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Latest & greatest articles for falls
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Podiatry interventions to prevent falls in older people: a systematic review and meta-analysis foot problems are independent risk factors for falls in older people. Podiatrists diagnose and treat a wide range of problems affecting the feet, ankles and lower limbs. However, the effectiveness of podiatry interventions to prevent falls in older people is unknown. This systematic review examined podiatry interventions for falls prevention delivered in the community and in care homes.systematic (...) of detection bias in 4/9 studies. Combining falls rate data showed significant effects for multifaceted podiatry interventions compared to usual care (falls rate ratio 0.77 [95% CI 0.61, 0.99]); and multifactorial interventions including podiatry (falls rate ratio: 0.73 [95% CI 0.54, 0.98]). Single component podiatry interventions demonstrated no significant effects on falls rate.multifaceted podiatry interventions and multifactorial interventions involving referral to podiatry produce significant
Effects of a falls prevention exercise programme on health-related quality of life in older home care recipients: a randomised controlled trial falls have serious consequences for quality of life (QOL) and contribute substantially to the global burden of disease. Home care is an important arena to address falls prevention and QOL, but this vulnerable group of older adults is underrepresented in health research. This study explores the effects of a falls prevention exercise programme on health (...) -related quality of life (HRQOL), physical function and falls self-efficacy in older fallers receiving home care.the study design is a parallel-group randomised controlled trial. The intervention group performed a falls prevention programme based on the Otago Exercise Programme (OEP). The control group received usual care. 155 participants were recruited from primary health care in six Norwegian municipalities. Local physiotherapists supervised the programme. The primary outcome, HRQOL, was measured
A combined physical activity and fall prevention intervention improved mobility-related goal attainment but not physical activity in older adults: a randomised trial In people aged ≥ 60 years, does a combined physical activity and fall prevention intervention affect physical activity and mobility-related goal attainment? Does the combined intervention also improve fall rates, daily steps, the proportion of people meeting the physical activity guidelines, quality of life, mood, fear of falling (...) , and mobility limitation?Randomised trial with concealed allocation, intention-to-treat analysis and assessor blinding.One hundred and thirty-one people living in the community and aged ≥ 60 years.The experimental group received one physiotherapist visit, fortnightly telephone-based health coaching, a pedometer, tailored fall prevention advice, and a fall prevention brochure. The control group received the same fall prevention brochure.Primary outcomes were mobility goal attainment (Goal Attainment Scale
Exercise for preventing falls in older people living in the community. At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing (...) falls in older people living in the community.We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies.We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke.We used
Assessment of falls in the elderly Assessment of falls in the elderly - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of falls in the elderly Last reviewed: February 2019 Last updated: January 2019 Summary Falls are often multifactorial in origin. Deandrea S. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010 Sep;21(5):658-68. http (...) ://www.ncbi.nlm.nih.gov/pubmed/20585256?tool=bestpractice.com The presence of the following factors is associated with greater probability of future falls, Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006 Sep;90(5):807-24. http://www.ncbi.nlm.nih.gov/pubmed/16962843?tool=bestpractice.com McInnes L, Gibbons E, Chandler-Oatts J. Clinical practice guideline for the assessment and prevention of falls in older people. Worldviews Evid Based Nurs
Effect of a Multistrain Probiotic on Cognitive Function and Risk of Falls in Patients With Cirrhosis: A Randomized Trial. Probiotics can modulate gut microbiota, intestinal permeability, and immune response and could therefore improve cognitive dysfunction and help avoid potential consequences, such as falls, in patients with cirrhosis. The aim of this study was to evaluate the effect of a multistrain probiotic on cognitive function, risk of falls, and inflammatory response in patients (...) with cirrhosis. Consecutive outpatients with cirrhosis and cognitive dysfunction (defined by a Psychometric Hepatic Encephalopathy Score [PHES] < -4) and/or falls in the previous year were randomized to receive either a sachet of a high-concentration multistrain probiotic containing 450 billion bacteria twice daily for 12 weeks or placebo. We evaluated the changes in cognitive function (PHES); risk of falls (Timed Up and Go [TUG] test, gait speed, and incidence of falls); systemic inflammatory response
