Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our
(Edited publisher abstract)
Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review.
(Edited publisher abstract)
Subject terms:
adults, falls, risk assessment, ageing, older people;
JBI Database of Systematic Reviews and Implementation Reports, 17(3), 2019, pp.390-413.
Publisher:
Wolters Kulwer
Objective: The objective of the review was too synthesize the best available evidence on the incidence and prevalence of falls among adults with intellectual disability (ID). Introduction: Falls among adults with ID frequently cause physical injury and may negatively impact on their quality of life. Studies investigating falls among people with ID have used differing methods and populations, making it difficult to determine the scope and extent of this problem. Inclusion criteria: This review considered all studies that included adults with ID aged 18 years and over and which reported percentage/numbers of individuals who fell, and the total number of falls and injurious falls sustained from a fall. Studies were included if they were conducted within community or residential settings. Data). Data was extracted using the Joanna Briggs Institute's standardized extraction tool. Data that directly reported or could be used to calculate the incidence and prevalence of falls were extracted. Quantitative data for the number (proportion) of people who fell were pooled in statistical meta-analysis using STATA version 14 (Stata Corp LLC, Texas, USA). Data measuring incidence of falls (rate of falls for the duration of the study) and incidence of injurious falls (rate of falls resulting in one or more injuries for the duration of the study) could not be pooled in meta-analysis, hence results have been presented in a narrative form including tables. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes is also reported. Results: Nine studies were eligible for inclusion in this review. Eight articles were observational cohort studies which reported on the incidence/prevalence of falls as outcome measures, and one article was a quasi-experimental study design. Overall the methodological quality of the included studies was considered moderate. The pooled proportion of people with ID who fell (four studies, 854 participants) was 39% (95% CI [0.35%-0.43%], very low GRADE evidence). The rate of falls (eight studies, 782 participants) ranged from 0.54 to 6.29 per person year (very low GRADE evidence). The rate of injurious falls (two studies, 352 participants) ranged from 0.33 to 0.68 per person year (very low GRADE evidence). Conclusions: Synthesized findings demonstrate that people with ID, who live in community or residential settings, may fall more frequently, and at a younger age, compared to general community populations. Studies should take a consistent approach to measuring and reporting falls outcomes. Further research is recommended to identify the impact of falls on health related outcomes for people with ID and subsequently evaluate falls interventions for their efficacy.
(Edited publisher abstract)
Objective: The objective of the review was too synthesize the best available evidence on the incidence and prevalence of falls among adults with intellectual disability (ID). Introduction: Falls among adults with ID frequently cause physical injury and may negatively impact on their quality of life. Studies investigating falls among people with ID have used differing methods and populations, making it difficult to determine the scope and extent of this problem. Inclusion criteria: This review considered all studies that included adults with ID aged 18 years and over and which reported percentage/numbers of individuals who fell, and the total number of falls and injurious falls sustained from a fall. Studies were included if they were conducted within community or residential settings. Studies that were conducted in hospitals were excluded. Cohort studies, case-control and cross-sectional studies were included. Studies that used an experimental design, both randomized controlled and quasi experimental design, were also included. Methods: A three-step search strategy was undertaken for published and unpublished literature in English from 1990 to 2017. An initial search of MEDLINE and CINAHL was undertaken before a more extensive search was conducted using keywords and index terms across 11 electronic databases. Two independent reviewers assessed the methodological quality of the included studies using the Joanna Briggs Institute standardized critical appraisal instrument for prevalence studies (Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data). Data was extracted using the Joanna Briggs Institute's standardized extraction tool. Data that directly reported or could be used to calculate the incidence and prevalence of falls were extracted. Quantitative data for the number (proportion) of people who fell were pooled in statistical meta-analysis using STATA version 14 (Stata Corp LLC, Texas, USA). Data measuring incidence of falls (rate of falls for the duration of the study) and incidence of injurious falls (rate of falls resulting in one or more injuries for the duration of the study) could not be pooled in meta-analysis, hence results have been presented in a narrative form including tables. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes is also reported. Results: Nine studies were eligible for inclusion in this review. Eight articles were observational cohort studies which reported on the incidence/prevalence of falls as outcome measures, and one article was a quasi-experimental study design. Overall the methodological quality of the included studies was considered moderate. The pooled proportion of people with ID who fell (four studies, 854 participants) was 39% (95% CI [0.35%-0.43%], very low GRADE evidence). The rate of falls (eight studies, 782 participants) ranged from 0.54 to 6.29 per person year (very low GRADE evidence). The rate of injurious falls (two studies, 352 participants) ranged from 0.33 to 0.68 per person year (very low GRADE evidence). Conclusions: Synthesized findings demonstrate that people with ID, who live in community or residential settings, may fall more frequently, and at a younger age, compared to general community populations. Studies should take a consistent approach to measuring and reporting falls outcomes. Further research is recommended to identify the impact of falls on health related outcomes for people with ID and subsequently evaluate falls interventions for their efficacy.
