Background: falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including 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.
(Edited publisher abstract)
Background: falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries. Methods: a steering committee was assembled and 10 working Groups were created to provide preliminary evidence-based recommendations. A cross-cutting theme on patient’s perspective was also created. In addition, a worldwide multidisciplinary group of experts and stakeholders, to review the proposed recommendations and to participate in a Delphi process to achieve consensus for the final recommendations, was brought together. Conclusion: 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.
(Edited publisher abstract)
Background and Objectives: Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people. Research Design and Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed. Results: Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: −1.047, 95% confidence interval [CI]: −1.598; −0.496) and delivery in a community setting (SMD: −0.528, 95% CI: −0.894; −0.161) were—compared to interventions without these characteristics—associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: −0.823, 95% CI: −1.255; −0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011). Discussion and Implications: Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.
(Edited publisher abstract)
Background and Objectives: Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people. Research Design and Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed. Results: Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: −1.047, 95% confidence interval [CI]: −1.598; −0.496) and delivery in a community setting (SMD: −0.528, 95% CI: −0.894; −0.161) were—compared to interventions without these characteristics—associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: −0.823, 95% CI: −1.255; −0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011). Discussion and Implications: Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.
(Edited publisher abstract)
... and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff. Discussion and Implications: Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly
(Edited publisher abstract)
Background and Objectives: Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations. Research Design and Methods: Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study. Results: We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff. Discussion and Implications: Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.
(Edited publisher abstract)
Journal of Gerontological Social Work, 64(4), 2021, pp.372-387.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Falls remain a major public health issue, particularly for frail older adults, such as those who receive home-delivered meals (HDMs). Social workers who assess the needs of HDM clients and routinely monitor their care are uniquely positioned to address fall prevention; however, the degree to which HDM social workers currently manage fall risk is unknown. To close this knowledge gap, we conducted
(Edited publisher abstract)
Falls remain a major public health issue, particularly for frail older adults, such as those who receive home-delivered meals (HDMs). Social workers who assess the needs of HDM clients and routinely monitor their care are uniquely positioned to address fall prevention; however, the degree to which HDM social workers currently manage fall risk is unknown. To close this knowledge gap, we conducted a retrospective chart review and evaluated HDM social workers’ current practices relative to identifying clients at risk for falling and the client characteristics associated with social workers’ perceptions of fall risk. A total of 230 client charts were included in our analysis. Thirty-eight percent of HDM clients were determined to be at risk of falling. Advanced age, activity limitations, and specific health conditions (e.g., diabetes mellitus) were associated with social workers’ fall risk concerns. However, over 80% of our sample presented with well-established fall risk factors (e.g., mobility impairment) suggesting that HDM social workers might be under-identifying fall-risks. Though HDM social workers are well positioned to play a critical role in fall risk management, systematic efforts are needed to optimize social workers’ capacity for effectively identifying HDM clients at risk for falling.
(Edited publisher abstract)
Subject terms:
risk management, falls, social work, service provision;
Journal of Applied Research in Intellectual Disabilities, 34(1), 2021, pp.274-285.
Publisher:
Wiley
Background: The prevalence of falls involving people with intellectual disabilities (ID) is high in comparison with the general population. There has been little evidence to date on the contributing risk factors. The objective of this review was to identify risk factors for people with intellectual disabilities. Method: Literature searches were conducted using electronic databases to explore evidence on the subject, and narrative synthesis was employed to analyse the results. Results: Seven risk factors were identified: decreasing physical ability, epilepsy, paretic conditions, impulsiveness, previous falls, incontinence and non‐use of assistive equipment. Thematic analysis identified factors across the four concepts: the person, the situation, ongoing and protective factors. Conclusion: Factors for falls involving people with intellectual disabilities are dynamic and multifactorial. Some are specific to the population; however, further research is required to develop the understanding of the possible reasons. The findings have implications across policy, education, practice and research.
(Edited publisher abstract)
Background: The prevalence of falls involving people with intellectual disabilities (ID) is high in comparison with the general population. There has been little evidence to date on the contributing risk factors. The objective of this review was to identify risk factors for people with intellectual disabilities. Method: Literature searches were conducted using electronic databases to explore evidence on the subject, and narrative synthesis was employed to analyse the results. Results: Seven risk factors were identified: decreasing physical ability, epilepsy, paretic conditions, impulsiveness, previous falls, incontinence and non‐use of assistive equipment. Thematic analysis identified factors across the four concepts: the person, the situation, ongoing and protective factors. Conclusion: Factors for falls involving people with intellectual disabilities are dynamic and multifactorial. Some are specific to the population; however, further research is required to develop the understanding of the possible reasons. The findings have implications across policy, education, practice and research.
(Edited publisher abstract)
Dementia: the International Journal of Social Research and Practice, 19(5), 2020, pp.1621-1640.
