A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension： a cross-sectional study

Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.

Balance training in the intervention of fall risk in elderly with diabetic peripheral neuropathy: A review

Diabetic peripheral neuropathy(DPN)was the most common complications of elderly diabetic,which could contribute to an increased risk of falling.Despite the increased prevalence of elderly diabetic,high risk of falls and serious consequences of falls in elderly with DPN,It is necessary to adopt means of reducing the risk of falls in elderly with DPN.Impaired balance in the elderly with DPN was the most important risk factor of increasing falls.This review will introduce the epidemiology of falls in elderly with DPN,analysis the reasons for high risk of falls in elderly with DPN,provide a review of the development of balance training in the intervention of fall risk in elderly with DPN and offer recommendations to medical personnels on how to provide an efficient balance training for elderly with DPN.

Relationship between fall risks and activities of daily living in older individuals

Objective:To investigate the relationship between fall risks and maintaining activities of daily living in individuals aged 65 and over.Methods:This study is cross-sectional.It was conducted with 233 individuals who were aged 65 and over in Family Health Centers located in the eastern part of Turkey between February and June 2018.Results:The mean older individuals’DENN Fall Risks Assessment Scale score was 11.73±7.13,and 62.2%of the participants were in the high-risk group.Barthel Index of Activities of Daily Living(ADL)mean score was 68.03±25.36,and 45.1%of the participants were in the moderately dependent group.There was a statistically significant,negative correlationship between Barthel Index of ADL score and age and DENN Fall Risks Assessment Scale score.In addition,there was a statistically significant,positive relationship between the DENN Fall Risks Assessment Scale score and age(p<0.01).Conclusions:This study found that level of dependency and fall risks increased with the increase in age.Effective global and multidisciplinary interventions are needed to decrease older individuals’dependency levels and fall risks today when the number of older individuals is increasing.

Reliability of a new rapid step test for older women and its relationship with fall risk and leg muscle function

This study aimed to examine trial-to-trial reliability of a new clinical test, rapid reaction step cued on a screen test, and its relationship with fall risk score, independence in activity of daily living score, and various leg muscle function tests. One-hundred fifty seven older women participated in this study. Nine square plates (32 × 32 cm) were lined up with three plates. Participants stood on a center plate and were instructed to step, using one leg, to one of the other eight plates, as quickly as possible, when that plate changed in color from white to red. The mean total time and the mean total error time of rapid reaction step cued on a screen and, fall risk score, activity of daily living score, lower muscle function (isometric muscle strength: toe flexion, plantar flexion, knee extension, hip flexion;balance: one leg standing time with eye open, functional reach test;gait: 10 m walk time with maximal speed). Results: trial-to-trial reliabilities of step parameters were high (intraclass correlation coefficient [ICC] = 0.75 - 0.85). The step parameters correlated significantly with the other parameters except for toe flexion and hip flexion strengths. In conclusion, the present step test was found to evaluate physical function related to prevention of falls in older people.

Selecting the Optimal Morse Falls Scale Cut-Off Point for Patient Fall Risk

Patient falls have long been a difficult problem and topic of research in the inpatient hospital environment. Hospitals experience heavy financial burden due to patient falls. Preventing falls can improve patient outcomes as well as reduce financial burden on both the patient as well as the healthcare organization. In this study, we determine the optimal cut-off value for patients at risk for falls using a Falls Screening Tool, the Morse Falls Scale. This study was conducted at a community-owned hospital with 256 acute care private rooms and 36 critical care rooms. This study used only the admission Morse Falls Scale (MFS) score in its analysis.