(Edited publisher abstract)
Subject terms:
systematic reviews, falls, learning disabilities, adults, independent living, community care, residential care;
... and exercise needed for particular ‘at-risk’ populations. This review identified studies suggesting that for the prevention of falls in people with a falls history and/or frailer older adult, those with a high risk of fracture, those in transition to frailty with poor strength and balance, and very frail older adults.
(Edited publisher abstract)
Summarises a rapid evidence review of muscle and bone strengthening and balance activities (MBSBA) for general health benefits in adults and older adults and makes suggestions for implementation of the main findings for the public, practitioners and policy makers. The reviews highlight increasing evidence on strengthening and balance activities for general health benefits, and suggest that all adults and older adults should “undertake a programme of exercise at least twice per week that includes high intensity resistance training*, some impact exercise (running, jumping, skipping etc.) and balance training. The evidence also highlighted the variable impacts of different types of sport, physical activity or exercise. Specific consideration was given to different types of physical activities and exercise needed for particular ‘at-risk’ populations. This review identified studies suggesting that for the prevention of falls in people with a falls history and/or frailer older adult, those with a high risk of fracture, those in transition to frailty with poor strength and balance, and very frail older adults.
(Edited publisher abstract)
Subject terms:
older people, very old people, adults, sport, literature reviews, falls, prevention;
British Journal of Occupational Therapy, 77(8), 2014, pp.400-409.
Publisher:
Sage
... Qualitative interviews were conducted with ten adults with learning disabilities (and their carers where appropriate) who had experienced serious or frequent injury or frequent falls with or without injury in a 12–month period.
Findings: The most commonly reported contributory factors for injuries and/or falls were related to physical health status (for example, epilepsy) and the environment (for example,
(Publisher abstract)
Introduction: People with learning disabilities experience higher rates of injury compared to the general population, but little is known about the circumstances and perceived impact of these injuries on people with learning disabilities themselves.
Method: Content analysis was conducted from interviews with 113 adults with learning disabilities who had at least one injury in a 12–month period. Qualitative interviews were conducted with ten adults with learning disabilities (and their carers where appropriate) who had experienced serious or frequent injury or frequent falls with or without injury in a 12–month period.
Findings: The most commonly reported contributory factors for injuries and/or falls were related to physical health status (for example, epilepsy) and the environment (for example, walking/banging into furniture or stairs/steps). In terms of perceived impact, the development of fear of walking outdoors unsupported or fear of crossing a road were highlighted. The non-use and misuse of assistive technology was also highlighted as a concern.
Conclusion: These findings demonstrate that occupational therapists have a key role to play in tailoring injury and fall prevention strategies and interventions for people with learning disabilities. In particular, environmental assessment and monitored use of assistive technology is important.
(Publisher abstract)
Subject terms:
falls, prevention, injuries, occupational therapy, intervention, learning disabilities, adults;
This evidence cluster addresses the evidence base associated with the topic of prevention in adults services. Much of the content of this cluster relates to older people. Research about falls prevention, housing adaptations, preventive home care, low level services and interventions, and cost effectiveness of preventive social care are included.
This evidence cluster addresses the evidence base associated with the topic of prevention in adults services. Much of the content of this cluster relates to older people. Research about falls prevention, housing adaptations, preventive home care, low level services and interventions, and cost effectiveness of preventive social care are included.
