Browsing by Subject "Accidental Falls"
Now showing 1 - 12 of 12
- Results Per Page
- Sort Options
Item Open Access A Cost-Effectiveness Analysis of a Randomized Control Trial of a Tailored, Multifactorial Program to Prevent Falls Among the Community-Dwelling Elderly.(Archives of physical medicine and rehabilitation, 2019-01) Matchar, David B; Eom, Kirsten; Duncan, Pamela W; Lee, Mina; Sim, Rita; Sivapragasam, Nirmali R; Lien, Christopher T; Ong, Marcus Eng HockObjective
To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people.Design
Randomized control trial.Settings
Communities.Participants
Adults aged at least 65 years (N=354) seen at the emergency department (ED) for a fall or fall-related injury and discharged home.Interventions
The intervention group received a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. They also received screening and referrals for low vision, polypharmacy, and environmental hazards. The Short Physical Performance Battery (SPPB) test was assessed at regular intervals to allocate participants into either a home-based or group center-based program. The control group received usual care prescribed by a physician and educational materials on falls prevention.Main outcome measures
The incremental cost-effectiveness ratio (ICER) over the 9-month study period based on intervention costs and utility in terms of quality-adjusted life years (QALYs) calculated from EuroQol-5D scores.Results
The ICER was 120,667 Singapore dollars (S$) per QALY gained (S$362/0.003 QALYs), above benchmark values (S$70,000). However, the intervention was more effective and cost-saving among those with SPPB scores of greater than 6 at baseline, higher cognitive function, better vision and no more than 1 fall in the preceding 6 months. The intervention was also cost-effective among those with 0-1 critical comorbidities (S$22,646/QALY).Conclusion
The intervention was, overall, not cost-effective, compared to usual care. However, the program was cost-effective among healthier subgroups, and even potentially cost-saving among individuals with sufficient reserve to benefit.Item Open Access Effect of Housing Type and Neighborhood Socioeconomic Indicators on Survival After Low Falls in Older Adults.(Journal of the American Medical Directors Association, 2019-05) Wei, Wycliffe E; Wong, Chek Hooi; Matchar, David B; Earnest, Arul; Wah, Win; Ong, Marcus Eng Hock; Wong, Ting HwayItem Open Access Gluteal compartment syndrome with sciatic nerve palsy caused by traumatic rupture of the inferior gluteal artery: a successful surgical treatment.(BMJ case reports, 2017-01) Rocos, Brett; Ward, AnthonyGluteal compartment syndrome is a rare entity, usually caused by direct trauma. This occurrence with sciatic nerve palsy caused by inferior gluteal artery laceration and compressive haematoma has not been reported in the literature. We describe such a case treated successfully by urgent surgical decompression and resolution of the sciatic nerve palsy. A man aged 41 years sustained blunt trauma to the right gluteal region causing a rupture of the inferior gluteal artery, gluteal compartment syndrome and rapidly progressive sciatic nerve palsy. The condition was treated urgently with interventional radiology, open surgical decompression and debridement. Recovery was complicated by recurrent haematoma formation, treated successfully with subsequent complete resolution of the sciatic nerve palsy. A review of the literature of traumatic gluteal compartment syndrome is presented with discussion of the clinical diagnosis, multidisciplinary treatment and recommendations for treatment of this injury.Item Open Access Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach.(BMC geriatrics, 2023-09) Lai, Wei Xuan; Chan, Angelique Wei-Ming; Matchar, David Bruce; Ansah, John Pastor; Lien, Christopher Tsung Chien; Ismail, Noor Hafizah; Wong, Chek Hooi; Xu, Tianma; Ho, Vanda Wen Teng; Tan, Pey June; Lee, June May Ling; Sim, Rita Siew Choo; Manap, NormalaBackground
Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults.Methods
A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies.Results
Four patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae.Conclusion
This work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.Item Open Access Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study.(Ear and hearing, 2022-03) Riska, Kristal M; Peskoe, Sarah B; Kuchibhatla, Maragatha; Gordee, Alexander; Pavon, Juliessa M; Kim, Se Eun; West, Jessica S; Smith, Sherri LObjectives
Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in vision, vestibular, somatosensation, age-related orthopedic changes, and polypharmacy). Hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association between self-reported hearing status and falls or falls-related injury. We hypothesized that hearing aid use would reduce the impact of hearing loss on the odds of falling and falls-related injury. If hearing aid users have reduced odds of falling compared with nonhearing aid users, then that would have an important implications for falls prevention healthcare.Design
Data were drawn from the 2004-2016 surveys of the Health and Retirement Study (HRS). A generalized estimating equation approach was used to fit logistic regression models to determine whether or not hearing aid use modifies the odds of falling and falls injury associated with self-reported hearing status.Results
A total of 17,923 individuals were grouped based on a self-reported history of falls. Self-reported hearing status was significantly associated with odds of falling and with falls-related injury when controlling for demographic factors and important health characteristics. Hearing aid use was included as an interaction in the fully-adjusted models and the results showed that there was no difference in the association between hearing aid users and nonusers for either falls or falls-related injury.Conclusions
