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Awareness weeks guide

Falls Awareness Month

April is Falls Awareness Month

No other single cause of injury, including road trauma, costs the health system more than falls. FallsSA







Patient resources







World guidelines for falls prevention and management for older adults: a global initiative
All older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. Age and aging 30 September 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

New horizons in falls prevention and management for older adults: a global initiative
In this New Horizons article, the global challenges in falls prevention are depicted, the goals of the worldwide task force are summarised and the conceptual framework for development of a global falls prevention and management guideline is presented. Age and aging 26 May 2021

European position paper on polypharmacy and fall‑risk‑increasing drugs recommendations in the World Guidelines for Falls Prevention and Management: implications and implementation
Aim The recent World Guidelines for Falls Prevention and Management provide several recommendations on how to prevent medication-related falls.
Findings Medication review and deprescribing are key interventions in falls prevention and should be structured, personalized, and patient-centered. Preferably, the medication review should be conducted as part of a comprehensive geriatric assessment.
Message Improved information sharing between various prescribers, deprescribing recommendations implemented in guidelines, and increased education and training for health care professionals are warranted to facilitate the deprescribing process.
European geriatric medicine 15 July 2023

Prevention of falls in Parkinson's Disease: Guidelines and gaps
Effective mitigation of fall risk requires specific targeting and strategies to reduce this debilitating and common problem in PD. While exercise is recommended, the types and modalities of exercise and how to combine them as interventions for different PD subgroups (cognitive impairment, freezing, advanced disease) need further study. Movement disorders 16 August 2023



Interactions that support older inpatients with cognitive impairments to engage with falls prevention in hospitals: An ethnographic study
Impact/What does this paper contribute to the wider global clinical community?

  • Older hospital inpatients with cognitive impairments are more vulnerable to harm from falls but little is known about engaging them in falls prevention.
  • Using empirical data from a study in English hospitals, the paper evidences interactions that support these patients to engage with staff and the relational skills involved. Although nurses had limited time for this, other clinical and non-clinical staff did so and passed information to nurses to inform patient care.
  • The research can benefit cognitively impaired inpatients at risk of falling and their families/carers, as well as nurses and other hospital staff involved in falls prevention.

Journal of clinical nursing 14 January 2024

A systems approach to assist policy action to prevent falls among community-dwelling older people in Australia
Falls prevention is a pressing public health concern that requires dedicated policy resources. Adopting a systems-oriented approach can help reduce falls and their associated burdens on individuals and the healthcare system. Acknowledging the urgency and complexity of this challenge is a first, essential step toward crafting a comprehensive national falls prevention policy. Public health research & practice 4 April 2024

The immediate and lasting balance outcomes of clinical falls-prevention programs: A non-randomised study
These results of this study indicate land-based and water-based falls-prevention programs improve physical outcome measures associated with falls-risk and many improvements are maintained for six months after the completion of the program. Plos one 14 March 2024

The effects of different types of Tai Chi exercises on preventing falls in older adults: a systematic review and network meta-analysis
Among the four types of Tai Chi studied, the 24-form simplified Tai Chi has shown better efficacy than other types. Aging clinical and experimental research 13 March 2024

Does yoga reduce the risk of falls in older people?
What you need to know

  • Exercise programmes that involve balance and functional exercises are effective at preventing falls in older people living in the community
  • Yoga provides small to moderate improvement in balance and mobility in this population, but there is lack of evidence on effect of yoga on falls
  • Health professionals can recommend yoga to older people to promote physical function and mental wellbeing if there are no clinical contraindications, but there is currently insufficient evidence to recommend yoga specifically for preventing falls

BMJ 3 September 2020

Leisure-time physical activity and falls with and without injuries among older adult women
Participation in leisure-time physical activity at the recommended level or above was associated with lower odds of both non-injurious and injurious falls. Brisk walking and both moderate and moderate-vigorous leisure-time physical activity were associated with lower odds of non-injurious falls. JAMA 31 January 2024

Influence of lower limb isokinetic muscle strength and power on the occurrence of falls in community-dwelling older adults: A longitudinal study
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. Plos one 4 April 2024



