Dual-task and electrophysiological markers of executive cognitive processing in older adult gait and fall-risk

Abstract In-hospital falls are a significant clinical, legal and regulatory problem. The Centers for Medicare and Medicaid no longer reimburse hospitals for falls that result in injury, adding increase pressure on acute care settings to prevent falls. Additionally, evidence-based practice recommendations for fall prevention in hospitals do not exist, thus leaving administrators to create their own programs. One common strategy used by hospital providers to prevent falls is to restrict patient mobility. Little information on how older adult patients experience fall prevention during a hospital stay has been published. The purpose of this study was to understand perceptions of care among older adults identified as fall risk during a hospital stay. This qualitative study utilized inductive content analysis. Older adults (N=20) from a large academic medical center in the Midwest were recruited to participate in one-to one in-depth interviews. Open coding, categorization and abstraction was used to analyze the data. Three main categories were identified that summarized the older adult patient perception of hospitalization: Act of Caring, something they received from staff, provide to staff or provided to self; Being Restricted in movement resulting in either accepting or rejecting the restriction and Being Freed at discharge, often being told “just be careful”. Older adult identified as fall risk described being restricted in movement during a hospital stay. Many passively accepted this restriction even though they felt a lack of movement would be harmful to them. Additional research on the patient experience with fall prevention is needed.

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94 Association between Dual-Task Timed “UP and GO” Test and Occurrence of Falls According to Age Group (Young-Older or Old-Older Adults): A Longitudinal Observation Study

Age and Ageing ◽

10.1093/ageing/afz164.94 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27

Author(s):

Tsuyoshi Asai ◽

Kensuke Oshima ◽

Yoshihiro Fukumoto ◽

Shogo Misu

Keyword(s):

Older Adults ◽

Older Adult ◽

Dual Task ◽

Community Dwelling ◽

Age Group ◽

Adult Group ◽

Observation Study ◽

Timed Up And Go ◽

Community Dwelling Older Adults

Abstract Aim To elucidate the association between the occurrence of falls and timed “up and go” (TUG) test score in a dual-task condition among community-dwelling older adults by age group. Methods This longitudinal observation study included 987 community-dwelling older adults at baseline. A TUG test (single-TUG) and a TUG test while counting aloud backward from 100 (dual-TUG) were conducted at baseline. The dual-task cost (DTC) value was computed from these results. Data on fall history were obtained using a self-administered questionnaire at the 1-year follow-up. At follow-up, 322 participants had dropped out and six participants had missing data for falls. The final analysis included 658 individuals (follow-up rate: 658/987, 67%) divided into a young-older adult group (aged 60–74 years) and an old-older adult group (aged 75 years or older). Associations between the occurrence of falls and TUG-related values were analyzed by age group using multivariate logistic regression models. Results For old-older adults, there were significant associations between the occurrence of falls and DTC value (odds ratio [OR] 0.981, 95% confidence interval [CI]: 0.963–0.999, p = 0.040) and single-TUG score (OR 1.129, 95% CI: 1.006–1.268, p = 0.039). However, no significant associations were observed for young-older adults. Conclusions Slower single-TUG test score and lower DTC value are associated with the occurrence of falls among old-older adults but not among young-older adults. Dual task assessment is useful for predicting falls in TUG fall assessment for old-older adults.

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Case report: a balance training program using the Nintendo Wii Fit to reduce fall risk in an older adult with bilateral peripheral neuropathy

Physiotherapy Theory and Practice ◽

10.3109/09593985.2014.971923 ◽

2014 ◽

Vol 31 (2) ◽

pp. 130-139 ◽

Cited By ~ 7

Author(s):

Renée Marie Hakim ◽

Charles J. Salvo ◽

Anthony Balent ◽

Michael Keyasko ◽

Deidre McGlynn

Keyword(s):

Case Report ◽

Peripheral Neuropathy ◽

Training Program ◽

Older Adult ◽

Fall Risk ◽

Balance Training ◽

Nintendo Wii ◽

Wii Fit ◽

Nintendo Wii Fit

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Determinants of Fall Prevention Guideline Implementation in the Home- and Community-Based Service Setting

The Gerontologist ◽

10.1093/geront/gnaa133 ◽

2020 ◽

Author(s):

Lisa A Juckett ◽

Alicia C Bunger ◽

Shannon E Jarrott ◽

Holly I Dabelko-Schoeny ◽

Jessica Krok-Schoen ◽

...

Keyword(s):

Older Adult ◽

Fall Prevention ◽

Fall Risk ◽

Adult Population ◽

Guideline Implementation ◽

Implementation Strategies ◽

Semistructured Interview ◽

Community Based ◽

Prevention Guideline ◽

Prevention Guidelines

Abstract Background and Objectives Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations. Research Design and Methods Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study. Results We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff. Discussion and Implications Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.

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Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies

American Journal of Lifestyle Medicine ◽

10.1177/1559827619880529 ◽

2019 ◽

pp. 155982761988052 ◽

Cited By ~ 1

Author(s):

Gwen Bergen ◽

Mark R. Stevens ◽

Ramakrishna Kakara ◽

Elizabeth R. Burns

Keyword(s):

Risk Factors ◽

Older Adult ◽

Health Care Providers ◽

Fall Risk ◽

The United States ◽

Adult Patients ◽

Care Providers ◽

Effective Prevention ◽

Fall Injuries ◽

Fall Injury

Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients’ modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.

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INTEREST GROUP SESSION—HEALTH BEHAVIOR CHANGE: USING DATA ABOUT PATIENT CHARACTERISTICS TO IMPROVE FALL PREVENTION

Innovation in Aging ◽

10.1093/geroni/igz038.2091 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S566-S566

Author(s):

Gwen Bergen

Keyword(s):

Older Adults ◽

Older Adult ◽

Fall Prevention ◽

Fall Risk ◽

Healthcare Providers ◽

Patient Characteristics ◽

Health Behavior Change ◽

Clinical Aspects ◽

Evidence Based ◽

Prevention Strategies

Abstract Over one in four U.S. older adults (age 65+) reports falling each year with fall-related medical costs estimated at $50 billion. The American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons recommends that healthcare providers assess and manage their patients’ fall risk. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative helps healthcare providers incorporate these guidelines by providing tools on how to screen, assess, and intervene to reduce risk. Evaluations of fall prevention have focused on the clinical process and outcomes. Understanding clinical activities is important in fall prevention but a better understanding of older adult characteristics that increase fall-risk, and attitudes that may affect their adoption of evidence-based interventions could improve the effectiveness of prevention strategies. The five presentations in this session include: 1. Demographic, health and functional characteristics of older adults with increased fall risk. 2. Caregivers of people with chronic conditions or disability as a group with increased fall risk. 3. The most effective and efficient ways of identifying older adults with increased fall risk. 4. Facilitators and barriers to older adults’ adherence to evidence-based fall interventions. 5. Applying knowledge of older adult attitudes to improving an implementation of STEADI-based fall prevention. Multifactorial fall prevention strategies such as STEADI focus on the clinical aspects of fall prevention but their success depends on understanding and incorporating older adult characteristics and attitudes. The information presented in this session can inform fall prevention strategies and improve health.

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