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 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].

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.

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.

Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis.

Background: Older adults experience a significant decline in muscle integrity and function with aging. Early detection of decreased muscle quality can pave the way for interventions to mitigate the progression of age-related physical declines. Phase angle (PhA) and impedance ratio (IR) are measures of muscle integrity, which can be assessed quickly via bioelectrical impedance analysis (BIA) and may be indicative of physical function. Objective: This study aimed to characterize the relationships among handgrip strength (HGS), sit-to-stand (STS), BTrackS balance scores, fear of falling (evaluated using the Short Falls Efficacy Scale-International [Short FES-I]), and IR among community-dwelling older adult women classified as having a low or high PhA. Methods: A cross-sectional analysis was conducted with 85 older women (mean age 75.0, SD 7.2 years; mean weight 71.0, SD 15.0 kg; mean height 162.6, SD 6.1 cm). To examine the influence of PhA on performance measures, participants were divided into 2 PhA groups: high (>4.1°; n=56) and low (≤4.1°; n=29). Data were nonnormative; hence, the Mann-Whitney U test was used to evaluate between-group differences, and Kendall τ coefficients were used to determine the partial correlations. Results: The low PhA group had a significantly higher IR (mean 0.85, SD 0.03) than the high PhA group (mean 0.81, SD 0.03; r=.92; P<.001). The high PhA group had superior HGS (mean 21.4, SD 6.2 kg; P=.007; r=0.36), BTrackS balance scores (mean 26.6, SD 9.5 cm; P=.03; r=0.30), and STS scores (mean 16.0, SD 5.5; P<.001; r=0.49) than the low PhA group (mean HGS 17.6, SD 4.7 kg; mean BTrackS balance score 37.1, SD 21.1 cm; mean STS score 10.7, SD 6.2). Both PhA and IR were significantly correlated with HGS and BTrackS balance, STS, and Short FES-I scores (P<.05). However, on adjusting for the whole sample's age, only PhA was strongly correlated with HGS (τb=0.75; P=.003) and STS scores (τb=0.76; P=.002). Short FES-I scores were moderately correlated with IR (τb=0.46; P=.07) after controlling for age. No significant between-group differences were observed for height, weight, or BMI. Conclusions: PhA and IR are associated with physical function and the fear of falling in older women. However, only PhA was significantly associated with physical function (HGS and STS) independent of age. Conversely, only IR was significantly associated with the fear of falling. Diminished physical function and increased IR appear to be characteristics of older women with a PhA of ≤4.1°. These findings suggest that PhA and IR measured through BIA together may serve as a valuable tool for early identification of older women at the risk of functional decline and a heightened fear of falling.

The effects of different types of Tai Chi exercises on preventing falls in older adults: a systematic review and network meta-analysis.

OBJECTIVES: Few studies comparing the effects of different types of Tai Chi exercises on preventing falls in older adults. We compared the effects for finding an optimal intervention. METHODS: We searched 12 databases, including PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI) and so on, from their inception to January 13, 2023. Randomized controlled trials incorporating different types of Tai Chi for preventing falls in older adults were included. The outcome measures were the incidence of falls and Berg Balance Scale (BBS). Network meta-analysis (NMA) was conducted using Stata 15.1 based on a frequentist framework. RESULTS: Seventeen trials were eligible, including 3470 participants and four types of Tai Chi. They were 24-form simplified Tai Chi (24-form), Yang style Tai Chi (Yang style), Sun style Tai Chi (Sun style) and Tai Chi exercise program (TCEP). In paired meta-analysis, for incidence of falls, 24-form (Relative Risk (RR) = 0.59, 95% confidence interval (CI) [0.40, 0.86]) was more efficient than the control group. For BBS outcome, 24-form (MD (mean difference) = 2.32, 95% CI [1.42, 3.22]) was better than the control group. In the NMA, the results of incidence of falls were as follows: 24-form > Yang style > Sun style > control > TCEP. The rank probability of BBS was as follows: 24-form > TCEP > Yang style > control. CONCLUSION: Among the four types of Tai Chi studied, the 24-form simplified Tai Chi has shown better efficacy than other types.

