and providers may benefit from an awareness of adverse outcomes associated with concurrent opioid and other CNS-active medication use. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: The main objective in this population-based study was to analyze the incidence of fall-related emergency department visits and recurrent falls among older people in a Finnish community. Findings: Thirteen percent of all ED visits of patients aged 80 years and over are fall-related. One in four of those discharged home had a new fall-related injury. Message: As the risk of subsequent fall-related injuries was high during the first month after the fall, we emphasize the need to intervene with the fall risk promptly. Purpose: Fall-related injuries are a significant cause of morbidity, mortality and functional decline among older people. The aim of this study is to analyze the incidence of fall-related emergency department (ED) visits and compare the characteristics of single and recurrent fallers in a population-based sample. Methods: Consecutive patients aged ≥ 80 years and living in the Tampere city region who visited collaborative emergency department within a two-year study period (1 January 2015 to 31 December 2016) due to fall-related injury were included. The incidence of fall-related injuries and recurrent falls was calculated using population statistics. Results: A total of 6915 ≥ 80-year-old patients visited our ED 17,769 times during the study period. Thirteen percent of these visits (n = 2347, median 87 years, 80–103 years; 74% female) were fall-related. The incidence of fall-related ED visits increased from 94/1000 person-years to 171/1000 among those aged 80–89 years and ≥ 90 years, respectively. Twenty-four percent of patients had recurrent falls (range 2–5) during the observational period. Twenty-five percent of those discharged home had a subsequent fall-related injury within one month after the index visit. The distribution of diagnoses was similar among those with single and recurrent falls. Conclusion: Fall-related injuries are a significant health issue. Almost one in eight of all ED visits were fall-related, and 24% of patients had recurrent fall-related injuries. The risk of subsequent injury was high during the first month after the first injury, emphasizing the need to intervene with the fall risk promptly. [ABSTRACT FROM AUTHOR]

Background: Whether exercise prevents fall-related injuries in different health conditions and with different training protocols is still unclear. This study aimed to determine the effect of exercise on fall-related injuries by participant characteristics and divergent exercise protocols. The safety and compliance of exercise were also examined.Methods: Electronic database searches were conducted in PubMed, Web of Science, and EMBASE for randomised controlled trials that evaluated the influence of exercise on fall-induced injuries in older people.Results: Twenty-five trials met the inclusion criteria. Exercise significantly reduced the risk of fall-related injuries in older adults, risk ratio (RR) 0.879 [95% confidence interval (CI) 0.832-0.928]. Among the injuries, events needing medical care or resulting fractures were also decreased by exercise intervention, with RR 0.681 (0.562-0.825) and 0.561 (0.366-0.860), respectively. When analysis was stratified by participant characteristics and exercise protocols, we found that participants at high risk of falling, or with osteoporosis, were sensitive to exercise intervention. Combined exercise protocols and balance training were the most effective exercise types in reducing fall-related injuries. Exercise-associated beneficial effects were even significant in very old people (≥80 years) and across the duration of interventions (< 6 months, 6 to 12 months and ≥ 12 months). Exercise only generated a very low injury rate per participant year (0.002, 95% CI 0-0.05) and showed relatively good compliance of exercise (as reported in the included papers) (78.5, 95% CI 72.8-84.2%).Conclusions: Exercise is effective in preventing fall-induced injuries across a variety of baseline participant characteristics and exercise protocols. Exercise was associated with a low injury rate and had a good compliance, suggesting it is a feasible approach to managing fall-related injuries. [ABSTRACT FROM AUTHOR]

Abstract Background Fall injuries are stressful and painful and they have a range of serious consequences for older people. While there is some clinical evidence of unintentional poisoning by medication following a severe fall injuries, population-based studies on that association are lacking. This is investigated in the current study, in which attention is also paid to different clinical conditions of the injured patients. Methods We conducted a matched case-control study of Swedish residents 60 years and older from various Swedish population-based registers. Cases defined as adverse drug events (ADE) by unintentional poisoning leading to hospitalization or death were extracted from the National Patient Register (NPR) and the Cause of Death Register from January 2006 to December 2009 (n = 4418). To each case, four controls were matched by sex, age and residential area. Information on injurious falls leading to hospitalization six months prior to the date of hospital admission or death from ADE by unintentional poisoning, and corresponding date for the controls, was extracted from the NPR. Data on clinical conditions, such as dispensed medications, comorbidity and previous fall injuries were also extracted from the Swedish Prescribed Drug Register (SPDR) and NPR. Effect estimates were calculated using conditional logistic regression and presented as odds ratios (OR) and 95% confidence intervals (CI). Results We found a three-fold increased risk of unintentional poisoning by medication in the six-month period after an injurious fall (OR 3.03; 95% CI, 2.54–3.74), with the most pronounced increase 1–3 weeks immediately after (OR, 7.66; 95% CI, 4.86–12.1). In that time window, from among those hospitalized for a fall (n = 92), those who sustained an unintentional poisoning (n = 60) tended to be in poorer health condition and receive more prescribed medications than those who did not, although this was not statistically significant. Age stratified analyses revealed a higher risk of poisoning among the younger (aged 60–79 years) than older elderly (80+ years). Conclusion Medication-related poisoning leading to hospitalization or death can be an ADE subsequent to an episode of hospitalization for a fall-related injury. Poisoning is more likely to occur closer to the injurious event and among the younger elderly. It cannot be ruled out that some of those falls are themselves ADE and early signs of greater vulnerability among certain patients.

