Maladaptive Fall Risk Appraisal and Falling in Community-Dwelling Adults Aged 60 and Older: Implications for Screening

2021 ◽  
pp. 1-10
Author(s):  
Ladda Thiamwong ◽  
Boon Peng Ng ◽  
Rick Yiu Cho Kwan ◽  
Jom Suwanno
Keyword(s):  
Fall Risk ◽  
Community Dwelling ◽  
Risk Appraisal

scholarly journals CHARACTERISTICS OF MALADAPTIVE FALL RISK APPRAISAL AMONG OLDER ADULTS AGES 60 YEARS AND OLDER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S470-S471
Author(s):  
Ladda Thiamwong ◽  
Boon Peng Ng
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Community Dwelling ◽  
Covariate Adjustment ◽  
Risk Appraisal ◽  
Stand Test ◽  
Fall Efficacy Scale ◽  
The Past ◽  
Southern Thailand ◽  
Community Dwelling Older Adults

Abstract Even though one-third of older adults have maladaptive fall risk appraisal (FRA), no studies has examined this discrepancy between perceived fall risk and physical fall risk among older adults in Thailand. We examined the characteristics of fall risk appraisal (FRA). 433 community-dwelling older adults were randomly selected from two provinces in Southern Thailand. Physical fall risk was assessed by a full tandem stand test and perceived fall risk was assessed by the Fall-Efficacy Scale International. We classified FRA into: 1) Rational FRA means low physical fall risk and low perceived fall risk; 2) Irrational FRA means low physical fall risk but high-perceived fall risk; 3) Congruent FRA means high physical fall risk and high-perceived fall risk; and 4) Incongruent FRA means high physical fall risk but low perceived fall risk. Irrational FRA and Incongruent FRA are a maladaptive FRA. About 60% of the participants had maladaptive FRA, which consisted of irrational FRA (57.3%) and incongruent FRA (2.3%). 20.8% were in rational FRA and 19.6% in congruent FRA. Among those with rational FRA, incongruent FRA, irrational FRA, and congruent FRA, 27.8%, 60%, 41.1%, and 74.1% reported having at least one fall in the past year, respectively. After covariate adjustment, participants in the congruent FRA group were 3.29 times more likely (p=0.006) to fall than those in rational FRA. High proportion of participants had maladaptive FRA so screening individuals with maladaptive FRA and prevent them to transition into the congruent FRA group is important efforts to mitigate health and economic burdens.

scholarly journals Cost-Effectiveness of an Exercise Programme that Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 714
Author(s):  
Isaac Aranda-Reneo ◽  
Laura Albornos-Muñoz ◽  
Manuel Rich-Ruiz ◽  
María Ángeles Cidoncha-Moreno ◽  
Ángeles Pastor-López ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Older People ◽  
Incremental Cost ◽  
Fall Risk ◽  
Community Dwelling ◽  
Effective Measure ◽  
The Individual ◽  
The Cost ◽  
Individual Training

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

Interactive effect between depression and chronic medical conditions on fall risk in community-dwelling elders

2012 ◽  
Vol 24 (9) ◽  
pp. 1409-1418 ◽  
Author(s):  
Senyeong Kao ◽  
Yun-Chang Wang ◽  
Ya-Mei Tzeng ◽  
Chang-Kuo Liang ◽  
Fu-Gong Lin
Keyword(s):  
Elderly People ◽  
Fall Risk ◽  
Medical Condition ◽  
Reference Group ◽  
Interactive Effect ◽  
Depression Scale ◽  
Community Dwelling ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Depression Status

ABSTRACTBackground: It is well documented that fall risk among elderly people is associated with poor health and depression. In this study, we set out to examine the combined effects of medical condition and depression status on fall incidents among community-dwelling elderly people.Methods: A cross-sectional study was carried out to investigate the fall history of community-dwelling elders involving 360 participants. Those who had experienced at least two falls over the previous year, or one injurious fall, were defined as “fallers.” The Geriatric Depression Scale-15 was used as a screening instrument for depression status.Results: Based on a multivariate logistic regression and stratification analysis, depression was found to interact with various medical conditions on fall risk. In comparison with the non-depressive reference group, a six-fold fall risk was discernible among depressed elders with polypharmacy, while a five-fold risk was found among depressive elders using ancillary devices, along with a four-fold risk among depressive elders with diabetes or cardiovascular disease. Finally, arthritis was found to produce a nine-fold risk of falls among such populations.Conclusions: These findings suggest that greater emphasis should be placed on the integration of depression screening as an element of fall risk assessment in elderly people.

scholarly journals Multisensory integration involved in the body perception of community-dwelling older adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Hide ◽  
Y. Ito ◽  
N. Kuroda ◽  
M. Kanda ◽  
W. Teramoto
Keyword(s):  
Older Adults ◽  
Multisensory Integration ◽  
Fall Risk ◽  
Community Dwelling ◽  
The Body ◽  
Risk Of Falling ◽  
Body Perception ◽  
Rubber Hand ◽  
Timed Up And Go ◽  
Community Dwelling Older Adults

AbstractThis study investigates how the multisensory integration in body perception changes with increasing age, and whether it is associated with older adults’ risk of falling. For this, the rubber hand illusion (RHI) and rubber foot illusion (RFI) were used. Twenty-eight community-dwelling older adults and 25 university students were recruited. They viewed a rubber hand or foot that was stimulated in synchrony or asynchrony with their own hidden hand or foot. The illusion was assessed by using a questionnaire, and measuring the proprioceptive drift and latency. The Timed Up and Go Test was used to classify the older adults into lower and higher fall-risk groups. No difference was observed in the RHI between the younger and older adults. However, several differences were observed in the RFI. Specifically, the older adults with a lower fall-risk hardly experienced the illusion, whereas those with a higher fall-risk experienced it with a shorter latency and no weaker than the younger adults. These results suggest that in older adults, the mechanism of multisensory integration for constructing body perception can change depending on the stimulated body parts, and that the risk of falling is associated with multisensory integration.

