Is quality of life related to risk of falling, fear of falling, and functional status in patients with hip arthroplasty?
Buker Nihal,Eraslan Umut,Kitis Ali,Kiter Ahmet Esat,Akkaya Semih,Sutcu Gulsah
Physiotherapy research international : the journal for researchers and clinicians in physical therapy
OBJECTIVE:The aim of the study was to investigate the relation between health-related quality of life and risk of falling, fear of falling, and functional status in patients with hip arthroplasty. METHODS:In this cross-sectional study, 48 hips of 45 patients who aged between 33 and 79 (53.56 ± 12.50) years and had cementless total hip arthroplasty between 2010 and 2014 were evaluated. Twenty-seven of the patients participated in the study were female (60.0%) and 18 were male (40.0%). Health-related quality of life with Nottingham Health Profile, function of the hip joint with Harris Hip Score, risk of falling with Performance-Oriented Motion Assessment I, and fear of falling with Falls Efficacy Scale were assessed. In addition, chair stand test, 40-m walk test, stair-climb test, and single leg stance test were carried out. In analysing the relationships between these parameters, Pearson correlation analysis was employed. The level of significance was considered as p < 0.05. RESULTS:Among the cases, who were evaluated 87.10 ± 45.22 (22.43-214.71) weeks after the operation, a significant correlation was found between health-related quality of life and risk of falling, function of hip joint, and functional tests (p < 0.05). CONCLUSION:The evaluation of the factors related to health-related quality of life in hip arthroplasty patients may help identify patient needs and guide the rehabilitation process.
Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial.
Trudelle-Jackson Elaine,Smith Susan S
Archives of physical medicine and rehabilitation
OBJECTIVE:To investigate the effects of a late-phase exercise program for patients who underwent total hip arthroplasty (THA) 4 to 12 months earlier. DESIGN:A single-blind, randomized controlled trial. SETTING:Exercises were performed in subjects' homes. Exercise instruction and measurements taken before and after the trial were performed in an outpatient research and treatment center. PARTICIPANTS:Convenience sample of 34 adults 4 to 12 months post-THA randomly allocated to experimental or control groups. Twenty-eight subjects completed the study. INTERVENTION:An 8-week, hip-exercise intervention, during which the control group received basic isometric and active range of motion exercises; the experimental group received strength and postural stability exercises. MAIN OUTCOME MEASURES:Score on the 12-Item Hip Questionnaire; fear of falling; hip flexor, extensor, abductor, and knee extensor muscle torque; and postural stability in single stance. RESULTS:There was a statistically significant improvement in all measures of self-perceived function, muscle strength (hip flexors, 24.4%; hip extensors, 47.8%; hip abductors, 41.2%; knee extensors, 23.4%), and postural stability (36.8%) in the experimental group and no significant change in the control group. Neither group had statistically significant changes in fear of falling measures. CONCLUSIONS:An exercise program emphasizing weight bearing and postural stability significantly improved muscle strength, postural stability, and self-perceived function in patients 4 to 12 months after THA.
Counselling for physical activity, life-space mobility and falls prevention in old age (COSMOS): protocol of a randomised controlled trial.
Edgren Johanna,Karinkanta Saija,Rantanen Taina,Daly Robin,Kujala Urho M,Törmäkangas Timo,Sievänen Harri,Kannus Pekka,Heinonen Ari,Sipilä Sarianna,Kannas Lasse,Rantalainen Timo,Teittinen Outi,Nikander R
INTRODUCTION:The most promising way to promote active life years in old age is to promote regular participation in physical activity (PA). Maintaining lower extremity muscle function with good balance has been associated with fewer falls and the need of help from others. This article describes the design and intervention of a randomised controlled trial (RCT) investigating the effectiveness of a health and PA counselling programme on life-space mobility and falls rates in community-dwelling older adults at the Health Kiosk and/or Service Centre. METHODS AND ANALYSIS:Community-dwelling men and women (n=450) aged 65 years and over with early phase mobility limitation will be recruited to a 24-month RCT with a 24-month follow-up. Participants will be randomly allocated into either a health and PA counselling group (intervention) or relaxation group (control intervention). All participants will receive five group specific face-to-face counselling sessions and 11 phone calls. The counselling intervention will include individualised health counselling, strength and balance training, and guidance to regular PA. The control group will receive relaxation exercises. Outcomes will be assessed at baseline, 12, 24 and 48 months. Primary outcomes are average life-space mobility score and falls rates. Life-space mobility will be assessed by a validated questionnaire. Falls rates will be recorded from fall diaries. Secondary outcomes are data on fall-induced injuries and living arrangements, number of fallers, fracture risk, mean level of PA, physical performance, quality of life, mood, cognition, balance confidence and fear of falling. Data will be analysed using the intention-to-treat principle. Cost-effectiveness of the programme will be analysed. Ancillary analyses are planned in participants with greater adherence. ETHICS AND DISSEMINATION:Ethical approval was obtained from the Ethics Committee of the Tampere University Hospital (R15160). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences. TRIAL REGISTRATION:ISRCTN65406039; Pre-results.
[Accidental fall-induced, proximal femoral fracture in the elderly--etiology and rehabilitation].
Herrmann R,Meier-Baumgartner H P
Zeitschrift fur Gerontologie und Geriatrie
55 patients aged 65 years and older with a fracture of the proximal end of femur caused by a fall who have been admitted to the Medizinisch-Geriatrische Klinik Albertinen-Haus Hamburg for rehabilitation during the period of half a year took part in the study. Aim of the study was to describe the success of treatment as well as to prevent further falls by identifying the reason for their recent fall. Three defined moments are the basis of this analysis: admission and discharge of the Albertinen-Haus and a follow-up research four years later by interviewing their general practitioners. In addition the general physical condition and life surroundings prior to the fall have been evaluated by an anamnestic questionnaire. The average age was 81.1 years. All but three had been living at home prior to the fall and 72% could be discharged to their home after rehabilitation. Five patients died while still at hospital. The reason for falling has been classified into intrinsic and extrinsic factors. Twenty-six patients (47.3%) toppled due to an extrinsic and 20 (36.4%) due to an intrinsic cause. In nine cases (16.4%) no reason could be identified. No correlation between the patient's age and the success of treatment was found. However, the fear to fall again had a significant negative influence on the success of treatment. The inquiry of 45 patients four years later showed that 42.2% were living at home and 31.1% in a nursing home. Within the four years 26.7% died; 93.7% of the surviving patients were able to walk.
Characteristics of outdoor falls among older people: a qualitative study.
Nyman Samuel R,Ballinger Claire,Phillips Judith E,Newton Rita
BACKGROUND:Falls are a major threat to older people's health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people's experiences of outdoor falls to develop understanding of how they may be prevented. METHODS:We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. RESULTS:Forty-four adults aged 65 - 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. CONCLUSIONS:This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.
[Consequence and risk factors of falls-related injuries in community-dwelling elderly in Beijing].
Zhou Bai-Yu,Shi Jing,Yu Pu-Lin
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi
OBJECTIVE:To investigate the incidence of falls during the past year,as well as the consequence of falls so as to explore the risk factors for fall-related injuries in the community-dwelling elderly in Beijing. METHODS:A cross-sectional study was conducted in a community in Beijing. A total of 1512 persons aged 60 years and over were selected using stratified cluster sampling method. Information related to all kinds of falls was collected with a standardized structured questionnaire through face-to-face interview. Binary logistic regression was used to explore the related factors for consequence of any falls, especially falls-related injuries in the elderly. RESULTS:272 older adults had one falling episode at the baseline study, with the incidence rate of fall and the frequency of falls as 18.0% (272/1512) and 379 times respectively. Among the 1512 interviewees, 8.7% (131) suffered from injuries as a result of falls. Out of the total 379 times of falls, 143 resulted in injuries. Most common injuries appeared to be soft tissue related (84 times, 58.7%) and epidermal abrasion (57 times, 39.9%), followed by fracture (20 times, 14.0%) and open wound (9 times, 6.3%). The most common injured areas were lower limbs (67 times, 46.9%), followed by upper limbs (39 times, 27.3%), head (27 times, 18.9%), face (19 times, 13.3%), hip (11 times,2.9%), waist/abdomen (10 times, 2.6%), chest (6 times, 1.6%) ,vertebral column (5 times, 1.3%) and neck (3 times, 0.8%). Data from logistic regression analysis showed that being female (OR = 2.09), with proper bench height (OR = 1.94), being alcoholic (OR = 3.10), being able to walk more than 400 meters (OR = 2.11), fear of falls (OR = 3.30) etc. were risk factors, while enough handrails provided in surrounding areas (OR = 0.41) showed as the protective factor for falls-related injuries in the elderly. CONCLUSION:The incidence rates of falls and falls-related injuries among elderly community-dwellers in urban areas of Beijing were considered to be high. Falls and its related injuries were caused by varied factors, suggesting the intervention strategies should be targeted to the related factors as well as focusing on primary prevention.
[Epidemiological analysis of accidental falls by the elderly in Zurich and Geneva].