Objective: To evaluate whether a multifactorial programme delivered in a real practice setting would help prevent serious fall-related injuries in high-risk older patients.Design: A 6-month pre-post intervention study in 134 fallers (81.6 ± 7.2 years) consecutively referred to a fall prevention clinic after repeated falls in the previous year or after a fall associated with balance, gait, or strength disorders. The programme was delivered by a physiotherapist, an occupational therapist, a podiatrist, and a geriatrician based on a 3-hour fall risk assessment.Results: The proportion of patients with serious and moderate fall-related injuries was significantly lower in the 6 months after than in the 6-months preceding clinic attendance [8 (6.1%) vs 40 (30.5%), and 11 (8.2%) vs 19 (14.2%), respectively; p < 0.0001], as were the overall proportion of fallers (32.1% vs 95.4%; p < 0.0001) and the number of falls per patient (-5.2 ± -20.4; p < 0.0001). When compared with baseline, fear of falling at 6 months was reduced (p < 0.05), mobility was maintained, and the proportion of patients with an ADL score ≤ 2 was increased (5.6% vs 9.7% respectively; p < 0.001). Adherence to the main recommendations and satisfaction with the programme were > 75% at 6 months post-clinic.Conclusions: A multifactorial fall prevention programme delivered by a multidisciplinary geriatric team in older patients at high risk of falling helps to reduce over a 6-month period the risk of serious and moderate injuries related to falls, the risk of falling, and the fear of falling, and helps to maintain mobility and improve functional status. [ABSTRACT FROM AUTHOR]

Reading or texting with a mobile phone while walking requires cognitive resource allocation and consequently induces changes in gait. Fifty-six young adults walked along the GAITRite© walkway under baseline, low-, and high-cognitive loads. Participants’ Functional Ambulation Profile (FAP), velocity, and stride length decreased while double-support time increased under higher cognitive load. This result shows that during cognitively loaded multitasking conditions participants are unable to stabilize their gait. In addition, lower FAP scores across the conditions suggest an increased risk for future injurious falls. This study demonstrates that distracted walking using a mobile phone can affect several parameters of gait and it would be prudent to not read or text on a mobile phone while walking.

The purpose of this study is to investigate the adoption of Information and Communication Technologies (ICTs) of elderly with hip fracture after a fall. Demographic and clinical data using a general questionnaire were obtained from 67 elderly patients with a hip fracture after fall and compared with 67 gender-age matched elderly healthy controls regarding their knowledge and use of ICT-based devices. Univariate and multivariate analyses were conducted at p=0.05. 25.4% of the patients vs 10.5% of the controls uses ICT-based devices (p=0.024). Among patients, the demographic factors significantly associated with the use of ICT-based devices included area of residence, educational level and financial status (p<0.001 to p=0.045). In conclusion, based on a small sample, it seems that the adoption of ICT by the elderly vulnerable populations is limited. [ABSTRACT FROM AUTHOR]

We investigated the association between elevated plasma concentrations of circulating soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and injurious falls and mortality over a 5-year period. We studied the prospective relationship between levels of circulating adhesion molecules and falls in 680 community-dwelling participants in the MOBILIZE Boston Study. The mean sVCAM-1 (±SD) concentration was 1192 ± 428 ng/mL. Over 5-years of follow-up, 10.2% of participants died. The baseline sVCAM-1 (±SD) concentration was 1434 ± 511 ng/mL in those who died vs. 1162 ± 402 ng/mL in those who survived (P < 0.0001). sVCAM-1 level was associated with recurrent falls (P < 0.01); compared to the lowest quintile, the highest quintile of sVCAM-1 was associated with increased risk of injurious falls [multivariable adjusted Incidence Rate Ratio = 1.9, 95% CI (1.2–2.9), P = 0.009]. On survival analysis, the highest sVCAM-1 quintile was associated with the greatest mortality over 5 years (log-rank test, P < 0.0001). The adjusted hazard ratio was 2.4 [95% CI (2.1–2.7), P = 0.002]. High sVCAM-1 blood concentration was strongly associated with recurrent falls, injurious falls, and mortality in older adults. [ABSTRACT FROM AUTHOR]

