scholarly journals Developing and Establishing Biomechanical Variables as Risk Biomarkers for Preventable Gait-Related Falls and Assessment of Intervention Effectiveness

2021 ◽  
Vol 3 ◽  
Author(s):  
Mark D. Grabiner ◽  
K.R. Kaufman
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Biomedical Literature ◽  
Public Health Approach ◽  
Important Research ◽  
Perturbation Training ◽  
Prevention Interventions ◽  
Research Opportunity ◽  
Risk Biomarkers ◽  
Care Costs

The purpose of this review is to position the emerging clinical promise of validating and implementing biomechanical biomarkers of falls in fall prevention interventions. The review is framed in the desirability of blunting the effects of the rapidly growing population of older adults with regard to the number of falls, their related injuries, and health care costs. We propose that biomechanical risk biomarkers may be derived from systematic study of the responses to treadmill-delivered perturbations to both identify individuals with a risk of specific types of falls, such as trips and slips as well as quantifying the effectiveness of interventions designed to reduce that risk. The review follows the evidence derived using a specific public health approach and the published biomedical literature that supports trunk kinematics as a biomarker as having met many of the criteria for a biomarker for trip-specific falls. Whereas, the efficacy of perturbation training to reduce slip-related falls by older adults appears to have been confirmed, its effectiveness presently remains an open and important question. There is a dearth of data related to the efficacy and effectiveness of perturbation training to reduce falls to the side falls by older adults. At present, efforts to characterize the extent to which perturbation training can reduce falls and translate the approaches to the clinic represents an important research opportunity.

scholarly journals A Systematic Review on Detraining Effects after Balance and Fall Prevention Interventions

2021 ◽  
Vol 10 (20) ◽  
pp. 4656
Author(s):  
Shaghayegh Modaberi ◽  
Esmaeel Saemi ◽  
Peter A. Federolf ◽  
Steven van Andel
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Fall Prevention ◽  
Intervention Programs ◽  
Positive Effects ◽  
Specific Focus ◽  
The World ◽  
Prevention Interventions ◽  
Review Study

Since the COVID-19 pandemic hit, lockdowns have been implemented to fight off infections in countries around the world. Whilst this measure is without a doubt effective against spreading infection, it might also decrease participation in exercise. For older adults, exercise is particularly important in the prevention of falls, and sudden detraining because of a lockdown or due to other causes might have detrimental consequences. This systematic review study aims to assess what is currently known on detraining effects for balance outcomes. Nine studies were included within this review. Results suggest that detraining effects could already be significant as early as 4 weeks after stopping the intervention. Programs that specifically focus on improving balance were more robust against detraining, with most positive effects still being present after 8 weeks. However, even with a specific focus on balance, studies started to show some signs of detraining. The current study is limited by the low number of included studies in the review, indicating a need to further confirm these results.

scholarly journals App-based strength and balance self-test in older adults: an exploratory study from a user perspective

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Marina Arkkukangas
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Exploratory Study ◽  
Smartphone Application ◽  
Small Sample ◽  
User Perspective ◽  
Future Studies ◽  
Sit To Stand ◽  
Prevention Interventions ◽  
Self Test

Abstract Objectives Falls are a common problem, especially in the older population. The number of older adults aged over 65 years is increasing globally, leading to a major challenge in providing effective fall prevention interventions to older adults requiring such interventions. This study aimed to explore the usability of an app-based strength and balance self-tests in a small sample of four older adults. This study is a side product of another project. Results The results from this study indicated that self-test of strength and balance by using a smartphone application is a challenge for older adults. Basic test measures, such as start and stop and counts of sit-to-stand, were difficult to self-administer. However, from a user perspective, the possibility of independently performing these measures was considered important and needed to be further developed and evaluated in future studies.

scholarly journals 111 Disparities between Actual and Perceived Fall Risk Affect Participation in 5 Fall Prevention Interventions

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Pey June Tan ◽  
Silvia Sim ◽  
Noor Hafizah Ismail ◽  
Jagadish Mallya ◽  
Angelique Chan ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Help Seeking ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Risk Level ◽  
Prevention Interventions ◽  
Aware Group