Gostynski M,Ajdacic-Gross V,Gutzwiller F,Michel J P,Herrmann F
Schweizerische medizinische Wochenschrift
The purpose of the study was to determine the prevalence rate of fallers (PRF%) and fall-related consequences among the elderly according to age, gender and setting. Data derive from a cross-sectional study on dementia, depression and handicaps among the elderly, carried out between 1995 and 1996. Elderly people aged 65 and over living in Zurich or Geneva were considered eligible for the study. By means of the Canberra Interview for the Elderly, 921 subjects' and/or informants' interviews were completed. The subjects were classified as a faller if the subject and/or informant reported a fall in the year prior to the interview. Overall PRF% amounted to 27.8% and was higher to a statistically significant degree among females (30.9%) than males (22.5%). Gender difference in PRF was found only among the non-institutionalized elderly. Age-specific PRF increased significantly with the age of the elderly. However, this increase was observed only among male subjects. 143 subjects (PRF 17.1%) have fallen once and 101 (PRF 9.9%) two or more times. Females showed a substantially higher propensity to recurrent falls (age-adjusted OR 1.86; 95% confidence interval 1.11-3.10). While the risk of suffering two or more falls increased with age, it did not increase among one-time fallers. Residents of nursing homes had significantly higher risk of falling as compared with home-dwelling subjects (age-adjusted OR 2.46; 95% confidence interval 1.04-5.78). Every second fall caused fall-related consequences. 9.1% of all falls led to fall-related fracture. The risk of suffering fall-related consequences depended on neither age nor gender. One third of fallers reported fear of further falling. Falls among the elderly occur often and contribute substantially to morbidity.
The risk factors related to falling in elderly females.
Keskin Dilek,Borman Pinar,Ersöz Murat,Kurtaran Aydan,Bodur Hatice,Akyüz Müfit
Geriatric nursing (New York, N.Y.)
The purpose of this study was to explore the relationship between muscle strength and functional mobility and falls in women aged 65 and over. Thirty-one female subjects with a mean age of 69.57 +/- 4.89 years (65-78) were enrolled in the study. Demographic properties, body mass index, comorbid medical conditions, smoking, the number of medications taken, and fall characteristics were recorded. Knee flexor and extensor strength of the dominant extremity was measured by Biodex isokinetic system, and physical capacity was assessed with a 6-minute walk test. Cognitive status was evaluated by the Mini-Mental State Examination, and disability in daily activities was determined with the Barthel Index. Twelve subjects (38.7%) reported experiencing a fall in the previous year. Eight (25.8%) had experienced a fall outside the home and 4 (12.9%) inside the home. Nine subjects had fallen once, 2 subjects twice, and 1 subject had fallen 3 times. Six (19.4%) subjects reported a fracture after falling. Muscle strength of the knee extensors and flexors and work capacity was similar between those who had fallen and those who had not. The risk factors related to falling were evaluated, but no related factor was determined. Fear of falling was found to be high in patients who had fallen in the previous year. In conclusion, knee extensor and flexor strength are not significant factors in falls or the risk of falling for elderly women, particularly those who are able to function independently. Balance tests in current use are not effective predictors of falls in older adults who live independently and who do not have any significant health problem. These results suggest that there may be a significant interactive effect of the many causal factors that we need to address. Further study is needed to develop new assessment tools for active elderly people to help prevent falls and fall-related injuries.
The level of physical activity in patients with osteoporosis in relation to the risk and prevention of falls.
Lewczuk Emilia,Białoszewski Dariusz
Ortopedia, traumatologia, rehabilitacja
Background. Thanks to modern methods of diagnosis, treatment and rehabilitation, we currently possess the means to counteract the consequences of osteoprosis and limit the number of falls in osteoporotic patients. Material and methods. Based on an original questionnaire, we analyzed a group of 54 patients (48 women and 6 men) under treatment for osteoporosis in order to assess the level of physical activity and the reasons for its reduction in patients with osteoporosis, to determine the situations mostly endangered by falls, and to survey the opinion of patients regarding the need for a rehabilitation program to prevent falls. Results. 68.5% of the patients stated that osteoporosis has reduced their everyday physical activity. Among these patients, 54% reported a fall during the last year. The most common reasons for reduced activity were fear of falling and incurring a fracture (38.8%)and pain (34.7%). The activity most likely to cause a fall was slow walking (51.6%). 92.6% of the surveyed patients were willing to participation in rehabilitation classes to reduce the risk of a fall; of these patients, 50% reported reduced physical activity, 20% significantly reduced, and 30% no change. Conclusions. Falls and consequent fractures, both prior and anticipated, are the most common reason for reduced physical activity in patients with osteoporosis. Pain was a major cause of reduced everyday activity among patients who had already incurred osteoporotic fractures and had symptoms of osteoporosis for more than 6 years. According to patients, the activity bearing the greatest risk of a fall is walking.
Falls among community-dwelling elderly in Japan.
Aoyagi K,Ross P D,Davis J W,Wasnich R D,Hayashi T,Takemoto T
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
Japanese have a lower incidence of hip fracture than Caucasians despite having lower bone mass. Hip fractures usually occur after a fall, and differing incidence rates of falls might explain the observed differences in hip fracture rates. To explore this hypothesis, we studied falls and related conditions among 1534 (624 men, 910 women) community-dwelling people aged 65 years and over in Japan and compared the prevalence of falls to Japanese-Americans living in Hawaii and to published studies of Caucasians. In Japan, 9% of the men and 19% of the women reported one or more falls during the past year. The prevalence of falls increased with age in both genders and was greater among women compared with men. In logistic regression models, having musculoskeletal disease, physical disability or limited activity increased the risk of falls by two to four times in both genders. Most fallers (92%) reported fear of future falls, and about one third of fallers reported that they went out less often as a result of their falls. Compared with native Japanese, the age-standardized prevalence of falls among Japanese-Americans was similar but about twice as high for Caucasians, which may explain the lower hip fracture risk of Japanese.
Hip protectors improve falls self-efficacy.
Cameron I D,Stafford B,Cumming R G,Birks C,Kurrle S E,Lockwood K,Quine S,Finnegan T,Salkeld G
Age and ageing
OBJECTIVES:To investigate the effect of use of external hip protectors on subjects' fear of falling and falls self-efficacy (belief in their own ability to avoid falling). DESIGN:Randomized controlled trial. SETTING:Aged-care health services in Sydney, Australia. PARTICIPANTS:131 women aged 75 years or older, who had two or more falls or one fall requiring hospital admission in the previous year and who live at home. Sixty-one subjects were in the intervention group and 70 in the control group. INTERVENTION:Use of external hip protectors and encouragement to use the protectors by an adherence nurse. MEASUREMENTS:At the time of enrolment into a wider study examining the effect of hip protectors on hip fractures, participants recruited at home completed an assessment of fear of falling and falls efficacy as measured by the Falls Efficacy Scale and the Modified Falls Efficacy Scale. At 4-month follow-up, these scales were readministered by an observer who was not aware of the allocation of the participant to intervention or control groups. RESULTS:Fear of falling and falls self-efficacy, as measured by the Falls Efficacy and Modified Falls Efficacy Scales, were similar at baseline in both groups. Fear of falling was present at follow-up in 43% of subjects using hip protectors and 57% of the control group (chi2 = 2.58, P = 0.11). Hip protector users had greater improvement in falls self-efficacy at follow-up as measured by the Falls Efficacy Scale (t = 2.44, P = 0.016) and the Modified Falls Efficacy Scale (t = 2.08, P = 0.039). CONCLUSION:Hip protectors improve falls self-efficacy. As users of hip protectors feel more confident that they can complete tasks safely, they may become more physically active and require less assistance with activities of daily living.
[Diagnosis of the risk of accidental falls in the elderly].
Therapeutische Umschau. Revue therapeutique
The steep increase in the incidence of hip fractures and other fall-related fractures with advancing age is caused by an age-associated combination of increased fall frequency, typical fall mechanisms and reduced bone strength. This article reviews the current knowledge related to fall risk factors and fall mechanisms. Non-syncopal falls during normal daily activities are predominantly age-associated occurrences with serious consequences. 5% of all falls cause fractures, another 10 to 15% lead to a variety of further injuries. The most serious consequences of the geriatric fall syndrome are fractures of hip, humerus, wrist and pelvis. Fear of falling and self limitation of physical activity are self imposed psychological impairments. There is a pathological cascade from age-associated gait and balance disorders to locomotor falls and further to fall-related fractures. Significantly increased fall risk caused by gait and balance disorders can be considered as a distinct chronic pathological condition. It is strongly age-related and definitely has a multifactorial origin. The term "age-associated multifactorial gait disorder" has been coined for this condition. Assessing fracture risk requires evaluating fall risk, fall mechanisms and bone strength. Older people with gait and balance disorders fall mostly sideways, and the impact of such a fall from standing height generates enough force to break an older non-osteoporotic femur. Osteoporosis can decrease bone strength beyond the age-related grade, and is one of the several most important risk factors for fractures. Prospective studies have consistently found the following independent risk factors for non-syncopal falls: 1. Muscle power of lower extremities, 2. Lateral postural stability, 3. Clinical evaluation of gait, 4. Visual impairment, 5. Four or more different medications or certain psychotropic drugs, 6. Cognitive impairment, and 7. History of falling. The fall-related neuromuscular status can be adequately assessed by three diagnostic procedures: The chair rising test represents muscle power, and has proven its relevance for both fall risk and deterioration of mobility and functional independence. Measurement of lateral postural stability can be done by tandem manoeuvres. Clinical evaluation of gait should focus on the regularity of gait as a cyclic event. The fall risk status of an individual depends strongly on the number of the independent risk factors that one accumulates. Both prevention and therapy must focus on each of these individual risk factors. Preventing falls and its consequences is imperative for successful aging.