Subject terms:
home care, older people, prevention, social care provision, adults, assistive technology, falls;
Evidence-Based Interventions for Community Dwelling Older Adults presents an overview of significant evidence-based programs that can improve the health of seniors living in community-based settings. The book examines research conducted on a variety of health-related issues, including depression, care management, falls prevention, physical activity, and medications management. It also looks
Evidence-Based Interventions for Community Dwelling Older Adults presents an overview of significant evidence-based programs that can improve the health of seniors living in community-based settings. The book examines research conducted on a variety of health-related issues, including depression, care management, falls prevention, physical activity, and medications management. It also looks at research models that were translated into real-life practice settings, explores the benefits of implementing evidence-based models into care settings, and provides examples of how to adapt tested programs to meet local agency and population needs. The health care delivery system in the United States has embraced evidence-based medicine, largely based on its potential to reduce unwanted variations and keep a lid on escalating health care costs. But there are few resources available on how to gather information about model programs and even fewer on how to adapt them for practice. Evidence-Based Interventions for Community Dwelling Older Adults discusses how to effectively manage care beyond the hospital or clinic, as researchers, practitioners, policymakers, and academics provide an overview of evidence-based practice that works toward the best possible care for patients. The book also highlights the efforts of social workers, pharmacists, and case managers, and illustrates the importance of the leadership efforts of the Administration on Aging, National Council on Aging, and the Centers for Disease Control.
Subject terms:
intervention, medication, older people, adults, community care, falls, evidence-based practice;
Journal of Policy and Practice in Intellectual Disabilities, 3(2), June 2006, pp.136-138.
Publisher:
Wiley
Falls and fractures are a major health problem, especially among people with intellectual disabilities (ID). The authors report on an exploratory survey at one Dutch residential facility, aimed at determining the characteristics of people with ID who were prone to falling. Data on falls and fractures were compared with a number of characteristics of the institution's residents. Each week data about falls were sampled during the study period of 33 months. It was found that risk factors for falling included: previous fractures, increasing age, impaired vision, seizures, use of antiepileptic drugs, and impaired mobility. Some 57% of the population fell during the observation period, resulting in 26 fractures. The authors noted that as the expected incidence of falling was high, an important
Falls and fractures are a major health problem, especially among people with intellectual disabilities (ID). The authors report on an exploratory survey at one Dutch residential facility, aimed at determining the characteristics of people with ID who were prone to falling. Data on falls and fractures were compared with a number of characteristics of the institution's residents. Each week data about falls were sampled during the study period of 33 months. It was found that risk factors for falling included: previous fractures, increasing age, impaired vision, seizures, use of antiepileptic drugs, and impaired mobility. Some 57% of the population fell during the observation period, resulting in 26 fractures. The authors noted that as the expected incidence of falling was high, an important finding was that people capable only of walking inside the building have a high risk of falling. The risk factors found can help identify those persons who are prone to falling, and this information can be used in fall prevention programs.
Subject terms:
learning disabilities, residential care, risk, adults, falls, group homes;
Journal of Applied Research in Intellectual Disabilities, 28(3), 2015, p.257–264.
Publisher:
Wiley
Background: People with intellectual disabilities experience high rates of falls. Balance and gait problems are common in people with intellectual disabilities, increasing the likelihood of falls; thus, tailored exercise interventions to improve gait and balance are recommended. The present authors set up a physiotherapy-led falls pathway service (FPS) for clients with intellectual disabilities to promote exercise and prevent falls.
Method: Fifty clients with intellectual disabilities were referred in an 18-month period, 35 (70%) were prescribed exercise and 27 (54%) completed the exercise programme. The FPS was evaluated using the following outcome measures: Tinetti score, number of falls, clinician's judgement and carer's judgement.
Results: Improvement in balance and mobility and a decrease in the number of falls were reported post-exercise intervention.
Conclusion: Physiotherapists have a key role to play in promoting exercise to prevent falls in services for people with intellectual disabilities. This evaluation suggests positive outcomes for these clients to reduce or prevent further falls.
(Publisher abstract)
Background: People with intellectual disabilities experience high rates of falls. Balance and gait problems are common in people with intellectual disabilities, increasing the likelihood of falls; thus, tailored exercise interventions to improve gait and balance are recommended. The present authors set up a physiotherapy-led falls pathway service (FPS) for clients with intellectual disabilities to promote exercise and prevent falls.