The mediating effect of nutrition on oral frailty and fall risk in community-dwelling elderly people.

BACKGROUND: Population aging is accelerating, particularly in Asian countries. Falls are the leading cause of unintentional injuries in the elderly over 60 years old in China. Hence, it is crucial to anticipate the risk factors associated with fall risk. We aimed to explore whether oral frailty and fall risk were reciprocally related and whether nutrition mediated their association. METHODS: From October 2022 to March 2023, a total of 409 elderly individuals from the Yangzhou community were selected using the convenience sampling method. Cross-sectional data on older adults' oral frailty, nutrition, and fall risk were collected using questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro. RESULTS: The fall risk score was 1.0 (ranging from 0 to 4.0), with 107 cases (26.2%) identified as being at risk of falling. Spearman correlation analysis revealed a positive correlation between oral frailty and the risk of falls (rs = 0.430, P < 0.01). Nutrition was found to have a negative correlation with both oral frailty and fall risk (rs=-0.519、-0.457, P < 0.01). When controlling for covariates, it was observed that nutrition mediated the relationship between oral frailty and falls. The mediating effect value accounted for 48.8% of the total effect (P < 0.01). CONCLUSIONS: Oral frailty was significantly associated with fall risk, and nutrition might be a mediating factor for adverse effects of oral frailty and fall risk. Enhancing the nutrition of older individuals is a vital approach to mitigating fall risk among those with oral frailty.

Body composition, balance, functional capacity and falls in older women.

BACKGROUND: The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women. METHODS: The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The women were assigned to exercise intervention (n = 457) and control groups (n = 457). Clinical measurements were conducted at baseline, 12 months and 24 months. RESULTS: During the 2-year follow up, total of 546 women (59.7%) sustained a fall. The total number of falls was 1380 and out of these, 550 (40%) of falls were non-injurious and 745 (54%) were injurious. Higher femoral neck bone mineral density (BMD) was associated with a higher overall risk of falls [RR = 2.55 (95% CI = 1.70-3.84, p < 0.001)], but was a protective factor for severe fall injuries [RR = 0.03 (95% CI = 0.003-0.035, p < 0.01)]. Slower Timed Up and Go (TUG) was associated with an increased overall risk of falls [RR = 1.07 (95% CI = 1.05-1.10, p < 0.001)] and injuries requiring medical attention [RR = 1.10 (95% CI = 1.02-1.19, p = 0.02)]. Longer single leg standing time was a protective factor for falls [RR = 0.99 (95% CI = 0.99-1.00, p < 0.01)] and overall injurious falls [RR = 0.99 (95% CI = 0.99-1.00, p = 0.02)]. CONCLUSION: For postmenopausal women with higher femoral neck BMD appear to sustain more falls, but have a lower risk of severe fall injuries. Better TUG and single leg standing time predict lower risk of falls and fall injuries.

Comparison across age groups of causes, circumstances, and consequences of falls among individuals living in Canada: A cross-sectional analysis of participants aged 45 to 85 years from the Canadian Longitudinal Study on Aging.

Falls are a leading cause of injury-related deaths and hospitalizations among Canadians. Falls risk has been reported to be increased in individuals who are older and with certain health conditions. It is unclear whether rurality is a risk factor for falls. This study aimed to investigate: 1) fall profiles by age group e.g., 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 85 years; and 2) falls profiles of individuals, by age group, living in rural versus urban areas of Canada. Data (N = 51,338) from the Canadian Longitudinal Study on Aging was used to examine the relationship between falls and age, rurality, chronic conditions, need for medical attention, and fall characteristics (manner, location, injury). Self-reported falls within a twelve-month period occurred in only 4.8% (single fall) and 0.8% (multiple falls) of adults. Falls were not related to rural residence or age, but those with memory impairment, multiple sclerosis, as well as other chronic conditions such as mood disorder, anxiety disorder, and hyperthyroidism not often thought to be associated with falls, were also more likely to fall. Older individuals were more likely to fall indoors or fall while standing or walking. In contrast, middle-aged individuals were more likely to fall outdoors or while exercising. Type of injury was not associated with age, but older individuals were more likely to report hospitalization after a fall. This study shows that falls occur with a similar frequency in individuals regardless of age or urban/rural residence. Age was associated with fall location and activity. A more universally applicable multi-facted approach, rather than one solely based on older age considerations, to screening, primary prevention and management may reduce the personal, social, and economic burden of falls and fall-related injuries.