Body composition, balance, functional capacity and falls in older women
For postmenopausal women with higher femoral neck bone mineral density (BMD) appear to sustain more falls, but have a lower risk of severe fall injuries. Better Timed Up and Go (TUG) and single leg standing time predict lower risk of falls and fall injuries. Aging clinical and experimental research 21 March 2024

Indoor falls and number of previous falls are independent risk factors for long-term mortality after a hip fracture
Indoor falls and falling more than once in the previous year are long-term risk factors for mortality after hip fractures. It is always essential to take a careful patient history on admission to determine the number of falls and their circumstances, and special care should be taken to reduce mortality in patients at high risk. Aging clinical and experimental research 9 September 2023

Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women
The KaatumisSeula (KS) form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability. Aging clinical and experimental research 5 May 2023

E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial
The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies. BMJ 6 April 2021



The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study
The known: First eye cataract surgery reduces the risk of falls in older people, but the effect of second eye cataract surgery is less clear.
The new: The age‐ and sex‐adjusted incidence of falls among older people referred for cataract surgery was 31% lower after first eye surgery, and a further 50% lower after second eye surgery, restoring binocular vision.
The implications: Timely and equitable access to cataract surgery can prevent fall‐related injuries and support healthy ageing.
MJA 27 June 2022

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

Age-related risk of serious fall events and opioid analgesic use
The results of this cohort study suggest that prescription opioids were associated with increased risk of serious fall events among adults of all ages, with individuals 85 years or older at greatest risk. These risks should be considered when prescribing opioids, particularly for individuals with preexisting risk factors or when opioids are prescribed at higher doses. Targeted falls prevention efforts may be most effective within the first month following opioid initiation. JAMA 19 February 2024

Risk of falls and fractures in individuals with Cataract, Age-Related Macular Degeneration, or Glaucoma
The results of this study support recognition that people with 1 or more of these eye diseases are at increased risk of both falls and fractures. They may benefit from improved advice, access, and referrals to falls prevention services. JAMA 28 December 2023

Using machine learning models to predict falls in hospitalised adults

  • Falls in healthcare settings can result in significant patient harm and expense.
  • Previous research has shown that fall risk factors are complex and multifaceted.
  • Identification of patients at risk of falls is necessary for effective fall prevention initiatives.
  • Information systems are widespread and present an opportunity to analyse large quantities of data to inform fall prediction effectively.
  • It is feasible to use machine learning models to identify common fall risk factors and predict falls.
  • This study builds on international research by incorporating patient, workforce and organisational characteristics into the models.
  • Random forest and deep neural network models accurately predicted patient falls.
  • Predictors common to both models were classified as patient-related, staffing-related and admissions-related.

International journal of medical informatics 23 March 2024

Predictive validity of the Johns Hopkins Fall Risk Assessment Tool for older patients in Stroke rehabilitation
The aim of this retrospective, cross-sectional, observational study was to assess the frequency of falls and evaluate the predictive validity of the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) among patients aged ≥65 years, transferred to the rehabilitation ward of a university hospital. The predictive ability was assessed using receiver operating characteristic curve analysis, and the optimal threshold was established using the Youden index. We analyzed the overall cohort (N = 175) with subacute stroke and the subgroup with a low unaffected handgrip strength (HGS; men: <28 kg, women: <18 kg). Overall, 135/175 patients (77.1%) had a low HGS. The fall rate was 6.9% overall and 5.9% for patients with a low HGS. The JHFRAT predictive value was higher for patients with a low HGS than that for the overall cohort, but acceptable in both. The optimal cutoff score for the overall cohort was 11 (sensitivity, 67%; specificity, 68%), whereas that for the subgroup was 12 (sensitivity, 75%; specificity: 72%). These results are expected to aid nurses working in rehabilitation wards in more effectively utilizing JHFRAT outcomes for post-stroke older patients with a low HGS and contribute to the development of more appropriate fall prevention strategies for high-risk patients in the future. Healthcare 6 April 2024



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