Factors predicting fractures during falling impacts among home-dwelling older adults.
Luukinen H,Koski K,Laippala P,Kivelä S L
Journal of the American Geriatrics Society
OBJECTIVE:To investigate the predictors of fractures during falling impacts among home-dwelling older adults. DESIGN:A case-control study within a prospective, population-based survey. SETTING:Five rural municipalities in northern Finland. PARTICIPANTS:The study population consisted of all home-dwelling persons aged 70 or older living in these five municipalities (n = 790 (85%)). The cases for this study were those with fracture, using the first fracture (n = 82) in the analyses, during a follow-up period of 4 years. Controls (n = 82) were selected from among the persons who suffered soft tissue injuries; matching was by age, sex, and location of the first injury during the period. MEASUREMENTS:During a 4-year follow-up period, all falls in the population were recorded using fall diaries, telephone interviews, and information from medical records. Risk factors for fractures during the 4-year follow-up were determined according to the number and severity of previous falls, circumstances and place of falls, disease history, use of medicines, symptoms, clinical examinations and tests, nutritional status, functional abilities and social and health behavior. Cross-tabulations for categorial variables, paired t tests for the means of continuous variables, and conditional logistic regression analysis were performed. RESULTS:According to the bivariate analyses, the risk factors for falls resulting in a fracture were frequent fear of falling, abnormal heel-shin test, reduced knee extension strength, reduced grip strength, poor distance visual acuity, low supine pulse rate, inability to carry a 5-kg load 100 meters, not doing heavy outdoor work, and no habitual exercise. A limited amount of social participation was associated negatively with fracturing. Conditional logistic regression analysis showed that the risk factors for fracture-causing falls were frequent fear of falling (OR 2.50; CI 1.11-5.65), reduced knee extension strength (OR 3.38; CI 1.00-11.4), and poor distance visual acuity (OR 3.45; CI 1.13-10.6), whereas limited social participation (OR 0.29; CI 0.11-0.79) protected against the occurrence of fractures. CONCLUSION:Impaired perception, muscle strength, and psychological and social functioning may influence fracture risk during injurious fall impacts. Studies with larger sample sizes are needed to confirm this and to examine the circumstances and mechanisms contributing to the fracture risk during falls via these risk factors.
[Proximal femoral fractures in the elderly: pathogenesis, sequelae, interventions].
Runge M,Schacht E
Hip fractures are a health problem of paramount importance for the individual and society. They are associated with a sharp increase of the incidence of immobility, dependency, nursing home placement, and death. In Germany, more than 100,000 elderly suffer a hip fracture every year. 90% of fractures of the proximal femur result from a fall with an impact near the hip. The kinetic energy of a fall from standing height without successful protective reactions is far above the fracture threshold of a femur in a man aged 70 and older, regardless of osteoporosis and sex. Therefore, propensity to fall and mechanisms of falling are more important in the pathogenesis of hip fracture than bone mineral density alone. The combination of age-associated gait and balance disorders, which increase the probability of falls, and age-related decreasing strength of the femur is responsible for the high incidence of hip fractures. Besides the interventions to reduce the fall frequency it is possible to decrease the number of hip fractures by a passive protection of the trochanter. An energy-shunting protector (crash helmet-like, hip padding) has been developed by Lauritzen and Lund (safehip). The protector consists of two stiff shells, sewn into special undergarment. The shells disperse the impact away from the trochanter to soft tissue, and increase the area of contact. A controlled study among nursing home residents has demonstrated a relative risk of hip fracture of 0.44 (95% CC 0.21 to 0.94) in the intervention group, i.e., the protector has reduced the number of hip fractures by more than a half. No hip fracture has happened during use of the protector. Using the protector can improve self-confidence and diminish self-restraint of physical activity, which is not rarely caused by fear of falling. Further investigations of compliance are necessary.
Methodology and baseline characteristics for the Sarcopenia and Hip Fracture study: a 5-year prospective study.
Fiatarone Singh Maria A,Singh Nalin A,Hansen Ross D,Finnegan Terence P,Allen Barry J,Diamond Terrence H,Diwan Ashish D,Lloyd Bradley D,Williamson Dominique A,Smith Emma U R,Grady Jodie N,Stavrinos Theodora M,Thompson Martin W
The journals of gerontology. Series A, Biological sciences and medical sciences
BACKGROUND:Age-related hip fractures are associated with poor functional outcomes, resulting in substantial personal and societal burden. There is a need to better identify reversible etiologic predictors of suboptimal functional recovery in this group. METHODS:The Sarcopenia and Hip Fracture (SHIP) study was a 5-year prospective cohort study following community-dwelling older persons admitted to three Sydney hospitals for hip fracture. Information was collected at baseline, and 4 and 12 months, including health status, quality of life, nutritional status, body composition, muscle strength, range of motion, gait velocity, balance, walking endurance, disability, cognition, depression, fear of falling, self-efficacy, social support, physical activity level, vision, and fall-related data, with residential status, disability, and mortality reassessed at 5 years. RESULTS:193 participants enrolled (81 +/- 8 years, 72% women). High levels of activities of daily living, disability and sedentariness were present prior to fracture. At admission, the cohort had high levels of chronic disease; 38% were depressed, 38% were cognitively impaired, and 26% had heart disease. Seventy-one percent of participants were sarcopenic, 58% undernourished, and 55% vitamin D deficient. Mobility, strength, and vision were severely impaired. There was little evidence that these comorbidities were either recognized or treated during hospitalization. Disability, sedentariness, malnutrition, and walking endurance predicted acute hospitalization length of stay. CONCLUSIONS:The complex comorbidity, pre-existing functional impairment, and sedentary behavior in patients with hip fracture suggest the need for thorough screening and targeting of potentially reversible impairments. Rehabilitation outcomes are likely to be highly dependent on amelioration of these highly prevalent accompaniments to hip fracture.
Hip fracture reduction in northwest arkansas nursing homes.
Miles Richard W
Journal of the American Medical Directors Association
INTRODUCTION AND RATIONALE:Hip fracture rates in US nursing homes are alarmingly high, and low treatment rates of osteoporosis suggest a large degree of therapeutic nihilism among health care providers. Reports of reduction in hip fracture rates in the nursing home have been scarce, and experts wonder whether evidence-based treatments, effective in younger populations, will transfer to nursing home residents. METHODS:A practice redesign project was undertaken in response to high rates of hip fracture in northwest Arkansas nursing homes. Hip fracture rates during the 3 years prior to the project were noted to be at benchmark, but were considered excessive. Those who fractured hips were typically not being treated for osteoporosis. The project sought a systematic method for addressing chronic illness, and the rigorous application of evidence-based medicine recommendations with a focus on hip fracture and preventable hospitalizations. There was a commitment to avoid soft reasons to undertreat the elderly, particularly ageism and the fear of polypharmacy. OUTCOME MEASURES:Only 2 outcome measures were tracked before and during the project: hip fracture rates and rates of treatment of osteoporosis. Compliance with an adequate antiresorptive regimen was greatly improved, and a sustained reduction in rates of hip fracture was observed throughout the project. An 8-point post fall assessment was developed as an integral process for sustaining vigilance in patients at highest risk. DISCUSSION:Problems with data collection were encountered and are likely to be typical for quality projects performed with no intention to publish. Because multiple interventions were offered to nursing home residents on an individualized basis, it is not possible to know which of these interventions factored into the outcomes. These interventions were constantly refreshed for patients at highest risk, and the large relative reduction in hip fracture rates suggests a synergistic effect. CONCLUSIONS:These observations suggest that hip fracture rates in nursing home residents can be reduced using a rigorous individualized approach. A similar approach would be reasonable for consideration by other nursing home practitioners.
Balance function and fall-related efficacy in patients with newly operated hip fracture.
Ingemarsson A H,Frändin K,Hellström K,Rundgren A
OBJECTIVE:To investigate the relation between fall-related efficacy in daily-life activities and functional as well as instrumental tests of balance in patients with hip fracture. DESIGN:Analysis of different aspects of balance using the Falls Efficacy Scale, Swedish version FES(S), questions on fear of falling, Functional Reach (FR) and tests on a balance platform (Chattanooga). SUBJECTS:Fifty-five elderly inpatients (mean age 82.3) with newly operated hip fracture who were assessed during the last week in hospital before discharge. RESULTS:The results showed a significant relationship between the subjective ability measured with the FES(S) and the objectively measured balance in the Functional Reach test and also between fall-related efficacy measured with FES(S) and fear of falling. Very few significant correlations were found between the results from balance tests on the force platform and those obtained with FES(S) and FR. CONCLUSIONS:Both the Falls Efficacy Scale, Swedish version, and the Functional Reach have been shown to be useful in analysing balance function in elderly patients newly operated on for hip fracture. The Falls Efficacy Scale also indicates which of the daily activities the patient perceives as troublesome and thus require further training.
