Effect of a coaching intervention to enhance physical activity and prevent falls in community-dwelling people aged 60+ years: a cluster randomised controlled trial.

OBJECTIVES: To evaluate the effect of a coaching intervention compared with control on physical activity and falls rate at 12 months in community-dwelling people aged 60+ years. DESIGN: Cluster randomised controlled trial. SETTING: Community-dwelling older people. PARTICIPANTS: 72 clusters (605 participants): 37 clusters (290 participants) randomised to the intervention and 35 (315 participants) to control. INTERVENTION: Intervention group received written information, fall risk assessment and prevention advice by a physiotherapist, activity tracker and telephone-based coaching from a physiotherapist focused on safe physical activity. Control group received written information and telephone-based dietary coaching. Both groups received up to 19 sessions of telephone coaching over 12 months. OUTCOMES: The co-primary outcomes were device-measured physical activity expressed in counts per minute at 12 months and falls rate over 12 months. Secondary outcomes included the proportion of fallers, device-measured daily steps and moderate-to-vigorous physical activity (MVPA), self-reported hours per week of physical activity, body mass index, eating habits, goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being and disability. RESULTS: The mean age of participants was 74 (SD 8) years, and 70% (n=425) were women. There was no significant effect of the intervention on device-measured physical activity counts per minute (mean difference 5 counts/min/day, 95% CI -21 to 31), or falls at 12 months (0.71 falls/person/year in intervention group and 0.87 falls/person/year in control group; incidence rate ratio 0.86, 95% CI 0.65 to 1.14). The intervention had a positive significant effect on device-measured daily steps and MVPA, and self-reported hours per week of walking, well-being, quality of life, and disability. No significant between-group differences were identified in other secondary outcomes. CONCLUSION: A physical activity and fall prevention programme including fall risk assessment and prevention advice, plus telephone-based health coaching, did not lead to significant differences in physical activity counts per minute or falls rate at 12 months. However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability. TRIAL REGISTRATION NUMBER: ACTRN12615001190594.

Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years.

OBJECTIVES: Falls in older people can lead to serious injury and significant societal health and financial burden. Obstructive sleep apnoea (OSA) is associated with impaired gait/balance and may increase fall risk, yet few studies examined whether treating OSA reduces fall risk. This study examined the effect of continuous positive airway pressure (CPAP) on fall risk markers in people over 65yrs diagnosed with OSA. DESIGN: Single arm intervention study. SETTING: University and tertiary care CPAP clinic. PARTICIPANTS: Individuals over 65 years diagnosed with OSA and recommended CPAP. INTERVENTION: 3-6 months CPAP therapy. MEASUREMENTS: 28 participants had a physiological profile assessment (PPA) at baseline and following 3-6 months of CPAP. The PPA examines visual contrast sensitivity, lower limb proprioception, knee extension strength, reaction time and postural sway to generate a fall risk score (FRS). t-tests were used to determine difference between pre- and post-treatment FRS. Regression was used to examine the associations between CPAP use and daytime sleepiness with FRS. RESULTS: CPAP significantly reduced the FRS ([Mean ± SD] 0.59 ± 1.0 vs 0.04 ± 1.1, p = 0.016), contrast sensitivity and lower limb proprioception (P < 0.05). Increased CPAP use was associated with improvement in FRS in unadjusted analysis (ß = -0.213, 95%CI -0.371 to -0.056, p = 0.01). Reduction in Epworth sleepiness score was associated with a reduction in FRS in unadjusted (p = 0.023) and adjusted analysis (adjusted for AHI p = 0.027 or O2Nadir p = 0.015). CONCLUSIONS: CPAP may reduce fall risk in people over 65yrs, possibly related to better CPAP adherence and reduced daytime sleepiness. Future controlled trials and mechanistic studies are needed to elucidate how CPAP may reduce fall risk.

Pain, balance, and mobility in people 1 year after total knee arthroplasty: a non-randomized cross-sectional pilot study contrasting posterior-stabilized and medial-pivot designs.

