Intervention leads to increase in primary care screenings for older adults

by Regenstrief Institute

Credit: CC0 Public Domain

Falls and dementia are some of the most common syndromes affecting the health of older adults, but many primary care physicians are not specifically trained to screen for them. The Indiana Geriatrics Education and Training Center (Indiana GETC) created a successful intervention combining education and workflow that increased primary care screenings for these geriatric conditions. 

29 jan 2022--"There is a shortage of geriatrics specialists, so most older adults receive care from a primary care provider. That's why it is so important to integrate geriatrics into primary care," said lead study author Debra Litzelman, M.D., M.A., research scientist at Regenstrief Institute and the principal investigator and director of Indiana GETC.  "We created an intervention that improves attitudes toward older adults and leverages teamwork to integrate these important screenings into care delivery. This study demonstrates that this intervention can be successfully implemented in primary care settings."

The Indiana GETC delivered an interdisciplinary education course for primary care providers and staff including medical assistants, nurses, and social workers about older adults' specific health concerns and screenings. They also created an electronic health record (EHR) flow sheet with screening questions that would be automatically triggered for office visits of patients 65 years or older. Each survey was only two questions and delivered by medical assistants as the patient was being taken to the exam room. Results were then communicated to the primary care provider. 

The intervention was rolled out at eight Federally Qualified Health Centers in a health system in Indianapolis. More than 6,600 geriatric patients were cared for during the course of this study. Populations served were 51 percent Black and 33 percent Caucasian. 

The study team found that after the education sessions, provider attitudes toward older patients and perceptions of the importance of a team approach to care became significantly more positive. 

Screening rates also increased during training, and continuously increased afterward. This has happened at all sites for both dementia and falls surveys. 

"The greater understanding of the needs of older adults provided by the education sessions likely primed the care teams to implement changes related to screenings," said Dr. Litzelman. "The fact the screeners did not disrupt the patient flow was also a key to success. This intervention is actively being shared with other national Geriatrics Workforce Enhancement Programs."

"Combined interprofessional education and system intervention to improve screening older adults for dementia and falls" is published in Gerontology & Geriatrics Education online ahead of print. 

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More information: Debra K. Litzelman et al, Combined interprofessional education and system intervention to improve screening older adults for dementia and falls, Gerontology & Geriatrics Education (2021). DOI: 10.1080/02701960.2021.2001336

 

Wearable accelerometer and vibrator 'thimble' could reduce falls amongst seniors

by Yokohama National University

Overview of the proposed wearable light-touch device for human balance support. Credit: Yokohama National University

Japanese researchers have developed and tested a prototype device—wearable on the fingertips—that incorporates the concept of 'light touch' to enhance the sense of balance. If widely implemented, the device should significantly reduce incidence of falls amongst seniors. The findings are published in the journal Scientific Reports on April 1.

As we age, our sense of balance can become impaired. The resulting increase in postural sway in turn increases the risk of falls and consequent injuries. Meanwhile, older people make up a large and increasing proportion of the population in highly developed countries. This makes efforts to reduce the effects of postural sway ever more imperative.

Aids such as canes and walking frames help a great deal, but research suggests their use or misuse in certain circumstances such as on stairs or stepping into or out of vehicles can actually exacerbate the problem with sense of balance and increase the risk of injury.

In order to address the challenge of human balance in the elderly, in recent years a great deal of research has focussed on the phenomenon known as 'light touch.' Even with eyes closed, a subject that lightly touches a curtain or piece of paper draped in front of them with just their fingertips is given enough of a stimulus cue to reduce their swaying. This happens even though a curtain or piece of paper cannot deliver any postural support in the way that a cane or walking frame can.

Researchers with Yokohama National University (YNU) and the Prefectural University of Hiroshima wanted to test a way to create a 'virtual light touch' (VLT) system to achieve the same result—in effect creating a virtual curtain.

The first step was a basic VLT system that incorporated a small device that fits over a fingertip of a subject—much like wearing a thimble—and delivers a vibrotactile 'nudge' when they begin to sway. Assessment of swaying in this first attempt at a VLT was performed by a 3-D motion capture system akin to what is used by special effects professionals in the movie industry.

Initial tests on subjects with this proof-of-concept system showed results equivalent to the use of a physical curtain.

"The use of such a large and complex motion capture system is no more practical in daily life than a curtain," said Keisuke Shima, Associate Professor at faculty of engineering of YNU and lead author of the study.

"But the tests on live subjects showed that the concept worked," added YNU researcher Mami Sakata, a co-author of the paper. "The next step was to transform the VLT into a system that could be used in everyday life."

The researchers swapped out the motion capture system for an accelerometer—an electromechanical device that measures acceleration forces—similar to what is found in most smartphones. The vibrotactile nudges were still delivered by the vibrotactile thimble device.

The accelerometer-and-vibrotactile-thimble VLT system was then tested on 150 volunteers ranging in age from their sixties to their nineties and again found that postural sway was reduced as significantly as a physical curtain.

The acceleration-based VLT set-up is immediately practical as a balance aid in everyday life as it involves a simple, lightweight and compact sensor and motor. It should enjoy widespread adoption amongst elderly people.

However, the researchers want to improve their system further by making the device even more lightweight and compact, and to enhance its reduction of postural sway. For this latter enhancement, they will need to explore precisely how the still poorly understood light-touch effect works to support human balance.

More information: Keisuke Shima et al, A wearable light-touch contact device for human balance support, Scientific Reports (2021). DOI: 10.1038/s41598-021-85687-4

Provided by Yokohama National University

 

Older people with early, asymptomatic Alzheimer's at risk of falls

by Tamara Bhandari, Washington University School of Medicine

Credit: CC0 Public Domain

Falls are the leading cause of fatal injuries in older adults, causing more than 800,000 hospitalizations and about 30,000 deaths in the U.S. every year. Some risk factors are well-known—advanced age, problems with vision or balance, muscle weakness—but an under-recognized factor is early Alzheimer's disease. Older people in the earliest stages of Alzheimer's, before cognitive problems arise, are more likely to suffer a fall than people who are not on track to develop dementia.

20 september 2020--Researchers at Washington University School of Medicine in St. Louis have found that, in older people without cognitive problems who experience a fall, the process of neurodegeneration that leads to Alzheimer's dementia already may have begun. The findings, available online in the Journal of Alzheimer's Disease, suggest that older people who have experienced falls should be screened for Alzheimer's and that new strategies may be needed to reduce the risk of falling for people in the disease's early stages.

