Prevalence and Related Factors of Falls among the Elderly in an Urban Community of Beijing

Objective To understand the prevalence, consequences and risk factors of falls among urban community-dwelling elderly in Beijing. Methods A cross-sectional study was conducted in Longtan Community, Beijing. A total of 1512 individuals aged 60 years or over were selected by stratified cluster sampling. Data regarding the frequency of falls in the previous year, as well as circumstances, consequence and related factors of falls were collected from the elderly through face-to-face interviews with questionnaires in their home. Results The prevalence of falls was 18.0% on the average among 1512 participants, higher in women （20.1%） than in men （14.9%） （P=0.006）, and increased with age （Х^2 for trend=10.37, P=0.001）. The total rate of falls-induced injuries among the fallers was 37.7%. Falls usually resulted in soft-tissues bruises （58.7%）, fear of repeated episodes of falls （58.8%）, loss of independence and confidence in movement （35.7%） and even in hip fracture. In addition to the burden of medical care, falls also generated a big economic burden. Occurrence of falls was significantly associated with both intrinsic and extrinsic factors. The related factors of falls in the elderly included age≥60-70 years, femininity, less physical activities, fear of future falls, living alone, severely impaired vision, health problem-impacted activities of daily living, chronic diseases （diabetes, hypertension, postural hypotension, stroke sequela, cataract, arthritis, dementia and depression）, medications （psychoactive, anti-diabetic）, gait imbalance, high bed and faintly-lighted stairway. Conclusion The prevalence of falls among urban community-dwelling elderly in Beijing is closely associated with significant associated with intrinsic and extrinsic factors. Efforts to prevent falls in the elderly should be made at community level.

Incidence and Associated Factors for Single and Recurrent Falls among the Elderly in an Urban Community of Beijing

Objective To investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing. Methods A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews. Results The incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age （X^2for trend=21.06, 19.20, P=0.001, 0.002）. Binary logistic stepwise regression analysis showed that age （OR=2.20）, living alone （OR=4.67） and gait disturbance （OR=1.27） were risk factors, while housing with elevators （OR=0.35）, appropriate width/height of stair steps （0R=0.78）, sufficient lighting for stairway （OR=0.45） and regular exercise （OR=0.12） could lower the risk for single fall; factors such as low monthly family income （OR=1.39）, poor vision （OR=1.83）, low physical ability （OR=4.47）, abnormal static balance （OR=2.48）, and fear of falls（OR=2.23） were risk factors, while appropriate width/height of stair steps （OR=0.49） and easiness of access to daily supplies （OR=0.41） were protective factors for recurrent falls. Conclusion The incidence of falls in commun and their related injuries have been associated ty-dwelling elderly people in Beijing is common, and falls with both intrinsic and extrinsic factors.

Pressure Drop of Liquid–Solid Two-Phase Flow in the Vertical Tube Bundle of a Cold-Model Circulating Fluidized Bed Evaporator

A cold-model vertical multi-tube circulating fluidized bed evaporator was designed and built to conduct a visualization study on the pressure drop of a liquid–solid two-phase flow and the corresponding particle distribution.Water and polyformaldehyde particle(POM)were used as the liquid and solid phases,respectively.The effects of operating parameters such as the amount of added particles,circulating flow rate,and particle size were systematically investigated.The results showed that the addition of the particles increased the pressure drop in the vertical tube bundle.The maximum pressure drop ratios were 18.65%,21.15%,18.00%,and 21.15%within the experimental range of the amount of added particles for POM1,POM2,POM3,and POM4,respectively.The pressure drop ratio basically decreased with the increase in the circulating flow rate but fluctuated with the increase in the amount of added particles and particle size.The difference in pressure drop ratio decreased with the increase in the circulating flow rate.As the amount of added particles increased,the difference in pressure drop ratio fluctuated at low circulating flow rate but basically decreased at high circulating flow rate.The pressure drop in the vertical tube bundle accounted for about 70%of the overall pressure drop in the up-flow heating chamber and was the main component of the overall pressure within the experimental range.Three-dimensional phase diagrams were established to display the variation ranges of the pressure drop and pressure drop ratio in the vertical tube bundle corresponding to the operating parameters.The research results can provide some reference for the application of the fluidized bed heat transfer technology in the industry.

