Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study.

BACKGROUND: comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. OBJECTIVE: to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. DESIGN: complementary mixed-methods pre-post study, based on an embedded quasi-experimental model. SETTING: geriatric fracture centre. METHODS: qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12 weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. RESULTS: thirty community-dwelling patients aged ≥65 years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. CONCLUSION: as patients' individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population.

Influence of lower limb isokinetic muscle strength and power on the occurrence of falls in community-dwelling older adults: A longitudinal study.

INTRODUCTION: Previous studies have highlighted the association between lower limb muscle strength and falls in older adults. However, a comprehensive understanding of the specific influence of each lower limb muscle group on fall occurrences remains lacking. OBJECTIVE: This study aimed to investigate the impact of knee, ankle, and hip muscle strength and power on falls in older adults, with the goal of identifying which muscle groups are more predictive of fall risk in this population. METHODS: This longitudinal observational study enrolled 94 community-dwelling older adults. Muscle strength and power of the ankle's plantiflexors and dorsiflexors, knee flexors and extensors, and hip flexors, extensors, adductors, and abductors were assessed using a Biodex System 4 Pro® isokinetic dynamometer. Fall occurrences were monitored through monthly telephone contact over a year. RESULTS: Participants, with a median age of 69 years (range 64-74), included 67% women, and 63.8% reported a sedentary lifestyle. Among them, 45,7% of older adults were classified as fallers. Comparative analyses revealed that non-fallers displayed significantly superior isokinetic muscle strength in the hip abductors and adductors, along with higher muscle power in the hip abductors, hip flexors, and knee flexors compared to fallers. Multivariate logistic regression analysis indicated that a 1 Nm/Kg increase in hip abductor strength reduced the chance of a fall by 86.3%, and a 1 Watt increase in hip flexor power reduced the chance of a fall by 3.6%. CONCLUSION: The findings indicate that hip abductor strength and hip flexor power can be considered protective factors against falls in independent older adults in the community. These findings may contribute to developing effective fall-prevention strategies for this population.

Enhancing knowledge, attitude, and perceptions towards fall prevention among older adults: a pharmacist-led intervention in a primary healthcare clinic, Gemas, Malaysia.

BACKGROUND: Falls and fall-related injuries are very common among older adults, and the risk of falls increases with the aging process. The lack of awareness of falls and fall-related injuries among older adults can contribute to an increasing risk of falls. Hence, a study was carried out to improve the knowledge, attitude, and perception of falls and fractures among older adults in a primary care setting in Gemas, a rural area of the Selangor state of Malaysia. METHOD: A structured educational intervention was provided to older adults who visited the primary care setting in Gemas and provided written informed consent to participate in the study. A total of 310 older adult patients was included in the study using a convenience sampling technique. RESULTS: Before the intervention, 74.84% of the respondents (n = 232) agreed that falls and related fractures are the leading causes of hospital admission among older adults. In post-intervention, the number of respondents who agreed with this statement increased to 257 (82.91%). At baseline, 28 respondents (9.03%) had poor knowledge, 160 respondents (51.61%) had average knowledge levels, and 122 respondents (39.35%) had good knowledge. In post-intervention, respondents with poor and average knowledge reduced to 1.93% (n = 6) and 29.35% (n = 91) respectively. A majority of respondents' knowledge levels improved significantly after the intervention (n = 213; 68.71%). About eight respondents (2.58%) had a negative perception of falls. In post-intervention, the percentage reduced to 0.65% as only two respondents had a negative perception. A total of 32 types of fall-risk-increasing drugs (FRIDs) have been prescribed to the respondents. A strong correlation (r = 0.89) between pre- and post-intervention knowledge was shown among the respondents. Paired t-test analysis showed a statistically significant difference. CONCLUSION: The pharmacist-led educational intervention significantly improved the knowledge, attitude, and perception of falls among older adults. More structured and periodical intervention programmes are warranted to reduce the risk of falls and fractures among older adults.