"In the world of fall research, we generally say that you're at risk of falling if you lose strength and balance," said co-senior author Susan Stark, Ph.D., an associate professor of occupational therapy, of neurology and of social work. "If you lose strength and balance, the recommended treatment is to work on strength and balance. But if someone is falling for another reason, maybe because his or her brain has begun accumulating Alzheimer's-related damage, that person might need a different treatment entirely. We don't yet know what that treatment might be, but we hope we can use this information to come up with new treatment recommendations that will reduce the risk of falls in this population."

In 1987, John C. Morris, MD, then a trainee at Washington University, discovered that older people with Alzheimer's dementia are more than twice as likely to suffer a traumatic fall than people of the same age without dementia. Morris is now the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology and head of the university's Charles F. and Joanne Knight Alzheimer's Disease Research Center.

Since Morris' discovery more than three decades ago, scientists have learned that the brains of Alzheimer's patients start undergoing changes decades before memory loss and confusion become apparent. First, plaques of amyloid proteins form, then tangles of tau protein. Some brain areas begin to shrink, and communication networks between distant parts of the brain start to decay. Stark and colleagues have shown that the link between Alzheimer's and falling holds true even during the silent phase of the disease: People with so-called preclinical Alzheimer's are at increased risk of falling despite having no apparent cognitive problems.

To better understand why people without cognitive symptoms are at risk of falling, first author Audrey Kelemen, a graduate student in Stark's lab, and colleagues followed 83 people over age 65 for a year. All participants were assessed as cognitively normal by a qualified neurologist at the beginning of the study. Each participant filled out monthly calendars recording any falls and underwent brain scans for amyloid and for signs of atrophy and impaired connectivity.

The researchers discovered that the presence of amyloid in the brain alone did not put people at increased risk of falling but that neurodegeneration did. Participants who fell had smaller hippocampi—brain regions that are devoted to memory and that shrink in Alzheimer's disease. Their somatomotor networks—webs of connections that are involved in receiving sensory inputs and controlling movement—also showed signs of decay. The researchers concluded that falling is most likely to occur in the neurodegeneration phase of preclinical Alzheimer's—the last five years or so before memory loss and confusion arise.

"Since I started working on this project, I've started asking my patients about falls, and I can't tell you how often that has helped me start understanding what is going on with the individual," said co-senior author Beau M. Ances, MD, Ph.D., the Daniel J. Brennan, MD, Professor of Neurology and a professor of radiology and of biomedical engineering. Ances treats patients who have dementia and other neurological conditions on the Washington University Medical Campus.

"When a person's mobility is being diminished, even though the person looks very normal, that could be a sign that something needs further evaluation," Ances said. "It's actually a really important potential marker that should make us say, 'Wait a minute. Let's dive into this more. Are there other things that go along with it?'"

The researchers have begun further experiments to better understand why brain changes in Alzheimer's put people at risk of falling, so they can develop fall-prevention recommendations. In the meantime, simple changes could go a long way toward protecting older people from devastating falls, Stark said.

"You can prevent a lot of falls just by making the environment safer," Stark said. "Simple changes could help and can't hurt: making sure the tub isn't slippery; making sure you can get up easily off the toilet; balance and strength training; reviewing your prescriptions to see if certain medications or combinations of medications are increasing the risk of falling. Until we have specific fall-prevention treatments for people with preclinical Alzheimer's, there are still plenty of things we can do to make people safer."

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More information: Audrey Keleman et al, Falls Associate with Neurodegenerative Changes in ATN Framework of Alzheimer's Disease, Journal of Alzheimer's Disease (2020). DOI: 10.3233/JAD-200192

Journal information: Journal of Alzheimer's Disease 

Simple test helps to predict and prevent falls

by Staffordshire University

Designed by Staffordshire University Cartoon and Comic Arts student Josh Thomas who won a competition to illustrate the study. Credit: Staffordshire University/Josh Thomas

The "enhanced paper grip test" validated by researchers from the Centre for Biomechanics and Rehabilitation Technologies (CBRT) at Staffordshire University involves pulling a small card from underneath the participant's foot while asking them to grip with their big toe (Hallux).

25 july 2020--The proposed test can potentially be used to monitor muscle weakness in clinics for better falls-risk assessment in patients with diabetes.

Dr Aoife Healy, Associate Professor of Human Movement Biomechanics at CBRT, said: "The paper grip test is a simple, clinically applicable test to detect muscle weakness in the foot. The current paper builds on our previous work and shows its usefulness in assessing strength and balance in this group of vulnerable patients."

The experiment involved assessing twenty healthy volunteers at Staffordshire University's specialist Biomechanics labs and ten people with diabetes at a diabetic foot clinic in India.

Hallux grip force was previously found to be strongly linked to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The latest results published in Gait and Posture on a modified test shows the reliability and validity of Hallux grip force during clinical assessment.

Dr Lakshmi Sundar, a co-author in this study and a diabetic foot specialist from Chennai in India, added: "This type of simple clinical assessment is extremely valuable in low resource settings and helps in providing effective clinical advice."

Dr Panagiotis Chatzistergos, Associate Professor in Orthopaedic and Rehabilitation Biomechanics, who led this study highlighted: "The original version of the paper grip test was shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, we have developed this enhanced test that replaces the pass/fail outcome with a continuous measurement of the pulling force that is needed to remove the card."

This latest study is part of the Centre for Biomechanics and Rehabilitation Technologies' wider work in the area of diabetic foot management which includes research to help prevent life-threatening foot ulcers and amputations.

Professor Nachi Chockalingam, Director of the Centre for Biomechanics and Rehabilitation Technologies, said: "Falls and fear of falling are a major issue in the management of older adults. Also, falling for the first time sets in motion a cycle of increased fear of falling, reduced activity and loss of strength. This leads to a higher risk for further falls. So, it is important to identify individuals who might fall and preventing the first fall is extremely important."

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More information: Panagiotis E. Chatzistergos et al, Reliability and validity of an enhanced paper grip test; a simple clinical test for assessing lower limb strength, Gait & Posture (2020). DOI: 10.1016/j.gaitpost.2020.07.011

Exercise, not vitamin D, recommended to prevent falls

Falls and fractures are a major cause of disability in old age. An influential U.S. medical task force is recommending exercise and, in some cases, medical evaluation to help seniors stay on their feet.