Establishing the Reliability and Validity of Health in Motion^©Automated Falls Screening Tool

Introduction: Blue Marble Health Company has created a digital fall risk screening tool (Health in Motion©) that can be used by means of self-report (touch/mouse) or by means of motion capture (Microsoft Kinect Sensor). Health in Motion©consists of automated versions of the Fall Risk Question-naire, 30-Second Chair Stand Test, and the One Leg Stance Test. Methods: We compared the three methods (self-report, sensor, and clinical standard measurement) using stopwatch and observation in 15 community-dwelling older adults, aged 63 - 80 years old. Each version was completed three times each in random order, for a total of nine trials. Results: Health in Motion©falls screening tool accessible via self-report and sensor is a valid and reliable automated at-home self-assessment for falls risk. Conclusion: Results support the use of Health in Motion©falls screening tools as viable alternatives to standard falls risk assessments for use by older adults at home.

Risk factors for accidental falls in the elderly and intervention strategy

As the population ages, older people's health and quality of life are becoming a matter of public concern increasingly. Through review of the literatures and analysis of the reasons for falls in older people, we worked out some measures to cope with such a situation, provided the self-care knowledge of falls prevention for older people and improved the quality life of older persons. The recovery process is long, if the old people fall down, which brings a lot of inconvenience to individuals and families, and it can also cause a lot of complications. If wary of fall risk factors, the quality of life of older persons can be improved. According to the different conditions of the elderly, we should take effective measures to create suitable living environment for senior citizens, and propagandize the knowledge of the old people's health care, which has the great significance in preventing the elderly's fall, and improving their living quality.

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.

Effects of particle type on the particle fluidization and distribution in a liquid–solid circulating fluidized bed boiler

A liquid-solid circulating fluidized bed boiler is designed and built for visualization research by applying the fluidized bed heat transfer and fouling prevention technology to the water side of the boiler. Four types of engineering plastic particles with different physical properties are selected as the solid working media. The effect of particle types on the fluidization and distribution of particles in the boiler is investigated under different feedwater flow rates and amount of added particles by using the charge couple device image measurement and acquisition system. The results show that all kinds of particles can't be normally fluidized and accumulate in the drum at low amount of added particles and feedwater flow rate. The particles with great density and low sphericity are more likely to accumulate. The average solid holdup in the riser tubes increases with the increase in feedwater flow rate and the amount of added particles. The non-uniform degree of particle distribution in the riser tubes generally decreases with the increase in feedwater flow rate and the amount of added particles. The particles with small density and settling velocity have high average solid holdup in the riser tubes under close sphericity. In generally,the smaller the density and settling velocity, the more uniform the particle distribution in the riser tubes.Three-dimensional diagrams of the non-uniform degree of particle distribution in the riser tubes of the boiler are established.

Effectiveness of a Group Exercise Class vs. Home Exercise Program as a Follow-up to Physical Therapy for Older Adults with High Fall Risk

This quasi-experimental study compared the results of a traditional model of physical therapy(PT)care to a PT wellness model known as GroupHab.The traditional model included discharge from PT with a home exercise program(HEP)to be self-administered with or without the addition of a community-based exercise program.The wellness model included participation in a PT-designed and supervised group exercise program(GroupHab class)in an outpatient clinical setting following discharge from PT.Independent t-tests were used to compare the number of falls,exercise frequency,and exercise duration between the two groups.A repeated measures,analysis of variance(RM-ANOVA)compared changes in balance confidence scores both within and between groups,and a multivariate analysis of variance(MANOVA)analyzed group differences across multiple quality of life ratings using the SF-20.All data were analyzed at the 0.05 alpha level using SPSS 24 statistical software.Our results showed a significantly greater reduction in recurrent falls among the GroupHab wellness group compared to the HEP group(t=2.811,p=0.009).The resulting odds ratio for subsequent falls was 2.2 among HEP participants and 0.2 among GroupHab participants.Exercise adherence was also greater for those who participated in the GroupHab class.They documented greater exercise frequency(t=-3.253,p=0.002)and more exercise minutes(t=-7.188,p<0.001)than those who participated in the HEP.When comparing changes in the participants’balance confidence,we found an average increase of 5%among GroupHab participants compared to a 6%decrease among HEP participants(F=16.877,p<0.001,power=0.981).Although our multivariate analysis of the SF-20 scores revealed no significant difference overall(F=0.768,p=0.73),the univariate analyses showed significantly greater improvements among GroupHab participants in selected areas of physical function.These results suggest that at-risk older adults who are discharged into a functionally-based group exercise class are less likely to experience recurrent falls and are more likely to have more confidence in their balance than those who are discharged with a standard HEP and/or use of community-based exercise classes.