[Indicators and outcomes associated with the quality of care: how to use them and interpret results]. / Indicatori ed esiti associati alla qualità dell'assistenza: come usarli e come interpretare i risultati.

. Indicators and outcomes associated with the quality of care: how to use them and interpret results. Outcomes related to care (or nursing sensitive outcomes) such as pressure ulcers, failure to rescue, accidental falls are specific patient outcomes influenced by nursing care. They are used to monitor the quality of care and patient safety in hospitals across the country. However, their association with nursing care is not always clear, and the attention should be focused on avoidable events. From the following issue a reflection on the main indicators will be proposed with some hints on how to collect data and interpret the results.

[Association between the severity of neurocognitive disorders and the seriousness of falls in the elderly]. / Association entre la sévérité des troubles neurocognitifs et la gravité des chutes chez les personnes âgées.

Falls cause severe morbidity and mortality in people over 65 years old in all countries. Cognitive frailty is considered to be one of the risk factors for falls in the elderly. Approximately 60% of the elderly with neurocognitive disorders fall annually and this is two times more compared to elderly with no cognitive impairment. We already know that neurocognitive disorders and their severity are a risk factor for falls in older people. Few studies are conducted to investigate the association between the severity of neurocognitive disorders and the severity of falls. This study is therefore interested in investigating the association between the severity of neurocognitive disorders and the serious falls in the elderly. This is a non-interventional retrospective study of 100 patients admitted for fall in a geriatric hospital. The correlation between MMSE and fall severity remains uncertain. Serious falls are more frequent in patients with Parkinsonian syndromes, but this result is not statically significant. Polypharmacy remains very prevalent in our population with 70 % of patients having more than four drugs. Polydrug use in our study was very high, with 70% of patients taking more than four medications. We did not find a statistically significant association between the severity of neurocognitive disorders evaluated with the MMSE and the serious falls. More studies with tailored neurocognitive testing are needed to investigate the link between executive function disorders and the serious of falls.

Silhoutte of Deaths In Connection With Fatal Fall from Height Injuries.

As medicolegal consultant, we often encounter cases of fall from height related deaths which are invariably subjected to medicolegal autopsy and the numbers are gradually increasing day by day. During the study period of three years data were collected by using a pre-tested structured proforma, police inquest reports, hospital records and thorough medicolegal autopsy done at Chittagong Medical College Mortuary. This retrospective autopsy based study revealed 175 cases of fall from height casualties out of the total 2850 autopsies. We observed that the age group of 41-50 years i.e. 55 cases were mostly affected followed by 31-40 years i.e. in 40 cases. Males (144) were the main sufferers than the females (31). Maximum victims were construction workers 57 cases (32.57%) followed by 45 factory workers (25.71%). Construction sites were the main place of fall i.e. in 57 cases (32.57%) followed by working places 46 cases (26.28%). Most of the victims had head-neck injuries i.e. in 143 cases (81.71%) followed by thoracic injury 82 cases (46.85%). Multiple injuries i.e. in 92 cases (52.57%) were the main cause of death followed by head-neck injuries in 79 cases (45.14%). These casualties are definitely preventable by adopting safety measures and by educating the workers in the factories and construction sites.

Dispositional mindfulness: Is it related to knee osteoarthritis population's common health problems?

BACKGROUND: A growing body of research supports dispositional mindfulness as important in influencing physical and mental health as well as physical activities in patients with chronic illnesses. Knee osteoarthritis (OA), which often causes health problems, is one of the most common chronic illnesses, but less is known about dispositional mindfulness in relation to this condition. OBJECTIVE: To explore possible associations between dispositional mindfulness and physical and mental health as well as physical activity in knee OA patients. METHODS: For this cross-sectional study, we recruited a purposive sample of orthopedic clinic patients in hospitals in Southern Taiwan. Instruments included the Mindful Attention Awareness Scale (MAAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health-related characteristics were also measured. Demographic statistics, bivariate correlations, and multiple linear regression informed our exploration of potentially related factors for dispositional mindfulness. RESULTS: Participants with knee OA (N = 250) were mostly elderly (88%), female (70.5%), and married (84%). Marital status, perceived health status, depression, and physical activity were associated with dispositional mindfulness. Better perceived health, lower depression, and greater physical activity were significantly associated with greater dispositional mindfulness. However, the severity of symptoms, fear of falling, and exercise self-efficacy did not reach statistical significance in relation to dispositional mindfulness. CONCLUSION: Greater emphasis should be placed on the cultivation of mindfulness to enhance individuals' perceived health, decrease their depressive mood, and promote their engagement in physical activity, which could indirectly alleviate their experience of pain and improve their physical function, yielding better quality of life and well-being. Future research should focus on interventions to apply dispositional mindfulness in order to determine whether dispositional mindfulness can effectively improve physical and mental health as well as physical activity in those with knee OA.

