Health beliefs and adherence of the elderly to fall prevention measures: a quasi-experimental study

ABSTRACT Objective: To evaluate the effect of an educational intervention on health beliefs and adherence of elderly people to fall prevention measures. Methods: This is a quasi-experimental study, carried out at the Senior Citizens' Center. Sixty-eight elderly completed the intervention. The intervention consisted of four meetings focused on beliefs about falls and prevention, and the evaluation occurred at baseline and 30 days after completion. Results: The elderly were predominantly women (83.82%), with one to four years of schooling (36.76%), with health problems (95.59%), and 48.53% had fallen. There was a significant increase in perceived susceptibility, severity, benefits, barriers, and total health belief score post educational intervention. By adding total to partial adherence, there was a significant increase in the adherence of the elderly to fall prevention measures after the educational intervention. Conclusion: Educational intervention was able to improve the beliefs and adherence of the elderly to fall prevention measures.

Managing Fall Prevention through Exercise in Older Adults Afflicted by Cognitive and Strength Impairment

<b><i>Introduction:</i></b> A growing trend in medicine is older adults and increased need for geriatric services. Falls contribute heavily to hospitalizations and worsening of overall health in this frail demographic. There are numerous biological and physical culprits which, if targeted, can prevent falls. The objective was to review benefits of different types of exercises for fall prevention for older persons who are community-dwelling or living in long-term care facilities. <b><i>Methods:</i></b> A systematic review was conducted to determine the different types of exercises for fall prevention. Data extraction via a standardized protocol was performed to assess study design, outcomes, limitations, and author’s conclusions. Corroborative themes were identified and the authors responsible for the contributing research were cited as they came up. Nineteen randomized controlled trials were identified, between 1990 and 2018, using MEDLINE, PubMed, Cochrane, CINAHL, and Web of Science databases. Studies involving adults greater than age 60 in high-risk community or nursing home populations in the English language with a duration longer than or equal to 6 weeks with focuses on either low-risk balance, strength, or combination of both and whole-body vibration. <b><i>Results:</i></b> Balance exercise training increased balance at 6 and 12-month intervals involving balance, strength, and cognitive training. <b><i>Discussion:</i></b> Insignificant results were seen in whole-body vibration and differing results existed for Tai Chi. It is important to recognize that although exercises help reduce the risk of falling and play a significant role in improving mobility safely, there will always be a risk of falls.

Social Isolation and Falls Risk: Lack of Social Contacts Decreases the Likelihood of Bathroom Modification Among Older Adults With Fear of Falling

Fall prevention strategies exist, but little is known about factors that influence whether they are used. We assessed whether social isolation modifies the association between fear of falling (FOF) and bathroom environmental modification. Data were included from 2858 Medicare beneficiaries in the National Health and Aging Trends Study. FOF and social isolation were assessed at baseline (2011); new bathroom modifications were assessed 1-year post-baseline. Social network size was dichotomized as any versus no social contacts. Logistic regression assessed associations between FOF and bathroom modification. Effect modification between FOF and social isolation was assessed with multiplicative interaction terms. FOF was associated with increased odds of bathroom modification. We observed a statistically significant interaction between FOF and social isolation ( p = 0.03). Among those with no social contacts, FOF was associated with reduced odds bathroom modification that did not reach statistical significance (OR 0.5, 95% CI 0.2–1.3).

Grab Bar Use Influences Fall Hazard During Bathtub Exit

Objective This study evaluated the hazard (risk of unrecovered balance loss and hazardous fall) and strategies associated with grab bar use, compared to no grab bar use, during unexpected balance loss initiated whilst exiting a bathtub. Background While independent bathing is critical for maintaining self-sufficiency, injurious falls during bathing transfer tasks are common. Grab bars are recommended to support bathing tasks, but no evidence exists regarding fall prevention efficacy. Method Sixty-three adults completed a hazardous bathtub transfer task, experiencing an unpredictable external balance perturbation while stepping from a slippery bathtub to a dry surface. Thirty-two were provided a grab bar, while 31 had no grab bar available. Slips and grab bar use were recorded via four video cameras. Slip occurrence and strategy were identified by two independent video coders. Results Participants who had a grab bar were 75.8% more likely to recover their balance during the task than those who did not have a grab bar. Successful grab bar grasp was associated with balance recovery in all cases. Attempts to stabilize using other environmental elements, or using internal strategies only, were less successful balance recovery strategies. Grab bar presence appeared to cue use of the environment for stability. Proactive grasp and other strategies modified grasping success. Conclusion Grab bars appear to provide effective support for recovery from unexpected balance loss. Grab bar presence may instigate development of fall prevention strategies prior to loss of balance. Application Bathroom designs with grab bars may reduce frequency of fall-related injuries during bathing transfer tasks.

Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson’s disease. Protocol for a longitudinal, randomized clinical trial

Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.

Analysis of Falls from Height Variables in Occupational Accidents

Fall-from-height accidents are linked to severe and fatal consequences for impacted workers. A better understanding of the related variables is necessary to improve worker safety. This study analyzed all fall-from-height occupational accidents recorded in Spain from 2009 to 2019, selected significant variables, and evaluated the influence concerning the seriousness of the falls from height. Based on a total of 290,583 fall-from-height accidents, the study shows that a male inexperienced worker in a small company working in a non-habitual workplace is more likely to suffer fatal consequences once the accident happens. An improved knowledge of fall-from-height accidents will improve safety conditions. The workers should be trained and informed about their specific risk depending on the variables analyzed. Safety training should consider more risky profiles. Results from the current study can help identify suitable fall prevention and risk mitigation actions in safety programs for companies.

