The Effectiveness of Remote Video Monitoring on Fall Prevention and Nurses' Acceptance.

BACKGROUND: The use of remote visual monitoring (RVM) technology as a "telesitter" in hospitals can reduce falls and increase the efficiency of patient observation. PURPOSE: This study aimed to examine RVM effectiveness as a strategy to decrease patient falls and investigate nurses' acceptance and perceived usefulness of RVM technology. METHODS: Remote visual monitoring was implemented within a health system in the Southeastern United States. Falls data 6 months prior to and postimplementation were analyzed, and 106 nurses completed a survey evaluating their acceptance of the RVM technology. RESULTS: There was a significant 39.15% reduction in falls with injury ( P = .006), and 70.6% of the RVM redirections were successful. Nurses' acceptance and perceived usefulness of RVM were moderate. CONCLUSION: Implementing RVM has the potential to enhance patient safety by reducing falls with injuries and is considered acceptable and useful by nurses.

A pilot study on fear and risk of fall: The impact of an 8-month multicomponent exercise program in community-dwelling aged adults / Un estudio piloto sobre el miedo y el riesgo de caída: el impacto de un programa de ejercicios de componentes múltiples de 8 meses en adultos mayores que viven en la comunidad / Um estudo piloto sobre medo e risco de queda: o impacto de um programa de exercício multicomponente de 8 meses em adultos idosos residentes na comunidade

Este estudio tuvo como objetivo examinar el impacto del efecto de un programa de ejercicio de componentes múltiples de 8 meses en adultos mayores que viven en la comunidad. Utilizamos una estrategia inclusiva para examinar la viabilidad de un programa de ejercicio de tres veces por semana. Tener más de 60 años, la capacidad de pararse y caminar con o sin equipo de asistencia, ser físicamente inactivo, autorización médica y vivir en la comunidad fueron todos los criterios de elegibilidad. Se utilizaron la prueba Timed-up and Go y la Berg Balance Scale para examinar el riesgo de caídas. Se utilizó la Fall-Efficacy Scale International para examinar el miedo a las caídas. El programa de ejercicio basado en la comunidad involucró a treinta y cinco participantes, la edad promedio fue de 67.54 años (SD = 3.81) y el 71% eran mujeres. Las tasas de asistencia variaron de 76% a 100% en promedio. Hubo una tendencia significativa hacia una mejora clínicamente importante en el timed-up and go test (t = 4.66; p < .001; d = 0.20), escala de equilibrio de Berg (t = -11.20; p < .001; d = 1.47) y escala internacional de eficacia contra caídas (t = 5.81; p < .001; d = 0.88). Este estudio ha proporcionado evidencia preliminar de que un programa de ejercicio de bajo costo basado en la comunidad de 8 meses puede ser efectivo para mejorar la agilidad, el equilibrio y disminuir el miedo a caerse en las personas mayores. (AU)

The objective of this study was to investigate the impact of an 8-month multicomponent exercise program in community-dwelling older adults. A comprehensive approach was employed to assess the feasibility and effectiveness of a thrice-weekly exercise intervention. Aged over 60 years, the capacity to stand and walk with or without assistive equipment, being physically inactive, medical clearance, and living in the community were all eligibility criteria. The Timed-up and Go test and Berg Balance Scale were used to examine risk of falling. The Fall-Efficacy Scale International was used to examine the fear of falling. The community-based exercise program involved thirty-five participants, the average age was 67.54 years (SD = 3.81) and 71% were female. At-tendance rates ranged from 76% to 100% on average. There was a significant trend toward a clinically important improvement in the timed-up and go test (t = 4.66; p < .001; d = 0.20), berg balance scale (t = -11.20; p < .001; d = 1.47) and fall-efficacy scale international (t = 5.81; p < .001; d = 0.88). This study has provided preliminary evidence that an 8-month community-based low-cost exercise program may be effective in improving agility, balance, and decreasing fear of falling in older people. (AU)