28 sept 2017--But the new draft recommendations from the U.S. Preventive Services Task Force (USPSTF) say there isn't enough evidence at this time to either endorse or advise against taking vitamin D or calcium supplements to prevent broken bones.
And based on current evidence, the panel recommends against taking vitamin D solely to prevent falls.
For Americans 65 and older, falls are the leading cause of injuries and injury-related deaths, according to the U.S. Centers for Disease Control and Prevention. On average, one older person falls every second in the United States, the CDC says.
"Fortunately, there are things we can do to help prevent falls," said Dr. Alexander Krist, a task force member.
However, "we found that it is unclear whether vitamin D and calcium can help prevent fractures at higher doses," said Krist, an associate professor of family medicine and population health at Virginia Commonwealth University. "They do not prevent fractures at lower doses."
More research is needed to evaluate the potential benefit of high-dose calcium and vitamin D supplementation for fracture prevention after menopause, the task force noted.
"We hope that you talk to your primary care provider about exercise to prevent falls if you have any concerns about falling, as well as vitamin D or calcium supplementation if you have any questions about your personal risk of fractures," Krist added.
The USPSTF, an independent panel of experts, provides guidance to physicians about how to prevent medical problems.
The proposed guidelines are intended to help prevent falls and fractures in generally healthy adults aged 65 and older who live at home and don't have medical problems such as osteoporosis, vitamin D deficiency, Parkinson's disease or dementia.
After reviewing the available studies, "we found that exercise had a moderate benefit in preventing falls in older adults at increased risk for falls," Krist said.
The task force didn't suggest any particular type of exercise. Still, "supervised exercise that improves balance, the way someone walks, and helps with completing common tasks are helpful," Krist said.
"These can be done in group or individual classes and either at home or in the community. Patients should talk with their clinician about what exercise programs are best for them," he added.
The task force also recommends that health care providers "selectively check older adults' risks for falls, and then offer tailored interventions that address those specific risks."
However, one expert doubts that such risk assessments will become common.
"Medical offices are businesses. Anything that adds time to the office visit, without adding revenue, is unlikely to be added to the majority of visits," said Dr. Chris Sciamanna, a professor of medicine and public health sciences at Penn State College of Medicine. He wasn't involved in writing the draft recommendations.
Sciamanna suggested that seniors test themselves: "If you can't stand on either leg for 10 seconds without grabbing onto something, you're at risk and should talk to your doctor," he said.
But, he added, "the reality is that there's little for doctors to do other than to refer you to an exercise program or, in some cases, reduce the dose of a medicine that may be hurting your balance, like a blood pressure medicine."
In a perfect world, Sciamanna said, he would have his patients enroll in a strength and balance program three times each week, and also "get aerobic exercise, preferably something that would be fun and build their agility."
Although the task force recommends against taking vitamin D to prevent falls, there's no recommendation regarding whether seniors should take vitamin D for general health.
As for other ideas, the task force said there's not enough evidence to show the value of single strategies like managing medications or making the home environment safer.
The task force released its draft recommendations Sept. 26 and is accepting comments about them on their website until Oct. 23.

More information: Alexander Krist, M.D., MPH, associate professor of family medicine and population health, Virginia Commonwealth University, Richmond, Va.; Chris Sciamanna, M.D., MPH, professor, medicine and public health sciences and vice chair, research, department of medicine, Penn State College of Medicine, Hershey, Pa.; U.S. Preventive Services Task Force, draft recommendations, Sept. 26, 2017.

Evidence Review 1
Draft Recommendation Statement 1
Comment on Recommendation 1
Evidence Review 2
Draft Recommendation Statement 2
Comment on Recommendation 2

Hospital or home? Guidelines to assess older people who have fallen

Guidelines to help paramedics make the right decision for older people who have fallen are safe, cost-effective and help reduce further 999 calls, according to new research led by a team at Swansea University Medical School.

26 mar 2017--Falls are a very common problem in older people, with severe consequences. Many 999 calls are made for older people who fall. Many callers fall more than once.

• Approximately 30% of people over 65 living at home fall every year
• In the UK, falls account for almost £1 billion of the NHS budget
• Around 8% of 999 calls in the UK are for falls

If the person who has fallen is not injured they may be left at home by the ambulance crew, rather than taken to hospital. On average this happens in around 40% of cases currently. In some places ambulance services have made local links with community falls services. However, there is not enough evidence to show whether this is safe, effective for patients or worth the cost.
This is where the Swansea research comes in, part of a project called SAFER 2 (Support and Assessment for Fall Emergency Referrals). The team carried out a large-scale trial to test new guidelines - known as a protocol - for paramedics to use to assess people following a 999 call for a fall. The protocol helps them decide whether they should take the patient to hospital, or leave them at home with a referral to a community-based falls service if appropriate
The trial involved105 paramedics based at 14 ambulance stations, across three UK ambulance services. The team monitored over 4000 people who called for an ambulance after falling.
The research showed that the new protocol:

• Was safe and inexpensive
• Led to an 11% decrease in further 999 calls by people who have fallen - so there would now be 8 calls for every 9 made previously
• Left fewer people without continuing care after their fall
• Did not have any wider effects on Accident and Emergency admissions or death rates
• Had limited effects on patients' quality of life or satisfaction
• Was not used as much or as consistently by paramedics as expected

Professor Helen Snooks of Swansea University Medical School, who led the project, said:
"The findings show that this new way of assessing patients who fall is safe. Ambulance services can introduce it knowing that it does not increase the risk of harm to patients.
We also showed that the protocol was associated with a small reduction in 999 calls from patients who had fallen previously. As costs and pressures are so high in emergency care, even a small reduction can make a big difference."


Provided by Swansea University

Scientists discover link between common medications and serious falls in older men

29 july 2015--Using data from The Irish Longitudinal Study on Ageing (TILDA), scientists from Trinity College Dublin, St James's Hospital, Dublin, Ireland and three UK Universities have discovered a significant link between serious falls causing injury in older men and a particular group of commonly used medicines. The findings are published today by the Journal of the American Geriatrics Society.

Many medicines which are commonly prescribed for older people for bladder problems, depression, psychosis, insomnia, and respiratory problems, have anti-cholinergic effects. The medications affect the brain by blocking a key chemical called acetylcholine which is involved in passing messages between nerve cells. This can lead to side effects including blurred vision, increased heart rate, sedation and confusion.

Previous studies have shown an impact on cognitive function and mortality from taking multiple anti-cholinergic medicines. In this important new study, the researchers led by Dr Kathryn Richardson who carried out the research at the Department of Gerontology in Trinity and at the Faculty of Medicine and Health Sciences at the University of East Anglia, examined whether the use of such medicines increased the risk of subsequent serious falls (which caused injury) in people aged over 65 years in Ireland.

Using the TILDA data which recorded the medications the participants were taking and the number and type of falls they had experienced, the team found that falls resulting in injury were more than twice as likely in men taking medicines with potent anti-cholinergic activity. The effect remained even after accounting for differences in health and other risk factors for falls. A greater use of such medicines increased the risk for these men further. There was no such association for women, however.

