Associations of Gait Disorders and Recurrent Falls in Older People: A Prospective Population-Based Study

<b><i>Background:</i></b> Recurrent falls represent a major source of serious adverse health outcomes in the general older population. Gait impairment has been linked to recurrent falls, but there are only limited long-term data on this association. <b><i>Objectives:</i></b> The objective of the study was to investigate the association of gait disorders (GDs) and gait tests with future falls in an existing longitudinal population-based cohort. <b><i>Method:</i></b> The study was performed in participants of the Bruneck Study cohort 2010 aged 60–97 years, with prospective 5-year follow-up. At baseline, participants underwent a clinical gait assessment (to determine neurological and non-neurological GDs according to an established classification) and were also evaluated by quantitative and semiquantitative gait tests (Hauser Index, Tinetti balance and gait test, and gait speed). Logistic regression analysis adjusted for age and sex was used to determine the relationship of baseline variables with incident recurrent falls at 5-year follow-up. <b><i>Results:</i></b> Of 328 included participants, 22 (6.7%) reported recurrent falls at follow-up. Baseline presence of GDs was associated with recurrent falls at follow-up (odds ratio [OR] 4.2; 95% confidence interval [CI] 1.6–11.1; <i>p</i> = 0.004), and this effect was largely driven by neurological GDs (OR 5.5; 95% CI 1.7–17.4; <i>p</i> = 0.004). All 3 simple gait tests were predictive for incident falls (Hauser Index, <i>p</i> = 0.002; Tinetti test, <i>p</i> = 0.006; and gait speed, <i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Clinical assessment of GDs and gait tests both had independent significant predictive value for recurrent falls over a 5-year follow-up period. This highlights the potential of such assessments for early fall risk screening and timely implementation of fall-preventive measures.

Falls in Older People

This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.

Oncology clinic nurses’ attitudes and perceptions regarding implementation of routine fall assessment and fall risk screening: A survey study

Falls in older adults with cancer are often under-recognized and under-reported. The objective of this study was to explore oncology clinic nurses’ willingness and perceived barriers to implement routine falls assessment and falls screening in their practice. Nurses working in outpatient oncology clinics were invited to complete an online survey. Data were analyzed using descriptive statistics and sorted into thematic categories. The majority of respondents indicated willingness to routinely ask older patients about falls (85.7%) and screen for fall risks (73.5%). The main reasons for unwillingness included: belief that patients report falls on their own, lack of time, and lack of support staff. Findings from this study show many oncology nurses believe in the importance of routine fall assessment and screening and are willing to implement them routinely, although falls are not routinely asked about or assessed. Future work should explore strategies to address barriers nurses face given the implications of falls amongst this vulnerable population.

Predicting Falls in Healthy Elderly: A Comparison between Unified Balance Scale versus Four-Square Step Test

Background: Falls is a major incidence in elderly life and its sequence may be a major cause of mortality. Falls can be predicted and thus prevented. Screening scales are either a brief one component balance or more composite multifactorial assessment. Four Square Step test is an easy, less time consuming, versus Unified Balance scale which is multi domain. The present study was intended to see which of the two scales could accurately predict adults who were at risk of falls. Thus, helping therapist perform a single test to screen them and give them targeted treatment. Method: 80 Healthy elderly above the age of 60 years were included in the study. Fall history was noted post which Four Square Step test and Unified Balance Scale was administered in sequence. Data Analysis was done, and sensitivities and specificities were calculated. Result: Statistical Analysis was done by plotting the contingency table and plotting the Receiver Operating Curve. The Unified Balance Scale had a better combination of sensitivity and specificity than Four Square step test. Conclusion: Unified Balance scale is better than Four-Square step test in predicting falls in healthy elderly. Key words: Elderly, Fall-Risk, Screening, Four Square Step Test, Unified Balance Scale, Prediction.

Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs

Objectives: Physical therapists (PTs) are integral team members in fall prevention in clinical settings; however, few studies have investigated PTs' engagement in pro-bono community-based falls prevention. Therefore, we aimed to describe the characteristics of PTs and physical therapist assistants (PTAs) in the United States who conduct community-based fall screenings, the reach of screenings, their knowledge and utilization of the Centers for Disease Control and Prevention's fall-risk screening toolkit (STEADI, Stopping Elderly Accidents, Deaths, and Injuries), and therapists' knowledge and referrals to evidence-based programs (EBPs) and community resources.Methods: A cross-sectional survey distributed to a convenience sample of PTs/PTAs in the United States through news-blasts, and social media.Results: Four hundred and forty-four therapists who worked with older adults completed the survey. Approximately 40% of the respondents (n = 180) conduct screenings, most frequently annually. People who screen tend to be PTs with &gt;20 years of experience, work in outpatient/wellness or academia, and be involved in the least amount of direct patient care. The majority (n = 344, 77.5%) of survey respondents were somewhat to very familiar with the STEADI, and ~84% (n = 114) of respondents who were very familiar with the STEADI (n = 136) use the toolkit to conduct community-based, pro-bono fall risk screenings. Twenty-six percent (n = 14) out of the 53 PTAs who responded to the survey conduct falls screenings in the community. Of the PTs/PTAs who conduct community-based fall screenings (n = 180), ~ 75% (n = 136) are aware of and refer older adults to EBPs. Over half also refer to Silver Sneakers and/or senior centers.Discussion: PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community. Data helps inform community organizations that most PTs who engage in community-based fall risk screening utilize the STEADI toolkit and refer to community-based programs. Community organizations seeking PT partners to engage in fall risk screenings and promote referrals to local resources or EBPs will likely have the most success collaborating with local physical therapy education programs or physical therapy clinic managers.

Can Fall Risk Screening and Fall Prevention Advice in Hospital Settings Motivate Older Adult Patients to Take Action to Reduce Fall Risk?

Objective: We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action. Method: Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on their individual risk factors. Three months after screening, preventive steps taken by patients were surveyed. Results: Two hundred sixteen patients were screened. Of the 83 patients completing a 3-month follow-up, 51.8% took action; among patients who received tailored advice ( n = 20), 70% took action. Patients most often adhered to advice on improving muscle strength and undergoing vision checkups (20%). Tailored advice and a reported low quality of life were associated with consulting a health care provider. Discussion: Patients at risk in these settings are inclined to take action after screening. However, they do not always adhere to the tailored prevention advice.

Bone Density and Fall Risk Screening in Algarve

Osteoporosis is a major cause of morbidity and mortality around the world and is a silent disease characterized by low bone strength that results in an increased risk of fracture. The benefits of being physically active in advanced ages to reduce the loss of bone mineral density (BMD) and improve functional capacities are well known. Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity for the assessment of skeletal status, along with fall risk assessment. This chapter consists of a brief review of the literature on osteoporosis and describes ongoing activities on bone density and fall risk prevention in Algarve, Portugal as part of EIP AHA´s action group on fall prevention with the presentation of a preliminary study. This study aimed to demonstrate that the postmenopausal female seniors who adhere to the recommendations for the regular program of physical activity after osteoporosis screening one year later show a slower decrease in BMD.

A Practical and Validated Fall Risk Screening Instrument: A Systematic Review

Early detection of a high fall risk is important to start fall preventive interventions in time and to reduce fall risk among older people. Several fall risk screening instruments are available, however it is unclear which instrument is validated and most suitable for the primary care setting. This systematic review aims to identify the most suitable fall risk screening instrument(s) for the primary care setting (i.e. requires limited time, no expensive equipment and no additional space) with good prognostic ability to assess high fall risk among independently living older people. An extensive search was conducted in the databases PubMed, EMBASE CINAHL, Cochrane and PsycINFO. Twenty-six out of 2277 articles published between January 2000 and February 2019 were included. Six fall risk screening instruments were identified; TUG test, Gait Speed test, BBS, POMA, FR test, Fall History. Most articles reported AUCs ranging from 0.5-0.7 for all instruments. Sensitivity and specificity varied substantially across studies (e.g. TUG, sens.: 10-83.3%, spec.:37-96.6%). The results showed that none of the included screening instruments had sufficient (AUC&gt;0.7) predictive performance (Šimundić, 2009). As suitability for the primary care setting prevails for now, Fall History appears to be the most suitable screening instrument. Compared to the other instruments, Fall History requires the least amount of time, no expensive equipment, no training, and no space (adjustments). Patient’s fall history together with a health care professional’s clinical judgment, might be a promising screening strategy for the primary care setting to identify high fall risk among older people.