Age-related fall risk characteristics in Japanese community-dwelling elderly

This study aimed to determine age-related fall risk characteristics among 2324 Japanese community-dwelling elderly through comparisons between young-old and old-old populations. Fall risk characteristics associated with “physical function”, “disease and physical symptom”, “behavior and character”, and “environment” were evaluated, and whether each individual has a high-risk symptom for each risk factor was assessed. The frequencies of individuals for all 16 risk types, which were determined by a combination of the four risk factors, were calculated. The prevalence of each risk type and the incidence of falling in each risk type were calculated within the young-old and old-old groups, and significant differences between these percentages were examined using the chi-square test. The prevalence of the no high-risk symptom group was significantly lower in the old-old group (17.0%) than in the young-old group (45.2%). Although there was no significant difference in the prevalence of the single high-risk symptom group, the prevalence of the two or more high-risk symptom groups was significantly higher in the old-old group. The incidence of fall among the elderly with high-risk symptoms did not change with age, although the incidence of fall with no high-risk symptom increased in the old-old group. Furthermore, high prevalence was observed in risk types with high-risk symptoms for “physical function” and “behavior and character”, particularly in the symptoms of gait, going up and down stairs, and fear of falling. These age-related differences are interesting and meaningful.

Effects of Mild and Severe Knee Joint Pain on the Frequency of Falls and Fall Risk in Elderly Females

This study aimed to examine differences in the frequency of falls during the past year and fall risk among 392 elderly females was categorized into five groups on the basis of the knee pain expe-rienced: no knee pain, mild unilateral knee pain, mild bilateral knee pain, severe unilateral knee pain, and severe bilateral knee pain. The subjects participated in a fall risk survey comprising 50 items representing five risk factors: “symptoms of falling”, “disease and physical symptoms”, “en-vironment”, “behavior and character”, and “physical function”. The frequency of falls during the past year, score for each risk factor, and the total fall risk score were not significantly different between the mild unilateral and mild bilateral knee pain groups, and between the severe unilateral and severe bilateral knee pain groups. Therefore, these groups were pooled to form a mild knee pain group and a severe knee pain group and analyzed. The severe knee pain group had experienced a significantly greater number of falls during the past year compared with the no knee pain group. Furthermore, the symptom of falling score was significantly higher in the severe knee pain group than in the no knee pain group, while the disease and physical symptoms score was significantly higher in the mild and severe knee pain groups than in the no knee pain group. The physical function score and total fall risk score were significantly higher in the following order: the severe knee pain group, the mild knee pain group, and the no knee pain group. Our results indicate that for elderly females who can achieve ADL independently, the degree of knee pain (mild or severe) has a marked effect on fall risk, irrespective of laterality of the pain (unilateral or bilateral). Factors such as symptoms of falling, disease and physical symptoms, and physical function are also related to fall risk in this population. Furthermore, elderly individuals with severe knee pain experience frequent falls.

Discrepancy between Patients’ and Nurses’ Estimates of Patients’ Activities of Daily Living for Fall Risk Assessment: A Quantitative Observational Study

Background: Patient falls are a serious problem in a rehabilitation unit. Although patient falls have been described in the healthcare literature for more 60 years, and many risk assessment tools have been developed, the rate of falls in hospitals in Japan has remained unchanged for the last 8 years. A previous study reported that about 50% of patients in rehabilitation estimated their fall risk lower than that estimated by their nurses. We believe that patients in rehabilitation tend to overestimate their ability to perform ADLs. Aim: To identify discrepancies between patients’ and nurses’ estimates of patients’ ability to perform activities of daily living (ADL) and clarify any relationship between the discrepancies and patient falls. Methods: Participants comprised 82 patients (42 men) admitted to a rehabilitation unit in Osaka, Japan from July to December of 2017. Patients and their nurses answered the same questionnaire about patients’ ability to perform ADL. The questionnaire was developed based on the Functional Independence Measure (FIM) and administered at admission, at 1 month after admission, and at discharge. Participants were classified into the overestimating group and the accurately estimating/underestimating group, and groups were compared using Wilcoxon rank-sum tests. Results: The mean age of participants was 76.4 years. At admission, approximately 72% of participants estimated their own ability to perform ADL higher than did the nurses. The percentage of overestimating participants dropped to 30% at discharge. Fifteen of the participants experienced a fall;all were in the overestimating group. The ADL Discrepancy and fall-assessment scores for these 15 participants were significantly higher than those of other participants. Conclusions: There are discrepancies between patients’ and nurses’ estimates of patients’ ability to perform ADL and had important significance for assessing their risk of fall. And minimizing the discrepancy may support the prevention of falls.