Publisher:
Sage
People diagnosed with dementia are at greater risk of falls. Given the increasing incidence of dementia globally, high quality and methodologically rigorous research is needed to inform evidence-based practice initiatives. Aims: To describe the published literature related to describing, reducing or preventing fall incidences for people living with dementia including: (1) trends in the total number of intervention and non-intervention studies between 1997 and 2016; (2) the methodological quality of identified intervention studies; and (3) the effectiveness of interventions designed to reduce the incidence of falls among people living with dementia.Methods: A systematic review of five databases was conducted to identify studies reporting any aspect of falls incidence for people study demonstrated a significant reduction in falls among people living with dementia. Conclusions: There is currently insufficient evidence to endorse any intervention to reduce falls for people living with dementia in any setting. More high-quality intervention studies are needed.
Keywords
(Publisher abstract)
People diagnosed with dementia are at greater risk of falls. Given the increasing incidence of dementia globally, high quality and methodologically rigorous research is needed to inform evidence-based practice initiatives. Aims: To describe the published literature related to describing, reducing or preventing fall incidences for people living with dementia including: (1) trends in the total number of intervention and non-intervention studies between 1997 and 2016; (2) the methodological quality of identified intervention studies; and (3) the effectiveness of interventions designed to reduce the incidence of falls among people living with dementia.Methods: A systematic review of five databases was conducted to identify studies reporting any aspect of falls incidence for people with a diagnosis of dementia. Studies meeting the eligibility criteria were coded as intervention or non-intervention studies. Intervention studies were assessed using Cochrane’s Effective Practice and Organisation of Care tool. Data about the effectiveness of interventions meeting Effective Practice and Organisation of Care criteria were extracted. Results: Seventy-two eligible studies were identified; 57 were non-intervention studies, and 15 were intervention studies. The number of published studies increased between 1997 and 2016, peaking in 2013 (n = 10). Of the 15 intervention studies, seven studies met Effective Practice and Organisation of Care design criteria with one study rated low risk on all eight Effective Practice and Organisation of Care risk of bias domains. One high-risk exercise-based intervention study demonstrated a significant reduction in falls among people living with dementia. Conclusions: There is currently insufficient evidence to endorse any intervention to reduce falls for people living with dementia in any setting. More high-quality intervention studies are needed.
Keywords
(Publisher abstract)
Subject terms:
falls, dementia, intervention, systematic reviews;
International Journal of Geriatric Psychiatry, 33(10), 2018, pp.1383-1388.
Publisher:
Wiley
Objective: The purpose of this study was to examine the impact of falls on depressive symptoms among the oldest old in Germany longitudinally. Methods: Data were used from 2 waves of the multicenter prospective cohort “Study on needs, health service use, costs and health‐related quality of life in a large sample of oldest‐old primary care patients (85+)” (AgeQualiDe). This study covers primary care patients ≥85 years (at baseline: n = 547, average age of 88.9 ± 3.0 years; ranging from 85 to 100 years). General practitioner‐diagnosed falls were used as explanatory variable. The Geriatric Depression Scale was used as outcome measure. Results: Linear fixed effects regressions showed that the occurrence of falls is associated with an increase in depressive symptoms (β = .60, P = .02), whereas on a large, population‐based longitudinal study, this study underlined the impact of falls on depressive symptoms and consequently extended previous knowledge about an association between falls and depressive symptoms in the oldest old. Developing strategies to prevent falls might also help to prevent depressive symptoms.
(Edited publisher abstract)
Objective: The purpose of this study was to examine the impact of falls on depressive symptoms among the oldest old in Germany longitudinally. Methods: Data were used from 2 waves of the multicenter prospective cohort “Study on needs, health service use, costs and health‐related quality of life in a large sample of oldest‐old primary care patients (85+)” (AgeQualiDe). This study covers primary care patients ≥85 years (at baseline: n = 547, average age of 88.9 ± 3.0 years; ranging from 85 to 100 years). General practitioner‐diagnosed falls were used as explanatory variable. The Geriatric Depression Scale was used as outcome measure. Results: Linear fixed effects regressions showed that the occurrence of falls is associated with an increase in depressive symptoms (β = .60, P = .02), whereas changes in marital status, ageing, social support, functional decline (instrumental activity of daily living), cognitive impairment, and an increase in chronic diseases did not affect depressive symptoms. In sensitivity analysis, an increase in depressive symptoms was associated with functional impairment (basic activities of daily living; Barthel index; β = −.04, P = .005). Conclusions: Based on a large, population‐based longitudinal study, this study underlined the impact of falls on depressive symptoms and consequently extended previous knowledge about an association between falls and depressive symptoms in the oldest old. Developing strategies to prevent falls might also help to prevent depressive symptoms.