Fall-Related Injuries in Community-Dwelling Older Adults in Qom Province, Iran, 2010-2012.
Gilasi Hamid Reza,Soori Hamid,Yazdani Shahram,Taheri Tenjani Parisa
Archives of trauma research
BACKGROUND:Falls and related injuries are common health problems in the elderly. Fractures, brain and internal organ injuries and death are the common consequences of the falls, which result in dependence, decreased self-efficacy, fear of falling, depression, restricted daily activities, hospitalization and admission to the nursing home and impose costs on the individual and the society. OBJECTIVES:The purpose of this study was to determine the types of fall-related injuries and the related risk factors in the elderly population of Qom province, Iran. PATIENTS AND METHODS:This retrospective study was performed on 424 elderly people (65 years and over) referred to Shahid Beheshti Hospital, Qom, Iran, due to falls between 2010 and 2012. The ICD-10 codes of external causes of injury from w00 to w19 related to falls were selected from the health information system of the hospital and demographic variables of the patients and external causes of falls were extracted after accessing the files of the patients. Data were analyzed using SPSS version 18 (SPSS Inc., USA). The duration of hospital stay and its relationship with underlying variables were investigated using t test and ANOVA. The level of significance was considered P < 0.05. RESULTS:Among 424 elderly people, 180 cases (42.45%) were male and the mean age of the patients was 78.65 ± 7.70 years. Fall on the same level from slipping, tripping, and stumbling was the most common external cause with 291 victims (68.60%), and hip fracture in 121 patients (29.00%), intertrochanteric fracture in 112 patients (26.90%), and traumatic brain injury in 51 patients (12.20%) were the most common causes of hospital stay. The mean hospital stay was 7.33 ± 3.63 days. CONCLUSIONS:Lower limb fracture and traumatic brain injury were the most common causes of hospitalization, which resulted in the longest hospital stay and highest hospitalization costs in the elderly.
Recurrent and injurious falls in the year following hip fracture: a prospective study of incidence and risk factors from the Sarcopenia and Hip Fracture study.
Lloyd Bradley D,Williamson Dominique A,Singh Nalin A,Hansen Ross D,Diamond Terrence H,Finnegan Terence P,Allen Barry J,Grady Jodie N,Stavrinos Theodora M,Smith Emma U R,Diwan Ashish D,Fiatarone Singh Maria A
The journals of gerontology. Series A, Biological sciences and medical sciences
BACKGROUND:The incidence and etiology of falls in patients following hip fracture remains poorly understood. METHODS:We prospectively investigated the incidence of, and risk factors for, recurrent and injurious falls in community-dwelling persons admitted for surgical repair of minimal-trauma hip fracture. Fall surveillance methods included phone calls, medical records, and fall calendars. Potential predictors of falls included health status, quality of life, nutritional status, body composition, muscle strength, range of motion, gait velocity, balance, walking endurance, disability, cognition, depression, fear of falling, self-efficacy, social support, physical activity level, and vision. RESULTS:193 participants enrolled in the study (81 +/- 8 years, 72% women, gait velocity 0.3 +/- 0.2 m/s). We identified 227 falls in the year after hip fracture for the 178 participants with fall surveillance data. Fifty-six percent of participants fell at least once, 28% had recurrent falls, 30% were injured, 12% sustained a new fracture, and 5% sustained a new hip fracture. Age-adjusted risk factors for recurrent and injurious falls included lower strength, balance, range of motion, physical activity level, quality of life, depth perception, vitamin D, and nutritional status, and greater polypharmacy, comorbidity, and disability. Multivariate analyses identified older age, congestive heart failure, poorer quality of life, and nutritional status as independent risk factors for recurrent and injurious falls. CONCLUSIONS:Recurrent and injurious falls are common after hip fracture and are associated with multiple risk factors, many of which are treatable. Interventions should therefore be tailored to alleviating or reversing any nutritional, physiological, and psychosocial risk factors of individual patients.
Incidence of falls and their effect on mobility of individuals over 65 years of age relative to their place of residence.
Białoszewski Dariusz,Słupik Anna,Lewczuk Emilia,Gotlib Joanna,Mosiołek Anna,Mierzwińska Anna
Ortopedia, traumatologia, rehabilitacja
BACKGROUND:Nowadays, there are over 300 mln. people aged 65 years or more living in the world. It is estimated that the number will grow to more than 1.5 billion by 2050. The maintenance of physical fitness of the elderly at a level that enables full functional independence for as long as possible should therefore be a priority. Loss of independence leads to long-term medical, social and economic consequences. The problem of falls has only recently been perceived as one of more significant aspects influencing the fitness and independence of individuals over 65. Identifying the scale of the incidence of falls is a prerequisite for initiating prevention activities. The aim of this study was to compare the incidence of falls and their consequences (including fractures and the reduction of physical activity) among persons over 65 years of age living in a big urban area, medium-size and small towns, and rural areas. MATERIAL AND METHODS:The study enrolled 235 inhabitants of a big city (over 1 mln. inhabitants-Warsaw), 85 inhabitants of medium-size and small towns (20-60 thousand inhabitants) and 112 inhabitants of villages (up to 3 thousand inhabitants). The subjects were asked to complete an anonymous questionnaire composed of questions concerning the circumstances of a fall, fracture, fear of another fall and a subjective assessment of mobility before and after a fall. The statistical analysis of the data utilised basic statistical parameters and the following tests: the Mann-Whitney U test, the Wilcoxon signed-rank test and the McNemara test. RESULTS:77% of the inhabitants of towns/cities had suffered a fall, compared to 89% of the inhabitants of villages. The falls most frequently occurred at home and its vicinity (village) and in the street (town/city). Falls had led to fractures in 35-56% of the subjects, depending on the group. Falls led to a significant reduction in mobility--from moderate to low. According to the subjects, this was due to the fear of another fall, an awareness that one was ill and feeling weak, with pain contributing to a smaller extent. Fear of falling occurred significantly more often in the group which had experienced a fall as compared with those with no history of falls. The fear was mainly connected with walking on flat surfaces, climbing stairs, as well as with bending forwards and being in a bathroom. CONCLUSIONS:1. The incidence of falls in the study group was an important problem concerning approx. 81% of the respondents. 2. Fractures, which occurred in about half of subjects, were a dangerous consequence of falls. 3. A fall significantly reduced mobility of the subjects--from moderate to low. 4. The fear of falling was most frequently indicated as the reason for the reduced mobility.
Physical function and fear of falling after hip fracture rehabilitation in the elderly.
Petrella R J,Payne M,Myers A,Overend T,Chesworth B
American journal of physical medicine & rehabilitation
OBJECTIVE:The purpose of this study was to determine the relationship between physical function and fall-related self-efficacy in older patients with a hip fracture who are undergoing an intensive rehabilitation program. DESIGN:We used a prospective cohort study over 12 mo to determine the effect of a specialized hip fracture rehabilitation program in a geriatric hospital on physical function and fear of falling. Fifty-six patients were admitted consecutively from acute care. Physical function was assessed using the Functional Independence Measure, and fall-related self-efficacy was measured using two scales: the Falls-Efficacy scale and the Activities-Specific Balance Confidence scale. We also used the Vitality scale to measure quality of life. All measures, represented by change scores, were determined at the beginning and end of the patients' rehabilitation programs. RESULTS:Significant improvement in physical function and fall self-efficacy was observed. The Vitality scale was also improved after rehabilitation. The Falls-Efficacy scale appeared to be more sensitive to change than the Activities-Specific Balance Confidence scale, whereas no correlation was found between changes in the fall-related self-efficacy measures and the Functional Independence Measure. CONCLUSIONS:These findings may represent a discrepancy between attention of the rehabilitation program on functional outcomes and less emphasis on confidence building behaviors. Restrictions in function from a fear of falling may negate any gains made through rehabilitation, and this could limit the long-term success of these programs and patient outcomes after hip fracture.
The Journey Toward Taking the Day for Granted Again: The Experiences of Rural Older People's Recovery From Hip Fracture Surgery.
Segevall Cecilia,Söderberg Siv,Björkman Randström Kerstin
BACKGROUND:A hip fracture is an unexpected, subjective, traumatic experience that affects the person in both physical and emotional ways. PURPOSE:The purpose of this study was to describe rural older people's experiences of recovering after hip fracture surgery. METHODS:Thirteen individual interviews were conducted with older people. The interview texts were analyzed with qualitative content analysis. RESULTS:Patients described finding themselves in a new and vulnerable situation, dependent on others for simple everyday chores. They struggled to regain independence while staying positive, convinced that they would recover. Fear of another fall, as well as lack of information, made recovery at home difficult. CONCLUSION:Older people who experience hip fractures need support during the recovery process. Because recovery begins at the hospital, this study highlight patients' need to participate in recovery planning, as well as the need to have information about what it means to be affected by a hip fracture and how to prevent it from happening again. This study emphasizes that nurses' awareness of patients' need to participate in planning the recovery process is crucial for enabling patients' return to a daily life that is similar to their prefracture life.
Risk of falls in patients with ankylosing spondylitis.