BACKGROUND: Total knee arthroplasty (TKA) is a common treatment for severe knee osteoarthritis. Medial-pivot TKA systems (MP-TKA) are theoretically better than posterior-stabilized TKA systems (PS-TKA) in improving static and dynamic balance of patients although it is difficult to objectively quantify these balance parameters in a clinical setting. Therefore, this pilot study aimed to evaluate the feasibility of using wearable devices in a clinical setting to examine whether people with MP-TKA have better postoperative outcomes than PS-TKA, and their balance control is more akin to age-matched asymptomatic controls. METHODS: The current cross-sectional pilot study recruited 57 participants with 2 different prosthesis designs (20 PS-TKA, 18 MP-TKA) and 19 asymptomatic controls. At 1-year post-TKA, pain, knee stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Static balance, mobility, and gait stability of the participants were evaluated based on data collected from wearable motion sensors during the near tandem stance, timed-up-and-go, and 6-min walk tests. RESULTS: Compared to asymptomatic controls, both TKA groups reported significantly more pain and stiffness and demonstrated reduced functional mobility, increased stride-time-variability, and impaired balance. After Bonferroni adjustment, no significant differences in pain, balance, and mobility performance were observed between PS-TKA and MP-TKA participants 1 year after surgery. However, there was a trend for increased anteroposterior sway of the lumbar and head regions in the MP-TKA participants when undertaking the near tandem stance test. The wearable motion sensors were easy to use without any adverse effects. CONCLUSIONS: It is feasible to use wearable motion sensors in a clinical setting to compare balance and mobility performance of patients with different TKA prothesis designs. Since this was a pilot study and no definite conclusions could be drawn, future clinical trials should determine the impacts of different TKA prosthesis designs on post-operative outcomes over a longer follow-up period.

The use of predictive fall models for older adults receiving aged care, using routinely collected electronic health record data: a systematic review.

BACKGROUND: Falls in older adults remain a pressing health concern. With advancements in data analytics and increasing uptake of electronic health records, developing comprehensive predictive models for fall risk is now possible. We aimed to systematically identify studies involving the development and implementation of predictive falls models which used routinely collected electronic health record data in home-based, community and residential aged care settings. METHODS: A systematic search of entries in Cochrane Library, CINAHL, MEDLINE, Scopus, and Web of Science was conducted in July 2020 using search terms relevant to aged care, prediction, and falls. Selection criteria included English-language studies, published in peer-reviewed journals, had an outcome of falls, and involved fall risk modelling using routinely collected electronic health record data. Screening, data extraction and quality appraisal using the Critical Appraisal Skills Program for Clinical Prediction Rule Studies were conducted. Study content was synthesised and reported narratively. RESULTS: From 7,329 unique entries, four relevant studies were identified. All predictive models were built using different statistical techniques. Predictors across seven categories were used: demographics, assessments of care, fall history, medication use, health conditions, physical abilities, and environmental factors. Only one of the four studies had been validated externally. Three studies reported on the performance of the models. CONCLUSIONS: Adopting predictive modelling in aged care services for adverse events, such as falls, is in its infancy. The increased availability of electronic health record data and the potential of predictive modelling to document fall risk and inform appropriate interventions is making use of such models achievable. Having a dynamic prediction model that reflects the changing status of an aged care client is key to this moving forward for fall prevention interventions.

Modifiable intrinsic factors related to occupational falls in older workers.

