Musculoskeletal Adaptation of Young and Older Adults in Response to Environmental, Physical, and Cognitive Conditions

Accidental falls present a large functional and financial burden among people aged 65 years and older. Falls, injuries associated with falls, and the fear of falling decrease quality of life, physical function, and independence for older adults. To prevent falls, improve stability, and protect joints from damage or injury, the typical response to "challenging" conditions include cautious gait, increase muscle co-contraction, and decreased range of motion. These compensatory strategies are more pronounced in the older adult population with apprehensive "cautious" gait at slower speeds, decreased knee flexion, and increased muscle activation around the knee and ankle. The underlying mechanisms and driving forces behind accidental falls are not well investigated. Additionally, the effects of aging on the ability of the musculoskeletal system to adapt to changing and challenging conditions is poorly understood. There exists a gap in knowledge regarding the relationship between accidental fall risk factors, knee joint stability, adaptation mechanisms, and whole-body function. Establishing these relationships between stability and musculoskeletal adaptation may have far reaching implications on improving whole-body function through targeted joint- and muscle-level interventions. The purpose of this study was to compare neuromechanics (whole-body function) of young and older adults walking across various external challenging conditions, quantifying adaptation strategies for both cohorts. This was accomplished through two objectives. In the first objective, joint kinematics, ground reaction force loading and impulse, and lower-limb muscle activation strategies for ten young and ten older adults walking on normal, slick, and uneven surfaces were compared to assess how musculoskeletal adaptation strategies change with age. For the second objective, a pipeline to create subject-specific lower-limb finite element models was developed to investigate joint-level behavior across cohorts. Proof-of-concept for the model development and analysis process was demonstrated for an older and a young adult to implement a novel metric for functional stability and dynamic laxity of the knee joint during the stance phase of gait. Kinematic, force, and muscle activation analysis showed that an uneven surface reduced sagittal joint kinematics during the first 25% of stance, indicating a surface-specific compensatory strategy. Additionally, older adults tended to prepare for and step onto the uneven surfaces in a more conservative manner with joints more flexed or bent. This anticipatory or cautious musculoskeletal adaptation of older adults was also seen in reduced magnitude of initial vertical loading during the loading response of stance (0-25% stance). Results of this research study provide insight into the differences that exist in joint stiffening and other musculoskeletal adaption strategies for young and older adults during external challenging conditions. Specifically, understanding the relationships between joint-level stability and whole-body musculoskeletal function has the potential to inform targeted muscle training programs and joint-level interventions to improve whole-body musculoskeletal function and reduce risk of injuries.

Hospitalization of unintentional fall injuries in Kuwait: a national database study

Background Accidental falls are a major cause of morbidity placing pressure on hospital capacity and utilizing costly services. Evaluating the burden of falls is key for planning, implementation, and evaluation of prevention strategies. To date, no studies have been published on accidental falls at the population level in Kuwait. We studied the burden of accidental falls on public hospital inpatient capacity in Kuwait and identified the subgroups with the highest utilization of inpatient service days. Methods From the national database of inpatient hospitalizations, we selected hospitalizations of patients admitted to Kuwait’s public hospitals for unintentional injury caused by an accidental fall from 1 January through 31 December 2016. We studied the number of inpatient service days (bed days), length of stay (LOS), and number of hospitalizations by age group, gender, and nationality. Mann–Whitney, Kruskal-Wallis, and Chi square tests were used for comparison. Logistic regression was used to quantify the risk of prolonged LOS and fractures among fall-related hospitalizations. Results Accidental falls were responsible for 2.9% of inpatient hospitalizations, 3.7% of inpatient service days (61,140 days) with an ALOS of 9.1 days in Kuwait’s public hospitals in 2016. Accidental falls were responsible for 4.6% of older adult service days, and an even higher 5.6% of older women service days. In the age group 13–64, fall-related service days for non-Kuwaitis (5.7%) were more than triple those for Kuwaitis (1.8%) with a substantial percentage among male non-Kuwaitis (8.1%). The risk factors for exceeding the national ALOS for fall-related hospitalizations were female gender (OR 1.36), age 65 and older (OR 9.72), age 13–64 (OR 5.20), being non-Kuwaiti (OR 1.39), sustaining a femur fracture (OR 11.67), and undergoing surgery (OR 2.63). Fall-related hospitalizations associated with a higher risk of fractures were females (OR 1.22), patients 65 years and older (OR 5.09), patients aged 13–64 (OR 3.65), and non-Kuwaitis (OR 1.28). Conclusions Accidental falls impose a considerable burden on inpatient service utilization in Kuwait. This varies by age, gender, and nationality. To reduce this burden, prevention programs should target working-age non-Kuwaiti males and older females.

Accidental falls and associated factors among the elderly in Thailand: a national cross-sectional study in 2007, 2011, 2014 and 2017

PurposeThis study assesses the prevalence of accidental falls in Thailand's older adult population and the contingent influences surrounding this prevalence.Design/methodology/approachData were drawn from the Cross-Sectional National Surveys of Older Persons in Thailand, pooling of four survey datasets which took place in 2007, 2011, 2014 and 2017. Stratified two-stage sampling was employed. Interviews were conducted with sample sizes of 11,370, 11,061, 13,775 and 12,457 senior citizens, aged 60 and above, in the respective survey years. Further investigation was conducted on subjects who reported to be of good health and without any disability, yet experienced accidental falls. The prevalence of accidental falls was examined, and variable aspects concerning fall risk were assessed with probability-weighted multiple logistic regression.FindingsThe average prevalence of accidental falls from the four surveys was 4.7%. Significant risk factors identified were advanced age, being female, living in a rural residence, having worked in the previous 7 days, lack of/excessive exercise, alcohol consumption, smoking and having an outdoor lavatory.Originality/valueAccidental falls tend to increase among community-dwelling seniors aged 60 and above. Falls increase with age and are more common among the women in that demographic. Findings suggest the need for government and local agencies to consider tailoring some public health approaches to the prevention of accidental falls. This study also highlights the necessity of proper work environment maintenance to prevent these falls.