Este estudo teve como objetivo examinar o impacto do efeito de um programa de exercício multicomponente de 8 meses em idosos residentes na comunidade. Usamos uma estratégia inclusiva para examinar a viabilidade de um programa de exercícios três vezes por semana. Idade acima de 60 anos, capacidade de ficar em pé e andar com ou sem equipamento auxiliar, ser inativo fisicamente, ter autorização médica e morar na comunidade foram todos os critériosde elegibilidade. O teste Timed-up and Go e a Escala de Equilíbrio de Berg foram usados para examinar o risco de queda. A Fall-Efficacy Scale International foi utilizada para examinar o medo de cair. O programa de exercícios comunitários envolveu trinta e cinco participantes, a idade média foi de 67,54 anos (DP = 3.81) e 71% eram do sexo feminino. As taxas de adesão variaram de 76% a 100%, em média. Houve uma tendência significativa para uma melhora clinicamente importante no timed-up and go test (t = 4.66;p < .001; d = 0.20), escala de equilíbrio de Berg (t = -11.20; p < .001; d = 1.47) e escala de eficácia de queda internacional (t = 5.81; p < 0.001; d = 0.88). Este estudo forneceu evidências preliminares de que um programa de exercícios de baixo custobaseado na comunidade de 8 meses pode ser eficaz para melhorar a agilidade, o equilíbrio e diminuir o medo de cair em idosos. (AU)

Motor Reaction Time, Sarcopenia and Functional Skills in Elderly Women: A Cross-Sectional Study.

IMPORTANCE: Aging generates changes over the years. Because of this, the musculoskeletal system is directly degraded and suffer deficits in its performance in elderly patients with Sarcopenia, as this condition is characterized by a decrease in muscle mass and function. OBJECTIVE: Correlate the motor reaction time and functional skills of non-sarcopenic, pre-sarcopenic and sarcopenic elderly women, and analyze influence on the risk of falls. DESIGN: Cross-sectional observational analytical study, following the methodological strategies of STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), carried out under the approval of the Research Ethics Committee of the Unievangélica University, no. 3.694.235/2019. SETTING: Participants were evaluated regarding: cognitive status, level of physical activity, fear of falling, body composition, motor reaction time, static and dynamic balance, gait kinetics, strength and endurance of the lower limbs and finally handgrip strength. PARTICIPANTS: A total of 59 volunteer elderly women were assessed following the diagnostic criteria for sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). RESULTS: The results show that there was a greater difference in motor reaction time between the non-sarcopenic and sarcopenic elderly women due to the executing organ being damaged by the presence of sarcopenia, causing motor response to slowdown. Functional deficit, fear of falling and greater risk of falls were observed in the sarcopenic group, under the harmful influence of increased motor reaction time. CONCLUSION: Sarcopenic elderly women present increased motor reaction time, that is, slowed motor responses due to decreased muscle mass, strength and impaired musculature, which generate functional deficits that contribute to an increased risk of falls.

Anterior knee pain as a potential risk factor for falls in older adults: insights from the osteoarthritis initiative data.

BACKGROUND: Knee joint pain has been demonstrated to be a separate risk factor for falling. A common pain site in the knee, anterior knee pain(AKP), is believed to be associated with early knee osteoarthritis (KOA).This study investigated the relationship between falls and AKP in people with or at risk for KOA. METHODS: Four years of follow-up data from the Osteoarthritis Initiative cohort trial, a large-scale, multicenter observational investigation, were analyzed in this study. A patellar quadriceps tenderness/tendinitis knee exam was performed to evaluate AKP. Falls were self-reported. The associations between falls (recurrent falls: ≥2 falls/year; any falls: ≥1 fall(s)/year) and AKP were analyzed using the generalized estimation equation of repeated logistic regression and adjusted for confounding variables. RESULTS: The study analyzed data from 3,318 participants, split into two groups: those with AKP (720 participants) and those without AKP (2,598 participants). The primary outcome of the study, which focused on repeated falls, revealed that participants with AKP were 1.27 times more likely to experience repeated falls compared to those without AKP (95% CI: 1.07-1.52, P = 0.007). However, when considering any falls experienced by an individual as an additional outcome, it is important to note that our findings did not indicate a significant predictive effect of AKP on any falls investigated. Sensitivity analyses, which excluded knee arthroplasty cases, yielded consistent results with the aforementioned findings. CONCLUSIONS: Older adults with AKP experience a higher frequency of falls compared to those without AKP in individuals diagnosed with KOA or at a high risk of developing KOA.