Use of the Tinetti Index to Assess Fall Risk in Patients with Sequelae of Stroke

Background and Objective: The knowledge about risk of falls in patients with sequelae of stroke by applying a scale constitutes an important factor fort nurses since it allows planning for quality care and consequently improves the quality of life of such patients. The present study aimed to assess the risk of falls of patients with sequelae of stroke using Tinetti Index. Methods: Transversal descriptive study with 61 hospitalized patients. The data were collected through the application of Tinetti Index, the total score of which is 28 points. Results: The index evaluation shows que 47.9% had 19 points under the ideal score, indicating a high risk of falls, 41.7% from 24 to 28, indicating moderate risk and 10.4% from 19 to 23 points, indicating low risk of falls. The final average was (15.23), the median (16.50) and standard deviation (±11.034). Conclusions: There is a high risk of falls in this population, a quantification of impaired balance and gait anticipate the future risk of falls. The use of assessment instruments has important implications for improving the quality of life in patients with symptomatic stroke.

The correlation between white matter hyperintensity and balance disorder and fall risk:An observational, prospective cohort study

Objective: The presence of an association between white matter hyperintensity (WMH) and the risk of falls in older people is uncertain, with little supporting prospective evidence available at present. We aimed to determine whether WMH was associated with dysfunctions of balance and gait, and other sensorimotor factors leading to falls, and the independent factors related to falls in older Chinese people. The protective effect of exercise against falls was also addressed. Methods: In a representative sample of hospital-based individuals aged 50 years and older in China, the patients' history of falls, magnetic resonance imaging data, scores on the 9-item Berg Balance Scale (BBS-9) test and timed up-and-go test (TUGT), and sensorimotor measures of computerized dynamic posturography (CDP) were analyzed. Incident falls were recorded prospectively over a 12-month period. Using regression modeling, the association between the risk of falls and baseline WMH was estimated. Results: Only individuals with severe WMH were at an increased risk of falls, and CDP was more sensitive than BBS-9 in detecting WMH-related balance and gait dysfunction. However, WMH was not an independent predictor of falls. Taller height and overweight or obese body habitus were identified as novel protective factors for falls. Female, fall history, and increased TUGT score were identified as independent risk factors for falls in older Chinese people.

Physical Activation of Elderly and the Decrease of Falling Risk

A Physical Activation Program was designed and implemented with a particular emphasis in recovering of motor independence, and in an indirect manner;the increase of activities was carried out in a social context in such a way that it allowed isolated elderly to develop their ability to perform daily activities diminishing the burden on their caregivers. 30 people were randomly selected: 15 subjects in the experimental group and 15 in the control group;7 women and 8 men each group. Subjects aged between 60 - 84 years with a mean age of 78 years and a standard deviation of 6.5 were applied in a three-month Physical Activation Program with a 45-min daily sessions. Results obtained showed that physical activity in elderly, systematically improved their amplitude and joint mobility which impact directly and indirectly their quality of life, reducing their risk of falling.