Effects of Taekkyon-based exercise program on balance, lower extremity strength, and gait parameters in community-dwelling older women: Randomized controlled trial.

BACKGROUND: As individuals age, they experience a decline in muscle strength and balance, leading to diminished functional capacity and an increased risk of falls. The purpose of the current study was to investigate the effects of the Taekkyon-based exercise program on balance, muscle strength, and gait ability in women aged over 65-year-old residing in the local community. METHODS: Forty-eight subjects were randomly allocated into the Taekkyon-based exercise program as an experimental group (EG = 25; mean age: 71.68 ±â€…3.26) or a fall prevention program as a control group (CG = 23; mean age: 73.65 ±â€…5.88). EG participants received 1-hour Taekkyon exercise sessions twice a week for 12 consecutive weeks. CG participants received a typical fall prevention program. The measurements in each group included assessments of balance levels (the timed up-and-go test, one-leg stance, and functional reach test), lower extremity strength (the 5-chair stand test and 30-second chair stand test), and gait parameters (cadence, step length, step width, stride length, stride time, and gait velocity) before and after the intervention. RESULTS: After the intervention, balance (timed up-and-go test, one-leg stance, and functional reach test), lower extremity strength (5-chair stand test and 30-second chair stand test), and gait parameters (cadence, stride time, and gait velocity) showed a significant improvement in EG participants compared to CG participants (P < .05). Compared to the normal value of balance ability and strength of elderly women over 65 years of age, most outcomes were greater than average normal values for those receiving Taekkyon exercise. CONCLUSION: Taekkyon-based exercise program was more effective in improving balance, lower extremity strength, and gait capacity than the usual fall prevention program in elderly women over 65 years of age. Its effects can approach normal values for women in this age group. The 12-week Taekkyon-based exercise program could be useful as part of a fall prevention program to elderly people.

The characteristics and risk factors of fatal falls among adults aged 60 and above in Southwest China.

Falls constitute a leading cause of unintentional injury deaths among older adults. This study aimed to examine the comprehensive characteristics of fatal falls among older individuals in Yunnan Province, China, to highlight the challenges faced in elderly care. A total of 22,798 accidental fall-related deaths were extracted from China's National Disease Surveillance Points System aged 60 and above between 2015 and 2019. Quantitative and textual data were analyzed to assess the incidence rates of initiating factors, locations, symptoms, and overall survival (OS) outcomes after falling. Hypertension emerged as the most significant intrinsic factor, especially among individuals aged between 70 and 79, female older adults, and urban residents (P < 0.001). Home was identified as the most common location where fatal falls occurred (61.19%). The head was the most commonly injured body region (58.75%). The median of OS for all fatal falls was 2 days (0.13, 30), of which deaths occurred within 24 h [9287 (49.36%)]. There were instances where timely discovery after falling did not occur in 625 cases; their median of OS was significantly shorter compared to those discovered promptly after falling (P < 0.001). Targeted interventions focusing on fall prevention and post-fall care are equally crucial for the well-being of older adults.

Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults.

Purpose: The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes. Methods: Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage. Results: Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over $1 million with a per-patient enrolled savings of $19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of $4.95 million or $15,618 per enrolled patient. Conclusion: Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.

This study explored the feasibility and impact of implementing an evidence-based fall prevention model into emergency medical services for older adults. The outcomes resulted in an efficient and effective manner to screen older adults for falls during emergency response services and connect high-risk older adults with in-home follow-up care from community paramedics. In addition, fall prevention services were provided for vulnerable adults following a recent discharge from hospital care. These initiatives to address fall prevention resulted in a majority of older adults receiving preventive fall risk screening during emergency response calls, significant changes in quality of life measures for adults with multiple comorbidities and fall risk, and significant potential cost savings in reduced healthcare services.