Fall risk management in interventional prenatal diagnosis perioperative pregnant women based on tracking methodology and failure mode and effect analysis application.

The aim was to explore the effectiveness of a tracing methodology combined with failure mode and effect analysis (FMEA) for managing falls in pregnant women during the perioperative period of interventional prenatal diagnosis. Using the tracing methodology, the process was evaluated and analyzed using FMEA after reviewing data, on-site interview, case tracking and on-site inspection, and improvement measures were proposed for the existing risk factors, and the fall-related quality indicators, satisfaction with fall-related health education, and risk priority number were compared before and after implementation. Effectiveness analysis for interventional prenatal diagnosis of perioperative maternal falls risk management resulted in a significant decrease in risk priority number (P < .01), a significant increase in the rate of correct fall risk identification and assessment, correct handover rate of pregnant women at risk of falls, correct intervention rate of pregnant women at high risk of falls, and effective coverage of falls-related health education (P < .01), a significant increase in satisfaction with falls-related health education (P < .001), and the incidence of falls among pregnant women decreased from 0.12% to 0%. The use of tracking methodology combined with FMEA can reduce the risk of perioperative maternal falls in interventional prenatal diagnosis and improve the safety of maternal visits.

Advances in mobility aid use reporting: situational context and objective measurement improve understanding of daily aid use in older adults.

BACKGROUND: Understanding mobility aid use has implications for falls risk reduction and aid prescription. However, aid use in daily life is understudied and more complex than revealed by commonly used yes/no self-reporting. AIMS: To advance approaches for evaluating mobility aid use among older adults using a situational (context-driven) questionnaire and wearable sensors. METHODS: Data from two cross-sectional observational studies of older adults were used: (1) 190 participants (86 ± 5 years) completed tests of standing, sit-to-stand, walking, grip strength, and self-reported fear of falling and (2) 20 participants (90 ± 4 years) wore two body-worn and one aid-mounted sensors continuously for seven days to objectively quantify aid use during walking. Situational and traditional binary reporting stratified participants into aid dependency levels (0-4) and aid-user groups, respectively. Physical performance and fear of falling were compared between aid users, and dependency levels and sensor-derived walking behaviors were compared to reported aid use. RESULTS: Physical performance and fear of falling differed between aid-user groups (P < 0.05). Sensor-derived outputs revealed differences in walking behaviors and aid use when categorized by dependency level and walking bout length (P < 0.05). Walking bout frequency (rho(18) = - 0.47, P = 0.038) and aid use time (rho(13) = .72, P = 0.002) were associated with dependency level. DISCUSSION: Comparisons of situational aid dependency revealed heterogeneity between aid users suggesting binary aid use reporting fails to identify individual differences in walking and aid use behaviors. CONCLUSIONS: Enhanced subjective aid use reporting and objective measurements of walking and aid use may improve aid prescription and inform intervention to support safe and effective mobility in older adults.

Prevalence of falls among adult mothers in Saudi Arabia: a cross-sectional study.

BACKGROUND: The prevalence of falls among mothers (18-49 years old) in Saudi Arabia has been overlooked and understudied. Therefore, the study aimed to identify the 1-year prevalence, rate of falls, and consequent injuries among mothers in Saudi Arabia. METHODS: In this cross-sectional study, a self-administered online questionnaire, including sociodemographic data and questions related to the history of falls and consequent injuries during the past 12 months, was disseminated through social media in Saudi Arabia. RESULTS: A convenience sample of 986 mothers were voluntarily recruited for this study with a median age of 33 years and an interquartile range of 10 years. The 1-year prevalence of falls among mothers was 14.1 % (n = 139), and 52.5 % (n = 73/139) of the fallers experienced more than one fall. Among mothers who had experienced a fall, 25.4 % (n = 33/139) experienced a fall incident during pregnancy. The reported consequences of falls were pain in 37.4 % (n = 52/139), muscle and ligament injuries in 7.2 % (n = 10/139), and fractures in 2.2 % (n = 3/139) of participants. The study's findings indicate that asthma and high cholesterol level predicts the risk of falls in mothers. CONCLUSIONS: According to our convenience sampling, 14.1% of mothers had experienced one or more falls in the past 12 months. The increased prevalence of falls among this age group of women supports the idea that falls are not only an issue for the older adult population, but fall prevention strategies for this age range are also needed.