Salsa Dance Could Improve Effectively to Body Balance in Elderly with Risk of Falls

Currently the number of elderly in Indonesia tends to increase. Based on 2014 Susenas data, the number of elderly in Indonesia reaches 20.24 million people (8.03%). One of the most common physical disorders in the elderly is disruption of the body’s balance and risk to falls. The risk of falling in the elderly can be prevented by doing physical exercise in the form of Salsa dance. Salsa dance has movements that can improve stability, flexibility, mobility and body balance. This study aims to analyze the effectiveness of Salsa dance on body balance in the elderly. The research method used quasi-experimental with the pre test-post test design control group. As many as 70 elderly who experienced balance disruption in the Puskemas Sarijadi had participated in this study. The sample was taken by using consecutive sampling, then divided equally between the control group and the intervention group. The instrument used to measure elderly balance is Short Physical Performance Battery (SPPB). Data analysis is carried out in two stages, namely univariate analysis using the mean, standard deviation, maximum value and minimum value and percentage;then followed by bivariate analysis using the Wilcoxon signed rank test and independent T test. The result shows that there are differences in the balance of the elderly before and after the intervention in the treatment group, whereas in the control group there were no significant differences. Therefore, it can be concluded that Salsa dance can significantly improve elderly body balance, especially if done regularly. The increase will appear significant after the intervention carried out for 10 and 20 times. It is suggested that nurses utilize Salsa dance as an alternative in dealing with symptoms of body balance disorders in the elderly. This intervention can be implemented along with other activities of the elderly in community centre health services.

老年特发性正常压力脑积水患者的姿势稳定性特征

背景:姿势控制能力受损是特发性正常压力脑积水患者发生跌倒、引发继发性损害的重要危险因素,现有研究大多是对患者直线行走时的步态参数进行分析,鲜有对患者在静态与动态活动中的姿势稳定性特征进行分析。目的:分析老年特发性正常压力脑积水患者的姿势稳定性特征。方法:选择2022年9月至2023年2月在上海市复旦大学附属华东医院神经外科临床诊断为特发性正常压力脑积水的患者22例作为患者组,同时选择健康陪诊家属18名作为健康对照组。分别采用计时起立-行走测试、多方向性伸展测试、Berg平衡量表和静态平衡功能测试(反应时间、移动速度、方向控制、最大偏移距离、端点行程)评估受试者的姿势稳定性特征。结果与结论:①患者组完成计时起立-行走测试所需时间及静态平衡功能测试的反应时间均长于健康对照组(P<0.05),前、后、左、右方向上的伸展测试手臂伸展距离均小于健康对照组(P<0.05),Berg平衡量表得分低于健康对照组(P<0.05),静态平衡功能测试的移动速度、方向控制、最大偏移距离和端点行程均小于健康对照组(P<0.05)。②结果提示,特发性正常压力脑积水患者表现出整体的姿势控制能力障碍,反应能力与执行能力受损使得这类患者在面对来自内部或外部的干扰时无法做出及时、准确的运动反应而出现姿势不稳,增加了发生跌倒的风险。

养老机构老年人跌倒风险综合评估工具的研制与检验

背景我国自1999年宣布进入老龄化社会以来,人口老龄化程度日益严重,养老机构成为老年人养老热门选择,但跌倒问题频发且现有评估工具效果不佳。目的研制养老机构老年人跌倒风险综合评估工具并检验其信效度。方法2021年3—12月,通过文献回顾、半结构式访谈、2轮专家函询及预调查,形成量表初始条目,并在养老机构随机选择老年人和养老护理员进行调查。采用SPSS 26.0和AMOS 26.0软件进行信效度分析和评价,采用相关系数法、临界比值法、内部一致性分析及探索性因素分析进行条目分析和筛选,选用内在信度、分半信度、评定者间信度和同质性信度检验评估工具的信度,选用表面效度、内容效度、效标关联效度、结构效度和区分效度检验评估工具的效度,采用受试者工作特征曲线检验评估工具的预测能力。结果构建的评估工具包括3个子工具:(1)老年人跌倒风险评估量表;(2)老年人跌倒史风险追踪调查表;(3)老年人跌倒风险每日检查清单。老年人跌倒风险评估量表总Cronbach'sα系数为0.73,评定者间系数为0.85;探索性因子分析提取3个公因子,累识方差贡献率为57.95%;验证性因子模型拟合度参数中的卡方自由度比值(χ^(2)/df)、拟合优度指数(GFI)、调整后拟合优度指数(AGFI)、基于标准化适度指标(NFI)、比较拟合指数(CFI)、Tucker-Lewis系数(TLI)、近似误差均方根(RMSEA)分别为2.43、0.95、0.91、0.89、0.93、0.91、0.07,区分效度经验证存在统计学意义(P<0.001)。预测能力分析结果显示,以Morse跌倒评估表(MFS)≥55分为标准时,受试者工作特征曲线下面积(AUC)为0.87;以MFS≤25分为标准时,AUC为0.84。老年人跌倒史风险追踪调查表和老年人跌倒风险每日检查清单经专家和养老护理员的评价后,形成最终版本。结论本研究开发养老机构老年人跌倒风险综合评估工具,包含3个子量表,三者间相辅相成,完善养老机构从评估到预防的全路径,具有良好的信效度和预测能力,可为日后我国养老机构跌倒预防及管理提供参考。