Dursun Nigar,Sarkaya Selda,Ozdolap Senay,Dursun Erbil,Zateri Coskun,Altan Lale,Birtane Murat,Akgun Kenan,Revzani Aylin,Aktas İlknur,Tastekin Nurettin,Celiker Reyhan
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
BACKGROUND:Risk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. METHODS:Eighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured. RESULTS:Forty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients' BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R =0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000). CONCLUSIONS:Assessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.
Multifactorial intervention for hip and pelvic fracture patients with mild to moderate cognitive impairment: study protocol of a dual-centre randomised controlled trial (OF-CARE).
Dautel Anja,Eckert Tobias,Gross Michaela,Hauer Klaus,Schäufele Martina,Lacroix André,Hendlmeier Ingrid,Abel Bastian,Pomiersky Rebekka,Gugenhan Julia,Büchele Gisela,Reber Katrin C,Becker Clemens,Pfeiffer Klaus
BACKGROUND:A hip or pelvic fracture is a major fall-related injury which often causes a decline in mobility performance and physical activity. Over 40% of patients with hip fracture have cognitive impairment or dementia and poorer rehabilitation outcomes than those without cognitive impairment. In this subgroup, there is a lack of evidence on the best practices supporting recovery. The main aim of this study is to investigate the effects of a transitional care intervention after inpatient rehabilitation on physical activity and functional performance in this group of cognitively impaired patients. METHODS/DESIGN:This dual-centre, randomised controlled trial compares a multifactorial intervention with usual care as control condition. Two hundred and forty community-dwellers (≥ 65 years) with a hip or pelvic fracture and mild to moderate cognitive impairment (MMSE 17-26) are recruited at the end of inpatient rehabilitation. The four-month intervention consists of (a) an individually tailored, progressive home exercise program and physical activity promotion delivered by professional instructors and lay instructors (two home visits per week) and (b) a long-term care counselling approach addressing unmet care needs, pleasurable activities, and caregiver issues if needed. Primary outcome parameters are physical activity, measured as daily walking duration with an accelerometer-based activity monitor (activPAL™) over 72 h, and functional performance, assessed with Short Physical Performance Battery sum scores. Secondary outcome parameters are fear of falling, fall related self-efficacy, falls, quality of life, depression and activity of daily living. Data are collected at the end of rehabilitation, before the intervention at the patient's home (baseline), after four months (post-intervention), and seven months (follow-up). In addition to completer and intent-to-treat analyses of outcomes, economic data and incremental cost-effectiveness are analysed. DISCUSSION:Existing service models of volunteer services and legal counselling provided by care counsellors were considered when developing the intervention protocol. Therefore, it should be feasible to translate and deliver the intervention into real-world practice if it has been demonstrated to be effective. TRIAL REGISTRATION:German Clinical Trials Register, DRKS00008863 (Accessed 17 Apr 2019), ISRCTN registry, ISRCTN69957256 (Accessed 17 Apr 2019).
[Current evidence based interventions for preventing fall and fall-related hip fracture of the older people].
Kanzaki Hideto,Ikezoe Tome,Nagase Tokiko
Nihon rinsho. Japanese journal of clinical medicine
For older people, the consequences of falling include injury, fear of falling, decreased activity, functional deterioration, reduced quality of life, and death. According to reliable systematic reviews and guidelines, exercise programs including balance and strength training, multifactorial interventions, and home safety assessment and modification interventions are effective at reducing the rates of falls and risks of falling among community-dwelling elderly people. Taking vitamin D supplements might be effective for reducing falls in older people who exhibit lower vitamin D levels in the blood. Hip protectors apparently reduce the risk of hip fractures in frail older residents of care facilities. Taking vitamin D with calcium supplements might reduce the risk of hip fractures.
Rehabilitation Utilization for Falls Among Community-Dwelling Older Adults in the United States in the National Health and Aging Trends Study.
Moreland Briana L,Durbin Laura L,Kasper Judith D,Mielenz Thelma J
Archives of physical medicine and rehabilitation
OBJECTIVE:To determine the characteristics of community-dwelling older adults receiving fall-related rehabilitation. DESIGN:Cross-sectional analysis of the fifth round (2015) of the National Health and Aging Trends Study (NHATS). Fall-related rehabilitation utilization was analyzed using weighted multinomial logistic regression with SEs adjusted for the sample design. SETTING:In-person interviews of a nationally representative sample of community-dwelling older adults. PARTICIPANTS:Medicare beneficiaries from NHATS (N=7062). INTERVENTIONS:Not applicable. MAIN OUTCOMES MEASURES:Rehabilitation utilization categorized into fall-related rehabilitation, other rehabilitation, or no rehabilitation. RESULTS:Fall status (single fall: odds ratio [OR]=2.96; 95% confidence interval [CI], 1.52-5.77; recurrent falls: OR=14.21; 95% CI, 7.45-27.10), fear of falling (OR=3.11; 95% CI, 1.90-5.08), poor Short Physical Performance Battery scores (score 0: OR=6.62; 95% CI, 3.31-13.24; score 1-4: OR=4.65; 95% CI, 2.23-9.68), and hip fracture (OR=3.24; 95% CI, 1.46-7.20) were all associated with receiving fall-related rehabilitation. Lower education level (less than high school diploma compared with 4-y college degree: OR=.21; 95% CI, .11-.40) and Hispanic ethnicity (OR=.37; 95% CI, .15-.87) were associated with not receiving fall-related rehabilitation. CONCLUSIONS:Hispanic older adults and older adults who are less educated are less likely to receive fall-related rehabilitation. Recurrent fallers followed by those who fell once in the past year were more likely to receive fall-related rehabilitation than are older adults who have not had a fall in the past year.
Fear of falling, falls efficacy, and health outcomes in older people following hip fracture.
McKee K J,Orbell S,Austin C A,Bettridge R,Liddle B J,Morgan K,Radley Kate
Disability and rehabilitation
PURPOSE:This study sought to determine whether fear of falling and falls efficacy independently contribute to the prediction of health outcomes after a fall, controlling for length of stay in hospital, prefall activity problems, and history of falls. METHOD:Eighty-two older people (> or = 65 years) admitted to hospital as a result of a fall, with proximal femoral fracture, were interviewed to assess variables of interest. At two months after initial interview, participants (n = 57) were re-interviewed in their own home, and their functional limitation and further fall events were assessed. Regression analyses were carried out to determine the ability of the variables assessed in hospital to predict functional limitation and further falls post discharge. RESULTS:Perceived risk of falling and falls efficacy did not explain variance in functional limitation when added to a model containing biomedical factors. In the prediction of further falls, addition of falls efficacy and worry over further falls to a model containing biomedical factors resulted in a statistically reliable improvement, although falls efficacy was not independently associated with outcome. CONCLUSIONS:Assessing worry over further falls in hospital may help to identify older people with hip fracture at risk of poor health outcomes.
Assessing the prevalence of modifiable risk factors in older patients visiting an ED due to a fall using the CAREFALL Triage Instrument.
van Nieuwenhuizen Roos C,van Dijk Nynke,van Breda Fenna G,Scheffer Alice C,Korevaar Johanna C,van der Cammen Tischa J,Lips Paul,Goslings Johannes C,de Rooij Sophia E,
The American journal of emergency medicine
OBJECTIVE:Falls in older people are a common presenting complaint. Knowledge of modifiable risk factors may lead to a more tailored approach to prevent recurrent falls and/or fractures. We investigated prevalence of 8 modifiable risk factors for recurrent falling and/or a serious consequence of the fall among older patients visiting the emergency department after a fall with the Combined Amsterdam and Rotterdam Evaluation of Falls Triage Instrument (CTI), a self-administrated questionnaire that consists of questions concerning demographics, possible cause(s) of the fall, and questions relating to (modifiable) risk factors for falling. METHODS:After treatment for their injuries, 1077 consecutive patients 65 years or older visiting the accident and emergency department due to a fall were evaluated by the CTI. The following were assessed: impaired vision, mobility disorder, fear of falling, mood disorder, high risk of osteoporosis, orthostatic hypotension, incontinence, and polypharmacy. RESULTS:The percentage of respondents who returned the questionnaire was 59.3%. The mean (SD) age was 78.5 (7.5) years, and 57.8% experienced a fall with serious consequences. There were 60.9% of patients with a recurrent fall versus 51% with a first fall who experienced with a serious consequence (P = .025). Age and risk factors mobility disorder (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3), high risk of osteoporosis (OR, 2.0; 95% CI, 1.2-3.2), incontinence (OR, 1.7; 95% CI, 1.0-2.7), fear of falling (OR, 2.2; 95% CI, 1.3-3.7), and orthostatic hypotension (OR, 2.4; 95% CI, 1.4-4.2) were independently associated with a recurrent fall. Age and high risk of osteoporosis were the only risk factors predicting a serious consequence of a fall (OR, 4.6; 95% CI, 2.9-7.2). CONCLUSIONS:Age and 5 modifiable risk factors assessed with the CTI were independently associated with a recurrent fall. Only high risk of osteoporosis was associated with a serious consequence.
The complex interplay of depression and falls in older adults: a clinical review.
Iaboni Andrea,Flint Alastair J
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture prevention guidelines.
Exercise for patients with osteoporosis: management of vertebral compression fractures and trunk strengthening for fall prevention.