Recurrent Neural Network Methods for Extracting Dynamic Balance Variables during Gait from a Single Inertial Measurement Unit.

Monitoring dynamic balance during gait is critical for fall prevention in the elderly. The current study aimed to develop recurrent neural network models for extracting balance variables from a single inertial measurement unit (IMU) placed on the sacrum during walking. Thirteen healthy young and thirteen healthy older adults wore the IMU during walking and the ground truth of the inclination angles (IA) of the center of pressure to the center of mass vector and their rates of changes (RCIA) were measured simultaneously. The IA, RCIA, and IMU data were used to train four models (uni-LSTM, bi-LSTM, uni-GRU, and bi-GRU), with 10% of the data reserved to evaluate the model errors in terms of the root-mean-squared errors (RMSEs) and percentage relative RMSEs (rRMSEs). Independent t-tests were used for between-group comparisons. The sensitivity, specificity, and Pearson's r for the effect sizes between the model-predicted data and experimental ground truth were also obtained. The bi-GRU with the weighted MSE model was found to have the highest prediction accuracy, computational efficiency, and the best ability in identifying statistical between-group differences when compared with the ground truth, which would be the best choice for the prolonged real-life monitoring of gait balance for fall risk management in the elderly.

A Lightweight Human Fall Detection Network.

The rising issue of an aging population has intensified the focus on the health concerns of the elderly. Among these concerns, falls have emerged as a predominant health threat for this demographic. The YOLOv5 family represents the forefront of techniques for human fall detection. However, this algorithm, although advanced, grapples with issues such as computational demands, challenges in hardware integration, and vulnerability to occlusions in the designated target group. To address these limitations, we introduce a pioneering lightweight approach named CGNS-YOLO for human fall detection. Our method incorporates both the GSConv module and the GDCN module to reconfigure the neck network of YOLOv5s. The objective behind this modification is to diminish the model size, curtail floating-point computations during feature channel fusion, and bolster feature extraction efficacy, thereby enhancing hardware adaptability. We also integrate a normalization-based attention module (NAM) into the framework, which concentrates on salient fall-related data and deemphasizes less pertinent information. This strategic refinement augments the algorithm's precision. By embedding the SCYLLA Intersection over Union (SIoU) loss function, our model benefits from faster convergence and heightened detection precision. We evaluated our model using the Multicam dataset and the Le2i Fall Detection dataset. Our findings indicate a 1.2% enhancement in detection accuracy compared with the conventional YOLOv5s framework. Notably, our model realized a 20.3% decrease in parameter tally and a 29.6% drop in floating-point operations. A comprehensive instance analysis and comparative assessments underscore the method's superiority and efficacy.

CNN-Based Self-Attention Weight Extraction for Fall Event Prediction Using Balance Test Score.

Injury, hospitalization, and even death are common consequences of falling for elderly people. Therefore, early and robust identification of people at risk of recurrent falling is crucial from a preventive point of view. This study aims to evaluate the effectiveness of an interpretable semi-supervised approach in identifying individuals at risk of falls by using the data provided by ankle-mounted IMU sensors. Our method benefits from the cause-effect link between a fall event and balance ability to pinpoint the moments with the highest fall probability. This framework also has the advantage of training on unlabeled data, and one can exploit its interpretation capacities to detect the target while only using patient metadata, especially those in relation to balance characteristics. This study shows that a visual-based self-attention model is able to infer the relationship between a fall event and loss of balance by attributing high values of weight to moments where the vertical acceleration component of the IMU sensors exceeds 5 m/s² during an especially short period. This semi-supervised approach uses interpretable features to highlight the moments of the recording that may explain the score of balance, thus revealing the moments with the highest risk of falling. Our model allows for the detection of 71% of the possible falling risk events in a window of 1 s (500 ms before and after the target) when compared with threshold-based approaches. This type of framework plays a paramount role in reducing the costs of annotation in the case of fall prevention when using wearable devices. Overall, this adaptive tool can provide valuable data to healthcare professionals, and it can assist them in enhancing fall prevention efforts on a larger scale with lower costs.