Biology,invasion and management of the agricultural invader:Fall armyworm,Spodoptera frugiperda(Lepidoptera:Noctuidae)

The fall armyworm(FAW),Spodoptera frugiperda(J.E.Smith),is native to the Americas.It has rapidly invaded 47 African countries and 18 Asian countries since the first detection of invasion into Nigeria and Ghana in 2016.It is regarded as a super pest based on its host range(at least 353 host plants),its inherent ability to survive in a wide range of habitats,its strong migration ability,high fecundity,rapid development of resistance to insecticides/viruses and its gluttonous characteristics.The inherently superior biological characteristics of FAW contribute to its invasiveness.Integrated pest management(IPM)of FAW has relied on multiple applications of monitoring and scouting,agricultural control,chemical pesticides,viral insecticides,sex attractants,bio-control agents(parasitoids,predators and entomopathogens)and botanicals.Knowledge gaps remain to be filled to:(1)understand the invasive mechanisms of S.frugiperda;(2)understand how to prevent its further spread and(3)provide better management strategies.This review summarizes the biological characters of FAW,their association with its invasiveness and IPM strategies,which may provide further insights for future management.

Effect of structured nurse-patient conversation on preventing falls among patients in an acute care hospital:A mixed study

Objectives:Inpatient falls are a major patient safety issue in acute care hospitals.Multifactorial inhospital fall prevention programs have shown reductions in falls and related risks.One common element of successful programs is active patient involvement.This study objective was to explore patients’and nurses’experiences with a structured intervention to foster patient involvement.Methods:This study was conducted between September 2020 and April 2021 in a university hospital neurological ward.The studied intervention consisted of a falls information leaflet,and a structured nurse-patient conversation about fall risk-reduction activities.Nurses were trained to deliver the intervention and supported throughout the study.Nurses’and patients’experiences regarding personal involvement,satisfaction,and confidence were surveyed and analyzed quantitatively and qualitatively.Results:Fifty-six patients recruited by ward nurses received the intervention.After receiving the intervention,patients reported high levels of satisfaction with the in-hospital fall prevention conversation.Twenty-one nurses indicated that they would use the leaflet and communication aid.Twenty-one nurses commented on intervention facilitators and barriers.More specific facilitators included their shared perception that“handing out the leaflet to patients was not problematic”and that the leaflet was seen as“applicable in many patient situations.”Their comments indicated two particularly prominent barriers to conducting the intervention in clinical practice:1)“finding the time for the implementation in the daily clinical routine and workload”and 2)“environmental factors like a noisy and busy atmosphere on the ward.”Conclusions:This study provides insights into a patient involvement intervention featuring a structured nurse-patient discussion about fall risks.The accompanying information leaflet and communication guide require adaptations to facilitate sustainable implementation into the hospital’s fall prevention program,but proved useful.

Development of a fall prevention protocol for replication in a virtual environment

Several effective fall prevention exercise programs address the problem of falls. The primary challenge is not to develop effective programs, but to find ways to motivate older people to begin and maintain these programs while delivering these programs to as many older adults as possible. This short-term pilot study collected preliminary data on the design and testing of a balance rehabilitation protocol that could be replicated in a virtual gaming environment like the Wii Fit. The protocol, based on evidence- based practice, focused on strength, endurance, and functional reach. Eight older adults participated in twelve one hour sessions with an occupational therapist and exercise professional. Outcome measures included the Modified Falls Efficacy Scale, Life Space Questionnaire, and postural sway. Results suggest that the protocol was effective in improving postural sway (as measured by a force plate), reducing fear of falling, and increasing perceived life space.