Protocol for serious fall injury adjudication in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study. This paper describes a protocol for determining the incidence of serious fall injuries for Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), a large, multicenter pragmatic clinical trial with limited resources for event adjudication. We describe how administrative data (from participating health systems and Medicare claims) can be used (...) to confirm participant-reported events, with more time- and resource-intensive full-text medical record data used only on an "as-needed" basis.STRIDE is a pragmatic cluster-randomized controlled trial involving 5451 participants age ≥ 70 and at increased risk for falls, served by 86 primary care practices in 10 US health systems. The STRIDE intervention involves a nurse falls care manager who assesses a participant's underlying risks for falls, suggests interventions using motivational interviewing
Falls - risk assessment Falls - risk assessment - NICE CKS Share Falls - risk assessment: Summary A fall is defined as an event which causes a person to, unintentionally, rest on the ground or other lower level. For the purpose of this CKS topic, a simple fall is defined as one occurring as a result of a chronic impairment of cognition, vision, balance, or mobility. It is distinguished from a collapse caused by an acute medical problem, such as an acute arrhythmia, transient ischaemic attack (...) , or vertigo. Falls are common in older people, especially those aged 65 years and over, and the prevalence increases with age. The risk of falling is multifactorial, and prevention is usually based on assessing multiple risk factors. A history of falls is one of the strongest risk factors for a fall, and all older people in regular contact with healthcare professionals should be asked routinely whether they have fallen in the past year. Other risk factors for falls in older people include: Conditions
Fall Prevention in Community-Dwelling Older Adults. Falls are common among older adults. One in 3 adults aged 65 years or older and 1 in 2 adults aged 80 years or older fall each year. Interventions for prevention have been identified; however, they are often not addressed in primary care practice. Screening all older adults annually for falls can identify who will benefit from further clinical evaluation and management. Falls and the need for care from subsequent injury increase with age
Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: systematic review and meta-analysis exercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness.to assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling.eight databases were searched to identify randomised/quasi
An economic evaluation of the SUNBEAM programme: a falls-prevention randomized controlled trial in residential aged care To estimate the cost-effectiveness of a strength and balance exercise programme (SUNBEAM) which has been shown to be clinically effective in reducing the rate of falls in residents of aged care facilities.An economic evaluation was conducted alongside a pragmatic cluster randomized controlled trial that included 16 residential care facilities and 221 participants. Mean (...) participant age was 86 years, 65% were female and 78% relied on a mobility aide. A cost-effectiveness analysis examined the costs of providing the exercise programme and costs of health service use arising from falls in each arm (intervention and usual care) over 12 months.Incremental cost-effectiveness ratios were calculated for the cost per fall avoided. Costs were bootstrapped to obtain adjusted confidence intervals for the incremental cost-effectiveness ratios.Of 63 facilities contacted, 16 met
Factors associated with the likelihood of fall-related injury among people with lower limb loss People with lower limb loss that live in the community fall at a rate that exceeds that of other vulnerable populations such as hospitalized elderly people. Past research in a small single state study has identified factors associated with fall-related injury. The purpose of this study was to use a larger multistate sample of people with lower limb loss living in community settings to evaluate (...) factors associated with fall-related injury in a multivariable model.This retrospective cohort study included community-dwelling people with lower limb loss participating in wellness-walking programs in 6 states within the United States. Fall-related injury was considered injury sustained during a fall to the ground that required medical care. Pearson's Chi-squared test and student's t-test were used for descriptive statistics. Odds ratios and 95% confidence intervals from multivariable logistic