Association between postoperative fall history and toe grip strength in patients after total knee arthroplasty: A prospective observational study.

BACKGROUND: Factors associated with falls after total knee arthroplasty (TKA) have been rarely reported. The aim of this study was to identify factors that influence the incidence of falls after TKA, focusing on toe grip strength (TGS) in particular, which has been associated with falls in older adults. METHODS: 217 patients who underwent TKA were included and followed up for 1 year. Main study outcome measures were the presence or absence of falls within 1 year after TKA. Multiple logistic regression analysis was used with postoperative falls as the dependent variable and preoperative falls and postoperative TGS on the affected sides as independent variables. RESULTS: 170 (43 and 127 in the fall and non-fall groups) patients were included in the analysis. The presence of a preoperative falls history before TKA and a weak postoperative affected TGS indicated an increased susceptibility of the patient to fall postoperatively. CONCLUSIONS: Results of the current study revealed the association between postoperative TGS and postoperative falls. We highlight the importance of preoperative fall monitoring and postoperative TGS evaluation to prevent falls after TKA.

Preact to lower the risk of falling by customized rehabilitation across Europe: the feasibility study protocol of the PRECISE project in Italy.

Introduction: Falls are a major worldwide health problem in older people. Several physical rehabilitation programs with home-based technologies, such as the online DigiRehab platform, have been successfully delivered. The PRECISE project combines personalized training delivered through the application with an artificial intelligence-based predictive model (AI-DSS platform) for fall risk assessment. This new system, called DigiRehab, will enable early identification of significant risk factors for falling and propose an individualized physical training plan to attend to these critical areas. Methods: The study will test the usability of the DigiRehab platform in generating personalized physical rehabilitation programs at home. Fifty older adults participants will be involved, 20 of them testing the beta version prototype, and 30 participants testing the updated version afterwards. The inclusion criteria will be age ≥65, independent ambulation, fall risk (Tinetti test), Mini Mental State Examination ≥24, home residents, familiarity with web applications, ability and willingness to sign informed consent. Exclusion criteria will be unstable clinical condition, severe visual and/or hearing impairment, severe impairment in Activities of Daily Living and absence of primary caregiver. Discussion: The first part of the screening consists in a structured questionnaire of 10 questions regarding the user's limitations, including the risk of falling, while the second consists in 10 physical tests to assess the functional status. Based on the results, the program will help define the user's individual profile upon which the DSS platform will rate the risk of falling and design the personalized exercise program to be carried out at home. All measures from the initial screening will be repeated and the results will be used to optimize the predictive algorithms in order to prepare the tool in its final version. For the usability assessment, the System Usability Scale will be administered. The follow-up will take place after the 12-week intervention at home. A semi-structured satisfaction questionnaire will also be administered to verify whether the project will meet the needs of older adults and their family caregiver. Conclusion: We expect that personalized training prescribed by DigiRehab platform could help to reduce the need for care in older adults subjects and the care burden.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05846776].

A dangerous tradition: retrospective analysis of celebratory gunfire-related injuries in three tertiary hospitals.