Trends of Nursing Research on Accidental Falls: A Topic Modeling Analysis

This descriptive study analyzed 1849 international and 212 Korean studies to explore the main topics of nursing research on accidental falls. We extracted only nouns from each abstract, and four topics were identified through topic modeling, which were divided into aspects of fall prevention and its consequences. “Fall prevention program and scale” is popular among studies on the validity of fall risk assessment tools and the development of exercise and education programs. “Nursing strategy for fall prevention” is common in studies on nurse education programs and practice guidelines to improve the quality of patient safety care. “Hospitalization by fall injury” is used in studies about delayed discharge, increased costs, and deaths of subjects with fall risk factors hospitalized at medical institutions due to fall-related injuries. “Long-term care facility falls” is popular in studies about interventions to prevent fall injuries that occur in conjunction with dementia in long-term care facilities. It is necessary to establish a system and policy for fall prevention in Korean medical institutions. This study confirms the trends in domestic and international fall-related research, suggesting the need for studies to address insufficient fall-related policies and systems and translational research to be applied in clinical trials.

Bibliometric Analysis on Research Trend of Accidental Falls in Older Adults by Using Citespace—Focused on Web of Science Core Collection (2010–2020)

The present study aimed to identify the trends in research on accidental falls in older adults over the last decade. The MeSH (Medical Subject Headings) and entry terms were applied in the Web of Science Core Collection. Relevant studies in English within articles or reviews on falls in older adults were included from 2010 to 2020. Moreover, CiteSpace 5.6.R5 (64-bit) was adopted for analysis with scientific measurements and visualization. Cooper Cyrus, Stephen R Lord, Minoru Yamada, Catherine Sherrington, and others have critically impacted the study of falls in older adults. Osteoporosis, dementia, sarcopenia, hypertension, osteosarcopenia, traumatic brain injury, frailty, depression, and fear of falling would be significantly correlated with falls in older adults. Multiple types of exercise can provide effective improvements in executive cognitive performance, gait performance, quality of life, and can also lower the rates of falls and fall-related fractures. Fall detection, hospitalization, classification, symptom, gender, and cost are the current research focus and development direction in research on falls in older adults. The prevention of falls in older adults is one of the most important public health issues in today’s aging society. Although lots of effects and research advancements had been taken, fall prevention still is uncharted territory for too many older adults. Service improvements can exploit the mentioned findings to formulate policies, and design and implement exercise programs for fall prevention.

Bilateral Parietal Skull Fractures in Infants Attributable to Accidental Falls

<b><i>Introduction:</i></b> Multiple skull fractures, including bilateral parietal skull fractures (BPSFs) in infants are considered to be suspicious for abusive head trauma (AHT). The aim of this report is to describe a series of BPSF cases in infants which occurred due to accidental falls. <b><i>Methods:</i></b> We searched our neuroradiology database for BPSF in infants (&#x3c;1 year old) diagnosed between 2006 and 2019; we reviewed initial presentation, mechanisms of injury, clinical course, head imaging, skeletal survey X-rays, ophthalmology, social work and child abuse physicians (CAP) assessments, and long-term follow-up. “Confirmed accidental BPSF” were strictly defined as having negative skeletal survey and ophthalmology evaluation and a CAP conclusion of accidental injury. <b><i>Results:</i></b> Twelve cases of BPSF were found; 3 were confirmed to be accidental, with a mean age at presentation of 3 months. Two infants had single-impact falls, and 1 had a compression injury; all 3 had small intracranial hemorrhages. None had bruises or other injuries, and all remained clinically well. A literature search found 10 similar cases and further biomechanical evidence that these fractures can occur from accidental falls. <b><i>Conclusion:</i></b> While AHT should be kept in the differential diagnosis whenever BPSFs are seen, these injuries can occur as a result of accidental falls.

Assessment of Gait Speed and Timed Up and Go Measures as Predictors of Falls in Older Breast Cancer Survivors

Background: Older breast cancer survivors are at an increased risk of loss of postural balance and accidental falls, however, the ability of clinical mobility measures to predict falls has not been determined. The purpose of this study was to examine the prognostic ability, sensitivity, and specificity to predict accidental falls in measures of gait speed and functional mobility in older breast cancer survivors. Methods: Thirty-four breast cancer survivors 65 years and older performed 3 measures of gait speed (GS) (usual, fast, dual-task) and Timed Up and Go (TUG) (TUG, TUG-Cognitive, TUG-Manual). Follow-up calls were made 3 months after testing to track falls. Results: The area under the curve (AUC) was below 0.5 for all GS measures, indicating poor predictive ability and all GS measures had low sensitivity and specificity to predict falls. All TUG measures had AUC values above 0.5. The cutoff score with the best sensitivity/specificity to predict falls was: TUG-Cognitive = 11.32 seconds, Sens = 0.64, Spec = 0.80; TUG-Manual = 9.84 seconds, Sens = 0.71, Spec = 0.65. Conclusion: When assessing fall risk in older breast cancer survivors, performance on the TUG and TUG-Cognitive are able to predict falls.