Low-Dose Trazodone, Benzodiazepines, and Fall-Related Injuries in Nursing Homes: A Matched-Cohort Study To evaluate whether risk of fall-related injuries differs between nursing home (NH) residents newly dispensed low-dose trazodone and those newly dispensed benzodiazepines.Retrospective, matched cohort study in linked, population-based administrative data. Matching was based on propensity score ( ± 0.2 standard deviations of the score as a caliper), age ( ± 1 year), sex, frailty status (...) , and history of dementia. The derived propensity score included demographic characteristics, clinical comorbidities, cognitive and functional status, and risk factors for falls.All NHs in Ontario, Canada.Propensity score-matched pairs of residents aged 66 and older who received a full clinical assessment between April 1, 2010, and March 31, 2015 (N=7,791).Hospitalization (emergency department visit or acute care admission) for a fall-related injury within 90 days of exposure. Subdistribution hazard
Economic Evaluations of Falls Prevention Programs for Older Adults: A Systematic Review To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies.Systematic review of economic evaluations on falls prevention programs.Studies (N=31) of community-dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017.Adults aged 60 (...) and older.Information on study characteristics and health economics was collected. Study quality was appraised using the 20-item Consensus on Health Economic Criteria.Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two-thirds of all reported incremental cost-effectiveness ratios (ICERs) with quality-adjusted life-years (QALYs) as outcome were
The effectiveness of exercise for fall prevention in nursing home residents: A systematic review meta-analysis The aim of this study was to determine the effectiveness of exercise on fall prevention in nursing home residents.Nursing home residents have a high risk of falling. No conclusive evidence exists on the effectiveness of exercise on fall prevention in nursing home residents.Systematic review and meta-analysis of randomized controlled trials.Databases of PubMed, Web of Science, EMBASE (...) , Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and China Biology Medicine were searched from inception to March 2017, with no language limitation.The review was conducted according to the guidelines of the Cochrane Collaboration. Studies on exercise interventions to prevent falls in nursing home residents were eligible. The primary outcome was the odds ratio with 95% confidence intervals of falls.Nine studies were included in the meta-analysis
Central Nervous System Medication Burden and Risk of Recurrent Serious Falls and Hip Fractures in Veterans Affairs Nursing Home Residents To examine the association between central nervous system (CNS) medication dosage burden and risk of serious falls, including hip fractures, in individuals with a history of a recent fall.Nested case-control study.Veterans Health Administration (VHA) Community Living Centers (CLCs).CLC residents aged 65 and older with a history of a fall or hip fracture (...) in the year before a CLC admission between July 1, 2005, and June 30, 2009. Each case (n = 316) was matched to four controls (n = 1264) on age, sex, and length of stay.Outcomes were serious falls identified using International Classification of Diseases, Ninth Revision (ACD-9) or Current Procedural Terminology (CPT) E codes, diagnosis codes, or procedure codes associated with a VHA emergency department visit or hospitalization during the CLC stay. Bar code medication administration data were used
Exercise for reducing falls in people living with and beyond cancer. Current treatment modalities for cancer have been successful in achieving improved survivorship; however, they come with a number of long-term adverse effects. Accidental falls are a common and clinically significant adverse event in people living with and beyond cancer and rates are higher than in the rest of the population.To assess the effects of prescribed or provided exercise for reducing accidental falls, and falls risk (...) investigating exercise interventions versus no treatment, usual care or non-exercise interventions on falls incidence or falls risk factors in adults living with and beyond cancer (18 years of age or older at diagnosis). We excluded cross-over studies and studies in acute or inpatient hospice care.At least two review authors independently completed data extraction for included papers. We used Covidence software to manage screening, data collection and extraction. We assessed evidence using GRADE
Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiple sclerosis: a prospective cohort study To investigate discriminative ability and clinical utility of the Timed Up and Go under single- and dual-task conditions between fallers and non-fallers in multiple sclerosis (MS).Prospective cohort study.Neurology service in a tertiary hospital.Participants were 101 people with MS and Expanded Disability Status Scale score of 3-6.5 (...) . One participant withdrew after the baseline assessment, and hence the data were analysed for 100 participants.No specific intervention.Timed Up and Go and Timed Up and Go-Cognitive. Three-month prospective diaries recorded falls.Mean age was 52.6 (SD 10.7) and 66 were female. Majority of the participants had progressive MS (72) and 73 used a walking aid; 56 participants recorded 791 falls. The area under the receiver operating characteristic curve values for Timed Up and Go and Timed Up and Go