AIM: Identification of modifiable intrinsic factors for occupational falls is required for initiating effective fall prevention strategies for older workers. This study aimed to identify modifiable intrinsic factors related to falls during occupational activities among older workers. METHODS: This retrospective study involved 1164 older workers (aged ≥60 years, workdays ≥4/month) sampled from 18 public employment agencies for seniors in Saitama, Japan. Participants were assessed regarding the following 10 modifiable intrinsic factors: multimorbidity, polypharmacy, fall-risk-increasing medication use, self-rated vision and hearing, functional strength, bilateral stepping, standing balance, executive function and visuospatial ability. The number of falls during occupational activities in the past year was also recorded. RESULTS: In total, 111 falls occurred in 73 of the 1164 participants during occupational activities in the past year. A negative binomial regression model showed that use of fall-risk-increasing medications (incidence rate ratio [IRR]: 2.23, 95% confidence interval [CI]: 1.08, 4.60, P = 0.031), reduced functional strength (IRR: 1.81, 95% CI: 1.02, 3.21, P = 0.042), poor standing balance (IRR: 1.83, 95% CI: 1.09, 3.09, P = 0.023) and poor visuospatial ability (IRR: 1.56, 95% CI: 1.03, 2.36, P = 0.034) were independently associated with occupational falls. CONCLUSIONS: Our findings suggest that the assessment of medication use, functional strength, standing balance and visuospatial ability in regular health checks in the workplace may be useful for screening older workers at risk of occupational falls. Geriatr Gerontol Int 2022; 22: 338-343.

Statistical analysis plan for the coaching for healthy AGEing trial - a cluster-randomised controlled trial to enhance physical activity and prevent falls in community-dwelling older people.

BACKGROUND: This statistical analysis plan details the Coaching for Healthy AGEing (CHAnGE) trial analysis methodology. OBJECTIVE: To investigate the effect of a combined physical activity and fall prevention program on physical activity and falls compared to a healthy eating among people aged 60 years and over. METHODS: The CHAnGE trial is a pragmatic parallel-group cluster-randomised controlled trial with allocation concealment and blinded assessors. Clusters are allocated to either (1) a physical activity and fall prevention intervention or (2) to a healthy eating intervention. The primary outcomes are: objectively measured physical activity at 12 months post-randomisation, and self-reported falls throughout the 12-month trial period. Secondary outcomes include the proportion of participants reporting a fall, the proportion of participants meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and use of health and community services. ANALYSIS: We will follow the intention-to-treat principle. All analysis will allow for cluster randomisation using a generalised estimating equation approach. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression models adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will take into account cluster randomisation and will be adjusted for baseline scores. A subgroup analysis will assess differential effects of the intervention by baseline physical activity levels and history of falls.

Androgen deprivation in prostate cancer: benefits of home-based resistance training.

INTRODUCTION: Androgen deprivation therapy (ADT) has detrimental effects on body composition, metabolic health, physical functioning, bone mineral density (BMD) and health-related quality of life (HRQOL) in men with prostate cancer. We investigated whether a 12-month home-based progressive resistance training (PRT) programme, instituted at the start of ADT, could prevent these adverse effects. METHODS: Twenty-five patients scheduled to receive at least 12 months of ADT were randomly assigned to either usual care (UC) (n = 12) or PRT (n = 13) starting immediately after their first ADT injection. Body composition, body cell mass (BCM; a functional component of lean body mass), BMD, physical function, insulin sensitivity and HRQOL were measured at 6 weeks and 6 and 12 months. Data were analysed by a linear mixed model. RESULTS: ADT had a negative impact on body composition, BMD, physical function, glucose metabolism and HRQOL. At 12 months, the PRT group had greater reductions in BCM by - 1.9 ± 0.8 % (p = 0.02) and higher gains in fat mass by 3.1 ± 1.0 % (p = 0.002), compared to the UC group. HRQOL domains were maintained or improved in the PRT versus UC group at 6 weeks (general health, p = 0.04), 6 months (vitality, p = 0.02; social functioning, p = 0.03) and 12 months (mental health, p = 0.01; vitality, p = 0.02). A significant increase in the Matsuda Index in the PRT versus UC group was noted at 6 weeks (p = 0.009) but this difference was not maintained at subsequent timepoints. Between-group differences favouring the PRT group were also noted for physical activity levels (step count) (p = 0.02). No differences in measures of BMD or physical function were detected at any time point. CONCLUSION: A home-based PRT programme instituted at the start of ADT may counteract detrimental changes in body composition, improve physical activity and mental health over 12 months. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, ACTRN12616001311448.

