Falls awareness month
April 2023
No other single cause of injury, including road trauma, costs the health system more than falls. Whether you have been affected by falls yourself or care for someone who has, or know of someone who has, falls prevention is everyone’s business, and in South Australia we are building strategies to get falls incidents on the decline. Falls SA
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Articles
Prevention
Does yoga reduce the risk of falls in older people?
What you need to know
BMJ 3 September 2020
Fall detection and monitoring using machine learning: A comparative study
The detection of falls has emerged as an important topic for the public to discuss because of the prevalence and severity of unintentional falls, particularly among the elderly. A Fall Detection System, known as an FDS, is a system that gathers data from wearable Internet-of-Things (IoT) device and classifies the outcomes to distinguish falls from other activities and call for prompt medical aid in the event of a fall. In this paper, we determine either fall or not fall using machine learning prior to our collected fall dataset from accelerometer sensor. From the acceleration data, the input features are extracted and deployed to supervised machine learning (ML) algorithms namely, Support Vector Machine (SVM), Decision Tree, and Naive Bayes. The results show that the accuracy of fall detection reaches 95%, 97 % and 91% without any false alarms for the SVM, Decision Tree, and Naïve Bayes, respectively. International journal of advanced computer science and applications 1 April 2023
Development and external validation of a risk prediction model for falls in patients with an indication for antihypertensive treatment: retrospective cohort study
This prediction model uses commonly recorded clinical characteristics and distinguishes well between patients at high and low risk of falls in the next 1-10 years. Although miscalibration was evident on external validation, the model still had potential clinical utility around risk thresholds of 10% and so could be useful in routine clinical practice to help identify those at high risk of falls who might benefit from closer monitoring or early intervention to prevent future falls. Further studies are needed to explore the appropriate thresholds that maximise the model’s clinical utility and cost effectiveness. BMJ 8 November 2022
Evaluation of clinical practice guidelines on fall prevention and management for older adults: A systematic review
This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders. JAMA 15 December 2021
Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation
The Guide to Action for Care Homes (GtACH) programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency. BMJ 7 December 2021
The effectiveness of multimedia education on patients' knowledge and behavior on fall prevention: An interventional study
The findings of the present study suggest that patient education can be considered one of the main strategies to prevent falls, especially in a hospital setting. Further, the use of multimedia education simultaneously with face-to-face training has a synergistic effect and increases the effectiveness of fall prevention education programs. Journal of preventive, diagnostic and treatment strategies in medicine 13 March 2023
Preventing patient falls overnight using video monitoring: A clinical evaluation
The aim of this cohort study was to evaluate effectiveness of overnight portable video monitoring as an adjunct falls prevention strategy for high falls risk patients in inpatient clinical units. International journal of environmental research and public health 22 October 2022
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Risks
Quality use of medicines indicators and associated factors in residential aged care facilities: Baseline findings from the pharmacists in RACF study in Australia
Prescribing potentially inappropriate medications (PIMs), including antipsychotics and benzodiazepines, has been used as an indicator of the quality use of medicines in residential aged care facilities (RACFs). PIMs are associated with an increased risk of falls and hospitalisations in the elderly. The purpose of this study is to assess the extent of prescribing of PIMs in RACFs at baseline in the Pharmacists in residential aged care facilities (PiRACF) study and examine the association of resident and system factors with the number of PIMs. A cross-sectional analysis of 1368 participants from 15 Australian RACFs was performed to detect PIMs using the American Geriatrics Society 2019 Beers® criteria. Most residents (68.1%) were taking at least one regular PIM; 16.9% were taking regular antipsychotics and 11.1% were taking regular benzodiazepines. Long-term proton pump inhibitors were the most frequent class of PIMs. History of falls and higher Charlson Comorbidity Index were associated with an increased number of prescribed PIMs, while dementia diagnosis and older age (85 years or more) were associated with decreased number of PIMs (p-value <0.05). Residents in facilities with lower nurse-to-resident ratios were more likely to have an increased number of PIMs (p value = 0.001). This study indicates that potentially inappropriate prescribing is common in RACFs and interventions to target residents at highest risk are needed. Journal of clinical medicine 1 September 2022
Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series
The incidence of falls and fractures was high in the pretreatment period, suggesting that factors other than the study drugs, such as underlying diseases, should be taken into consideration when evaluating the association between the risk of falls and fractures and use of cholinesterase inhibitors and antipsychotic drugs. The treatment periods were also associated with a higher risk of falls and fractures compared with the non-treatment period, although the magnitude was much lower than during the pretreatment period. Strategies for prevention and close monitoring of the risk of falls are still necessary until patients regain a more stable physical and mental state. BMJ 9 September 2021
Exploring mediation effects of gait speed, body balance, and falls in the relationship between physical activity and health-related quality of life in vulnerable older adults
In the context of falls, gait speed (GS) and body balance (BB) partially mediated the association between physical activity (PA) and HRQoL in approximately 29.7%, 56%, and 49.2%, respectively. The total health-related quality of life (HRQoL) model explained a variance of 36.4%. The results can help to understand the role that GS, BB, and falls play in the relationship between PA and HRQoL of the vulnerable older adult population. International journal of environmental research and public health 29 October 2022
Vertigo in the elderly: A systematic literature review
Audio-vestibular disorders represent the most frequent cause of vertigo in the elderly. The etiologies affecting the vertigo patient must be defined in order to identify potential life-threatening conditions, such as cardiovascular and neurological disorders, which according to the data of this review constitute the second and third common causes of vertigo. A multidisciplinary strategy, involving different specialists (such as ENTs, Neurologists, Cardiologists, Geriatricians) is recommended for the correct assessment of these disorders. Journal of clinical medicine 11 March 2023
Cumulative effects of comorbid burden and overactive bladder symptoms on fall risk among older women seeking treatment for urogynecologic conditions
The presence of 3 easily identifiable patient characteristics is strongly associated with a risk of falls in women seeking care for pelvic floor disorders. Urogynecology 8 March 2023
Development and evaluation of a simple predictive model for falls in acute care setting
The authors developed a simple and reliable six-item model to predict patients at high risk of falling in acute care settings. The model has also been verified to perform well with non-random partitioning by time and future research is expected to make it useful in acute care settings and clinical practice. Journal of clinical nursing 10 March 2023
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Research
Daily low-dose Aspirin and risk of serious falls and fractures in healthy older people: A substudy of the ASPREE randomized clinical trial
In this substudy of a randomized clinical trial, the failure of low-dose aspirin to reduce the risk of fractures while increasing the risk of serious falls adds to evidence that this agent provides little favorable benefit in a healthy, White older adult population. JAMA 7 November 2022
Instrumented Timed Up and Go Test (iTUG)—More than assessing time to predict falls: A systematic review
The Timed Up and Go (TUG) test is a widely used tool for assessing the risk of falls in older adults. However, to increase the test’s predictive value, the instrumented Timed Up and Go (iTUG) test has been developed, incorporating different technological approaches. This systematic review aims to explore the evidence of the technological proposal for the segmentation and analysis of iTUG in elderlies with or without pathologies. Sensors 24 March 2023
Does a fall from a standing height warrant CT in an elderly patient with polytrauma?
Through this review article, the evidence for and against selective CT vs. WBCT continues to be a matter of debate. There is a dearth of randomised controlled trials investigating this in the context of elderly trauma as a fall from a standing height. The clinician needs to make an informed clinical judgment based on the mechanism of injury, the patient’s frailty, and through experiential learning, the preferred choice of imaging. This has to be a case-bycase scenario whilst acknowledging the risks of the choice taken. Further research is needed in this domain before there can be any change in clinical practice. World journal of emergency medicine 25 March 2023
Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program
This economic evaluation found that fall-related adverse events represented a clinical and financial burden to health care systems and that the current Medicare policy limits reimbursement. In this study, costs of falls only differed marginally by injury level. Policies that incentivize organizations to implement evidence-based strategies that reduce the incidence of all falls may be effective in reducing both harm and costs. JAMA 20 January 2023
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