PM & R : the journal of injury, function, and rehabilitation
Maintenance of bone health and quality requires mechanical strain, but the mechanical force needs to be within the bone's biomechanical competence. In osteoporosis, compression of vertebral bodies can be insidious. Therefore, absence of pain does not necessarily indicate absence of vertebral microfracture and deformity. Further, patients with previous vertebral fractures are at risk for further vertebral fractures and their associated morbidity. Exercise is a part of the comprehensive management of patients with osteoporosis and has been associated with improvement of quality of life and lowered risk of future fracture. The exercise prescription needs to match the needs of the patient. If exercise is not prescribed properly, then it may have negative consequences. In general, an exercise program, therapeutic or recreational, needs to address flexibility, muscle strength, core stability, cardiovascular fitness, and gait steadiness. As with pharmacotherapy, therapeutic exercises need to be individualized on the basis of musculoskeletal status and an individual's exercise interest. In osteoporosis, axial strength and stability are of primary importance. In particular, a spinal extensor strengthening program should be performed with progressive measured resistance as tolerated. To address falls and fractures, an exercise program should also include balance and lower extremity strength training. Proper dosing of oral cholecalciferol and calcium supplements can enhance the effect of strengthening exercises. Finally, a coordinated approach, such as the Spinal Proprioception Extension Exercise Dynamic (SPEED) program, can improve back extensor strength, the level of physical activity, and locomotion, and reduce back pain and fear and risk of falls.
Balance confidence was associated with mobility and balance performance in older people with fall-related hip fracture: a cross-sectional study.
Portegijs Erja,Edgren Johanna,Salpakoski Anu,Kallinen Mauri,Rantanen Taina,Alen Markku,Kiviranta Ilkka,Sihvonen Sanna,Sipilä Sarianna
Archives of physical medicine and rehabilitation
OBJECTIVE:To study the relationship between balance confidence, a concept closely related to fear of falling, mobility and balance performance, and perceived mobility limitation in older people after a fall-related hip fracture. DESIGN:Cross-sectional analyses of pretrial data of 2 randomized controlled trials of physical rehabilitation. SETTING:University research center. PARTICIPANTS:Community-dwelling people aged over 60 years, 6 weeks to 7.5 years after a fall-related hip fracture (N=130). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:The main outcome was the self-reported Activities-specific Balance Confidence (ABC) scale score. Assessments also included perceived ability to walk outdoors or climb 1 flight of stairs, and assessments of self-preferred walking speed, modified Timed-Up-and-Go test, and Berg Balance Scale. RESULTS:Higher ABC scale scores were related to better mobility and balance performance (ρ>.47) and perceived mobility function (ρ>.54). In univariate general linear models, all associations also remained significant after adjustment for age, sex, time since fracture, number of chronic diseases, and either level of physical activity or muscle strength of the fractured leg. An ABC scale score <85 points identified those with mobility and balance limitation across measures. CONCLUSIONS:In people who have had a fall-related hip fracture, an independent relationship exists between balance confidence and mobility and balance performance as well as perceived mobility function. Since lack of balance confidence may compromise rehabilitation and recovery, the ABC scale may help to identify older hip fracture patients with mobility and balance limitation.
Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density.
Pang M Y C,Eng J J
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
UNLABELLED:Chronic stroke survivors with low hip bone density are particularly prone to fractures. This study shows that fear of falling is independently associated with falls in this population. Thus, fear of falling should not be overlooked in the prevention of fragility fractures in these patients. INTRODUCTION:Chronic stroke survivors with low bone mineral density (BMD) are particularly prone to fragility fractures. The purpose of this study was to identify the determinants of balance, mobility and falls in this sub-group of stroke patients. METHODS:Thirty-nine chronic stroke survivors with low hip BMD (T-score <-1.0) were studied. Each subject was evaluated for the following: balance, mobility, leg muscle strength, spasticity, and fall-related self-efficacy. Any falls in the past 12 months were also recorded. Multiple regression analysis was used to identify the determinants of balance and mobility performance, whereas logistic regression was used to identify the determinants of falls. RESULTS:Multiple regression analysis revealed that after adjusting for basic demographics, fall-related self-efficacy remained independently associated with balance/mobility performance (R2 = 0.494, P < 0.001). Logistic regression showed that fall-related self-efficacy, but not balance and mobility performance, was a significant determinant of falls (odds ratio: 0.18, P = 0.04). CONCLUSIONS:Fall-related self-efficacy, but not mobility and balance performance, was the most important determinant of accidental falls. This psychological factor should not be overlooked in the prevention of fragility fractures among chronic stroke survivors with low hip BMD.
Self-reported consequences and healthcare costs of falls among elderly women.
Alekna Vidmantas,Stukas Rimantas,Tamulaitytė-Morozovienė Inga,Šurkienė Genė,Tamulaitienė Marija
Medicina (Kaunas, Lithuania)
BACKGROUND AND OBJECTIVE:Although the falls in elderly people lead to serious health consequences, the economic burden is underestimated. The aim of this study was to calculate the medical costs of fall consequences in elderly women. MATERIALS AND METHODS:Women aged 65 years and older were interviewed by phone recording the consequences and healthcare procedures related to every fall sustained during the previous 12 months. The healthcare costs were estimated by calculating the sum of costs for all self-reported contacts with medical care providers: ambulance, emergency department, visits to family doctor and other specialists, hospitalisations, and rehabilitation. RESULTS:The study population consisted of 878 community-dwelling women (mean age 72.2±4.8 years). Falls were reported by 310 (35.3%) women; one in three of them had fallen twice or more. Of all women who fell, 280 (90.3%) reported their fall resulted in an injury, and 77 (15.3%) falls led to bone fractures. Fear of falling was reported by 72.9% of women. Fall-related medical care was provided to 135 women (43.5% of those fallen), and 18 (5.8%) subjects were hospitalised, mostly for the fracture. The mean estimated healthcare cost was 254 EUR per patient receiving fall-related medical care, and 116 EUR per women fallen. The highest mean cost (1289 EUR) was estimated in falls resulted in hip fracture; the lowest (135 EUR), in nonfracture injury. CONCLUSION:The data on the self-reported consequences of falls in elderly women showed a significant number of fall-related injuries and a high cost of healthcare.
Motoric Cognitive Risk Syndrome Using Three-Item Recall Test and Its Associations with Fall-Related Outcomes: The Korean Frailty and Aging Cohort Study.
Shim Hayoung,Kim Miji,Won Chang Won
International journal of environmental research and public health
Motoric cognitive risk (MCR) syndrome is originally defined as the presence of subjective cognitive complaints (SCCs) and slow gait (SG). MCR is well known to be useful for predicting adverse health outcomes, including falls and dementia. However, around four out of five older Korean adults reported SCCs, thereby, it may not be discriminative to define MCR in Korea. We adopted the three-item recall (3IR) test, instead of SCCs, to define MCR. This cross-sectional analysis included 2133 community-dwelling older adults aged 70-84 years, without dementia or any dependence in activities of daily living from the Korean Frailty and Aging Cohort Study. The newly attempted criteria of MCR using 3IR were met by 105 participants (4.9%). MCR using 3IR showed synergistic effects on fall-related outcomes, whereas the conventional definition of MCR using SCCs was not superior to SG only. MCR using 3IR was associated with falls (odds ratio [OR]: 1.92; 95% confidence interval (CI): 1.16-3.16), recurrent falls (OR: 2.19; 95% CI: 1.12-4.32), falls with injury (OR: 1.98; 95% CI: 1.22-3.22), falls with fracture (OR: 2.51; 95% CI: 1.09-5.79), fear of falling (OR: 3.00; 95% CI: 1.83-4.92), and low activities-specific balance confidence (OR: 3.13; 95% CI: 1.57-6.25). We found that MCR using 3IR could be useful in predicting fall-related outcomes in a cultural background reporting more SCCs, such as Korea.
Concerns for Older Adult Patients with Acute Hip Fracture.
Yoo Jun Il,Lee Young Kyun,Koo Kyung Hoi,Park Young Jin,Ha Yong Chan
Yonsei medical journal
PURPOSE:The purpose of this study was to identify concerns among older adult patients with acute hip fracture. MATERIALS AND METHODS:This study was performed with 152 consecutive patients with hip fracture. Details were obtained on perioperative concerns about hip fracture using a questionnaire that was specifically designed for this study and was administered face to face upon admission. The study inclusion criteria were age older than 65 years and having experienced femur neck, intertrochanteric, or subtrochanteric fracture. The exclusion criteria were not understanding the study purpose, having difficulty communicating, or refusing to participate. RESULTS:Older adult patients with acute hip fracture expressed concerns regarding excessive pain, medical staff, postoperative recovery, rehabilitation, and hospital expenses. In addition, fear of falling from the bed and anxiety regarding re-fracture were the patients' most significant concerns. CONCLUSION:Older adult patients reported fear of falling from bed and re-fracture as primary concerns. To overcome these concerns, fracture liaison services to prevent re-fracture should be introduced and enforced.
Functional Restriction for the Fear of Falling In Family Caregivers.