(Edited publisher abstract)
Subject terms:
falls, depression, very old people, longitudinal studies;
... and residents who fell. Physical restraint use was related to falls after controlling for structural characteristics and PSC. In practical terms the findings translate into a 10% increase in the PSC score in an average 110 bed facility having 3-4 fewer residents who are physically restrained. It is suggested that staff in these NHs may be more aware of the alternatives to physical restraint and may
It is suggested that the vulnerability of nursing home (NH) residents may put them at particular risk of harmful consequences of errors in their care. Studies have shown that patient safety culture (PSC) is relatively poorly developed in NHs. Using management responses from a nationally representative sample of 3,557 NHs on the US 2008 Nursing Home Survey on PSC, the Online Survey, Certification, and Reporting Database, and the Minimum Data Set, the authors examined the relationships among the three components of Donabedian’s SPO model: structure (PSC), a process of care (physical restraints), and patient safety outcomes (residents who fell). Results from generalised estimating equations indicated that higher ratings of PSC were significantly related to lower prevalence of physical restraints and residents who fell. Physical restraint use was related to falls after controlling for structural characteristics and PSC. In practical terms the findings translate into a 10% increase in the PSC score in an average 110 bed facility having 3-4 fewer residents who are physically restrained. It is suggested that staff in these NHs may be more aware of the alternatives to physical restraint and may be practising newer methods for achieving patient safety. Investing time and energy in promoting a safety culture could result in a better process of care and improved safety outcomes.
Health care costs are known to increase in the year following a fall. This study examined the components of cost that drive this increase over time, stratified by injury severity. Data were drawn from cost and utilisation information (2004-2007) for persons enrolled in an integrated care delivery system in Seattle. The study used a longitudinal cohort design, with each individual providing 2–3 years data. A total of 8,969 medical fallers were identified using ICD codes and 8,956 nonfaller controls were included matched by age and gender. Total costs were partitioned into 7 components: inpatient, outpatient, emergency, radiology, pharmacy, postacute care, and “other.” It appears that the large increase in costs after a hospitalised fall is mainly associated with inpatient and postacute care. The spike in costs after a nonhospitalised fall is attributable to outpatient and “other” (e.g., ambulatory surgery or community health services) components. Hospitalised fallers’ inpatient, emergency, postacute care, outpatient, and radiology costs were not always greater than those for nonhospitalised fallers. It is concluded that the components associated with increased costs after a medical fall vary over time and by injury severity. The authors suggest that future studies should examine whether delivering certain acute and postacute health services after a fall improve health and reduce cost trajectories more than others.
Health care costs are known to increase in the year following a fall. This study examined the components of cost that drive this increase over time, stratified by injury severity. Data were drawn from cost and utilisation information (2004-2007) for persons enrolled in an integrated care delivery system in Seattle. The study used a longitudinal cohort design, with each individual providing 2–3 years data. A total of 8,969 medical fallers were identified using ICD codes and 8,956 nonfaller controls were included matched by age and gender. Total costs were partitioned into 7 components: inpatient, outpatient, emergency, radiology, pharmacy, postacute care, and “other.” It appears that the large increase in costs after a hospitalised fall is mainly associated with inpatient and postacute care. The spike in costs after a nonhospitalised fall is attributable to outpatient and “other” (e.g., ambulatory surgery or community health services) components. Hospitalised fallers’ inpatient, emergency, postacute care, outpatient, and radiology costs were not always greater than those for nonhospitalised fallers. It is concluded that the components associated with increased costs after a medical fall vary over time and by injury severity. The authors suggest that future studies should examine whether delivering certain acute and postacute health services after a fall improve health and reduce cost trajectories more than others.
Journal of Assistive Technologies, 6(3), 2012, pp.202-215.
Publisher:
Emerald
This review explored the recent literature regarding the development of fall detector technology. The review was part of a service evaluation on the use of fall detectors across the region funded by NHS West Midlands. The authors also discuss the application and use of products designed to detect falls and alert help from end-user and health and social care staff perspectives. The literature of robust evidence regarding different approaches to technology in the management and detection of falls. Users had mixed views regarding the use of fall detectors, with some people having concerns about privacy, lack of human contact, user-friendliness and appropriate training, whilst others clearly identified the benefits of detecting falls and raising an alert. The implications of these findings
This review explored the recent literature regarding the development of fall detector technology. The review was part of a service evaluation on the use of fall detectors across the region funded by NHS West Midlands. The authors also discuss the application and use of products designed to detect falls and alert help from end-user and health and social care staff perspectives. The literature of the last ten years was reviewed and the main themes from the literature summarised. While there is a wide variety of new technology applied to fall detectors in development, the range of technologies currently available through health and social services to users is limited. Health and social care staff appear to be less convinced of the benefits of fall detectors than end-users. There was also a lack of robust evidence regarding different approaches to technology in the management and detection of falls. Users had mixed views regarding the use of fall detectors, with some people having concerns about privacy, lack of human contact, user-friendliness and appropriate training, whilst others clearly identified the benefits of detecting falls and raising an alert. The implications of these findings for practice are discussed.
Subject terms:
user views, assistive technology, attitudes, falls;