The results of the present study show that when examining self-reported hearing status in a longitudinal sample, hearing aid use does not impact the association between self-reported hearing status and the odds of falls or falls-related injury.Item Open Access Learning from falling.(Child Dev, 2006-01) Joh, Amy S; Adolph, Karen EWalkers fall frequently, especially during infancy. Children (15-, 21-, 27-, 33-, and 39-month-olds) and adults were tested in a novel foam pit paradigm to examine age-related changes in the relationship between falling and prospective control of locomotion. In trial 1, participants walked and fell into a deformable foam pit marked with distinct visual cues. Although children in all 5 age groups required multiple trials to learn to avoid falling, the number of children who showed adult-like, 1-trial learning increased with age. Exploration and alternative locomotor strategies increased dramatically on learning criterion trials and displays of negative affect were limited. Learning from falling is discussed in terms of the immediate and long-term effects of falling on prospective control of locomotion.Item Open Access Physical Performance Predictor Measures in Older Adults With Falls-Related Emergency Department Visits.(Journal of the American Medical Directors Association, 2019-06) Pua, Yong-Hao; Matchar, David BOBJECTIVES:Identifying strong predictors for falls and mobility limitations in older adults with a falls-related emergency department visit is crucial. This study aimed to compare, in this clinical population, the incremental predictive value of the Short Physical Performance Battery (SPPB) component tests for incident falls, injurious falls, and mobility limitations. DESIGN AND MEASURES:Prospective cohort study. SETTING AND PARTICIPANTS:A total of 323 community-dwelling older adults with a falls-related emergency department visit participated. Baseline physical performance was measured by the SPPB standing balance test, sit-to-stand test, and habitual gait speed test. Six-month prospective fall rate and self-reported mobility limitations at 6 months post baseline assessment were also measured. An injurious fall was defined as a fall for which the participant sought medical attention or that restricted his or her daily activities for at least 48 hours. RESULTS:In multivariable proportional odds analyses adjusted for demographics and clinical covariates, higher levels of full-tandem balance and sit-to-stand performance were significantly associated with fewer incident falls (P = .04 and .02, respectively) and lower odds of mobility limitations (P = .05 and .03, respectively) and marginally associated with lower odds of injurious falls (P = .06 and .07, respectively). Habitual gait speed was the weakest predictor of falls but the strongest predictor (odds ratio 0.24, 95% confidence interval 0.08-0.70; P < .001) of mobility limitations. CONCLUSIONS/IMPLICATIONS:In high-fall-risk older adults, the SPPB balance and sit-to-stand tests predicted falls whereas the SPPB gait speed test was adept at predicting mobility limitations. No one test is best across all situations, so the choice of test will depend on the goal of the assessment.Item Open Access Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study.(BMC geriatrics, 2019-12-26) Wei, Wycliffe E; De Silva, Deirdre A; Chang, Hui Meng; Yao, Jiali; Matchar, David B; Young, Sherry HY; See, Siew Ju; Lim, Gek Hsiang; Wong, Ting Hway; Venketasubramanian, NarayanaswamyBACKGROUND:Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. METHODS:This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤ 0.5 m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls. RESULTS:In all, 2255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died. After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21-9.65, p = 0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85-7.12, p = 0.098), 2.86 (95%CI:0.95-8.61, p = 0.062) and 1.93 (95%CI:0.44-8.52, p = 0.38) for patients with scores of 3, 4 and 5 respectively. CONCLUSIONS:An inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly. (263 words).Item Open Access Randomized Controlled Trial of Screening, Risk Modification, and Physical Therapy to Prevent Falls Among the Elderly Recently Discharged From the Emergency Department to the Community: The Steps to Avoid Falls in the Elderly Study.(Archives of physical medicine and rehabilitation, 2017-06) Matchar, David B; Duncan, Pamela W; Lien, Christopher T; Ong, Marcus Eng Hock; Lee, Mina; Gao, Fei; Sim, Rita; Eom, KirstenObjective
To evaluate the effectiveness of a multifactorial, tailored program of physical therapy to reduce the occurrence of falls among a heterogeneous group of high-risk elderly Singaporeans recently discharged from the emergency department (ED).Design
Randomized controlled trial.Setting
Communities.Participants
Adults (N=354) aged ≥65 years who were seen in the ED for a fall or fall-related injuries and discharged home.Interventions
The intervention primarily consisted of a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. Participants in the intervention group also received screening and follow-up for vision, polypharmacy, and environmental hazards. Participants in the control group received usual care prescribed by a physician and educational materials on falls prevention.Main outcome measures