Better informing everyday fall risk assessment: experimental studies with contemporary technologies.

BACKGROUND: Age-related mobility issues and frailty are a major public health concern because of an increased risk of falls. Subjective assessment of fall risk in the clinic is limited, failing to account for an individual's habitual activities in the home or community. Equally, objective mobility trackers for use in the home and community lack extrinsic (ie, environmental) data capture to comprehensively inform fall risk. We propose a contemporary approach that combines artificial intelligence (AI) and video glasses to augment current methods of fall risk assessment. METHODS: Two case studies were performed to provide a framework to assess extrinsic factors within fall risk assessment via video glasses. The first was AI-based detection of environment and terrain type. We developed convolutional neural networks (CNN) via a bespoke dataset (>145 000 images) captured from different settings (eg, offices, high streets) via free-licenced video on social media. AI automated a textual description to uphold privacy while describing the scene (eg, indoor and carpet). In the second case study, we provided video glasses to participants within a university campus (two men, 17 women; aged 21-60 years) to capture data for automatically labelling environment and objects (eg, fall hazards) via a CNN object detection algorithm. The case studies ran from Dec 5, 2022, to March 24, 2023. FINDINGS: To date, results show promise for the efficient, and accurate AI-based approach to better inform fall risk. Each component of the framework achieved at least 75% accuracy across a range of walks (indoor and outdoor and multiple terrains) from a dataset of 6283 new images. The AI achieved a mean average precision score of 0·93 for the identification of fall risk hazards. INTERPRETATIONS: The AI-based approach provides a contemporary means to better inform fall risk while providing an ethical means to uphold privacy. The proposed approach could have significant implications for improving overall health and quality of life, enabling ageing in place through habitual data collection with contemporary wearables to decentralise fall risk assessment. A limitation was the lack of data collection on older adults within real world, unscripted settings. However, the next phase of this research is the deployment of the AI on real-world data from a cohort of more than 40 participants within UK-based homes. FUNDING: National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) North-East and North Cumbria (NENC), Faculty of Engineering and Environment at Northumbria University.

How does the environment in and around the home affect social care and health outcomes for older people? A national longitudinal dynamic cohort study.

BACKGROUND: Reducing the burden of falls and fall-related admissions to hospital and care homes is an important policy area because falls cause significant injury leading to a reduced quality of life. We investigated the effect of the environment around people's homes on the risk of falls for older people in Wales. METHODS: In this longitudinal cohort study, we created a dynamic national e-cohort of individuals aged 60 years or older living in Wales between Jan 1, 2010, and Dec 31, 2019. Using the Secure Anonymised Information Linkage Databank, we linked routinely collected, anonymised health-data on general practitioner (GP) appointments; hospital and emergency admissions; and longitudinal individual-level demographic data to metrics detailing the built environment and deprivation as determined by the Welsh Index of Multiple Deprivation. Using adjusted cox regression models, we assessed how the risk of a fall changed with sex, age, deprivation quintile, urban or rural classification, household occupancy, care status, frailty, dementia diagnosis, and built environment metrics. Built environments of urban and rural areas are very different, so we stratified our analysis by urbanicity to compare these associations in each setting. FINDINGS: We analysed 5 536 444 person-years of data from 931 830 individuals (sex: 51·5% female, 48·5% male; age: 69·2% aged 60-64 years, 12·3% aged 65-69 years, 13·3% aged 70-79 years, 4·4% aged 80-89 years, and 0·7% aged ≥90 years). 154 060 (16·5%) had a fall between joining the cohort and Dec 31, 2019. Men had a lower risk of falling than women (adjusted hazard ratio [aHR] 0·736 [0·729-0·742]), and the risk increased with age compared with individuals aged 60-64 years (1·395 [1·378-1·412] for 65-69 years, 1·892 [1·871-1·913] for 70-79 years, 2·668 [2·623-2·713] for 80-89 years, 3·196 [3·063-3·335] for ≥90 years) and with frailty compared with fit individuals (1·609 [1·593-1·624] for mild frailty, 2·263 [2·234-2·293] for moderate frailty, and 2·833 [2·770-2·897] for severe frailty). Those living in rural areas were less likely to fall than those in urban areas (0·711 [0·702-0·720]). All p values were less than 0·0001. INTERPRETATION: Although preliminary, these results corroborate current knowledge that as we age and become frailer, the risk of falling increases. The effect of urbanicity on risk of fall suggests that the built environment could be associated with fall risk. We only detected falls that caused emergency or hospital admission, leading to potential selection bias. Nevertheless, this research could help guide policy to reduce the incidence of injuries caused by falls in older people. FUNDING: Health and Care Research Wales.