BACKGROUND: Firing guns into the air during celebrations is a tradition that poses significant risks to public safety. These falling bullets, often referred to as tired bullets, can attain high velocities during their descent and have the potential to cause serious injury or death to people and animals, or significant damage to property upon impact. METHODS: This study aimed to retrospectively detect and analyze incidents of celebratory gunfire-related injuries (CGRI) that were admitted to three different hospitals in two cities in Turkey over a 10-year period from 2014 to 2023. RESULTS: Data collected from Trabzon Kanuni Training and Research Hospital, Karadeniz Technical University Faculty of Medicine Farabi Hospital, and Yeditepe University Kozyatagi Hospital revealed 48 cases of injuries attributed to celebratory gunfire. Of these cases, 64.6% involved male victims. Children aged 0-17 years were the most affected demographic, with the head, neck, and face being the most frequently injured areas. The majority of incidents occurred in rural areas. Eight cases (16.7%) resulted in fatalities. The reasons for gunfire in 43.8% of the cases could not be determined. CONCLUSION: Sociologically, gun ownership is often associated with prestige and can trigger the use of firearms in celebrations, such as weddings, in some societies. However, this tradition can result in tragic consequences worldwide. Stricter regulations and legal frameworks are necessary to prevent the use of unlicensed weapons. Collaborative efforts are crucial for effectively addressing the societal normalization of celebratory gunfire. Future prospective studies can comprehensively evaluate the incidence of CGRI and identify effective preventive strategies to safeguard public health.

Fall prediction in a quiet standing balance test via machine learning: Is it possible?

The elderly population is growing rapidly in the world and falls are becoming a big problem for society. Currently, clinical assessments of gait and posture include functional evaluations, objective, and subjective scales. They are considered the gold standard to indicate optimal mobility and performance individually, but their sensitivity and specificity are not good enough to predict who is at higher risk of falling. An innovative approach for fall prediction is the machine learning. Machine learning is a computer-science area that uses statistics and optimization methods in a large amount of data to make outcome predictions. Thus, to assess the performance of machine learning algorithms in classify participants by age, number of falls and falls frequency based on features extracted from a public database of stabilometric assessments. 163 participants (116 women and 47 men) between 18 and 85 years old, 44.0 to 75.9 kg mass, 140.0 to 189.8 cm tall, and 17.2 to 31.9 kg/m2 body mass index. Six different machine learning algorithms were tested for this classification, which included Logistic Regression, Linear Discriminant Analysis, K Nearest-neighbours, Decision Tree Classifier, Gaussian Naive Bayes and C-Support Vector Classification. The machine learning algorithms were applied in this database which has sociocultural, demographic, and health status information about participants. All algorithm models were able to classify the participants into young or old, but our main goal was not achieved, no model identified participants at high risk of falling. Our conclusion corroborates other works in the biomechanics field, arguing the static posturography, probably due to the low daily living activities specificity, does not have the desired effects in predicting the risk of falling. Further studies should focus on dynamic posturography to assess the risk of falls.

From an obliquely falling rod in a viscous fluid to the motion of suspended magnetic bead chains that are driven by a gradient magnetic field and that make an arbitrary angle with the magnetic force vector: A Stokes flow study.

In view of the growing role of magnetic particles under magnetic field influence in medical and other applications, and perforce the bead chaining, it is important to understand more generally the chain dynamics. As is well known, in the presence of a magnetic field, magnetic beads tend to form chains that are aligned with the magnetic field vector. In addition, if there is a magnetic field gradient, there will be a magnetic force acting on this chain. The main goal of the present research is to study the motion of a magnetic bead chain that makes an arbitrary angle with the magnetic force vector in the Stokes flow limit, that is, in the limit of zero Reynolds number. We used the public-domain computer program HYDRO++ to calculate the mobility matrix, which relates the magnetic force acting on the chain to the velocity of the chain, for a chain of N beads making an arbitrary angle with the magnetic force vector. Because of the presence of off-diagonal elements of the mobility matrix, as the chain is drawn in the direction of the magnetic force, it is also deflected to the side. We derived analytic solutions for this motion. Also, for bead chains moving in directions both parallel and perpendicular to their lengths, we fit three-parameter functions to solutions from HYDRO++. We found the fits to be excellent. Combining these results with the analytic solutions, we obtained expressions for the velocity components for the bead chains that provide excellent fits to HYDRO++ solutions for arbitrary angles. Finally, we apply the methodology used for the bead chain studies to the study of an obliquely falling rod in a viscous fluid and derive analytic solutions for the velocity components of the obliquely falling rod.

