cognitive impairment is an established fall risk factor; however, it is unclear whether a disease-specific diagnosis (i.e. dementia), measures of global cognition or impairments in specific cognitive ...domains (i.e. executive function) have the greatest association with fall risk. Our objective was to evaluate the epidemiological evidence linking cognitive impairment and fall risk.
studies were identified through systematic searches of the electronic databases of MEDLINE, EMBASE, PyschINFO (1988-2009). Bibliographies of retrieved articles were also searched. A fixed-effects meta-analysis was performed using an inverse-variance method.
twenty-seven studies met the inclusion criteria. Impairment on global measures of cognition was associated with any fall, serious injuries (summary estimate of OR = 2.13 (1.56, 2.90)) and distal radius fractures in community-dwelling older adults. Executive function impairment, even subtle deficits in healthy community-dwelling older adults, was associated with an increased risk for any fall (summary estimate of OR = 1.44 (1.20, 1.73)) and falls with serious injury. A diagnosis of dementia, without specification of dementia subtype or disease severity, was associated with risk for any fall but not serious fall injury in institution-dwelling older adults.
the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk. There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values. Executive function was also associated with increased risk, which supports its inclusion in fall risk assessment especially when global measures are within normal limits.
IMPORTANCE: Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise. OBJECTIVE: To assess ...the potential effectiveness of interventions for preventing falls. DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned. STUDY SELECTION: Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older. DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted. MAIN OUTCOMES AND MEASURES: Injurious falls and fall-related hospitalizations. RESULTS: A total of 283 RCTs (159 910 participants; mean age, 78.1 years; 74% women) were included after screening of 10 650 titles and abstracts and 1210 full-text articles. Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio OR, 0.51 95% CI, 0.33 to 0.79; absolute risk difference ARD, −0.12 95% CI, −0.20 to −0.05); combined exercise and vision assessment and treatment (OR, 0.17 95% CI, 0.07 to 0.38; ARD, −0.38 95% CI, −0.53 to −0.22); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 95% CI, 0.13 to 0.70; ARD, −0.23 95% CI, −0.39 to −0.08); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 95% CI, 0.03 to 0.55; ARD, −0.17 95% CI, −0.33 to 0.00). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 95% CI, 0.33 to 1.81). CONCLUSIONS AND RELEVANCE: Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.
IMPORTANCE: Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown. OBJECTIVE: To assess the effect of a home-based exercise program as a ...fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall. DESIGN, SETTING, AND PARTICIPANTS: A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic. INTERVENTIONS: Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months. MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention. RESULTS: Among 345 randomized patients (mean age, 81.6 SD, 6.1 years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported. CONCLUSIONS AND RELEVANCE: Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT01029171; NCT00323596
The story of how the women's rights movement began at the Seneca Falls convention of 1848 is a cherished American myth. The standard account credits founders such as Elizabeth Cady Stanton, Susan B. ...Anthony, and Lucretia Mott with defining and then leading the campaign for women's suffrage. In her provocative new history, Lisa Tetrault demonstrates that Stanton, Anthony, and their peers gradually created and popularized this origins story during the second half of the nineteenth century in response to internal movement dynamics as well as the racial politics of memory after the Civil War. The founding mythology that coalesced in their speeches and writings--most notably Stanton and Anthony'sHistory of Woman Suffrage--provided younger activists with the vital resource of a usable past for the ongoing struggle, and it helped consolidate Stanton and Anthony's leadership against challenges from the grassroots and rival suffragists.As Tetrault shows, while this mythology has narrowed our understanding of the early efforts to champion women's rights, the myth of Seneca Falls itself became an influential factor in the suffrage movement. And along the way, its authors amassed the first archive of feminism and literally invented the modern discipline of women's history.
falls are a major cause of disability and death in older people. Women are more likely to fall than men, but little is known about whether risk factors for falls differ between the sexes. We used ...data from the English Longitudinal Study of Ageing to investigate the prevalence of falls by sex and to examine cross-sectionally sex-specific associations between a range of potential risk factors and likelihood of falling.
participants were 4,301 men and women aged 60 and over who had taken part in the 2012-13 survey of the English Longitudinal Study of Ageing. They provided information about sociodemographic, lifestyle and behavioural and medical factors, had their physical and cognitive function assessed and responded to a question about whether they had fallen down in the last two years.
in multivariable logistic regression models, severe pain and diagnosis of at least one chronic disease were independently associated with falls in both sexes. Sex-specific risk factors were incontinence (odds ratio (OR), 1.48; 95% CI, 1.19, 1.85) and frailty (OR 1.69, 95% CI 1.06, 2.69) in women, and older age (OR 1.02, 95% CI 1.04, 1.07), high levels of depressive symptoms (OR 1.33, 95% CI 1.05, 1.68), and being unable to perform a standing balance test (OR 3.32, 95% CI 2.09, 5.29) in men.
although we found some homogeneity between the sexes in the risk factors that were associated with falls, the existence of several sex-specific risk factors suggests that gender should be taken into account in designing fall-prevention strategies.