Abstract Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore. Methods This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities and knowledge that the intervention is to prevent falls. Results Final analysis included 549 older adults (mean age 70.6±6.9 years, 61% females). Majority (46%) were in the Vigorous group (no falls, low fear), 35% Anxious (no falls, high fear), 11% Frail Aware (falls, high fear) and 8% Stoics (falls, low fear). Only those in Anxious and Frail Aware group were significantly more likely to have talked to a healthcare professional on strategies to avoid falls [OR 1.8 (1.1-3.1) and 3.2 (1.6-6.4) respectively] and made home modifications [OR 1.9 (1.3-2.8) and 2.0 (1.1-3.6)] after adjustments. No association was found for participation in exercise, medication review and falls education. Discussion Individual profiles with high fear-of-falling component have different help-seeking behaviours compared to those with low fear regardless of history of falls. However, individuals in Frail Aware group have higher likelihood to uptake the interventions compared to Anxious group. Future research should examine other drivers of behaviour that will influence participation in other interventions.

scholarly journals An Interactive Home-Based Cognitive-Motor Step Training Program to Reduce Fall Risk in Older Adults: Qualitative Descriptive Study of Older Adults’ Experiences and Requirements (Preprint)

2018 ◽  
Author(s):  
Trinidad Valenzuela ◽  
Husna Razee ◽  
Daniel Schoene ◽  
Stephen Ronald Lord ◽  
Kim Delbaere
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Technology Use ◽  
Fall Risk ◽  
Perceived Barriers ◽  
Exercise Programs ◽  
Home Based ◽  
Prevention Interventions ◽  
Qualitative Descriptive ◽  
At Home

BACKGROUND Falls are a major contributor to the burden of disease in older adults. Home-based exercise programs are effective in reducing the rate and risk of falls in older adults. However, adherence to home-based exercise programs is low, limiting the efficacy of interventions. The implementation of technology-based exercise programs for older adults to use at home may increase exercise adherence and, thus, the effectiveness of fall prevention interventions. More information about older adults’ experiences when using technologies at home is needed to enable the design of programs that are tailored to older adults’ needs. OBJECTIVE This study aimed to (1) explore older adults’ experiences using SureStep, an interactive cognitive-motor step training program to reduce fall risk unsupervised at home; (2) explore program features that older adults found encouraged program uptake and adherence; (3) identify usability issues encountered by older adults when using the program; and (4) provide guidance for the design of a future technology-based exercise program tailored to older adults to use at home as a fall prevention strategy. METHODS This study was part of a larger randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted structured, open-ended in-person interviews with study participants who were randomly allocated to use SureStep at home for 4 months. All interviews were audiotaped and ranged from 45 to 60 min. Thematic analysis was used to analyze collected data. This study was guided by Pender’s Health Promotion Model. RESULTS Overall, 24 older adults aged 70 to 97 years were interviewed. Findings suggest older adults are open to use technology-based exercise programs at home, and in the context of optimizing adherence to home-based exercise programs for the prevention of falls, findings suggest that program developers should develop exercise programs in ways that provide older adults with a fun and enjoyable experience (thus increasing intrinsic motivation to exercise), focus on improving outcomes that are significant to older adults (thus increasing self-determined extrinsic motivation), offer challenging yet attainable exercises (thus increasing perceived self-competence), provide positive feedback on performance (thus increasing self-efficacy), and are easy to use (thus reducing perceived barriers to technology use). CONCLUSIONS This study provides important considerations when designing technology-based programs so they are tailored to the needs of older adults, increasing both usability and acceptability of programs and potentially enhancing exercise participation and long-term adherence to fall prevention interventions. Program uptake and adherence seem to be influenced by (1) older adults’ perceived benefits of undertaking the program, (2) whether the program is stimulating, and (3) the perceived barriers to exercise and technology use. Older adults shared important recommendations for future development of technologies for older adults to use at home.

Accessible Fall Prevention Interventions for Older Adults With Low Vision

2017 ◽  
Vol 33 (4) ◽  
pp. 280-285 ◽  
Author(s):  
Sarah E. Blaylock ◽  
Laura K. Vogtle ◽  
Mary Warren
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Low Vision ◽  
Prevention Interventions

Trends in Geospatial Drivers of Fall-Related Hospitalizations and Asset Mapping of Fall Prevention Interventions for Vulnerable Older Adults

2019 ◽  
Vol 32 (5-6) ◽  
pp. 328-339 ◽  
Author(s):  
Samuel D. Towne ◽  
Matthew Lee Smith ◽  
Minjie Xu ◽  
Sungmin Lee ◽  
Sushma Sharma ◽  
...  
Keyword(s):  
Older Adults ◽  
Population Density ◽  
Older Adult ◽  
Home Health Care ◽  
Fall Prevention ◽  
High Density ◽  
Factors Associated ◽  
Prevention Interventions ◽  
Evidence Based Programs ◽  
Hispanic Adult

