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)
Falls among residents in UK care homes are commonplace. A new study examined whether multiple medications and drugs that act on the brain may contribute to the risk. The research, which included 84 UK care homes, found that residents taking multiple medicines had an increased risk of falling. Risk was also increased with a regular prescription for antidepressants or benzodiazepines (sedative or 31%) had one or more falls; the risk was higher in those taking antidepressants and sedatives; older residents were more likely to fall than their younger counterparts; men had more falls than women; residents with dementia had 75% more falls than those without dementia.
(Edited publisher abstract)
Falls among residents in UK care homes are commonplace. A new study examined whether multiple medications and drugs that act on the brain may contribute to the risk. The research, which included 84 UK care homes, found that residents taking multiple medicines had an increased risk of falling. Risk was also increased with a regular prescription for antidepressants or benzodiazepines (sedative drugs). Two-thirds of the residents in the study were living with dementia. Researchers suggest that care homes should emphasise non-drug approaches such as massage, music or art therapies. These interventions could help residents with depression and common symptoms of dementia such as agitation or sleep disturbance. Over a three-month period, the study found that: almost one in three residents (519 or 31%) had one or more falls; the risk was higher in those taking antidepressants and sedatives; older residents were more likely to fall than their younger counterparts; men had more falls than women; residents with dementia had 75% more falls than those without dementia.
(Edited publisher abstract)
Using bullet points, this short publication provides information on reducing the risk of falls in people with learning disabilities. It covers the areas of: the impact of falls, how to reduce the risk of falls, how dementia can affect a person's perception, supporting people after a fall, and accessing Falls Prevention Clinics. It reports there is good evidence that falls are more common
(Edited publisher abstract)
Using bullet points, this short publication provides information on reducing the risk of falls in people with learning disabilities. It covers the areas of: the impact of falls, how to reduce the risk of falls, how dementia can affect a person's perception, supporting people after a fall, and accessing Falls Prevention Clinics. It reports there is good evidence that falls are more common in people with learning disabilities throughout their lives, not only as they age. It is part of the Wellbeing for Life toolkit created for the MacIntyre Dementia project in order to promote understanding about getting older with a learning disability and living well with dementia.
(Edited publisher abstract)
Subject terms:
falls, prevention, learning disabilities, older people;
The research explored the effects of varying lighting conditions on the movement of older people with sight loss as they climb up and down stairs, and in particular the clearance, or distance between their feet and the steps. Twelve participants (eight males and four females) with an average age of 77 years took part in the study. The results of this study showed that there were no statistically significant differences in clearance measures under the different lighting conditions used in the study. This means that the better lighting conditions did not affect the participants’ risk of falling.
(Edited publisher abstract)
The research explored the effects of varying lighting conditions on the movement of older people with sight loss as they climb up and down stairs, and in particular the clearance, or distance between their feet and the steps. Twelve participants (eight males and four females) with an average age of 77 years took part in the study. The results of this study showed that there were no statistically significant differences in clearance measures under the different lighting conditions used in the study. This means that the better lighting conditions did not affect the participants’ risk of falling.
(Edited publisher abstract)
Draws on recent research to summarise what is known about falls and falls prevention amongst older people with sight loss. It explores the implications of research findings for action to address and reduce the risk of falls among older people with sight loss and suggests key issues for health and social care professionals to consider when working with older people, many of whom may have sight loss, and for sight loss specialists to consider when addressing individuals’ risks of falls.
(Publisher abstract)
Draws on recent research to summarise what is known about falls and falls prevention amongst older people with sight loss. It explores the implications of research findings for action to address and reduce the risk of falls among older people with sight loss and suggests key issues for health and social care professionals to consider when working with older people, many of whom may have sight loss, and for sight loss specialists to consider when addressing individuals’ risks of falls.
(Publisher abstract)
Subject terms:
older people, falls, visual impairment, prevention;
International Journal of Geriatric Psychiatry, 27(7), July 2012, pp.727-733.
Publisher:
Wiley
It is suggested that fear of falling, one of the most common fears among community-dwelling older people, is as serious a health problem as the falls themselves. It often leads to activity avoidance. The authors believe that understanding fear of falling may help to identify strategies to reduce concern in the vulnerable old. This cross sectional study evaluated the psychological factors associated with fear of falling in a group of fallers transitioning to frailty compared with robust or non-frail fallers. A total of 301 fallers (mean age 75 years) underwent assessment. Fear of falling was measured using the Modified Falls Efficacy Scale, and frailty using the Biological Syndrome Model. Psychological assessment included anxiety, depression, loneliness, personality factors and cognition.
It is suggested that fear of falling, one of the most common fears among community-dwelling older people, is as serious a health problem as the falls themselves. It often leads to activity avoidance. The authors believe that understanding fear of falling may help to identify strategies to reduce concern in the vulnerable old. This cross sectional study evaluated the psychological factors associated with fear of falling in a group of fallers transitioning to frailty compared with robust or non-frail fallers. A total of 301 fallers (mean age 75 years) underwent assessment. Fear of falling was measured using the Modified Falls Efficacy Scale, and frailty using the Biological Syndrome Model. Psychological assessment included anxiety, depression, loneliness, personality factors and cognition. Frailer fallers had increased fear of falling compared to robust fallers. Age, female gender and lower cognitive scores were associated with greater fear of falling in the robust group. For frailer fallers, higher depression score was the only factor associated with fear of falling. The odds ratio of having case level depressive disorder if a frail faller was significantly higher than if robust. The authors conclude that fallers at a transitional level of frailty may be particularly vulnerable group psychologically and would benefit most from interventional strategies focussing on depressive symptoms.
Older people experiencing dementia are twice as likely to fall, resulting in serious injury, reduction in everyday activity and admission to long-term care. Carer burden also increases when a care-recipient falls. This study investigated the experiences of falling of community-living older people with dementia and their carers. Participants included 9 older people with Alzheimer's disease and their ten carers, recruited from a large mental health National Health Service trust. The antecedents, falls events and consequences of falls were discussed. Findings revealed three themes: ‘learning as you go’, ‘we're always together’, ‘nobody was interested’. The findings demonstrated how falling accentuates the impact of dementia on the dyad. Spouse-carers' discussion of their own falls highlighted
Older people experiencing dementia are twice as likely to fall, resulting in serious injury, reduction in everyday activity and admission to long-term care. Carer burden also increases when a care-recipient falls. This study investigated the experiences of falling of community-living older people with dementia and their carers. Participants included 9 older people with Alzheimer's disease and their ten carers, recruited from a large mental health National Health Service trust. The antecedents, falls events and consequences of falls were discussed. Findings revealed three themes: ‘learning as you go’, ‘we're always together’, ‘nobody was interested’. The findings demonstrated how falling accentuates the impact of dementia on the dyad. Spouse-carers' discussion of their own falls highlighted the need for joint assessment of health and well-being to reduce carer burden and preserve the “couplehood” of the dyad. Implications for practice are discussed.