社区老年衰弱患者跌倒风险感知的研究进展

社区老年衰弱患者因躯体功能减退,发生跌倒的风险较高。跌倒风险感知强调从患者角度探讨对跌倒风险的理解,对个体主动采取跌倒预防性行为,减少跌倒发生风险具有积极意义。本文主要就社区老年衰弱患者跌倒风险感知现状、影响因素、评估工具及干预方法进行综述,以期为医护人员开展相关研究进而制定针对性的跌倒预防管理方案提供参考。

老年胃癌病人营养风险和日常生活活动能力在衰弱与跌倒风险间的链式中介效应

目的:探讨营养风险和日常生活活动能力在老年胃癌病人衰弱和跌倒风险间的链式中介效应。方法:采用衰弱表型量表(FP)、Morse跌倒评估量表(MFS)、简易营养评估量表(MNA‐SF)以及日常生活活动能力量表(ADL)对235例老年胃癌病人进行调查。结果:本研究共纳入235例病人,其中衰弱病人76例,发生率为32.3%;不同年龄、职业、学历以及合并疾病老年胃癌病人的衰弱得分比较,差异有统计学意义(P<0.05)。Pearson相关分析结果显示,衰弱与跌倒风险呈正相关,营养风险与日常生活活动能力也呈正相关;衰弱和跌倒风险均与营养风险和日常生活活动能力呈负相关。中介效应检验结果显示,营养风险和日常生活活动能力在衰弱和跌倒风险之间的链式中介效应成立,总间接效应为52.1%。结论:营养风险和日常生活活动能力在衰弱和跌倒风险之间具有链式中介作用,可以通过改善营养状况、日常生活活动能力以及跌倒风险来减缓衰弱的发生,为推测衰弱的发生提供参考依据。

Hourly Rounding and Fall Prevention among the Elderly in Long Term Care: A change Process

Long term care facilities have a rising rate of falls and fall related injuries with increasing cost and more hospitalization.Hourly rounding®is an evidenced based intervention that is proactive for nursing staff to be able to identify patient’s needs.This helps with positive fall prevention out­come.This project focused on process improvement efforts for 10 weeks and examining the education and implementation of an evidenced-based hourly rounding program that assisted in reducing the number of falls in the pilot unit.The implementation of the intervention took place in a long-term care facility located in Dallas,Georgia.The hourly rounding tools used in this project were the Studer Group hourly rounding log and competency checklist with permission.Twenty staff members were in­cluded in the sample,age 18 years and 60 years.The unit has 41 residents who were included in the pilot case study design.Staff members were first educated regarding hourly rounding and documentation on the hourly rounding log was done two days before implementation and the pre and post fall rate was retrieved from the facilities fall database.Competency checklist was completed prior to implementation and post implementa­tion to evaluate staff understanding of the main tenets of the 4 P’s(potty,pain,possession,and position).For this project,descriptive statistics was used to help determine fall rates.Minitab was used to analyzed data and to determine if it was clinically significant.In the ten weeks following the hourly rounding implementation,participants performed hourly rounding by incorporating it to each resident’s daily routine and documented their rounds on the log sheet.The results indicated that it is statistically signifi­cant and with a P-values=-<0.0001 and t-value=-5.81.