Factors Affecting Minimum Foot Clearance in the Elderly Walking: A Multiple Regression Analysis

Because falls among the elderly can cause serious injury leading to a bedridden state, methods to maintain motor function in the elderly and prevent falls are important. Among falls by the elderly are tripping falls, in which the forefoot gets caught on the floor to cause the fall. Minimum foot clearance (MFC), the smallest distance between the floor and the foot during the swing phase of gait, has been given attention as a cause of tripping falls, as elderly people at risk of falling have been reported to have low MFC. No research has been done, however, to examine what geriatric factors determine MFC. In this study, various measurements were taken on muscle strength, joint angles, and other characteristics as factors possibly influencing the height of MFC, a multiple regression analysis was performed with MFC as the dependent variable, and those factors with high degrees of influence were extracted. The results revealed that the height of MFC is highly influenced by strength of the hip flexors and angle of ankle dorsiflexion. The results of this study should be taken into consideration when having elderly people do fall prevention training.

Cultural Sensitivity of a Community-Based Falls Prevention Program Targeting Older Arab American

Falls are a frequent and costly cause of injuries and functional decline in the elderly. Tai Chi is a cost-effective strategy for preventing falls in older adults. Many senior centers have introduced Tai Chi programs to increase mobility and decrease the risk of falls. However, the practice has yet to be widely disseminated to ethnic minorities who are not culturally connected to Tai Chi. This paper describes implementation barriers and recruitment and retention challenges of Arab American participants in a Tai Chi intervention-based health promotion program, including issues related to community organization and staffing, recruitment and retention, need for building relationships, need for translation and interpreters, and cultural barriers & misconceptions. Understanding and paying adequate attention to these challenges may help facilitate in planning other health promotion interventions targeting Arab American population.

Fall Prevention Education Reduces the Falling Rate on the Osteoporosis Patients Treated with Zoledronic Acid

Objective: Falls are one of the most common direct causes of fractures which are major causes of morbidity and mortality in osteoporosis patient. There are many factors related to falls, by interfering of fall prevention education on the patients with osteoporosis, our study is to investigate whether fall prevention education can reduce the falling rate on the osteoporosis patients treated with zoledronic acid. Methods: A total of 178 eligible female patients who first visited our osteoporosis department during January 2016 to June 2017 were invited to participate in this study, and all participants were randomly divided into an observation group (92 cases) and an intervention group (86 cases). All patients were administrated zoledronic acid once and received a questionnaire survey about factors related to falls at the beginning and a year later. The patients in the observation group only received regular orders of adopting a healthy lifestyle while those in the intervention group received fall prevention assessment and education, and a telephone follow-up and reinforced fall prevention education a month after discharge. A year later, relevant data regarding the falls of each patient of both groups during the year and the data of the questionnaire survey were collected for intergroup comparison. Results: The difference of the improvement of fall risk factors between the two groups is statistically significant (P Conclusion: For an osteoporosis patient treated with zoledronic acid, fall prevention education is an effective method to reduce the risk of falling, which would result in a lower risk of fractures and a better prognosis.

Clinical Characteristics and Prevention Strategies of Falls in Hospitalized Patients with Chronic Kidney Disease

Objectives: To analyze the clinical features of falls in hospitalized patients with chronic kidney disease (CKD), and to provide basis for preventing the occurrence of falls in hospitalized patients with CKD. Method: A retrospective study was conducted to analyze the 27 adverse events of falls in hospitalized patients from the department of nephrology in Peking University Shenzhen Hospital during May 2009 and May 2019. Results: Among the 27 patients with falls, people over 65 years old accounted for 55.56%;74.07% of the patients had caregivers;the peak period of falls was from June to August, accounting for 40.74%, mainly occurring from 7:00 to 8:00, 12:00 to 13:30 and 19:00 to 21:00;the locations of falls were mostly near the bed and in the bathroom, accounting for 33.33% and 22.22%, respectively;suffering from anemia, hypoproteinemia, abnormal serum potassium, calcium-phosphorus metabolism disorders accompanied by abnormal parathyroid hormone and hypertension accounted for 88.89%, 85.19%, 29.63%, 96.30% and 81.48% respectively. The inpatients on dialysis therapy accounted for 66.67%. Conclusion: The occurrence of falls in hospitalized patients with CKD was not only related to age, caregivers, time, months, locations or other conventional factors, but also the complications and dialysis therapies. To effectively reduce the occurrence of falls, it’s necessary to enhance the sense of safety and responsibility of caregivers. Besides, nurses should strengthen the inspection of wards for inpatients engaging in some intensive activities, and nurses should also pay more attention to the inpatients with anemia, hypoproteinemia, calcium-phosphorus metabolism disorders and those on dialysis therapies.