Using National Database of Nursing Quality Indicators data from July 2013 to June 2014, this correlational study examined the associations of injurious falls among all patient falls with multilevel factors in hospitals. The sample included all falls recorded in adult medical, surgical, combined medical-surgical, and step-down units (N = 2299) in participating hospitals (N = 488). Hierarchical negative binominal regression analyses were performed. Results revealed hospital and unit organizational factors associated with inpatient injurious falls. [ABSTRACT FROM AUTHOR]

To examine the association between the baseline number of chronic diseases and multimorbidity with regard to the incidence of all and injurious falls over 3 years among European community-dwelling older adults. Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. The main outcomes were the number of all falls and injurious falls experienced over 3 years. The number of chronic diseases and multimorbidity, defined as the presence of 3 or more chronic diseases at baseline, were assessed with the Self-Administered Comorbidity Questionnaire by Sangha et al. Among the 2155 participants included in the analyses (mean age: 74.9 years, 62% were women, 52% were physically active more than 3 times a week), 569 (26.4%) had multimorbidity at baseline. Overall, each 1-unit increase in the baseline number of chronic diseases was linearly associated with a 7% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) 1.07, 95% CI 1.03-1.12, P <.001] and a 6% increased incidence rate of injurious falls (aIRR 1.06, 95% CI 1.02-1.11, P =.003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (aIRR 1.21, 95% CI 1.07-1.37, P =.002) and a 17% increased incidence rate of injurious falls (aIRR 1.17, 95% CI 1.03-1.32, P =.02). Baseline number of prevalent chronic diseases and multimorbidity in generally healthy and active community-dwelling older adults were associated with increased incidence rates of all and injurious falls over 3 years. These findings support that multimorbidity may need consideration as a risk factor for falls, even in generally healthy and active older adults. [ABSTRACT FROM AUTHOR]

Background: Fall injuries are stressful and painful and they have a range of serious consequences for older people. While there is some clinical evidence of unintentional poisoning by medication following a severe fall injuries, population-based studies on that association are lacking. This is investigated in the current study, in which attention is also paid to different clinical conditions of the injured patients.Methods: We conducted a matched case-control study of Swedish residents 60 years and older from various Swedish population-based registers. Cases defined as adverse drug events (ADE) by unintentional poisoning leading to hospitalization or death were extracted from the National Patient Register (NPR) and the Cause of Death Register from January 2006 to December 2009 (n = 4418). To each case, four controls were matched by sex, age and residential area. Information on injurious falls leading to hospitalization six months prior to the date of hospital admission or death from ADE by unintentional poisoning, and corresponding date for the controls, was extracted from the NPR. Data on clinical conditions, such as dispensed medications, comorbidity and previous fall injuries were also extracted from the Swedish Prescribed Drug Register (SPDR) and NPR. Effect estimates were calculated using conditional logistic regression and presented as odds ratios (OR) and 95% confidence intervals (CI).Results: We found a three-fold increased risk of unintentional poisoning by medication in the six-month period after an injurious fall (OR 3.03; 95% CI, 2.54-3.74), with the most pronounced increase 1-3 weeks immediately after (OR, 7.66; 95% CI, 4.86-12.1). In that time window, from among those hospitalized for a fall (n = 92), those who sustained an unintentional poisoning (n = 60) tended to be in poorer health condition and receive more prescribed medications than those who did not, although this was not statistically significant. Age stratified analyses revealed a higher risk of poisoning among the younger (aged 60-79 years) than older elderly (80+ years).Conclusion: Medication-related poisoning leading to hospitalization or death can be an ADE subsequent to an episode of hospitalization for a fall-related injury. Poisoning is more likely to occur closer to the injurious event and among the younger elderly. It cannot be ruled out that some of those falls are themselves ADE and early signs of greater vulnerability among certain patients. [ABSTRACT FROM AUTHOR]

