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.

Observation on the Risk of Falling and Self-efficacy in Elderly Patients with Hip Fracture

Objectives:To study the risk of falling and self-efficacy in elderly patients with hip fracture.Methodology:Forty elderly patients with hip fractures that were caused by falling were admitted into our hospital from April 2018 to April 2019,and were enrolled into this study.All patients were assessed by using the Morse Fall Scale(MFS)and Falls Efficacy Scale(FES).The basic situation of the patients with hip fractures caused by falling and the scores of MFS and FES before and after falling were evaluated.Results:Results showed that the number of patients with femoral neck fractures accounted for 70%out of all patients,and the number of patients with intertrochanteric fractures accounted for the remaining 30%of the patients.The number of patients with academic qualification below primary school is 16,the number of patients with middle high school education is 11 and the number of patients with high school education and above is 13.Slipping is the cause of hip fracture that accounted for the most in patients,followed by outing activities,whereas least patients with hip fractures was caused by falling in nursing home.There were 29 patients’who used crutches or walking aids and this number was more than that of those who required the devices.After the MFS and FES analyses,the results(scores of MFS and FES)showed that the risk before the fall was lower.In contrast,the risk of fracture and post-surgery after the fall was greatly increased.Conclusion:The elderly patients with hip fractures were found to have increased risk of falling and thus,these patients require good care.

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.

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.

TRiceR: A Web Application for Supporting Risk Assessment of Ice Falling from Wind Turbine Blades

In regions with high population densities, the development of wind energy projects situated in an industrial environment or close to cities is a preferred option, since it represents some major advantages. On the other hand, it also represents a drawback in terms of safety during winter conditions. Ice accretion on the wind turbine blades represents a major risk as ice fall may cause incidents, even lethal accidents to people in the vicinity. The current common methodology to identify the potentially risky areas around wind turbines uses a deterministic approach which leads to excessively large zones around the turbines without granularity or circumstantial sub-zones. The approach presented in this paper is a probabilistic risk-based Monte Carlo methodology associated with an acceptance framework. Developed by Engie Tractebel, this methodology allows a much more detailed mapping of the risk zones and also enables to model the impact of mitigating measures. This represents a real risk-based decision tool for windfarm developers and operators. The approach is fully compliant with the IEA (International Energy Agency) Wind “International Recommendations for Ice Fall and Ice Throw Risk Assessments” and recent international safety standards. The tool is available as a cloud-based application called TRiceR.

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.

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.

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.

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.

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.

Incidence,prevalence,and causes of spinal injuries in China,1990-2019:Findings from the Global Burden of Disease Study 2019

Background:Spinal injuries are an urgent public health priority;nevertheless,no China-wide studies of these injuries exist.This study measured the incidence,prevalence,causes,regional distribution,and annual trends of spinal injuries in China from 1990 to 2019.Methods:We used data from the Global Burden of Diseases,Injuries,and Risk Factors Study 2019 to estimate the incidence and prevalence of spinal injuries in China.The data of 33 provincial-level administrative regions(excluding Taiwan,China)provided by the National Center for Chronic and Noncommunicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention(CDC)were use to systematically analyze the provincial etiology,geographical distribution,and annual trends of spinal injuries.The Bayesian meta-regression tool DisMod-MR 2.1 was used to ensure the consistency among incidence,prevalence,and mortality rates in each case.Results:From 1990 to 2019,the number of living patients with spinal injuries in China increased by 138.32%,from 2.14 million to 5.10 million,while the corresponding age-standardized prevalence increased from 0.20%(95%uncertainty interval[UI]:0.18-0.21%)to 0.27%(95%UI:0.26-0.29%).The incidence of spinal injuries in China increased by 89.91%(95%UI:72.39-107.66%),and the prevalence increased by 98.20%(95%UI:89.56-106.82%),both the most significant increases among the G20 countries;71.00%of the increase could be explained by age-specific prevalence.In 2019,the incidence was 16.47(95%UI:12.08-22.00,per 100,000 population),and the prevalence was 358.30(95%UI:333.96-386.62,per 100,000 population).Based on the data of 33 provincial-level administrative regions provided by CDC,age-standardized incidence and prevalence were both highest in developed provinces in Eastern China.The primary causes were falls and road injuries;however,the prevalence and specific causes differed across provinces.Conclusions:In China,the overall disease burden of spinal injuries increased significantly during the past three decades but varied considerably according to geographical location.The primary causes were falls and road injuries;however,the prevalence and specific causes differed across provinces.

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.