Impact of pain on reactive balance and falls in community-dwelling older adults: a prospective cohort study.

BACKGROUND: pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known. OBJECTIVE: to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults. DESIGN: 12-month prospective cohort study. SETTING: community. SUBJECTS: 242 community-dwelling older adults aged 70+ years. METHODS: participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months. RESULTS: participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures. CONCLUSIONS: older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.

Tai Chi Improves Cognition and Plasma BDNF in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial.

BACKGROUND: Effects of Tai Chi (TC) on specific cognitive function and mechanisms by which TC may improve cognition in older adults with amnestic mild cognitive impairment (a-MCI) remain unknown. OBJECTIVE: To examine the effects of TC on cognitive functions and plasma biomarkers (brain-derived neurotrophic factor [BDNF], tumor necrosis factor-α [TNF-α], and interleukin-10 [IL-10]) in a-MCI. METHODS: A total of 66 older adults with a-MCI (mean age = 67.9 years) were randomized to either a TC (n = 33) or a control group (n = 33). Participants in the TC group learned TC with a certified instructor and then practiced at home for 50 min/session, 3 times/wk for 6 months. The control group received educational material that covered information related to cognition. The primary outcome was cognitive performance, including Logical Memory (LM) delayed recall, Block Design, Digit Span, and Trail Making Test B minus A (TMT B-A). The secondary outcomes were plasma biomarkers, including BDNF, TNF-α, and IL-10. RESULTS: At the end of the trial, performance on the LM and TMT B-A was significantly better in the TC group compared with the control group after adjusting for age, gender, and education ( P < .05). Plasma BDNF level was significantly increased for the TC group, whereas the other outcome measures were similar between the 2 groups after adjusting for age and gender ( P < .05). CONCLUSIONS: TC training significantly improved memory and the mental switching component of executive function in older adults with a-MCI, possibly via an upregulation of BDNF.

Health coaching and pedometers to enhance physical activity and prevent falls in community-dwelling people aged 60†years and over: study protocol for the Coaching for Healthy AGEing (CHAnGE) cluster randomised controlled trial.

INTRODUCTION: Prevention of falls and promotion of physical activity are essential for maximising well-being in older age. However, there is evidence that promoting physical activity among older people without providing fall prevention advice may increase fall rates. This trial aims to establish the impact of a physical activity and fall prevention programme compared with a healthy eating programme on physical activity and falls among people aged 60+ years. METHODS AND ANALYSIS: This cluster randomised controlled trial will involve 60 groups of community-dwelling people aged 60+ years. Participating groups will be randomised to: (1) a physical activity and fall prevention intervention (30 groups), involving written information, fall risk assessment and prevention advice, a pedometer-based physical activity tracker and telephone-based health coaching; or (2) a healthy eating intervention (30 groups) involving written information and telephone-based dietary coaching. Primary outcomes will be objectively measured physical activity at 12 months post-randomisation and self-reported falls throughout the 12-month trial period. Secondary outcomes include: the proportion of fallers, the proportion of people meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and health and community service use. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will be preplanned, conducted while masked to group allocation, will take into account cluster randomisation, and will use an intention-to-treat approach. ETHICS AND DISSEMINATION: Protocol has been approved by the Human Research Ethics Committee at The University of Sydney, Australia (number 2015/517). Results will be disseminated via peer-reviewed journal articles, international conference presentations and participants' newsletters. TRIAL REGISTRATION NUMBER: ACTRN12615001190594.

Vitamin D response of older people in residential aged care to sunlight-derived ultraviolet radiation.