Method: Fifty clients with intellectual disabilities were referred in an 18-month period, 35 (70%) were prescribed exercise and 27 (54%) completed the exercise programme. The FPS was evaluated using the following outcome measures: Tinetti score, number of falls, clinician's judgement and carer's judgement.
Results: Improvement in balance and mobility and a decrease in the number of falls were reported post-exercise intervention.
Conclusion: Physiotherapists have a key role to play in promoting exercise to prevent falls in services for people with intellectual disabilities. This evaluation suggests positive outcomes for these clients to reduce or prevent further falls.
(Publisher abstract)
Subject terms:
physical exercise, falls, learning disabilities, prevention, physiotherapy, adults, intervention, physiotherapists;
Practice guideline providing evidence-based recommendations to support occupational therapists working with adults in the prevention and management of falls. The recommendations are intended to be used alongside the therapist's clinical expertise in their assessment of need and implementation of interventions. The guideline reviewed evidence relating to improved identification and assessment of people at risk; improved intervention to reduce falls risk; interventions to maximise functional independence, including positive risk taking; self-management; and improved understanding of the importance of education and training. Details of the guideline development process and guideline methodology are also included. The guideline recommendations focus on three key categories, to reflect the occupational therapists role: keeping safe at home: reducing risk of falls; keeping active: reducing fear of falling; falls management: making it meaningful. This guideline will also be useful to inform service users and carers, other health professionals, managers and commissioners working in adult services, about the roles and responsibilities of the occupational therapist in this area. Appendices provide
(Edited publisher abstract)
Practice guideline providing evidence-based recommendations to support occupational therapists working with adults in the prevention and management of falls. The recommendations are intended to be used alongside the therapist's clinical expertise in their assessment of need and implementation of interventions. The guideline reviewed evidence relating to improved identification and assessment of people at risk; improved intervention to reduce falls risk; interventions to maximise functional independence, including positive risk taking; self-management; and improved understanding of the importance of education and training. Details of the guideline development process and guideline methodology are also included. The guideline recommendations focus on three key categories, to reflect the occupational therapists role: keeping safe at home: reducing risk of falls; keeping active: reducing fear of falling; falls management: making it meaningful. This guideline will also be useful to inform service users and carers, other health professionals, managers and commissioners working in adult services, about the roles and responsibilities of the occupational therapist in this area. Appendices provide details of the service user consultation; literature search strategy and evidence-based review tables.
(Edited publisher abstract)
DH CARE NETWORKS. Telecare Learning and Improvement Network
Publisher:
DH Care Networks. Telecare Learning and Improvement Network
Publication year:
2008
Pagination:
16p.
Place of publication:
London
Since the time of data collection (April/May 2008), a number of other Local Authority/Primary Care Trust partnerships have been developing telehealth programmes. These have not been included in this report but can be identified through updates in the telecare newsletters. Some of the responses indicate that the service had not commenced at the time of the data collection but were planned for 2008 and beyond. The responses generally relate to small pilots (between 5 and 50 users) at the time of data collection apart from Kent (over 200). The main disease areas covered include heart failure, COPD and diabetes. There are case study and local evaluation reports of positive benefits for individual users (increased re-assurance and improved quality of life) and some indications from professional judgment that hospital admissions may have been prevented.
Since the time of data collection (April/May 2008), a number of other Local Authority/Primary Care Trust partnerships have been developing telehealth programmes. These have not been included in this report but can be identified through updates in the telecare newsletters. Some of the responses indicate that the service had not commenced at the time of the data collection but were planned for 2008 and beyond. The responses generally relate to small pilots (between 5 and 50 users) at the time of data collection apart from Kent (over 200). The main disease areas covered include heart failure, COPD and diabetes. There are case study and local evaluation reports of positive benefits for individual users (increased re-assurance and improved quality of life) and some indications from professional judgment that hospital admissions may have been prevented.
Subject terms:
information technology, long term conditions, mental health care, NHS, older people, telecare, adults, assistive technology, dementia, falls;