scholarly journals Fall Risk Classification in Community-Dwelling Older Adults Using a Smart Wrist-Worn Device and the Resident Assessment Instrument-Home Care: Prospective Observational Study (Preprint)

2018 ◽  
Author(s):  
Yang Yang ◽  
John P Hirdes ◽  
Joel A Dubin ◽  
Joon Lee
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Prospective Observational Study ◽  
Risk Classification ◽  
Community Dwelling ◽  
Assessment Instrument ◽  
Classification Models ◽  
Resident Assessment ◽  
Community Dwelling Older Adults ◽  
Resident Assessment Instrument

BACKGROUND  Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools such as the Resident Assessment Instrument-Home Care (RAI-HC). OBJECTIVE  This study aimed to (1) investigate the similarities and differences in physical activity (PA), heart rate, and night sleep in a sample of community-dwelling older adults with varying fall histories using a smart wrist-worn device and (2) create and evaluate fall risk classification models based on (i) wearable data, (ii) the RAI-HC, and (iii) the combination of wearable and RAI-HC data. METHODS  A prospective, observational study was conducted among 3 faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ≥2 falls) in a sample of older community-dwelling adults. Each participant was requested to wear a smart wristband for 7 consecutive days while carrying out day-to-day activities in their normal lives. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with 3 supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF). RESULTS  Of 40 participants aged 65 to 93 years, 16 (40%) had no previous falls, whereas 8 (20%) and 16 (40%) had experienced 1 and multiple (≥2) falls, respectively. Level of PA as measured by average daily steps was significantly different between groups (P=.04). In the 3 faller group classification, RF achieved the best accuracy of 83.8% using both wearable and RAI-HC data, which is 13.5% higher than that of using the RAI-HC data only and 18.9% higher than that of using wearable data exclusively. In discriminating between {G0+G1} and G2+, RF achieved the best area under the receiver operating characteristic curve of 0.894 (overall accuracy of 89.2%) based on wearable and RAI-HC data. Discrimination between G0 and {G1+G2+} did not result in better classification performance than that between {G0+G1} and G2+. CONCLUSIONS  Both wearable data and the RAI-HC assessment can contribute to fall risk classification. All the classification models revealed that RAI-HC outperforms wearable data, and the best performance was achieved with the combination of 2 datasets. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments.

Single-Session Evidence-Based Intervention and Fall Risk Awareness in Community-Dwelling Older Adults

2021 ◽  
Vol 37 (3) ◽  
pp. 198-206
Author(s):  
Brenda S. Howard ◽  
Fiona Brown Jones ◽  
Aundrea Sellers Steenblock ◽  
Kiersten Ham Butler ◽  
Ellen Thomas Laub ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Community Dwelling ◽  
Evidence Based ◽  
Risk Awareness ◽  
Single Session ◽  
Community Dwelling Older Adults

Sensorimotor performance and reference values for fall risk assessment in community-dwelling adults: The Yishun Study

2021 ◽  
Author(s):  
Benedict Wei Jun Pang ◽  
Shiou-Liang Wee ◽  
Lay Khoon Lau ◽  
Khalid Abdul Jabbar ◽  
Wei Ting Seah ◽  
...  
Keyword(s):  
Reaction Time ◽  
Muscle Strength ◽  
Reference Values ◽  
Representative Sample ◽  
Fall Risk ◽  
Age Groups ◽  
Community Dwelling ◽  
Risk Scores ◽  
Younger Adults ◽  
Sensorimotor Performance

ABSTRACT Objective What are the reference values of sensorimotor performance for fall risk in community-dwelling adults? How do our population norms compare to that of other populations? Are younger adults at risk of falls? Methods In a cross-sectional study design, sensorimotor functions and fall risk scores of community-dwelling adults were assessed and calculated to derive corresponding fall risk categories. Reference values were determined using the average scores by age-group. A total of 542 community-dwelling adults were recruited (21-90 years old) across 10-year (21-60 years) and 5-year age-groups (>60 years) to obtain a representative sample of community-dwelling adults in Singapore. We assessed five physiological domains: vision, proprioception, muscle strength, reaction time and postural balance, according to the Physiological Profile Assessment (PPA). Fall risk scores and the corresponding fall risk profiles were generated from an online calculator. Results Sensorimotor performance and PPA fall risk scores were significantly worse for increasing age categories (p < .01). Females had significantly slower reaction time (p < .001), lower muscle strength (p < .001) and higher fall risk (p = .008). Our representative sample of older adults (≥65 years) performed poorer in postural sway (z = −0.50) and reaction time (z = −0.55), but better in proprioception (z = 0.29) and vision (z = 0.23) compared to Caucasian norms. Among younger adults (21-59 years), 36.8% appeared to exhibit higher fall risk. Conclusions Our study presents important reference data and compared sensorimotor functions and physiological fall risk across the age groups of community-dwelling adults in a South-East Asian population. Poor sensorimotor performance and fall risk appear already pertinent in younger adults. Further studies are warranted to improve our understanding of fall risk among younger adults. Impact Statement In physical therapy practice, PPA reference values can aid clinicians in the development of targeted interventions tailored towards an individual’s physiological risk profile, addressing specific physiological systems that require particular attention.

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