Predictors of fall risk in older adults using the G-STRIDE inertial sensor: an observational multicenter case-control study.

BACKGROUND: There are a lot of tools to use for fall assessment, but there is not yet one that predicts the risk of falls in the elderly. This study aims to evaluate the use of the G-STRIDE prototype in the analysis of fall risk, defining the cut-off points to predict the risk of falling and developing a predictive model that allows discriminating between subjects with and without fall risks and those at risk of future falls. METHODS: An observational, multicenter case-control study was conducted with older people coming from two different public hospitals and three different nursing homes. We gathered clinical variables ( Short Physical Performance Battery (SPPB), Standardized Frailty Criteria, Speed 4 m walk, Falls Efficacy Scale-International (FES-I), Time-Up Go Test, and Global Deterioration Scale (GDS)) and measured gait kinematics using an inertial measure unit (IMU). We performed a logistic regression model using a training set of observations (70% of the participants) to predict the probability of falls. RESULTS: A total of 163 participants were included, 86 people with gait and balance disorders or falls and 77 without falls; 67,8% were females, with a mean age of 82,63 ± 6,01 years. G-STRIDE made it possible to measure gait parameters under normal living conditions. There are 46 cut-off values of conventional clinical parameters and those estimated with the G-STRIDE solution. A logistic regression mixed model, with four conventional and 2 kinematic variables allows us to identify people at risk of falls showing good predictive value with AUC of 77,6% (sensitivity 0,773 y specificity 0,780). In addition, we could predict the fallers in the test group (30% observations not in the model) with similar performance to conventional methods. CONCLUSIONS: The G-STRIDE IMU device allows to predict the risk of falls using a mixed model with an accuracy of 0,776 with similar performance to conventional model. This approach allows better precision, low cost and less infrastructures for an early intervention and prevention of future falls.

Fall accidents in older people: a time trend analysis of the period 2000-2020 and the estimated economic burden on the Brazilian health system in 2025. / Acidentes por quedas na população idosa: análise de tendência temporal de 2000 a 2020 e o impacto econômico estimado no sistema de saúde brasileiro em 2025.

Longitudinal monitoring of indicators of accidental falls can facilitate the planning of effective care and prevention actions. This article aims to analyze temporal trends in variables related to falls among older persons in Brazil and in the state of São Paulo during the period 2000-2020 and estimate the projected economic burden on the health system in 2025. We conducted a quantitative retrospective observational study using data from the Health Information System. The Joinpoint Regression Program version 4.7.0 and SPSS version 20.0 were used to perform linear regression and calculate the Average Annual Percent Change (AAPC), adopting a 95% confidence interval. There was an increase in mean and total admissions costs due to falls at national level in both intervals of the study period. There was an increase in total admissions costs and the total number of admissions due to falls in the state of São Paulo (AAPC of 8.5% and 4.3%, respectively). Projections for the year 2025 suggest that the total number of admissions due to falls in Brazil will be around 150,000, resulting in costs of approximately R$ 260 million. There was an increase in the variables analyzed by this study, revealing the importance of fall prevention programs associated with national public policies.

O acompanhamento longitudinal de indicadores, como os relacionados às quedas acidentais, pode facilitar o planejamento de ações mais eficazes de assistência e prevenção. O objetivo deste artigo é analisar a tendência temporal das variáveis relacionadas aos acidentes de quedas na população idosa no Brasil e no estado de São Paulo entre 2000 e 2020 e estimar o impacto econômico para o SUS em 2025. Este é um estudo observacional retrospectivo com abordagem quantitativa, com dados do Sistema de Informação em Saúde. Foram utilizados os softwares Joinpoint Regression Program versão 4.7.0 e SPSS versão 20.0 para a realização de regressões lineares, além da análise Average Annual Percent Change (AAPC), adotando um intervalo de confiança de 95%. No país, houve aumento das internações nos dois períodos analisados, assim como os gastos totais, em todos os segmentos analisados. Em concordância no estado de São Paulo, o valor total e as internações apresentaram aumento (AAPC, sendo 8,5% e 4,3% respectivamente). No ano de 2025, as internações por quedas no Brasil estarão próximas a 150 mil, gerando custos em torno de R$ 260 milhões. Houve o aumento das variáveis analisadas, mostrando a importância de programas de prevenção de quedas associados a políticas públicas nacionais.