Review of Recent Rehabilitation Techniques for Fall Prevention in Parkinson’s Disease

Background: Recurrent falls are a common phenomenon in Parkinson’s disease (PD) patients which leads to increased healthcare costs, poor quality of life, and caregiver burden. Through suitable exercise training fall in PD patients can be prevented or minimized. Aim of this review was to provide recent information of different intervention strategies to prevent falls in PD. Methodology: Electronic data base such as PubMed and Scopus indexed journals were searched from the past five year to retrieve recent evidence. Keywords such as Parkinson’s disease, fall prevention and rehabilitation were used. Only Systematic review and RCT were added for the higher-level evidence data extraction. Conclusion: Eexercise-based program and Tai chi were found to have positive evidences for preventing falls in PD patients. However, various mechanism behind the fall in PD as well as worsening of the symptoms as the result of disease progression may be the reason behind the negative results of some of the intervention.

Dynamic Performance-exposure Algorithm for Falling Risk Assessment and Fall Prevention in Community-dwelling Older Adults

Background: Several models and algorithms were designed to identify older adults at risk of falling supported on an intrinsically and extrinsically traditional approach. However, the dynamic interaction between multiple risk factors for falls must be considered. The present study aimed to design a dynamic performance-exposure algorithm for falling risk assessment and fall prevention in community-dwelling older adults.Methods: The study involved 1) a cross-sectional survey assessing retrospective falls, performance-related risk factors for falls (sociodemographic such as gender and age, cognitive, health conditions, body composition, physical fitness, and dual-task outcomes), exposure risk factors (environmental hazards and (in)physical activity), and performance-exposure risk factors (affordance perception), and 2) follow-up survey assessing prospective falls. Participants were Portuguese community dwellings (≥ 65 years). Data were reported based upon descriptive statistics, curve estimation regression, binary logistic regression, and ROC curve.Results: The selected and ordered outcomes included in the algorithm and respective cutoffs were: (1) falls in previous year (high risk: n>1, moderated: n=1, low risk: n=0); (2) health conditions (high risk: n >3, moderated: n=3, low risk: n<3); (3) multidimensional balance (high risk: score <32 points, moderated risk: 32 points ≤ score ≤33 points, low risk: score>33); (4) lower body strength (high risk: rep/30s< 11, moderated risk: 11≤ rep/30s ≤14, low risk: rep/30s >4); (5) perceiving action boundaries (high risk: overestimation bias, moderated risk: not applied, low risk: underestimation bias); (6) fat body mass (high risk: % fat >38, moderated risk: 37≤ % fat ≤38, low risk: % fat <7); (7) environmental hazards (high risk: n>5, moderated risk: n=5, low risk: n<5); (8) rest period (high risk: hours/day >4.5, moderated risk: 4≤ hours/day ≤4.5, low risk: hours/day <4); (9) physical activity metabolic expenditure (high risk: MET-min/week <2300 or >5200, moderated risk: 2300≤ MET-min/week <2800, low risk: 2800≤ MET-min/week ≤5200).Conclusions: Results demonstrated a dynamic relationship between older adults’ performance capacity and the exposure to falls opportunity, supporting the build algorithm’s conceptual framework. Fall prevention measures should consider the above factors that most contribute to the individual risk of falling, relative weights, and their distance from low-risk value, as proposed in the dynamic algorithm.

Older Adults’ Experience of an Exergaming Intervention to Improve Balance and Prevent Falls: A Nested Explanatory Qualitative Study

Falls are frequent and life-changing events for older adults worldwide. The ageing phenomenon has arrived in developing countries, which experience tensions between curative and rehabilitative services, combined with an increase in non-communicable diseases. Policies addressing issues of ageing have been poorly implemented, and there are few fall prevention initiatives. Compelling evidence from the Global North supports exercise-based interventions to improve balance and reduce fall risk in older adults. More recently, attention has focused on interactive videogaming, known as exergames, as a novel way to manage fall risk with exercise. Commercially available exergames have inherent appeal for low- and middle-income country contexts, where rehabilitation professionals and resources are scanty. The aim of this study was to explore the feasibility of a large-scale randomized control trial comparing an exergaming intervention with the gold-standard Otago Exercise Programme and a no-intervention arm. Exercise adherence was poor in both intervention arms, and this prompted a shift to mixed methodology to explore the construct of falls and participants’ experience of the exergaming intervention. Focus groups were conducted, and the results were analysed using content analysis. Whereas the results demonstrated improvements in physical outcome measures (e.g., Timed-Up-and-Go, MiniBESTest) related to balance and falls that were encouraging in both the gold-standard and exergaming intervention groups, few participants achieved optimal adherence. Attitudes toward falls and fall prevention were explored, as well as participants’ experiences of the exergaming programme. Consistent with a developing country context, participants acknowledged both intrinsic and extrinsic fall risk factors. Exergaming participants enjoyed the fun and playful aspects of the exercise programme, yet these were not sufficient to maximize adherence. The focus groups described the barriers and facilitators to participation, which included motivation. The focus groups discussed strategies to enhance participation, and these are discussed in the context of exergaming.