Timed Up and Go test score and factors associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries-a cross-sectional study.

Introduction: Peripheral artery and aorta diseases contribute to complex consequences in various areas, as well as increasing physical and mental discomfort resulting from the progressive limitation or loss of functional capacities, in particular in relation to walking, decreased endurance during physical exercise, a drop in effort tolerance, and pain suffered by patients. Limitations in functional capacities also increase the risk of falls. Most falls take place during the performance of simple activities. The aim of this study was to investigate factors associated with moderate-to-high risk of future falls in patients scheduled for vascular surgeries. Methods: This cross-sectional study included patients aged 33-87, scheduled for vascular surgeries. Based on the Timed Up and Go test, patients were categorized as having a moderate-to-high (≥ 10 s) or low risk of falls. Multiple logistic regression was carried out to assess the relationship between fall-risk levels and independent sociodemographic and clinical variables. Results: Forty-eight percent of patients were categorized as having a moderate-to-high risk of future falls. Females (OR = 1.67; Cl95%: 1.07-2.60) and patients who suffered from hypertension (OR = 2.54; Cl95%: 1.19-5.40) were associated with a moderate-to-high risk of future falls. The Barthel Index correlated negatively (OR = 0.69; Cl95%: 0.59-0.80), while age correlated positively with fall-risk levels (OR = 1.07; Cl95%: 1.02-1.12). Conclusion: Factors that may be associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries include age, female gender, hypertension, and the Barthel Index.

Lower-Limb Exoskeletons Appeal to Both Clinicians and Older Adults, Especially for Fall Prevention and Joint Pain Reduction.

Exoskeletons are a burgeoning technology with many possible applications to improve human life; focusing the effort of exoskeleton research and development on the most important features is essential for facilitating adoption and maximizing positive societal impact. To identify important focus areas for exoskeleton research and development, we conducted a survey with 154 potential users (older adults) and another survey with 152 clinicians. The surveys were conducted online and to ensure a consistent concept of an exoskeleton across respondents, an image of a hip exoskeleton was shown during exoskeleton-related prompts. The survey responses indicate that both older adults and clinicians are open to using exoskeletons, fall prevention and joint pain reduction are especially important features, and users are likely to wear an exoskeleton in the scenarios when it has the greatest opportunity to help prevent a fall. These findings can help inform future exoskeleton research and guide the development of devices that are accepted, used, and provide meaningful benefit to users.

Reducing falls among residents of retirement homes: A DNP project.

ABSTRACT: Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.

Nursing Interventions to Empower Family Caregivers to Manage the Risk of Falling in Older Adults: A Scoping Review.

Falls pose a significant risk to older adults, resulting in injuries and declining quality of life. The psychological impact, particularly the fear of falling, impairs their well-being. This pervasive fear affects daily activities, leading to self-imposed limitations and reduced engagement. This review aimed to identify nursing interventions to empower family caregivers to manage the risk of falling in older adults. A scoping review was developed following the JBI framework. We searched the CINAHL, MEDLINE, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials, MedicLatina, and Cochrane Database of Systematic Reviews. The findings of this review revealed that out of 460 initially identified records, nine articles met the eligibility criteria and were retained for further in-depth analysis. These articles provided insights into nine distinct categories of nurse interventions: Therapeutic Relationships, Family Involvement, Personalized Care, Health Education, Multifactorial Falls Risk Assessment, Home Modifications, Referral, Transition Between Healthcare Services, and Health Care Consultants. The findings of this review have significant implications for clinical practice, particularly in emphasizing the crucial role of nurses in empowering family caregivers and older adults to manage the risk of falling at home. Healthcare professionals, policymakers, and researchers can benefit from this informative resource to develop strategies and guidelines.