The primary outcome measure was experiencing at least 1 fall during the 9-month study period (a 3-mo active intervention phase and a 6-mo maintenance phase). Secondary outcome measures were the occurrence of at least 1 injurious fall during the study period and a change in the Short Physical Performance Battery (SPPB) score. Participants were assessed both after 3 and 9 months.Results
During the 9-month study period, 37.8% of the control group and 30.5% of the intervention group fell at least once, which was not statistically significantly different (odds ratio [OR]=.72; 95% confidence interval [CI], .46-1.12; P=.146). The intervention group had statistically significantly fewer individuals with injurious falls (OR=.56; 95% CI, .32-.98; P=.041) and less deterioration in physical performance, reflected by a mean difference of 0.6 in SPPB scores (P=.029). Multivariate analyses indicated a strong interaction effect between the intervention and the presence of 2 or more major comorbidities; after accounting for this effect, the intervention program reduced the number of people experiencing at least 1 fall (OR=.34; 95% CI, .17-.67; P=.002).Conclusions
We observed that in this heterogeneous population, the proportion of participants experiencing at least 1 fall during the study period was not statistically significantly lower in the intervention group compared with the control group. Secondary analyses strongly suggest that individuals with 2 or more major comorbidities do not benefit from a tailored physical therapy program; however, individuals with less comorbidity may substantially benefit.Item Open Access Spinal cord injury etiology, severity, and care in East Asia: a cross-sectional analysis of the International Spinal Cord Society Database Project.(Spinal cord, 2024-07) Holmes, Benjamin D; Brazauskas, Ruta; Chhabra, Harvinder SStudy design
Cross-sectional study.Objectives
To evaluate etiologic factors associated with spinal cord injury (SCI) severity and to identify predictive factors of reduction in SCI severity in six countries.Setting
SCI centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand.Methods
Data from centers collected between October 2015 and February 2021 were analyzed using descriptive statistics and logistic regression.Results
Among 2634 individuals, the leading cause of SCIs was falls (n = 1410, 54%); most occurred from ≥1 meter (n = 1078). Most single-level neurological injuries occurred in the thoracic region (n = 977, 39%). Greater than half of SCIs (n = 1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n = 757) of all one-level AIS A SCIs. The percentage of thoracic SCIs graded AIS A (78%) was significantly higher than high cervical (52%), low cervical (48%), lumbar (24%), and sacral (31%) SCIs (p < 0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted severity: age, neurological level, etiology, and country of residence. Four factors predicted improvement: age, neurological level, AIS grade on intake, and country of residence.Conclusions
Findings can be used by healthcare providers and public health agencies in these countries to inform the public of the risk of SCI due to falls. Future studies should examine the social and occupational milieux of falls. Country-to-country comparisons of prehospital and inpatient care are also justified. Fall prevention policies can encourage the use of safety equipment when performing tasks at heights ≥1 meter.Item Open Access The impact of nurse staffing on falls performance within a health care system: A descriptive study.(Journal of nursing management, 2022-04) Cooke, Melissa; de la Fuente, Margarita; Stringfield, Candice; Sullivan, Kelly; Brassil, Robert; Thompson, Julie; Allen, Deborah H; Granger, Bradi B; Reynolds, Staci SAim
The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system.Background
Evidence to support which staffing variables influence fall performance so that health care organizations can better allocate resources is lacking.Method
A descriptive study design was used to analyse the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables.Results
A total of nine units were included (five high and four low performing). Higher performing units showed less use of sitters and travellers, had fewer overtime hours worked by nurses, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units.Conclusion
Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes.Implications for nursing management
Nursing managers may consider trying to reduce use of sitters and travellers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.Item Open Access Why walkers slip: shine is not a reliable cue for slippery ground.(Percept Psychophys, 2006-04) Joh, Amy S; Adolph, Karen E; Campbell, Margot R; Eppler, Marion AIn a series of four studies, we investigated the visual cues that walkers use to predict slippery ground surfaces and tested whether visual information is reliable for specifying low-friction conditions. In Study 1, 91% of participants surveyed responded that they would use shine to identify upcoming slippery ground. Studies 2-4 confirmed participants' reliance on shine to predict slip. Participants viewed ground surfaces varying in gloss, paint color, and viewing distance under indoor and outdoor lighting conditions. Shine and slip ratings and functional walking judgments were related to surface gloss level and to surface coefficient of friction (COF). However, judgments were strongly affected by surface color, viewing distance, and lighting conditions--extraneous factors that do not change the surface COF. Results suggest that, although walkers rely on shine to predict slippery ground, shine is not a reliable visual cue for friction. Poor visual information for friction may underlie the high prevalence of friction-related slips and falls.