UNLABELLED: The aim of this study was to determine the vitamin D response to sunlight ultraviolet radiation in older people. Increases in vitamin D depended on the season of exposure, but the changes were small. Natural sun exposure is not a practical intervention for vitamin D deficiency in this population. PURPOSE: The purpose of this study is to measure the ultraviolet radiation (UVR) exposure of those in residential aged care in an earlier trial of sunlight exposure and to determine its effect on their vitamin D response. METHODS: Attendance data, demographic, clinical and biochemical variables for 248 participants were used for a secondary analysis of a previous cluster randomized trial of sunlight exposure and falls. The ambient solar UV Index data were used to calculate the participants' UVR dose. Multiple linear regression was used to test if UVR exposure over 6 months, as measured by the standard erythemal dose (SED), was a predictor of vitamin D response, controlling for age, gender, BMI, calcium intake, baseline vitamin D and season of exposure. RESULTS: The median 25-hydroxyvitamin D (25OHD) was 32.4 nmol/L at baseline and 34.6 nmol/L at 6 months (p = 0.35). The significant predictors of 25OHD at 6 months were UVR exposures in spring-summer (coefficient = 0.105, 95 % confidence interval (CI) 0.001-0.209, p = 0.05) and autumn-winter (coefficient = 0.056, 95 % CI 0.005-0.107, p = 0.03) and baseline vitamin D (adjusted coefficient = 0.594, 95 % CI 0.465-0.724, p = 0.00). In those starting sunlight sessions in spring, an increase of 1 unit in log SED was associated with 11 % increase in 25OHD. CONCLUSIONS: Natural UVR exposure can increase 25OHD levels in older people in residential care, but depends on the season of exposure. However, due to inadequate sun exposure, 25OHD did not reach optimal levels. Nevertheless, where sun exposure is encouraged in this group, the focus for the start of exposure should be in the months of spring or autumn, as this timing was associated with a vitamin D response.

The role of exercise for fall prevention in older age / El papel del ejercicio para la prevención de caídas en la vejez / O papel do exercício na prevenção de quedas entre idosos

Falls are a common, costly and preventable consequence of sensorimotor impairments that increase in prevalence with advancing age. A fall occurs when the physical ability of the individual is unable to match the immediate demands of the environment and/or of the activity being undertaken. Targeted exercise aimed at improving the physical ability of the individual, such as balance and strength training, is crucial for promoting functional independence and mobility and reducing the risk of falling in older age. Exercise programs that provide a high challenge to balance, have a high dose, include progression of intensity over time and are ongoing are most effective for preventing falls. This paper provides guidance to health professionals involved with the prescription of physical activity and exercise to older people regarding the safe and effective provision of programs aimed at improving strength and balance and preventing falls in older age.

As quedas são uma consequência comum, caras e evitáveis decorrentes das deficiências sensoriomotoras que aumentam em incidência com o avanço da idade. A queda ocorre quando a capacidade física do indivíduo não responde às demandas imediatas do ambiente e/ou da atividade realizada. Exercícios específicos destinados a melhorar a capacidade física do indivíduo, tais como equilíbrio e treinamento de força, são fundamentais para promover a independência funcional e mobilidade, e reduzir o risco de cair em idade mais avançada. Programas de exercício que oferecem um desafio maior ao equilíbrio, oferecidos com frequência, que incluem a progressão da intensidade ao longo do tempo e sem interrupção são mais eficazes para a prevenção de quedas. Este documento fornece orientações para os profissionais de saúde envolvidos com a prescrição de atividade física e exercício físico para pessoas idosas em relação à prestação segura e eficaz de programas destinados a melhorar a força e equilíbrio e prevenção de quedas na velhice.

Las caídas son una consecuencia común, costosa y prevenibles de discapacidades sensoriomotoras resultantes de ese aumento de la incidencia con la edad. La caída se produce cuando la capacidad física del individuo no responde a las exigencias inmediatas del medio ambiente y/o de la actividad desarrollada. Los ejercicios específicos diseñados para mejorar la capacidad física del individuo, tales como el equilibrio y entrenamiento de la fuerza, es crucial para promover la independencia funcional y la movilidad, y reducir el riesgo de caer en la vejez. Los programas de ejercicios que ofrecen un mayor desafío al equilibrio, se ofrece con frecuencia, incluyendo la progresión de la intensidad con el tiempo y sin interrupción son los más efectivos para la prevención de caídas. Este documento proporciona una guía para los profesionales de la salud implicados en la prescripción de la actividad física y el ejercicio para las personas ancianas con respecto a la prestación segura y eficaz de los programas destinados a mejorar la fuerza y el equilibrio y la prevención de caídas en la vejez.