Speaking about the significance of these findings for prescribing practices in older people, lead author Dr Kathryn Richardson, a former PhD student at Trinity, who is now a Research Fellow at the University of East Anglia said: "Our findings indicate the importance for doctors, pharmacists and healthcare professionals to regularly review the appropriateness of medications taken by their older patients. It is however, important that people don't stop taking any medications before speaking with their GP. It is not fully clear why the same link was not found in women and further research is needed to explore this and the reasons behind the findings in men".

Dr Richardson continued: "Experiencing a fall can have a devastating impact on older people's lives and is a major contributor to care home admission and hospitalisation, so it is vitally important for us to find ways to reduce the risk of falls or their severity."

Senior author and Principal Investigator of TILDA Professor Rose Anne Kenny said: "Falls are one of the leading causes of loss of independence as people get older and the principal reason given for admission into nursing home care in Europe. If early risk factors are identified and modified, falls can be prevented. This paper highlights important new risk factors for falls."

Dr Chris Fox, Clinical Reader/Honorary Consultant Psychogeriatrician at the University of East Anglia said: "With the rising levels of frailty in older people we must develop strategies to maintain health and avoid prescribing medicines which could cause a deterioration- such an approach could be simply implemented using tools available"

Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University said: "After a fall, an older person may never regain the same quality of life. This research helps us to understand how medication is linked to falls. It is vital that doctors, nurses and pharmacists review medication if someone has suffered a recent fall."

Provided by Trinity College Dublin

Tai chi helps prevent falls and improve mental health in the elderly

Tai chi has particular health benefits for older people, including helping to prevent falls and improving mental wellbeing, reveals a review published ahead of print in the British Journal of Sports Medicine.

24 may 2011--But the Chinese martial art widely practised for its health benefits does not help improve the symptoms of cancer or rheumatoid arthritis and the evidence is contradictory for many other health conditions and symptoms.

The effectiveness of t'ai chi for a variety of medical conditions and symptoms has been assessed in several studies and reviews, but their findings have been contradictory, so researchers from Korea Institute of Oriental Medicine in South Korea and the University of Exeter in the UK decided to compare the conclusions of these reviews to gain a better understanding of the benefits of t'ai chi.

Thirty five relevant reviews assessing t'ai chi were identified from English, Chinese and Korean databases. They looked at the effectiveness of the technique in a variety of disease areas, including cancer, Parkinson's disease, musculoskeletal pain, osteoarthritis, rheumatoid arthritis, cardiovascular disease, high blood pressure, osteoporosis and type 2 diabetes. Some reviews also assessed the benefits of t'ai chi for psychological health, balance and fall prevention, muscle strength and flexibility and improving aerobic capacity.

For several conditions, the findings of the reviews were contradictory. However, there was relatively clear evidence that t'ai chi is effective for fall prevention and improving psychological health and was associated with general health benefits for older people. On the other hand, t'ai chi seemed to be ineffective for the symptomatic treatment of cancer and rheumatoid arthritis.

The authors conclude: "Our overview showed that t'ai chi, which combines deep breathing and relaxation with slow and gentle movements, may exert exercise-based general benefits for fall prevention and improvement of balance in older people as well as some meditative effects for improving psychological health. We recommend t'ai chi for older people for its various physical and psychological benefits. However, t'ai chi may not effectively treat inflammatory diseases. "

Provided by British Medical Journal

Exercise and vitamin D help to prevent falls in seniors

22 dec 2010-- A systematic review of over 50 clinical trials finds that exercise and Vitamin D supplements are the best ways to reduce the risk of falling in people aged 65 and over. The review is published in the December 21 issue of Annals of Internal Medicine and was commissioned by the US Preventive Services Task Force. A researcher at the Drexel University School of Public Health worked with colleagues at the Kaiser Permanente Center for Health Research, which is part of the Oregon Evidenced-based Practice Center, to conduct the study.

“Our evidence review shows that exercise and Vitamin D supplementation are the most effective primary care interventions to prevent falls,” said Yvonne L. Michael, ScD, MS, an associate professor at the Drexel University School of Public Health and lead review author of the report. “This is important news because falls are extremely common in this population and they are the leading cause of death and injury for the elderly. We need to help primary care clinicians find better ways to prevent falls, and this review will help to do that.”

Michael and her colleagues evaluated 18 clinical trials of exercise and physical therapy involving nearly 4,000 people who were aged 65 or older. Some of the trials involved group exercise or Thai Chi classes; others involved individualized exercise instruction at home. There were a variety of exercises included but most were aimed at improving gait, balance, strength and flexibility needed to do everyday activities. The interventions ranged from six weeks to 12 months or longer and the evaluation periods lasted up to 18 months after the programs ended. When taken individually most of these trials showed no statistical difference, but when the results were pooled together the exercisers had a 13 percent lower risk of falling compared to those who did not exercise.

For the review of Vitamin D supplementation researchers evaluated nine clinical trials involving nearly 6,000 participants who received daily oral doses of Vitamin D with or without calcium. The dosage ranged from 10 to 1,000 IU’s per day, in one trial participants received a larger single intramuscular injection of 600,000 IU’s of Vitamin D. The trials lasted from eight weeks to three years. Follow up periods ranged from six to 36 months. Participants who received Vitamin D had a 17 percent reduced risk of falling, compared to participants who did not receive Vitamin D.

Other interventions that addressed single risk factors including vision correction, medication assessment, home hazard modification, and education and behavioral counseling did not significantly reduce the risk of falling in the elderly. Interventions that provided comprehensive risk assessment and management did reduce the risk of falling by 11 percent. In these trials—called multifactorial assessment and management interventions—healthcare providers evaluated and managed multiple risk factors including medication use, visual problems, home environment and gait and balance issues. In many of the successful trials, home health nurses or case managers developed an individual tailored approach specifically for that participant. For example, the nurse might conduct a home visit to remove obstacles, help the patient enroll in an exercise class to improve balance, and help the patient get in to see an ophthalmologist to address a vision problem.

Michael received her ScD in epidemiology and health and social behavior from the Harvard School of Public Health, master of science degree in health and social behavior from the Harvard School of Public Health and bachelor of arts degree in government from the College of William and Mary. Her research areas include the impact of social characteristics of communities and individuals on population health, particularly as it relates to active aging, women’s health and health disparities.