Background: Both exercise and vitamin D are recommended means to prevent falls among older adults, but their combined effects on fall-induced injuries are scarcely studied.Methods: A 2-year follow-up of a previous 2-year randomized controlled trial with vitamin D and exercise (Ex) of 409 older home-dwelling women using a factorial 2 × 2 design (D-Ex-, D+Ex-, D-Ex+, D+Ex+). Besides monthly fall diaries, femoral neck bone mineral density (fn-BMD), and physical functioning were assessed at 1 and 2 years after the intervention.Results: After the intervention, S-25OHD concentrations declined to baseline levels in both supplement groups. The groups did not differ for change in fn-BMD or physical functioning, except for leg extensor muscle strength, which remained about 10% greater in the exercise groups compared with the reference group (D-Ex-). There were no between-group differences in the rate of all falls, but medically attended injurious falls reduced in D+Ex- and D-Ex+ groups compared with D-Ex-. However, all former treatment groups had less medically attended injured fallers, HRs (95% CI) being 0.62 (0.39-1.00) for D+Ex-, 0.46 (0.28-0.76) for D-Ex+, and 0.55 (0.34-0.88) for D+Ex+, compared with D-Ex-.Conclusions: Exercise-induced benefits in physical functioning partly remained 2 years after cessation of supervised training. Although there was no difference in the rate of all falls, former exercise groups continued to have lower rate of medically attended injured fallers compared with referents even 2 years after the intervention. Vitamin D without exercise was associated with less injurious falls with no difference in physical functioning. [ABSTRACT FROM AUTHOR]

Objectives Cardiovascular disorders are recognized as important modifiable risk factors for falls. However, the association between falls and orthostatic hypotension ( OH) remains ambivalent, particularly because of poor measurement methods of previous studies. The goal was to determine for the first time to what extent OH (and variants) are risk factors for incident falls, unexplained falls ( UF), injurious falls ( IF) and syncope using dynamic blood pressure ( BP) measurements in a population study. Design Nationally representative longitudinal cohort study-The Irish Longitudinal Study on Ageing ( TILDA)-wave 1 (2009-2011) with 2-year follow-up at wave 2 (2012-2013). Setting Community-dwelling adults. Participants Four thousand one hundred twenty-seven participants were randomly sampled from the population of older adults aged ≥50 years resident in Ireland. Measurements Continuous BP recordings measured during active stands were analyzed. OH and variants (initial OH and impaired orthostatic BP stabilization OH(40)) were defined using dynamic BP measurements. Associations with the number of falls, UF, IF, and syncope reported 2 years later were assessed using negative binomial and modified Poisson regression as appropriate. Results Participants had a mean age of 61.5 (8.2) years (54.2% female). OH(40) was associated with increased relative risk of UF ( RR: 1.52 95% CI: 1.03-2.26). OH was associated with all-cause falls ( IRR: 1.40 95% CI: 1.01-1.96), UF( RR: 1.81 95% CI: 1.06-3.09), and IF( RR: 1.58 95% CI: 1.12-2.24). IOH was not associated with any outcome. Conclusion With the exception of initial orthostatic hypotension, beat-to-beat measures of impaired orthostatic BP recovery (delayed recovery OH (40) or sustained orthostatic hypotension OH) are independent risk factors for future falls, unexplained falls, and injurious falls. [ABSTRACT FROM AUTHOR]

• A low functional mobility level is associated with a history of injurious falls. • Maintaining or improving mobility post-amputation may reduce risk of injurious falls. • PLUS-M is an accessible and useful tool to guide prosthetic rehabilitation. • Continued need to explore modifiable clinical factors relative to prosthesis use. Injurious falls have a high cost and economic impact on an individual and the health system. Several studies have assessed performance-based functional mobility in lower limb prosthesis (LLP) users and fall risk including fall history. However, limited data exist regarding the relationship between functional mobility and a history of injurious falls in individuals who use a LLP. Such information could inform clinical practice and decision making from prosthesis design to policy. The purpose of this study was to identify factors associated with a history of injurious falls among LLP users using a clinical outcomes database. Retrospective (2016-2018) observational study. Logistic regression applied. A final sample of 12,044 LLP users was included for analysis. Within the sample, 1,529 individuals reported a history of an injurious fall within the previous 6 months. Self-reported functional mobility was stratified into low, middle, and high levels: differences were found between levels for history of an injurious fall. The lowest mobility level was associated with 2.29 higher odds of a history of an injurious fall (95% CI: 1.96-2.69) indicating a potentially greater serious fall risk compared to those with higher mobility levels while controlling for covariates (sex, cause of amputation and level of amputation). Self-reported functional mobility was associated with a history of injurious falls in LLP users. The Prosthetic Limb Users Survey of Mobility is an accessible tool that prosthetists could use to identify individuals with a high risk of falls; this can inform care planning. Rehabilitation plans and prosthesis designs that target LLP users who report low functional mobility may positively impact health outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet a majority of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls. Purpose: The purpose of this retrospective study was to determine which patient factors are associated with injurious falls in hospitalized adults. Methods: The study site's adverse event reporting database was used to identify 1,369 patients who fell between January 1, 2006, and October 31, 2013. Of these, 381 (27.8%) subjects suffered injurious falls. Variables of interest included age, sex, fall history, use of diuretics, use of central nervous system medications, cognitive impairment, primary discharge diagnoses, abnormal laboratory values, impaired mobility, and body mass index. Findings: Bivariate analysis revealed a statistically significant association between injurious falls and having a primary discharge diagnosis of "symptoms, signs, and ill-defined conditions." Having this discharge diagnosis was a significant predictor of injurious falls. Conclusions: Findings from this study may help hospital clinicians to better identify which patients are most at risk for injurious falls and to create better fall-related injury prevention interventions. [ABSTRACT FROM AUTHOR]