Change in vision, visual disability, and health after cataract surgery.

PURPOSE: Cataract surgery improves vision and visual functioning; the effect on general health is not established. We investigated if vision, visual functioning, and general health follow the same trajectory of change the year after cataract surgery and if changes in vision explain changes in visual disability and general health. METHODS: One-hundred forty-eight persons, with a mean (SD) age of 78.9 (5.0) years (70% bilateral surgery), were assessed before and 6 weeks and 12 months after surgery. Visual disability and general health were assessed by the CatQuest-9SF and the Short Formular-36. RESULTS: Corrected binocular visual acuity, visual field, stereo acuity, and contrast vision improved (P < 0.001) from before to 6 weeks after surgery, with further improvements of visual acuity evident up to 12 months (P = 0.034). Cataract surgery had an effect on visual disability 1 year later (P < 0.001). Physical and mental health improved after surgery (P < 0.01) but had returned to presurgery level after 12 months. Vision changes did not explain visual disability and general health 6 weeks after surgery. CONCLUSIONS: Vision improved and visual disability decreased in the year after surgery, whereas changes in general health and visual functioning were short-term effects. Lack of associations between changes in vision and self-reported disability and general health suggests that the degree of vision changes and self-reported health do not have a linear relationship.

Pain and anxiety mediate the relationship between dizziness and falls in older people.

OBJECTIVES: To identify medical, psychological, and physiological mediators of the relationship between dizziness and falls in older adults. DESIGN: Secondary analysis of a prospective cohort study. SETTING: Community. PARTICIPANTS: Five hundred sixteen community-dwelling adults aged 73 to 92. MEASUREMENTS: Participants completed questionnaires related to health and psychological well-being and underwent a tilt table blood pressure test, the Physiological Profile Assessment (PPA; vision, reaction time, proprioception, postural sway, and quadriceps strength), and leaning balance tests. Prospective falls data were collected using monthly calendars for 12 months. Participants were categorized into dizzy and nondizzy groups based on self-report of dizziness, vertigo, and light-headedness. RESULTS: Two hundred seventeen (42%) participants reported vertigo or dizziness (10%), light-headedness (16%), or both (16%). The dizzy participants were significantly more likely to report neck and back pain, past transient ischemic attacks, and feeling dizzy upon upright tilting. They also had poorer balance and less strength and scored higher on measures of depression and anxiety (P < .05). There were no blood pressure measurement-related differences between the groups. Dizziness increased the risk of multiple falls in an unadjusted analysis (relative risk (RR) = 1.55, 95% confidence interval = 1.08-2.23). After controlling for PPA scores, neck and back pain and anxiety were mediators that reduced the RR of the relationship between dizziness and faller status the most (14%) in a modified Poisson regression model. CONCLUSION: Suffering from neck and back pain and anxiety were mediators of the relationship between dizziness and falls after controlling for poor sensorimotor function and balance. Older people with dizziness might benefit from interventions targeting these mediators such as pain management and cognitive behavioral therapy.

Identifying older people at high risk of future falls: development and validation of a screening tool for use in emergency departments.