Provided by Drexel University

Elderly can blame fractures and falls on low sodium

Older adults with even mildly decreased levels of sodium in the blood (hyponatremia) experience increased rates of fractures and falls, according to a study presented at the American Society of Nephrology's 43rd Annual Meeting and Scientific Exposition. Falls are a serious health problem for the elderly and account for about 50 percent of deaths due to injury in the elderly.

22 nov 2010--"Screening for a low sodium concentration in the blood, and treating it when present, may be a new strategy to prevent fractures," comments Ewout J. Hoorn, MD, PhD (Erasmus Medical Center, Rotterdam, the Netherlands). However, hyponatremia does not appear to affect the risk of osteoporosis, as defined by low bone mineral testing, so more research is needed to understand the link between sodium levels and fracture risk.

The study included more than 5,200 Dutch adults over age 55, all with initial information on sodium levels and six-year follow-up data on fractures and falls. "A number of recent studies suggested a relationship between hyponatremia, falls, osteoporosis, and fractures," Hoorn explains. The authors' goal was to confirm these possible associations using prospective, long-term follow-up data.

About eight percent of the study participants, all community dwelling adults, had hyponatremia. This group of older participants had a higher rate of diabetes and was more likely to use diuretics (water pills) than those with normal sodium levels. Subjects with hyponatremia had a higher rate of falls during follow-up: 24 versus 16 percent. However, there was no difference in bone mineral density between groups, so hyponatremia was not related to underlying osteoporosis.

Nevertheless, the group with low sodium levels had a higher rate of fractures. With adjustment for other risk factors, the risk of vertebral / vertebral compression fractures was 61 percent higher in the older adults with hyponatremia. The risk of non-spinal fractures, such as hip fractures, was also significantly increased: a 39 percent difference.

The relationship between hyponatremia and fracture risk was independent of the increased rate of falls in the low-sodium group. Subjects with hyponatremia also had a 21 percent increase in the risk of death during follow-up.

Hyponatremia is the most common electrolyte disorder, usually developing because the kidneys retain too much water. "Although the complications of hyponatremia are well-recognized in hospitalized patients, this is one of the first studies to show that mild hyponatremia also has important complications in the general population," says Hoorn.

Further study will be needed to clarify the mechanism by which low sodium levels increase fracture risk. In the meantime, "Screening older adults for and treatment of hyponatremia in older adults may be an important new strategy to prevent fractures," adds Hoorn.

Provided by American Society of Nephrology

Elderly Falls Linked to Altered Blood Flow in Brain

19 may 2010-- High blood pressure can alter the flow of blood in the brain and lead to falls among the elderly, new research suggests.

The findings stem from research led by Dr. Farzaneh A. Sorond of Brigham and Women's Hospital, Hebrew SeniorLife's Institute for Aging Research and Harvard Medical School in Boston.

Sorond and her colleagues focused on 419 men and women over the age of 65, all of whom underwent walking speed monitoring and ultrasound testing to gauge brain blood flow. All the seniors and their caregivers also indicated how many times the participants had fallen in the previous two years.

In the May 18 issue of Neurology, the authors report that those seniors who were among the 20 percent of participants who experienced the smallest brain blood flow changes were 70 percent more likely to fall than those among the 20 percent with the largest brain blood flow changes.

In other words, those with the highest blood flow rate fell on average fewer than once per year, while those with the smallest blood flow rate fell almost 1.5 times per year.

"At age 60, 85 percent of people have a normal walking ability," Sorond said in a news release. "However, by age 85, only 18 percent of seniors can walk normally."

"Our findings suggest there could be a new strategy for preventing falls, such as daily exercise and treatments for high blood pressure, since blood pressure affects blood flow in the brain and may cause falls," she added.

In the United States, unintentional falls prompt 1.8 million visits to the emergency room each year, and lead to more than 16,000 deaths, the researchers noted.

More information

For more on falls, high blood pressure and the elderly, visit the Foundation for Healthy Aging.

Technological Safety Net For Fall Prone Elderly

11 jan 2010--Falls are the main cause of injuries among elderly people, but until now doctors have had few ways of effectively monitoring and counteracting mobility problems among patients. Work by European researchers is set to change that.

Mobility problems, ranging from frequent accidental falls to difficulty standing up or walking, affect millions of Europeans both young and old. Elderly people in particular become more liable to trip due to poor eyesight or poor balance, while health complications, such as strokes and circulatory problems, or debilitating diseases like Parkinson's and Alzheimer's can make performing everyday tasks even reaching into a cupboard difficult or even dangerous.

Injuries caused by falls among the elderly range from mild scrapes and bruises to serious complications requiring long-term treatment. Nine out of ten hip fractures, for example, occur in people over 50 and 80 percent of them women.

"Falls and other mobility problems have a major societal and economic impact," says Lorenzo Chiari, a researcher at the University of Bologna, Italy. "For the elderly, there is not only the risk of physical injury but also the psychological trauma falling causes and the long-term effects mobility problems have on quality of life. For healthcare systems, the costs of treating injuries caused by falls are only going to escalate as Europe's population ages."

In Chiari's view, new technology offers a solution. Just as advances in sensing devices and wireless communications are allowing doctors to monitor their patients' vital signs remotely through so-called telecare and telemedicine systems, similar technology can be used to monitor, prevent and detect mobility problems.

Monitoring mobility remotely

The approach, developed by a team of researchers led by Chiari as part of the EU-funded SensAction-AAL project, involves using a wearable, wireless-enabled device equipped with motion sensors to monitor people susceptible to falls. The information can then be used to help patients perform rehabilitation exercises to improve their balance and mobility, evaluate the progression of a disorder or, crucially, alert emergency services, doctors or relatives in the event of a fall.

"Falls in which a person does not get up, so-called unrecovered falls, are usually a sign that they need immediate assistance. But detecting them remotely is not easy. The main challenge is developing a software algorithm that can differentiate between an unrecovered fall and something less serious," Chiari explains.

The SensAction-AAL team's software is able to detect unrecovered falls with a high degree of accuracy and send an SMS or e-mail alert immediately. That makes it a potentially life-saving technology in the event that a user has suffered a heart attack, stroke or other serious health incident.

The software is embedded in the same compact device, designed to be worn around the waist, which also contains the gyroscopes and accelerometers used to carry out the motion and position sensing. Bluetooth or Zigbee wireless communications technology connect it to the user or doctor's computer and, via an internet connection, to a secure database and server.

"We wanted to ensure that the device was comfortable, compact and simple to use. We didn't want to have sensors and wires connected to people's arms, legs and chests as it is not very comfortable or practical for the patient," Chiari says. "Combined with the sense of safety and reassurance that remote monitoring gives patients, I think the design helped us overcome the obstacles that often occur when introducing new technology to older people."