Background: numerous tests have been suggested as fall risk indicators. However, the validity of these assessments has not been demonstrated in large representative samples of community-dwelling ...older people. Objective: the objective of this study was to examine the comparative ability and clinical utility of eight mobility tests for predicting multiple falls in older community-dwelling people. Methods: design—prospective cohort study; subjects −362 subjects aged 74–98 years; measurements—the sit-to-stand test with one and five repetitions, the pick-up-weight test, the half-turn test, the alternate-step test (AST), the six-metre-walk test (SMWT) and stair ascent and descent tasks. Falls were monitored for 1 year with fall calendars. Results: in the 12-month follow-up period, 80 subjects (22.1%) suffered two or more falls. Multiple fallers performed significantly worse than non-multiple fallers in the sit-to-stand test with five repetitions (STS-5), the AST, the half-turn test, the SMWT and the stair-descent test. When dichotomised using cut-off points from receiver-operated characteristics (ROC) curve analyses, these tests demonstrated reasonable sensitivity and specificity in identifying multiple fallers. A principal components analysis identified only one factor underlying the mobility tests. Poor performances in two mobility tests, however, increased the risk of multiple falls more than poor performance in one test alone (ORs = 3.66, 95% CI = 1.44, 9.27 and 1.61, 95% CI = 0.62, 4.16 respectively). Conclusions: the mobility tests appear to be measuring a similar ‘mobility’ construct. Based on feasibility and predictive validity, the AST, STS-5 and SMWTs were the best tests.
to determine the effect of exercise interventions on fear of falling in community-living people aged ≥65.
systematic review and meta-analysis. Bibliographic databases, trial registers and other ...sources were searched for randomised or quasi-randomised trials. Data were independently extracted by pairs of reviewers using a standard form.
thirty trials (2,878 participants) reported 36 interventions (Tai Chi and yoga (n = 9); balance training (n = 19); strength and resistance training (n = 8)). The risk of bias was low in few trials. Most studies were from high-income countries (Australia = 8, USA = 7). Intervention periods (<12 weeks = 22; 13-26 weeks = 7; >26 weeks = 7) and exercise frequency (1-3 times/week = 32; ≥4 times/week = 4) varied between studies. Fear of falling was measured by single-item questions (7) and scales measuring falls efficacy (14), balance confidence (9) and concern or worry about falling (2). Meta-analyses showed a small to moderate effect of exercise interventions on reducing fear of falling immediately post-intervention (standardised mean difference (SMD) 0.37, 95% CI 0.18, 0.56; 24 studies; low-quality evidence). There was a small, but not statistically significant effect in the longer term (<6 months (SMD 0.17, 95% CI -0.05, 0.38 (four studies) and ≥6 months post-intervention SMD 0.20, 95% CI -0.01, 0.41 (three studies)).
exercise interventions probably reduce fear of falling to a small to moderate degree immediately post-intervention in community-living older people. The high risk of bias in most included trials suggests findings should be interpreted with caution. High-quality trials are needed to strengthen the evidence base in this area.
Falls in community-dwelling older people have been recognised as a significant public health issue in China given the rapidly growing aged population. Although there are several reviews documenting ...falls prevention programs for community-dwelling older adults, no systematic reviews of the scope and quality of falls prevention interventions in Mainland China exist. Therefore, the aim of this study was to systematically review falls prevention interventions for community-dwelling older people living in Mainland China.
We systematically reviewed literature from Chinese and English databases. All types of randomised controlled trials (RCTs) and quasi-experimental studies published from 1st January 1990 to 30th September 2019 were included. Observational studies and studies in care facilities and hospitals were excluded. Narrative synthesis was performed to summarise the key features of all included studies. Quality assessment was conducted using the Cochrane Risk of Bias Tool and ROBINS-I tool for randomised and non-randomised studies respectively.
A total of 1020 studies were found, and 101 studies were included in the analysis. Overall, very few high quality studies were identified, and there was insufficient rigor to generate reliable evidence on the effectiveness of interventions or their scalability. Most interventions were multiple component interventions, and most studies focused on outcomes such as self-reported falls incidence or awareness of falls prevention.
There is an opportunity to undertake an evaluation of a rigorously-designed, large-scale falls prevention program for community-dwelling older people in Mainland China. To help mitigate the rising burden of falls in Mainland China, recommendations for future falls prevention interventions have been made. These include: (1) target disadvantaged populations; (2) incorporate personalised interventions; and (3) investigate the effectiveness of those under-explored interventions, such as psychological, social environment, management of urinary incontinence, fluid or nutrition therapy and surgery. The study results will also potentially provide a useful evidence base for other low-and-middle income countries in a similar situation.
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