Shen Jing,Hu Fangke,Liu Fucun,Tong Peijian
Hip fractures often result from falls, and most family caregivers fear another fall. This study aimed to assess this fear in family caregivers and analyze its influence on functional recovery.This study was retrospectively performed by interview at the clinic or through telephone contact. The Falls Efficacy Scale International (FES-I) was used to assess fall-related feelings of patients and their family caregivers.Of the 539 patients studied, hip fracture was caused by a fall in 467 (86.6%). The mean FES-I value of the family caregivers was significantly lower than that of the patients (85.39 versus 99.02, P < 0.001). The mean patient functional recovery score (FRS) was 68.41. A fracture caused by a fall and recurrent fall-related fractures both reduced caregiver FES-I scores. The difference between patient and caregiver FES-I scores showed a significant positive correlation with the FRS (P < 0.001).Family caregivers were more concerned about falls than were patients. Furthermore, a greater difference in the fall-related reaction between caregivers and patients was associated with greater adverse effects on rehabilitation.
Exercise for reducing fear of falling in older people living in the community.
Kendrick Denise,Kumar Arun,Carpenter Hannah,Zijlstra G A Rixt,Skelton Dawn A,Cook Juliette R,Stevens Zoe,Belcher Carolyn M,Haworth Deborah,Gawler Sheena J,Gage Heather,Masud Tahir,Bowling Ann,Pearl Mirilee,Morris Richard W,Iliffe Steve,Delbaere Kim
The Cochrane database of systematic reviews
BACKGROUND:Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls. OBJECTIVES:To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community. SEARCH METHODS:We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We handsearched reference lists and consulted experts. SELECTION CRITERIA:We included randomised and quasi-randomised trials that recruited community-dwelling people (where the majority were aged 65 and over) and were not restricted to specific medical conditions (e.g. stroke, hip fracture). We included trials that evaluated exercise interventions compared with no intervention or a non-exercise intervention (e.g. social visits), and that measured fear of falling. Exercise interventions were varied; for example, they could be 'prescriptions' or recommendations, group-based or individual, supervised or unsupervised. DATA COLLECTION AND ANALYSIS:Pairs of review authors independently assessed studies for inclusion, assessed the risk of bias in the studies and extracted data. We combined effect sizes across studies using the fixed-effect model, with the random-effect model used where significant statistical heterogeneity was present. We estimated risk ratios (RR) for dichotomous outcomes and incidence rate ratios (IRR) for rate outcomes. We estimated mean differences (MD) where studies used the same continuous measures and standardised mean differences (SMD) where different measures or different formats of the same measure were used. Where possible, we performed various, usually prespecified, sensitivity and subgroup analyses. MAIN RESULTS:We included 30 studies, which evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised. The studies included a total of 2878 participants with a mean age ranging from 68 to 85 years. Most studies included more women than men, with four studies recruiting women only. Twelve studies recruited participants at increased risk of falls; three of these recruited participants who also had fear of falling.Poor reporting of the allocation methods in the trials made it difficult to assess the risk of selection bias in most studies. All of the studies were at high risk of performance and detection biases as there was no blinding of participants and outcome assessors and the outcomes were self reported. Twelve studies were at high risk of attrition bias. Using GRADE criteria, we judged the quality of evidence to be 'low' for fear of falling immediately post intervention and 'very low' for fear of falling at short or long-term follow-up and all other outcomes.Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% confidence interval (CI) 0.18 to 0.56; 24 studies; 1692 participants, low quality evidence). Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling. Although none of the sensitivity analyses changed the direction of effect, the greatest reduction in the size of the effect was on removal of an extreme outlier study with 73 participants (SMD 0.24 favouring exercise, 95% CI 0.12 to 0.36). None of our subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention). However, there was some weak evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control.There was very low quality evidence that exercise interventions may be associated with a small reduction in fear of falling up to six months post intervention (SMD 0.17, 95% CI -0.05 to 0.38; four studies, 356 participants) and more than six months post intervention (SMD 0.20, 95% CI -0.01 to 0.41; three studies, 386 participants).Very low quality evidence suggests exercise interventions in these studies that also reported on fear of falling reduced the risk of falling measured either as participants incurring at least one fall during follow-up or the number of falls during follow-up. Very low quality evidence from four studies indicated that exercise interventions did not appear to reduce symptoms of depression or increase physical activity. The only study reporting the effects of exercise interventions on anxiety found no difference between groups. No studies reported the effects of exercise interventions on activity avoidance or costs. It is important to remember that our included studies do not represent the totality of the evidence of the effect of exercise interventions on falls, depression, anxiety or physical activity as our review only includes studies that reported fear of falling. AUTHORS' CONCLUSIONS:Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community.
Effect of pain on fear of falling in patients with femoral proximal fracture.
Kakihana Hironobu,Koeda Masaya,Kasahara Masashi,Yamashita Taku
Journal of physical therapy science
[Purpose] This study investigated the factors affecting fear of falling in patients with femoral proximal fracture. [Subjects and Methods] The participants were 26 patients with femoral proximal fracture (3 males and 23 females, average age: 80.2 ± 7.9 years). Fall self-efficacy, motor functions, and pain intensity were measured 4 weeks post-surgery, and the participants were divided into three groups based on their scores on the Falls Efficacy Scale. [Results] The group with low fall self-efficacy was significantly older and experienced stronger pain than the group with high fall self-efficacy did. In a multivariate analysis, age and pain intensity were extracted as factors influencing fall self-efficacy. [Conclusion] For patients with femoral proximal fracture, in addition to age, pain was identified as a correlated factor to fear of falling.
Predictors of Fear of Falling among Iranian Older Adults with Hip Fracture and Controls.
Soleimani Robabeh,Jalali Mir Mohammad,Mirbolook Ahmad-Reza
OBJECTIVES:To investigate predictors of fear of falling (FOF) among older people with or without hip fracture. METHODS:The FOF was assessed by the Visual Analogue Scale (VAS-FOF), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). The modified Berg Balance Scale (mBBS) to evaluate functional balance was used. All people were asked to complete the dizziness Handicap Inventory (DHI) and the 36-item Short Form Health Survey (SF-36) for evaluating quality of life. RESULTS:Eighty-eight older adults (44 cases; 44 controls) took part in this study. The case group had received surgical intervention for femoral neck or trochanteric fracture resulting from a fall. The results showed significantly more intensity of FOF in hip fracture patients than controls ( < .001). The FOF was significantly correlated with anxiety, DHI, mBBS, and SF-36. The results of the multiple linear regression showed that four predictors explained about 44% of the variance of the FOF. It was found that mBBS and DHI significantly predicted FOF ( < .001 and < .001, respectively). CONCLUSIONS:The hip fracture patients had a high degree of the fear of falling, low quality of life and low functional capacity. The mBBS and DHI were significant predictors of the FOF in older adults. CLINICAL IMPLICATIONS:It may be useful to employ an inter-disciplinary approach to addressing fear of falling to best understand physiological and psychological contributions.
Educational intervention to reduce falls and fear of falling in patients after fragility fracture: results of a controlled pilot study.
Rucker Diana,Rowe Brian H,Johnson Jeffrey A,Steiner Ivan P,Russell Anthony S,Hanley David A,Maksymowych Walter P,Holroyd Brian R,Harley Charles H,Morrish Donald W,Wirzba Brian J,Majumdar Sumit R
OBJECTIVES:Falls and fear of falling are a major health problem. We sought to determine the effectiveness of an educational intervention in reducing fear of falling and preventing recurrent falls in community-dwelling patients after a fragility fracture. METHODS:One hundred two community-dwelling patients aged 50 years or older who fell and sustained a wrist fracture and were treated at Emergency Departments in Edmonton, Alberta, Canada (2001-2002) were allocated to either standardized educational leaflets and post-discharge telephone counseling regarding fall prevention strategies ("intervention") or attention-controls ("controls"). Main outcomes were fear of falling and recurrent falls 3 months after fracture. RESULTS:Mean age was 67 years and most patients were female (80%). The majority of falls (76%) leading to fracture occurred outdoors. Three months post-fracture, almost half of patients (48%) reported increased fear of falling and 11 of 102 (11%) reported falling again. The intervention did not reduce the fear of falling (43% had increased fear vs. 53% of controls, adjusted P value=0.55) or decrease recurrent falls (17% fell vs. 5% of controls, adjusted P value=0.059) within 3 months of fracture. CONCLUSIONS:An educational intervention undertaken in the Emergency Department was no more effective than usual care in reducing fear of falling or recurrent falls in community-dwelling patients. Future strategies must address a number of dimensions beyond simple education.
Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation.
Pfeiffer Klaus,Kampe Karin,Klenk Jochen,Rapp Kilian,Kohler Michaela,Albrecht Diana,Büchele Gisela,Hautzinger Martin,Taraldsen Kristin,Becker Clemens
Age and ageing
BACKGROUND:fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT. METHODS:one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention. RESULTS:in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45). CONCLUSIONS:the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.
Prevalence of fear of falling in older adults, and its associations with clinical, functional and psychosocial factors: the Frailty in Brazilian Older People-Rio de Janeiro study.