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.

Prediction of upper limit position of bedding separation overlying a coal roadway within an extra-thick coal seam

Failure of the surrounding rock around a roadway induced by roof separation is one major type of underground roof-fall accidents.This failure can especially be commonly-seen in a bottom-driven roadway within an extra-thick coal seam("bottom-driven roadway"is used throughout for ease of reference),containing weak partings in their roof coal seams.To determine the upper limit position of the roof interlayer separation is the primary premise for roof control.In this study,a mechanical model for predicting the interlayer separation overlying a bottom-driven roadway within an extra-thick coal seam was established and used to deduce the vertical stress,and length,of the elastic,and plastic zones in the rock strata above the wall of the roadway as well as the formulae for calculating the deflection in different regions of rock strata under bearing stress.Also,an approach was proposed,calculating the stratum load,deflection,and limiting span of the upper limit position of the interlayer separation in a thick coal seam.Based on the key strata control theory and its influence of bedding separation,a set of methods judging the upper limit position of the roof interlayer separation were constructed.In addition,the theoretical prediction and field monitoring for the upper limit position of interlayer separation were conducted in a typical roadway.The results obtained by these two methods are consistent,indicating that the methods proposed are conducive to improving roof control in a thick coal seam.

Analysis of hospitalization costs related to fall injuries in elderly patients

BACKGROUND With the aging world population,the incidence of falls has intensified and fallrelated hospitalization costs are increasing.Falls are one type of event studied in the health economics of patient safety,and many developed countries have conducted such research on fall-related hospitalization costs.However,China,a developing country,still lacks large-scale studies in this area.AIM To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based,cost-related groupings.METHODS A retrospective study was conducted.Patient information and cost data for elderly inpatients(age≥60 years,n=3362)who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China.Quantile regression(QR)analysis was used to identify the factors related to fall-related hospitalization costs.A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes.RESULTS The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB,and the reimbursement rate of medical benefit funds was 51.0%(92039709.52 RMB/180479203.03 RMB).The medical material costs were the highest component of the total hospitalization cost,followed(in order)by drug costs,test costs,treatment costs,integrated medical service costs and blood transfusion costs The QR results showed that patient age,gender,length of hospital stay,payment method,wound position,wound type,operation times and operation type significantly influenced the inpatient cost(P<0.05).The cost grouping model was established based on the QR results,and age,length of stay,operation type,wound position and wound type were the most important influencing factors in the model.Furthermore,the cost of each combination varied significantly.CONCLUSION Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.

Heat Transfer Characteristics and Pressure Drop in a Horizontal Circulating Fluidized Bed Evaporator

A vapor-liquid-solid horizontal circulating fluidized bed evaporation setup was constructed to study the thermal-exchange properties and pressure change.The influences of the operating variables,including the amount of added particles,heat flux,and circulating flow velocity,were systematically inspected using resistance temperature detectors and pressure sensors.The results showed that the heat transfer eff ect was improved with the increase in the amount of added particles,circulating flow velocity,and particle diameter,but decreased with increasing heat flux.The pressure drop fluctuated with the increase in operating parameters,except circulating flow velocity.The enhancing factor reached up to 71.5%.The enhancing fac-tor initially increased and then decreased with the increase in the amount of added particles and circulating flow velocity,fluctuated with increasing particle diameter,and decreased with increasing heat flux.Phase diagrams showing the variation ranges of the operation variables for the enhancing factor were constructed.

Proposal of Walking to Prevent a Fall of a Planetary Exploration Legged Rover Using Effect of Loose Soil Caused by a Propagation of Vibration

In this study,a walking method that prevents a fall of the planetary exploration-legged rover is proposed.In the proposed walking method,the leg is sunk by giving vibration to the ground.The posture of the rover is changed to prevent a fall of the rover by sinking the leg.First,the relationship between the kind of vibration and the subsidence of the leg is confirmed.In this experimental result,the leg is shown to be easy to sink to the ground by giving vibration.Moreover,the larger the vibratory force is,the easier the leg sinks to the ground.Finally,the legged testbed walks on the loose ground with a slope using the proposed walking method.In this experimental result,the testbed is difficult to fall down when it uses the proposed walking.Moreover,the angle of a slope that the testbed can walk becomes large by using the proposed walking.