We should be screening for benign paroxysmal positional vertigo (BPPV) in all older adults at risk of falling: a commentary on the World Falls Guidelines.

Benign paroxysmal positional vertigo (BPPV) is amongst the commonest causes of dizziness and falls in older adults. Diagnosing and treating BPPV can reduce falls, and thereby reduce fall-related morbidity and mortality. Recent World Falls Guidelines recommend formal assessment for BPPV in older adults at risk of falling, but only if they report vertigo. However, this recommendation ignores the data that (i) many older adults with BPPV experience dizziness as vague unsteadiness (rather than vertigo), and (ii) others may experience no symptoms of dizziness at all. BPPV without vertigo is due to an impaired vestibular perception of self-motion, termed 'vestibular agnosia'. Vestibular agnosia is found in ageing, neurodegeneration and traumatic brain injury, and results in dramatically increased missed BPPV diagnoses. Patients with BPPV without vertigo are typically the most vulnerable for negative outcomes associated with this disorder. We thus recommend simplifying the World Falls Guidelines: all older adults (>60 years) with objective or subjective balance problems, irrespective of symptomatic complaint, should have positional testing to examine for BPPV.

Geospatial Mapping to Target Injury Prevention for Older Adult Ground-Level Falls: A Feasibility Study.

BACKGROUND: Trauma centers target injury prevention efforts based on trauma registry and local epidemiological data. Identifying geographic patterns of injury through geospatial mapping has emerged as a technology to help identify at-risk individuals. Yet, the feasibility of using spatial analysis to target injury prevention efforts remains unknown. OBJECTIVE: This study aims to demonstrate the use of geospatial mapping of older adult ground-level falls to target injury prevention efforts. METHODS: This retrospective cohort analysis of ground-level falls among older adults was conducted from 2017 to 2020 at a Level I trauma center and safety net hospital. Trauma admissions, U.S. census median income, Hispanic percentage, and population density by zip codes were combined to create choropleth and heat maps to identify injury hot spots to target fall prevention classes. RESULTS: A total of 5,629 patients were reviewed, of which 3,002 (53%) were fall cases. Low-level falls (<10 ft) accounted for 2,224 cases; 1,449 were among older adults centered around the study hospital. Ground-level falls accounted for 1,663 patients, of whom 1,182 were older adults clustering around senior housing, assisted living facilities, nursing homes, and rehabilitation centers. As a result, our fall prevention classes are now targeted at these newly identified locations. CONCLUSION: Geospatial analysis provided powerful visualization of fall injury locations to target our fall prevention efforts. Geospatial analysis is a feasible tool for trauma centers to guide injury prevention strategies that effectively target the populations most in need.

Targeted optimum care approach for osteoporotic fragility fractures: tailored strategy based on risk stratification to reduce incidents of falls-an initiative by the Egyptian Academy of bone health based on the FLS national register.

Since falling is the third cause of chronic disability, a better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention, and management programs for these individuals, particularly those at risk of sustaining a fragility fracture. OBJECTIVE: (1) To assess the incidence of falls among osteoporotic patients with fragility fractures. (2) To evaluate the potential for stratifying the people at risk of falling in bone health setting aiming to provide targeted optimum care for them. METHODS: This was a multi-center, cross-sectional, observational study. Both men and postmenopausal women, admitted with an osteoporotic fracture (whether major osteoporosis or hip fracture), were consecutively recruited for this work and managed under Fracture Liaison Service. All the patients were assessed for their Fracture risk (FRAX), falls risk (FRAS), and sarcopenia risk (SARC-F) as well as functional disability (HAQ). Blood tests for bone profile as well as DXA scan were offered to all the patients. RESULTS: Four hundred five patients (121 males, 284 females) were included in this work. Mean age was 70.1 (SD = 9.2) years. The incidence of falls was 64.9%. The prevalence of falls was high (64.8%) in the patients presenting with major osteoporosis fractures and in those with hip fractures (61.8%). The prevalence of fragility fractures was positively correlated with HAQ score and the SARC-F score (p = 0.01 and 0.021 respectively). Falls risk score was positively correlated with FRAX score of major osteoporotic fractures, HAQ score, and SARC-F score (p = 0.01, 0.013, and 0.003 respectively). Seventy percent of the osteopenia patients who sustained fragility fracture had high falls risk and/or SARC-F score. CONCLUSION: This study highlighted the importance of falls risk stratification in osteoporotic patients presenting with fragility fractures. Identification of the patients at increased risk of falls should be a component of the standard practice.