Objective: Given that one in four older adults suffer potentially preventable falls annually, we aimed to identify areas with (a) delivery gaps of evidence-based programs (EBPs) targeting fall prevention among older adults, namely A Matter of Balance (AMOB), and (b) high rates of fall-related hospitalizations—hotspots. Method: Analyses included multiple geospatially linked datasets. Results: EBPs were delivered ≥1 time in 84 counties in 2012 and 90 counties in 2014. Factors associated with EPB delivery gaps (absence; p<.05) included high-density older adult areas, non-fall-related hospitalization hotspots, lower population density, nonmetropolitan areas, high-density Hispanic adult areas, and areas with limited access to home health care agencies. Hotspots for fall-related hospitalization numbered 64 in 2012 and 62 in 2014. Factors associated with hotspots included low-density older adult areas, having AMOB delivered ≥1 time annually, high population density, and high-density Hispanic adult areas. Discussion: In resource-finite settings (e.g., the aging services sector), identifying high priority areas allows for precise allocation of limited resources.

scholarly journals Fall Prevention in Community-Dwelling Adults with Mild to Moderate Cognitive Impairment: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Megan Racey ◽  
Maureen Markle-Reid ◽  
Donna Fitzpatrick-Lewis ◽  
Muhammad Usman Ali ◽  
Hélène Gagné ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fear Of Falling ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Exercise Interventions ◽  
Prevention Interventions ◽  
Risk Of Falls

Abstract Background: Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and 60-80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. Methods: We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings.Results: 509 community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [-1.10, -0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [-0.94, -0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls.Conclusion: The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.

scholarly journals UNDERSTANDING FACILITATORS AND BARRIERS TO PARTICIPATION IN EVIDENCE-BASED FALL-PREVENTION INTERVENTIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S567-S567
Author(s):  
Janice Mark ◽  
Gwen Bergen ◽  
Briana Moreland
Keyword(s):  
Older Adults ◽  
Physical Therapy ◽  
Fall Prevention ◽  
Ecological Model ◽  
Medication Management ◽  
Evidence Based ◽  
Patient Attitudes ◽  
Cost Information ◽  
Prevention Interventions ◽  
Facilitators And Barriers

Abstract Prescribing evidence-based interventions based on older adults’ modifiable risk factors is recommended to prevent falls. Older adults need to adhere to the prescribed intervention to successfully reduce risk. This study reports on a structured systematic review to understand patient attitudes to adherence to fall prevention interventions. A systematic search for publications from 2008-2018 identified 72 articles on patient attitudes toward exercise, physical therapy, medication management, podiatry, and vision care for fall prevention. Three reviewers coded facilitators and barriers based on a socio-ecological model of interpersonal, intrapersonal, community, and policy factors. Perceived susceptibility to falling and perceived effectiveness of the intervention were important factors across all fall prevention interventions. Physician prescribing and discussion facilitated exercise, medication changes, and physical therapy. For attitudes related to community and policy, the most reported barriers were transportation and cost. Information from this review can be used to improve the implementation of fall prevention interventions.

Improving Local Service Delivery to Prevent Falls in Community-Dwelling Older Adults: Translating Research to Practice

2020 ◽  
Author(s):  
Travis M Gagen ◽  
Maria T Bulzacchelli
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Fall Prevention ◽  
Health Care Professionals ◽  
Prevention Programs ◽  
Community Dwelling ◽  
Local Health ◽  
Prevention Interventions ◽  
Unintentional Falls ◽  
Community Dwelling Older Adults

Abstract Unintentional falls are the leading cause of both fatal and nonfatal injuries among Americans 65 years of age and older and place an enormous burden on the health care system. As the population continues to age, preventing falls will be increasingly important for reducing morbidity, mortality, and medical costs. Evidence-based fall prevention interventions for older adults exist, but widespread adoption of these interventions is needed. Local health departments, Area Agencies on Aging, first responders, and health care professionals can all play important roles in implementing fall prevention programs. This article presents a conceptual model for local delivery of fall prevention programs for community-dwelling older adults. This model can serve as a guide for translating existing fall prevention research into practice.

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