Effects of a multimodal exercise protocol on functional outcomes,epigenetic modulation and brain-derived neurotrophic factor levels in institutionalized older adults:a quasi-experimental pilot study

Epigenetic changes have been shown to be associated with both aging process and aging-related diseases.There is evidence regarding the benefits of physical activity on the functionality,cognition,and quality of life of institutionalized older adults,however,the molecular mechanisms involved are not elucidated.The purpose of this pilot study was to investigate the effects of a multimodal exercise intervention on functional outcomes,cognitive performance,quality of life(QOL),epigenetic markers and brain-derived neurotrophic factor(BDNF)levels among institutionalized older adult individuals.Participants(n=8)without dementia who were aged 73.38±11.28 years and predominantly female(87.5%)were included in this quasi-experimental pilot study.A multimodal exercise protocol(cardiovascular capacity,strength,balance/agility andflexibility,perception and cognition)consisted of twice weekly sessions(60 minutes each)over 8 weeks.Balance(Berg Scale),mobility(Timed Up and Go test),functional capacity(Six-Minute Walk test),cognitive function(Mini-Mental State Examination)and QOL(the World Health Organization Quality of Life-BREF Scale questionnaire)were evaluated before and after the intervention.Blood sample(15 mL)was also collected before and after intervention for analysis of biomarkers global histone H3 acetylation and brain-derived neurotrophic factor levels.Significant improvements were observed in cognitive function,balance,mobility,functional capacity and QOL after the intervention.In addition,a tendency toward an increase in global histone H3 acetylation levels was observed,while brain-derived neurotrophic factor level remained unchanged.This study provided evidence that an 8-week multimodal exercise protocol has a significant effect on ameliorating functional outcomes and QOL in institutionalized older adult individuals.In addition,it was also able to promote cognitive improvement,which seems to be partially related to histone hyperacetylation status.The Ethics Research Committee of Centro Universitário Metodista-IPA,Brazil approved the current study on June 6,2019(approval No.3.376.078).

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.

In Community Dwelling Females Age 65 or Older, Gait Speed Declines as Kinesthetic Awareness of the Lower Legs Decreases

Purpose: This study investigates the existence of a correlation between the gait speed and kinesthetic sense in lower legs and to conduct further analysis of kinesthetic sense in relation to the risk of fall among community dwelling females aged 65 years or older. Materials and Methods: A non-experimental correlational, descriptive, and cohort study included 38 community dwelling females (average age of 82.5 years). The kinesthetic ruler (K-Ruler) and kinesthetic test protocol were created and used to assess lower extremity kinesthetic awareness. The GaitRite System was used to assess gait speed. Each subject was categorized into four groups: “LL” (Low K-Score and low gait speed), “LH” (Low K-Score and high gait speed), “HL” (High K-Score and low gait speed), and “HH” (High K-Score and high gait speed) according to kinesthetic awareness and gait speed measured. Voluntary fall incidence reporting over the 6-month period was followed by the initial data collection. Results: Pearson product-moment correlation (2-tailed) showed that there is a statistically significant, positive moderate-to-strong correlation between K-score and gait speed (ICC = 0.692, p Discussion: Gait speed declines as kinesthetic awareness of lower extremity decreases in community dwelling 65 or older female subjects. Additionally, the combination of kinesthetic awareness and gait speed can be served as a predictor of fall risk. The K-ruler can be used to assess lower extremity kinesthetic awareness in older people as a feasible and standard test.

Diagnosis of the Physical Area of Community-Dwelling Adults

A situational analysis of aspects related to the physical area of elderly residents of permanent stay of the city of Chihuahua was performed. Participating in the study 51 subjects, 30 women and 21 men, Tinetti and trunk flexion EUROFIT scales were applied to assess fall risk and range of motion. The poor results in balance, gait and range of motion can be stated that most of them are in serious risk of falling. The results obtained show the urgency of starting a physical activation program that emphasizes directly in recovery mobile independence so that enable seniors asylees enhance your ability to perform activities of daily life and reduce the burden on their caregivers.

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.

老年肌少症病人跌倒风险的研究进展

从老年肌少症病人跌倒的流行病学、危险因素、风险评估、干预措施等方面进行综述,以期为预防老年肌少症病人跌倒提供相应的理论依据,旨在降低老年肌少症病人跌倒的发生率。

肿瘤患者跌倒风险感知量表的编制及信效度检验

目的编制肿瘤患者跌倒风险感知量表并检验信效度,为肿瘤患者跌倒防范提供自评工具。方法通过文献回顾、专家函询、小组讨论等方式构建量表,选取407例肿瘤患者进行调查,检验量表信效度。结果肿瘤患者跌倒风险感知量表包括跌倒认知易感知性(5个条目)、生理状况易感知性(12个条目)、个人活动易感知性(5个条目)、环境因素易感知性(5个条目)、跌倒严重性感知(3个条目)5个维度共30个条目。探索性因子分析提取5个公因子,累计方差贡献率66.746%。量表总的Cronbach′sα系数为0.926,折半信度为0.672,各维度Cronbach′sα系数为0.914~0.970,折半信度为0.877~0.963。量表水平的内容效度指数为0.867,条目水平的内容效度指数为0.813~1.000。验证性因子分析结果显示,χ^(2)/df=1.845,RMSEA=0.059,GFI=0.840,CFI=0.971,NFI=0.939,AGFI=0.811,模型适配良好;AVE平方根均显著大于相关系数,各维度之间有显著相关性(均P<0.05)。结论肿瘤患者跌倒风险感知量表信效度良好,可用于肿瘤患者跌倒风险感知的评估。