The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veterans' nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%. [ABSTRACT FROM AUTHOR]

Summary: This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older home-dwelling Finnish women. Given a willingness to pay of €3000 per injurious fall prevented, the exercise intervention had an 86 % probability of being cost-effective in this population. Introduction: The costs of falling in older persons are high, both to the individual and to society. Both vitamin D and exercise have been suggested to reduce the risk of falls. This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older Finnish women. Methods: Economic evaluation was based on the results of a previously published 2-year randomized controlled trial (RCT) where 409 community-dwelling women aged 70 to 80 years were recruited into four groups: (1) no exercise + placebo (D−Ex−), (2) no exercise + vitamin D 800 IU/day (D+Ex−), (3) exercise + placebo (D−Ex+), and (4) exercise + vitamin D 800 IU/day (D+Ex+). The outcomes were medically attended injurious falls and fall-related health care utilization costs over the intervention period, the latter evaluated from a societal perspective based on 2011 unit costs. Incremental cost-effectiveness ratios (ICER) were calculated for the number of injurious falls per person-year prevented and uncertainty estimated using bootstrapping. Results: Incidence rate ratios (95 % CI) for medically attended injurious falls were lower in both Ex+ groups compared with D−Ex−: 0.46 (0.22 to 0.95) for D−Ex+, 0.38 (0.17 to 0.81) for D+Ex+. Step-wise calculation of ICERs resulted in exclusion of D+Ex− as more expensive and less effective. Recalculated ICERs were €221 for D−Ex−, €708 for D−Ex+, and €3820 for D+Ex+; bootstrapping indicated 93 % probability that each injurious fall avoided by D−Ex+ per person year costs €708. At a willingness to pay €3000 per injurious fall prevented, there was an 85.6 % chance of the exercise intervention being cost-effective in this population. Conclusions: Exercise was effective in reducing fall-related injuries among community-dwelling older women at a moderate cost. Vitamin D supplementation had marginal additional benefit. The results provide a firm basis for initiating feasible and cost-effective exercise interventions in this population. [ABSTRACT FROM AUTHOR]

Background and objective: previously, a randomised controlled exercise intervention study (RCT) showed that combined resistance and balance-jumping training (COMB) improved physical functioning and bone strength. The purpose of this followup study was to assess whether this exercise intervention had long-lasting effects in reducing injurious falls and fractures. Design: five-year health-care register-based follow-up study after a 1-year, four-arm RCT. Setting: community-dwelling older women in Finland. Subjects: one hundred and forty-five of the original 149 RCT participants; women aged 70-78 years at the beginning. Methods: participants' health-care visits were collected from computerised patient register. An injurious fall was defined as an event in which the subject contacted the health-care professionals or was taken to a hospital, due to a fall. The rate of injured fallers was assessed by Cox proportional hazards model (hazard ratio, HR), and the rate of injurious falls and fractures by Poisson regression (risk ratio, RR). Results: eighty-one injurious falls including 26 fractures occurred during the follow-up. The rate of injured fallers was 62% lower in COMB group compared with the controls (HR 0.38, 95% CI 0.17 to 0.85). In addition, COMB group had 51% less injurious falls (RR 0.49, 95% CI 0.25 to 0.98) and 74% less fractures (RR 0.26, 95% CI 0.07 to 0.97). Conclusions: home-dwelling older women who participated in a 12-month intensive multi-component exercise training showed a reduced incidence for injurious falls during 5-year post-intervention period. Reduction in fractures was also evident. These long-term effects need to be confirmed in future studies. [ABSTRACT FROM AUTHOR]