Besides alerting caregivers in the event of an emergency, the SensAction-AAL system also provides doctors with long-term information about patients' mobility, including objectively reporting falls that may otherwise go unreported, masking potentially serious health problems.

"Such information, taken from many patients will help the medical community gain a better understanding of what causes falls and what happens before, during and after a fall, ultimately leading to better preventive care," Chiari says.

In addition, the SensAction-AAL system can assist people undergoing rehabilitation programmes by encouraging them to perform prescribed exercises. Patients' movements, picked up by the accelerometers and gyroscopes, can be translated into feedback signals, such as sounds and vibrations emitted via an audio headset or small vibrating actuators on different parts of the user's body. The patients can learn to improve their balance and posture by responding to changes in pitch, tone and intensity.

"One application involves using the device as an MP3 player so the user can listen to their favourite music while exercising. If they move incorrectly the music will become distorted or change volume or tempo," Chiari says.

Improving quality of life

In trials conducted with sufferers of Parkinson's disease at three different sites in the Netherlands, Germany and Israel, test users were overwhelmingly positive in their evaluation of the system, underscoring particularly how increased monitoring can help their self-confidence and, in turn, improve their quality of life.

The wearable monitoring device developed by the project is currently being commercialised by project partner McRoberts, while other components and software have fed into products being developed or sold by other partners.

Chiari says that the consortium is interested in finding investment partners to help conduct more extensive clinical trials and develop a commercial version of the full system.

SensAction-AAL was funded under the ICT strand of the EU's Sixth Framework Programme for research.

This is the first of a two-part special feature on SensAction-AAL appearing on ICT Results.

Source: ICT Results

Chronic pain found to increase risk of falls in older adults

BOSTON, 30 nov 2009 – Chronic pain is experienced by as many as two out of three older adults. Now, a new study finds that pain may be more hazardous than previously thought, contributing to an increased risk of falls in adults over age 70. The findings appear in the November 25 issue of The Journal of the American Medical Association (JAMA).

"It's clear that pain is not just a normal part of aging and that pain is often undertreated in older adults," explains lead author Suzanne Leveille, PhD, RN, who conducted the research while a member of the Division of Primary Care at Beth Israel Deaconess Medical Center (BIDMC) and is currently on the faculty at the University of Massachusetts Boston. "Our findings showed that older adults who reported chronic musculoskeletal pain in two or more locations – mainly in the joints of the arms and legs – as well as individuals who reported more severe pain or pain that interfered with daily activities were more likely to experience a fall than other individuals."

Leveille used data gathered as part of MOBILIZE Boston (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a cohort study headquartered at the Institute for Aging Research at Hebrew SeniorLife and led by Principal Investigator Lewis Lipsitz, MD. One of the goals of the study is to gain a better understanding of what causes falls in older adults in order to develop new ways to prevent falls from occurring.

Between September 2005 and January 2008, 749 adults over the age of 70 enrolled in the MOBILIZE study were interviewed about their health, including being asked questions about pain. They also underwent a physical assessment by a nurse. Over the next 18 months, the participants recorded any falls they had on monthly calendar postcards that were then mailed to the Institute for Aging Research.

"At the beginning of the study, 40 percent of the participants reported experiencing chronic pain in more than one joint area and 24 percent reported chronic pain in a single joint," explains Leveille. "During the 18-month study period, the 749 participants reported a total of 1,029 falls, with more than half the participants falling at least once during this period." Data analysis revealed that compared with study participants who reported no pain, the participants who experienced chronic pain in two or more joints had a 50 percent greater risk of falling.

"Our results suggest that pain should be added to the list of risk factors for falls, as persons who have chronic pain in two or more joints, and those who have moderate to severe pain or disabling pain, are at significantly higher risk," says Leveille. "Assessment and management of chronic pain is a key part of health care for many older adults."

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This study was funded by a grant from the National Institute on Aging and support from Pfizer, Inc.

Study coauthors include Robert Shmerling, MD, of BIDMC; Hebrew SeniorLife Institute for Aging Research investigators Richard Jones, ScD, Dan Kiely, MPH, Douglas Kiel, MD, and Lewis Lipsitz, MD; Jonathan Bean, MD, of Spaulding Rehabilitation Hospital; Jeffrey Hausdorff, PhD, of Tel-Aviv Sourasky Medial Center; and Jack Guralnik, MD, PhD, of the National Institute on Aging.

About BIDMC: Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks in the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is a clinical partner of the Joslin Diabetes Center and is a research partner of the Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.

Physical Therapists Offer Tips For Falls Prevention In Aging Adults

18 sept 2009--As the nation observes Falls Prevention Awareness Day on September 22, the American Physical Therapy Association (APTA) is urging older adults to schedule a balance and falls assessment with a physical therapist to reduce risk of falls and related injuries.

According to the Centers for Disease Control and Prevention, more than one third of adults ages 65 and older fall each year in the United States. Falls are the leading cause of deaths due to injuries and the most common cause of nonfatal injuries and hospital admissions for trauma for the aging population.

"Too many people erroneously consider falls a normal consequence of growing old," says physical therapist and APTA spokesperson Judith Daniel, PT, MS, GCS. "It's simply not true. There are evidence-based interventions that can help reduce their risk of falling and reduce falls-related injuries. A comprehensive examination that includes a balance assessment performed by a physical therapist can be effective in determining the factors that are contributing to an individual's loss of mobility, risk for falls, and/or decreased confidence. Once this information has been gathered, the physical therapist can then determine which type of muscle strengthening and balance retraining program would be most beneficial to reduce the individual's risk of falling."

In addition to adhering to a program designed specifically by a physical therapist, older adults should:

- Ask all health care providers to review their medicines -- both prescription and over-the counter -- to reduce side effects and interactions.
- Have their eyes checked by an eye doctor at least once a year.
- Reduce hazards and improve the lighting in their homes.

Older adults who use canes and walkers as walking aids should also be properly assessed and fitted by a physical therapist to avoid fall-related injuries. The following are general recommendations for older adults who use walking aids can help reduce falls (See APTA's New Tip Sheet on Proper Fit of Walking Aids )

- The walker or cane should be about the height of your wrists when your arms are at your sides.
- When using a walker, your arms should be slightly bent when holding on, but you shouldn't have to bend forward at the waist to reach it.
- Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.

To find a physical therapist in your area, visit the Find-a-PT database on APTA's Web site and use the drop down menu to find a physical therapist who is right for you.

Falls Awareness Day, hosted by the National Council on Aging, is observed on the first day of fall to promote and increase public awareness about how to prevent and reduce falls among older adults.