BACKGROUND: Hospital emergency departments (EDs) treat a high proportion of older people, many as a direct consequence of falling. OBJECTIVE: To develop and externally validate a fall risk screening tool for use in hospital EDs and to compare the tool's predictive ability to existing screening tools. METHODS: This prospective cohort study involved two hospital EDs in Sydney, Australia. Potential participants were people aged 70+ years who presented to the ED after falling or with a history of 2+ falls in the previous year and were subsequently discharged. 219 people participated in the tool development study and 178 people participated in the external validation study. Study measures included number of fallers during the 6-month follow-up period, and physical status, medical history, fall history and community service use. RESULTS: 31% and 35% of participants fell in the development and external validation samples, respectively. The developed two-item screening tool included: 2+ falls in the past year (OR 4.18, 95% CI 2.61 to 6.68) and taking 6+ medications (OR 1.89, CI 1.18 to 3.04). The area under the receiver operating characteristic curve (AUC) was 0.70 (0.64-0.76). This represents significantly better predictive ability than the measure of 2+ previous falls alone (AUC 0.67, 0.62-0.72, p=0.02) and similar predictive ability to the FROP-Com (AUC 0.73, 0.67-0.79, p=0.25) and PROFET screens (AUC 0.70, 0.62-0.78, p=0.5). CONCLUSIONS: A simple, two-item screening tool demonstrated good external validity and accurately discriminated between fallers and non-fallers. This tool could identify high risk individuals who may benefit from onward referral or intervention after ED discharge.

Identification of high risk fallers among older people living in residential care facilities: a simple screen based on easily collectable measures.

PURPOSE: To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls. METHODS: This prospective study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated. Demographics, medical history, medication use, cognition (mini mental state examination (MMSE)), function (Barthel, balance and sit-to-stand ability) and behavior (neuro-psychiatric inventory (NPI) and impulsivity) were recorded at baseline. Falls and injuries were prospectively recorded over 6 months. Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis. RESULTS: Two hundred and forty residents completed the study. In the follow-up period, 50% fell ≥1 times. Fallers had worse function, cognition, behavior and balance and took more medications. Falling in the past year, walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling. Logistic regression identified MMSE<17, impulsivity score ≥ 2, standing balance score<6, requiring a walking frame, falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls. The area under the receiver operating curve (ROC) for this model was 0.79 (95% CI 0.73-0.84). CONCLUSIONS: This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period. The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group.

Associations between drug burden index and falls in older people in residential aged care.

OBJECTIVES: To evaluate the association between the Drug Burden Index (DBI), a measure of a person's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people, and falls in residents of residential aged care facilities (RACFs). DESIGN: Data were drawn from participants in a randomized controlled trial that investigated falls and fractures. SETTING: RACFs in Sydney, Australia. PARTICIPANTS: Study participants (N=602; 70.9% female) were recruited from 51 RACFs. Mean age was 85.7 ± 6.4, and mean DBI was 0.60 ± 0.66. MEASUREMENTS: Medication history was obtained on each participant. Drugs were classified as anticholinergic or sedative and a DBI was calculated. Falls were measured over a 12-month period. Comorbidity, cognitive impairment (Mini-Mental State Examination) and depression (Geriatric Depression Scale) were determined. RESULTS: There were 998 falls in 330 individuals during a follow-up period of 574.2 person-years, equating to an average rate of 1.74 falls per person-year. The univariate negative binomial regression model for falls showed incidence rate ratios of 1.69 (95% confidence interval (CI)=1.22-2.34) for low DBI (<1) and 2.11 (95% CI=1.47-3.04) for high DBI (≥1) when compared with those who had a DBI of 0. After adjusting for age, sex, history of falling, cognitive impairment, depression, use of a walking aid, comorbidities, polypharmacy, and incontinence, incident rate ratios of 1.61 (95% CI=1.17-2.23) for low DBI and 1.90 (95% CI=1.30-2.78) for high DBI were obtained. CONCLUSION: DBI is significantly and independently associated with falls in older people living in RACFs. Interventional studies designed for this population are needed to determine whether reducing DBI, through dose reduction or cessation of anticholinergic and sedative drugs, can prevent falls.

Vision and falls in older people: risk factors and intervention strategies.

Poor vision impairs balance and increases the risk of falls and fractures in older people. Multifocal glasses can add to this risk by impairing contrast sensitivity, depth perception, and ability to negotiate obstacles. Vision assessment and provision of new spectacles may not reduce, and may even increase, the risk of falls. Restriction of the use of multifocal glasses may reduce falls in active older people. Other effective fall prevention strategies include maximizing vision through cataract surgery and occupational therapy interventions in visually impaired older people.