Critical features of multifactorial interventions for effective falls reduction in residential aged care: a systematic review, intervention component analysis and qualitative comparative analysis.

BACKGROUND: Multifactorial fall prevention trials providing interventions based on individual risk factors have variable success in aged care facilities. To determine configurations of trial features that reduce falls, intervention component analysis (ICA) and qualitative comparative analysis (QCA) were undertaken. METHODS: Randomised controlled trials (RCTs) from a Cochrane Collaboration review (Cameron, 2018) with meta-analysis data, plus trials identified in a systematic search update to December 2021 were included. Meta-analyses were updated. A theory developed through ICA of English publications of trialist's perspectives was assessed through QCA and a subgroup meta-analysis. RESULTS: Pooled effectiveness of multifactorial interventions indicated a falls rate ratio of 0.85 (95% confidence interval, CI, 0.65-1.10; I2 = 85%; 11 trials). All tested interventions targeted both environmental and personal risk factors by including assessment of environmental hazards, a medical or medication review and exercise intervention. ICA emphasised the importance of co-design involving facility staff and managers and tailored intervention delivery to resident's intrinsic factors for successful outcomes. QCA of facility engagement plus tailored delivery was consistent with greater reduction in falls, supported by high consistency (0.91) and coverage (0.85). An associated subgroup meta-analysis demonstrated strong falls reduction without heterogeneity (rate ratio 0.61, 95%CI 0.54-0.69, I2 = 0%; 7 trials). CONCLUSION: Multifactorial falls prevention interventions should engage aged care staff and managers to implement strategies which include tailored intervention delivery according to each resident's intrinsic factors. Such approaches are consistently associated with a successful reduction in falls, as demonstrated by QCA and subgroup meta-analyses. Co-design approaches may also enhance intervention success.

Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis.

BACKGROUND: Cholinesterase inhibitors are commonly used to treat patients with neurocognitive disorders, who often have an elevated risk of falling. Effective use of these medications requires a thoughtful assessment of risks and benefits. OBJECTIVE: To provide an update on previous reviews and determine the association between cholinesterase inhibitors and falls, syncope, fracture and accidental injuries in patients with neurocognitive disorders. METHODS: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and AgeLine were systematically searched through March 2023 to identify all randomised controlled trials of cholinesterase inhibitors (donepezil, galantamine, rivastigmine) in patients with cognitive impairment. Corresponding authors were contacted for additional data necessary for meta-analysis. Inclusion criteria consisted of adults ≥19 years, with a diagnosis of dementia, Parkinson's disease, mild cognitive impairment or traumatic brain injury. Data were extracted in duplicate for the aforementioned primary outcomes and all outcomes were analysed using random-effects meta-analysis. RESULTS: Fifty three studies (30 donepezil, 14 galantamine, 9 rivastigmine) were included providing data on 25, 399 patients. Cholinesterase inhibitors, compared to placebo, were associated with reduced risk of falls (risk ratio [RR] 0.84 [95% confidence interval [CI] = 0.73-0.96, P = 0.009]) and increased risk of syncope (RR 1.50 [95% CI = 1.02-2.21, P = 0.04]). There was no association with accidental injuries or fractures. CONCLUSION: In patients with neurocognitive disorders, cholinesterase inhibitors were associated with decreased risk of falls, increased risk of syncope and no association with accidental trauma or fractures. These findings will help clinicians better evaluate risks and benefits of cholinesterase inhibitors.