Source
APTA

Certain drugs may increase risk of falling

NEW YORK, 10 aug 2009– In elderly men and women, certain medications can increase the risk of falling, new research shows.

Findings from a 4-year study conducted in France suggest the risk of falling is 1.4 times greater among elderly men and women taking a long-acting benzodiazepine, compared with age-matched men and women not using this type of anti-anxiety medication.

Dr. Annick Alperovitch, at INSERM in Paris, and colleagues also found a moderately increased risk of falling among elderly men and women who regularly used mood- and behavior-altering "psychotropic" medications.

Their findings, reported in the journal BMC Geriatrics, identified similar risk among elderly individuals reporting regular use of tranquilizers, muscle relaxants and anti-spasmodics, and some antihistamines that block nerve responses (so-called "anticholinergics").

The researchers assessed the association between the use of potentially inappropriate medications and the risk of falls in 6343 community-living men and women who were nearly 74 years old on average.

They defined "inappropriate medication" as drugs likely to have a greater effect on elderly individuals than on their younger counterparts, as well as medications (taken singly or with other drugs) with side effects (dizziness and drowsiness) potentially associated with increased risk for falling.

Overall, about 30 percent of study patients reported use of drugs with these qualities and during the course of the study, 22 percent of them had fallen 2 or more times.

"Use of inappropriate medications increased the risk of falls," they report, and use of long-acting benzodiazepines "was responsible for the main part of this increase."

Unlike regular and occasional users of long-acting benzodiazepines, men and women using short- or intermediate-acting benzodiazepines did not have an increased occurrence of falls.

Therefore, the investigators say the use of short- or intermediate-acting benzodiazepines, over long-acting anti-anxiety medications, are preferable in elderly patients.

SOURCE: BMC Geriatrics, July 23, 2009.

Study: Elderly women can increase strength but still risk falls

Research subject Ellen Prouty, 80, participates in a strength-building study conducted by Dain LaRoche, assistant professor of exercise science at UNH.

DURHAM, N.H., 26 oct 2008 – Elderly women can increase muscle strength as much as young women can, a new study from the University of New Hampshire finds, indicating that decline in muscle function is less a natural part of the aging process than due to a decline in physical activity.
The research, published in the journal Medicine & Science in Sports & Exercise, compared strength gains of inactive elderly women and inactive young women after both groups participated in an eight-week training regime. Yet while the two groups increased similar percentages of strength, the older group was far less effective in increasing power, which is more closely related to preventing falls.
"Power is more important than strength for recovery from loss of balance or walking ability," says Dain LaRoche, assistant professor of exercise science at UNH and the lead author of the study. Preventing falls, which occur in 40 percent of people over 65 and are the top reason for injury-related emergency room visits, is the driving force behind LaRoche's research agenda.

Researcher Dain LaRoche, assistant professor of exercise science at UNH, works with Jean Haigh.
Click here for more information.
LaRoche compared the initial strength of 25 young (18 – 33) and 24 old (65 – 84) inactive women then had both groups participate in resistance training on a machine that targeted knee extensor muscles, which are critical for walking, stair-climbing, or rising from a chair. "They're what let you live on your own," he says.
After eight weeks of training, the older group not only increased their strength by the same percentage as the younger group, they achieved gained strength similar to a control group of young inactive women. But the older group's ability to increase power – force over time – was significantly less than the younger group's; the elderly women saw only a ten percent increase in power versus the younger women's 50 percent increase.
"It's somewhat troublesome that these older individuals had a reduced capacity to increase performance that's so closely associated with falls," says LaRoche. It seems that the key to muscle power in the elderly is to maintain it over the lifespan rather than try to develop it later in life, he says.
Acknowledging that the type or frequency (six sets, three times per week) of his training protocol may have affected the older group's ability to make gains in power, LaRoche is continuing to research older women's capacity to develop muscle power. As baby boomers age, doubling the over-65 population by 2030, research that supports fall prevention and independent living is a growth area. "I tell my students, 'there's room for you in this field,'" says LaRoche.
Of those 40 percent of elderly people who will fall, research has shown that 20 to 30 percent suffer injuries that reduce mobility, independence and longevity. Health care cost of a fall injury totals nearly $20,000, and following a hip fracture, life expectancy is just two years.
LaRoche's own interest in fall prevention in the elderly arose after helping his parents and sister care for his completely sedentary grandmother, helping her stay in her own home until she died at age 93. She broke both hips, lost six inches of height, and had osteoporosis so severe that a caregiver accidently crushed several of her ribs just helping her out of a chair.
"There's a gap between life expectancy and quality of life in older age," LaRoche says. "We can improve that a lot with physical activity."
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An abstract of the research, "Elderly Women Have Blunted Response to Resistance Training Despite Reduced Antagonist Coactivation," is available to download here: http://www.chhs.unh.edu/docs/kin/LaRocheDP.pdf.

Falls Among Older Adults: An Overview
Older Adult Falls

10 aug 2008--How big is the problem?
More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).
Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2006).
In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2008).
The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).
What outcomes are linked to falls?
Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
Most fractures among older adults are caused by falls (Bell et al. 2000).
The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).
Who is at risk?
Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).
Women are 67% more likely than men to have a nonfatal fall injury (CDC 2006).
Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).
In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).
The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)
Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2006).
People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).
There is little difference in fatal fall rates between whites and blacks from ages 65 to 74 (CDC 2006).
After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2006).
White women have significantly higher rates of fall-related hip fractures than black women (Stevens 2005).
Among older adults, non-Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).

How can older adults prevent falls?Older adults can take several steps to protect their independence and reduce their risk of falling. They can:
Exercise regularly; exercise programs like Tai Chi that increase strength and improve balance are especially good.
Ask their doctor or pharmacist to review their medicinesboth prescription and over-the counterto reduce side effects and interactions.
Have their eyes checked by an eye doctor at least once a year.
Improve the lighting in their home.
Reduce hazards in their home that can lead to falls.

What is CDC doing to prevent falls among older adults?
CDC supports research and dissemination on ways to help prevent falls among older adults. To read about these activities, follow the link to CDC Fall Prevention Activities.
CDC has also developed brochures and posters, in partnership with the CDC Foundation and MetLife Foundation, to educate older adults and those who care for them about preventing falls and the injuries that result.
References
Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992;82(7):10203.
Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):1767.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2006) [cited 2007 Jan 15]. Available from URL: www.cdc.gov/ncipc/wisqars.
Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:1215.
Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):10506.
Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):1623.
Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 19921994. Academic Emergency Medicine 2000;7(2):13440.
Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990; 16(3): 717-40.
Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma-Injury, Infection and Critical Care 2001;50(1):1169.
Stevens JA. Falls among older adultsrisk factors and prevention strategies. NCOA Falls Free: Promoting a National Falls Prevention Action Plan. Research Review Papers. Washington (DC): The National Council on the Aging; 2005.
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:2905.
Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 199098: sex, race, and ethnic disparities. Injury Prevention 2002;8:2725.
Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention 2005;11:1159.
Stevens JA. Fatalities and injuries from falls among older adults  United States, 19932003 and 20012005. MMWR 2006;55(45).
Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189193.