社区老年脑卒中患者跌倒风险感知现状及影响因素研究

目的 了解社区老年脑卒中患者跌倒风险感知状况,并分析其影响因素,为激发患者自我预防意识、降低跌倒发生率提供参考。方法 2023年5-8月,采用便利抽样法选取山西省汾阳市3个社区的老年脑卒中患者228例为研究对象,采用社区老年人跌倒风险感知量表、D型人格量表(type D personality scale-14,DS14)、家庭关怀度量表(family APGAR index, APGAR)等对其进行调查。结果 社区老年脑卒中患者跌倒风险感知总分、DS14总分、APGAR总分分别为(40.31±8.99)分、(20.99±7.01)分和(4.91±1.50)分。不同文化程度、慢性病数量以及有无跌倒史的社区老年脑卒中患者,其跌倒风险感知得分差异均有统计学意义(均P<0.001)。跌倒风险感知总分与DS14总分呈负相关(r=-0.724,P<0.01),与APGAR总分呈正相关(r=0.782,P<0.01)。DS14总分、APGAR总分、跌倒史和慢性病数量是社区老年脑卒中患者跌倒风险感知的主要影响因素(均P<0.05)。结论 社区老年脑卒中患者跌倒风险感知呈中等偏下水平,社区卫生保健人员应重点关注存在D型人格、家庭关怀度低、有跌倒史、合并慢性病数量多的患者,采取针对性措施,降低跌倒发生率。

老年住院患者复合跌倒风险评分表的构建及应用研究

目的构建老年住院患者复合跌倒风险评分表,提高老年住院患者跌倒风险评估准确性。方法整合约翰霍普金斯跌倒评定量表和HendrichⅡ跌倒风险模型作为初始条目;采用前瞻性研究,收集42490例老年住院患者跌倒发生情况及相关风险因素,通过χ^(2)检验和logistic回归分析确定跌倒的影响因素,构建老年住院患者复合跌倒风险评分表。将复合跌倒风险评分表在1663例老年住院患者中进行验证。结果logistic回归分析得到18项危险因素,将各危险因素的风险比值比(OR)进行赋值,总分为100分。验证结果显示,老年住院患者复合跌倒风险评分表的ROC曲线下面积为0.825(95%CI:0.798~0.852),最佳截断值为7.5分,灵敏度为0.736,特异度为0.771。结论老年住院患者复合跌倒风险评分表能有效预测老年住院患者的跌倒风险,有助于临床护理人员及时筛查出高危患者,从而进行有针对性的预防干预。

老年人药物相关性跌倒预防与管理的证据总结

目的 :检索并总结老年人药物相关性跌倒预防与管理的相关证据,为降低老年人药物相关性跌倒发生率提供循证依据。方法 :按照证据资源“6S”模型自上而下依次系统检索国内外相关数据库和网站中关于老年人药物相关性跌倒预防与管理的临床决策、指南、专家共识、证据总结和系统评价,检索时限为从建库至2023年12月1日,对纳入文献进行质量评价和资料提取,根据证据汇总原则提取并整合证据。结果 :共纳入16篇文献,包括1篇临床决策、3篇指南、5篇专家共识、2篇证据总结和5篇系统评价。从跌倒风险评估、跌倒相关用药评估、预防策略、使用管理和健康教育5个方面形成了21条证据。结论 :本研究总结的老年人药物相关性跌倒预防与管理的证据内容可协助医护人员结合患者实际情况制定个性化干预方案,降低老年人药物相关性跌倒发生率。