Malini Flávia Moura,Lourenço Roberto Alves,Lopes Claudia S
Geriatrics & gerontology international
AIM:The present study estimated the prevalence of fear of falling in older adults, and its associations with clinical, functional and psychosocial factors. METHODS:Data from the Research Network Frailty in Brazilian Older People, specifically the Rio de Janeiro Study involving participants aged 65 years and older residing in the city of Rio de Janeiro, Brazil, were analyzed. Fear of falling was assessed by the Brazilian version of Falls Efficacy Scale-International. The following variables were assessed: history of falls, fracture after fall, number of comorbidities, number of medications, hospitalization in the previous year, use of walking support device, functional dependency in activities of daily living (including instrumental activities), hearing and visual impairments, hand grip strength, walking speed, self-rated health, depressive symptoms, cognitive impairment, living alone, social support, and activity level. Associations were evaluated by multiple logistic regression. RESULTS:Among the 742 participants, 51.9% had a fear of falling, which was more prevalent in women and older participants. Fear of falling was associated with a history of one to two falls (odds ratio [OR] 2.18; 95% confidence interval [CI] 1.42-3.36), three or more falls (OR 2.72, 95% CI 1.10-6.70), use of seven or more medications (OR 1.70, 95%CI 1.04-2.80), hearing impairment (OR 1.66, 95% CI 1.10-2.49), functional dependence in activities of daily living (OR 1.73, 95% CI 1.07-2.79), diminished gait speed (OR 1.64 95% CI 1.04-2.58), fair self-rated health (OR 1.89, 95% CI, 1.30-2.74), poor/very poor self-rated health (OR 4.92, 95% CI 1.49-16.27) and depressive symptoms (OR 1.68, 95% CI 1.07-2.63). CONCLUSIONS:The prevalence of fear of falling was high in this population, and was associated with history of falls, use of seven or more medications, hearing impairment, functional dependency in activities of daily living, diminished walking speed, fair and poor/very poor self-rated health and depressive symptoms.
Age, Comorbidities and Fear of Fall: mortality predictors associated with fall-related fractures.
Magdalini Velegraki,Petros Ioannou,Constantinos Tsioutis,Garyfalia S Persynaki,Emmanouil Pediaditis,Christos Koutserimpas,George Kontakis,Kalliopi Alpantaki,George Samonis,Symeon H Panagiotakis
To determine mortality predictors following fall related fractures in older patients. Patients aged ≥ 70 years hospitalized for fall related fractures were prospectively evaluated. Mortality was the main outcome. Age, functional-cognitive function, medications, comorbidities, fall history, fear of falls were also assessed. A total of 100 patients were enrolled. Ninety-one out of 100 (91%) suffered a hip fracture; 92 (92%) had surgery. The one-year post-discharge mortality was 20%. Univariate analysis revealed that older age, increased Charlson comorbidity index, low abbreviated mental test on admission, low modified Barthel index (MBI), fear of falls and delirium were significantly correlated with one-year post discharge mortality (p=.03, p=.003, p=.04, p=.005, p=.004, p=.015, respectively). Age, fear of falls and Charlson comorbidity index are predictors of one-year mortality after hospitalization for fracture. It is of utmost importance to identify older patients suffering from fracture at risk of dying that may benefit from patient-centered care.
A new measure of fear of falling: psychometric properties of the fear of falling questionnaire revised (FFQ-R).
Bower Emily S,Wetherell Julie Loebach,Merz C Caroline,Petkus Andrew J,Malcarne Vanessa L,Lenze Eric J
BACKGROUND:Although fear of falling is prevalent among older adults recovering from hip fracture, current instruments are inadequate due to focus on specific situations and measurement of self-efficacy rather than fear. METHODS:The authors revised and tested a form of the Fear of Falling Questionnaire with three groups of older adults: 405 recovering from hip fracture, 89 healthy community dwelling, and 42 with severe fear of falling. Test-retest reliability was evaluated in a subsample of 16 hip fracture patients. Internal consistency was compared across all groups. Construct validity was established through factor analysis, convergent validity with a measure of fall-related self-efficacy, and discriminant validity with measures of depression and affect. RESULTS:A revised two-factor, six-item scale appears to have adequate psychometric properties. Scores were lower in the healthy comparison group relative to the hip fracture and fear of falling groups. Cronbach's α ranged from 0.72-0.83, with test-retest reliability of 0.82. Correlations with a measure of fall-related self-efficacy were moderate for the hip fracture group (0.42) and high with the healthy comparison (0.68) and fear of falling (0.70) groups. Correlations with depression and negative and positive affect were low to moderate. CONCLUSIONS:The Fear of Falling Questionnaire - Revised shows promise as a self-report measure of fear of falling, and is one of the first to be tested in older adults recovering from hip fracture. Advantages are that it is global rather than situation-specific and measures fear rather than self-efficacy. Future research on this scale is recommended in other older adult samples for whom fear of falling is relevant.
Severity of fall-based injuries, fear of falling, and activity restriction: sex differences in a population-based sample of older Canadian adults.
LeBouthillier Daniel M,Thibodeau Michel A,Asmundson Gordon J G
Journal of aging and health
OBJECTIVES:Little is known about how different fall-based injuries relate to fear of falling and activity restriction, and if these relationships differ between sexes. We explored fear of falling and activity restriction in individuals who have experienced fall-based injuries. METHODS:A total of 16,369 older adults from the Canadian Community Health Survey reported their worst fall-based injury, whether they experience fear of falling, and whether they restrict activities from fear of falling. RESULTS:Females had greater odds of fear of falling than males. Only females who experienced a fracture or head injury had increased odds of fear of falling and only females who experienced a head injury had increased odds of restricting activities compared with females who fell without injury. DISCUSSION:Only severe fall-based injuries are associated with fear of falling and activity restriction, and this relationship is unique to females. Sex differences warrant further investigation and suggest a need for targeted interventions.
Hip and pelvic fracture patients with fear of falling: development and description of the "Step by Step" treatment protocol.
Kampe Karin,Kohler Michaela,Albrecht Diana,Becker Clemens,Hautzinger Martin,Lindemann Ulrich,Pfeiffer Klaus
OBJECTIVE:Based on a theoretical framework and sound evidence, this article describes a rehabilitation programme for patients with fear of falling after hip and pelvic fracture. RATIONALE:Based on exercise science principles, current knowledge from fall prevention, emotion regulation, and the Health Action Process Approach we developed a theoretical framework, from which the components of the intervention were derived. Description of the intervention: The intervention consists of 6 components: (1) relaxation, (2) meaningful activities and mobility-based goals, (3) falls related cognitions and emotions, coping with high risk tasks and situations, (4) individual exercise programme, (5) planning and implementing exercises and activities, and (6) fall risks and hazards. The intervention comprises of 8 individual sessions during 3 to 5 weeks of inpatient rehabilitation and 4 telephone calls and 1 home visit over a 2-month post-discharge period. Each session or telephone call takes about 30-60 minutes. It is provided to geriatric hip and pelvic fracture patients with concerns about falling and no cognitive impairment. To ensure completeness of reporting, the Template for Intervention Description and Replication (TIDierR) is used. RESULTS:Fifty-seven patients were assigned to the intervention group. All 46 completers met all pre-defined criteria for an intervention per protocol. CONCLUSION:The programme is feasible to administer. We have completed a randomised controlled trial, which will be submitted in due time (for trial protocol: www.isrctn.org ; ISRCTN79191813).
Correlates of fear of falling and falls efficacy in geriatric patients recovering from hip/pelvic fracture.
Eckert Tobias,Kampe Karin,Kohler Michaela,Albrecht Diana,Büchele Gisela,Hauer Klaus,Schäufele Martina,Becker Clemens,Pfeiffer Klaus
OBJECTIVE:To gain a better understanding about the nature of fear of falling, this study analyzed associations between psychological and physical aspects related to fear of falling and falls efficacy in hip/pelvic fracture patients. DESIGN:Baseline data of a randomized controlled trial. SETTING:Geriatric inpatient rehabilitation hospital. SUBJECTS:In all, 115 geriatric patients with hip/pelvic fracture (mean age: 82.5 years) reporting fear of falling within first week of inpatient rehabilitation. INTERVENTIONS:None. MAIN MEASURES:Falls efficacy (Short Falls Efficacy Scale-International; Perceived Ability to Manage Falls), fear of falling (one-item question), fall-related post-traumatic stress symptoms (six items based on (4th ed.; -IV) criteria), physical performance (Short Physical Performance Battery) and psychological inflexibility (Acceptance and Action Questionnaire-II) were assessed. RESULTS:Path analyses demonstrated that low falls efficacy (Short Falls Efficacy Scale International) was significantly related to poor physical performance (* = -.277, ⩽ .001), but not to psychological inflexibility and fall-related post-traumatic stress symptoms ( ⩾ .05.). Fear of falling was directly associated with fall-related post-traumatic stress symptoms (*= .270, = .007) and indirectly with psychological inflexibility (*= .110, = .022). Low perceived ability to manage falls was significantly related to previous falls (* = -.348, ⩽ .001), psychological inflexibility (* = -.216, = .022) and female gender (* = -.239, ⩽ .01). CONCLUSION:Falls efficacy and fear of falling constitute distinct constructs. Falls efficacy measured with the Short Falls Efficacy Scale International reflects the appraisal of poor physical performance. Fear of falling measured by the single-item question constitutes a fall-specific psychological construct associated with psychological inflexibility and fall-related post-traumatic stress symptoms.