Falls Are Top Cause of Injury, Death Among Elderly


21 july 2008-- Falls are a leading cause of serious injury and death among elderly people in the United States, and most of those falls occur in the home, says the American Geriatric Society (AGS).
"There are many steps people can take to make their home safer for those who are aging. Something as small as using a night light in a dark hallway can prevent an elderly person from falling during the night," Dr. Cheryl Phillips, a member of the AGS, said in a news release. "Falls are so dangerous to this particular population, and there are easy ways to help avoid them," she added.
Phillips offered the following safety suggestions:Remove loose carpets and rugs, and put non-skid backing on rugs to avoid tripping. Wear shoes with firm, non-skid soles around the house. Wearing slippers or socks without some type of rubber grip on the bottom can increased the risk of falls. Place night lights in dimly lit areas, at the top and bottom of stairs, and in bedrooms and bathrooms. Remove clutter, boxes and low furniture from the house, and especially from near staircases. Install hand rails near any stairs in the home or backyard and check that existing hand rails are sturdy. Install grab bars near the toilet and bath tub, and no slip decals or a rubber mat in the tub or shower. Place contrasting strips at the edge of each step to clearly define where the step ends.
"I advise caregivers to walk through the home and check each room for potential dangers. Not all homes are the same, so caregivers should ask themselves what safety issues are unique to the particular house," Phillips said.
Each year, about one in three Americans aged 65 and older suffers a fall, and 30 percent of those falls cause injuries that require medical treatment. In 2005, almost 16,000 older adults in the United States died from falls, 1.8 million were treated in emergency departments, and 433,000 were hospitalized.

Common-sense actions cut falls in elderly: study

By Gene Emery
17 july 2008--Falls by elderly people are cut significantly when health care providers take basic steps such as prescribing physical therapy, monitoring medications and checking standing blood pressure, researchers said on Wednesday.
Such a program in Connecticut reduced the number of falls among people age 70 and older by 9 percent, Dr. Mary Tinetti of the Yale School of Medicine and colleagues reported.
Their program resulted in about 1,800 fewer hospitalizations or trips to the emergency room and an 11-percent reduction in fall-related medical services.
"In addition to discomfort and disability averted, this decrease represents a potential savings of more than $21 million in health care costs on the basis of an average acute care cost of $12,000 per event," they wrote in their report, published in the New England Journal of Medicine.
In 2005, nearly 300,000 Americans had hip fractures associated with a fall, and an average of 24 percent of hip-fracture patients aged 50 and over died in the next year, according to the National Osteoporosis Foundation.
Among people over 65, fall-related injuries account for 10 percent of the cases that show up in an emergency department and 6 percent of hospitalizations.
LOWER PRIORITY
There is also evidence that doctors don't do enough to prevent them.
"If you ask most old people and clinicians, they will say falls are common, but it's not considered a disease or health condition on par with strokes or heart attacks. It hasn't sunk in that it's the responsibility of clinicians to recognize and prevent them," Tinetti said in a telephone interview.
Her team spent four years encouraging doctors and other health care providers to reduce, if possible, the doses of medicines that might increase the risk of falling.
They were also urged to measure blood pressures while standing, as well as lying down, because older people can lose consciousness when their blood pressure drops suddenly as they stand.
And the health care workers were encouraged to send older patients to physical or occupational therapists if they needed to improve their balance and strength.
At the end of the study, the researchers, using data maintained by the Connecticut Hospital Association, found that the annual risk of serious fall-related injuries had gone from 3.19 per 100 people to 2.86. In another area of the state where the interventions were not done, the risk went from 3.12 to 3.14.
"That's a similar magnitude to what you see for a lot of heart attack prevention and stroke prevention," said Tinetti.
Another team, at Harvard University and the Massachusetts Institute of Technology in Cambridge, took a more high-tech approach with shoe insole technology that could help doctors detect balance problems.
The device, developed by government-funded research, is based on technology used by NASA to help monitor balance problems in astronauts returning from space, MIT said in a statement on Wednesday.
It analyzes the pressure distribution of the foot and transmits the information to a computer that analyzes the data. The plans are to equip the insoles with an alarm to alert family members of any falls.

Yoga Program May Help Prevent Falls in Elderly

FRIDAY, April 4-- A specific type of yoga may help improve stability and balance in women over age 65, possibly helping them to avoid falls, a preliminary study reports.
After nine weeks of participating in an Iyengar yoga program designed for senior citizens, 24 elderly females had a faster stride, an increased flexibility in the lower extremities, an improved single-leg stance and increased confidence in walking and balance, according to the findings of researchers at Temple University's Gait Study Center.
The researchers, scheduled to present their findings Friday at the Gait and Clinical Movement Analysis Society's annual meeting in Richmond, Va., suggested that improving balance and stability through yoga could help reduce the risk of falling.
"We were very impressed at the progress our participants made by the end of the program," principal investigator Dr. Jinsup Song, director of the Gait Study Center, said in a prepared statement. "Subjects demonstrated improved muscle strength in lower extremities, which helps with stability. There was also a pronounced difference in how pressure was distributed on the bottom of the foot, which helps to maintain balance."
The U.S. Centers for Disease Control and Prevention has said that falls are the leading cause of nonfatal injuries and hospital admissions for trauma among people aged 65 and older. Almost a third of older adults suffer some type of fall each year, the CDC reported.
The program was crafted specifically for elderly people who have had little or no yoga experience. The Iyengar technique, which is known for the use of props such as belts and blocks, was chosen to help participants gradually master the poses while building their confidence.
"In the past, similar studies have been done that look at gait and balance improvement in elderly females using a more aggressive form of yoga," Song said. "For this study, we worked to create a very basic regimen that taught participants proper ways to breathe, stand and pose."
Researchers also found that some participants who had unrelated back and knee pain were pain-free by the end of the study.
Song said he hoped the work will pave the way for a larger study on how Iyengar yoga affects the function of the foot to improve balance and stability and prevent falls.
More information
The National Institute on Aging has more about how to prevent falls and fractures.