The Impact of Weather and Seasons on Falls and Physical Activity among Older Adults with Glaucoma: A Longitudinal Prospective Cohort Study

Understanding periods of the year associated with higher risk for falling and less physical activity may guide fall prevention and activity promotion for older adults. We examined the relationship between weather and seasons on falls and physical activity in a three-year cohort of older adults with glaucoma. Participants recorded falls information via monthly calendars and participated in four one-week accelerometer trials (baseline and per study year). Across 240 participants, there were 406 falls recorded over 7569 person-months, of which 163 were injurious (40%). In separate multivariable regression models incorporating generalized estimating equations, temperature, precipitation, and seasons were not significantly associated with the odds of falling, average daily steps, or average daily active minutes. However, every 10 °C increase in average daily temperature was associated with 24% higher odds of a fall being injurious, as opposed to non-injurious (p = 0.04). The odds of an injurious fall occurring outdoors, as opposed to indoors, were greater with higher average temperatures (OR per 10 °C = 1.46, p = 0.03) and with the summer season (OR = 2.69 vs. winter, p = 0.03). Falls and physical activity should be understood as year-round issues for older adults, although the likelihood of injury and the location of fall-related injuries may change with warmer season and temperatures.

Comparing Longitudinal Changes in Physical Activity and Fear of Falling in Non-Fallers, Fallers, and Injurious Fallers

Older adults with visual impairments experience a higher risk of falling, and are more vulnerable to associated adverse health consequences than those with normal vision. We investigated the onset and magnitude of declines in physical activity (PA), and corresponding changes in self-reported fear of falling (FoF) in 234 visually impaired persons (mean age=69.8, 48.7% women) over three years. PA was measured using the Actical hip-worn accelerometer and falls were reported using a calendar. In fully adjusted linear models, PA declined 426 steps/year (p<0.01) and 15.1 active minutes/year (p<0.01) among injurious fallers compared to non-fallers; PA did not change among non-injurious fallers. No longitudinal declines in FoF scores were observed. Among visually impaired older adults, an injurious fall contributed to subsequent declines in activity, although FoF remained unchanged. Further longitudinal research is warranted to better understand how different groups respond to falls, either by behavioral changes and/or changes in FoF.

Improved Processing Speed Is a Potential Mechanism by Which Exercise Reduces Falls

A 12-month trial demonstrated the Otago Exercise Program (OEP), a home-based exercise program of strength and balance retraining exercises, significantly reduced the rate of subsequent falls among 344 older adults receiving care after a fall (JAMA, 2019). A significant improvement in processing speed, as measured by the Digit Symbol Substitute Test (DSST), was also observed. Given the DSST is a predictor of falls, we conducted mediation analyses to determine whether improved DSST mediated the effects of OEP on rate of: 1) total falls; 2) non-injurious falls; 3) mild injurious falls; and 4) severe injurious falls over the 12-month trial. Our causal mediation analyses were conducted using the mediation package in R, using quasi-Bayesian estimates and 95% confidence intervals. Compared with usual care, OEP significantly reduced the rate of total falls (IRR= 0.64; 95% CI: 0.44, 0.91; p= 0.013) and mild injurious falls (IRR= 0.49; 95% CI: 0.31, 0.77; p= 0.002). Improved DSST score was also associated with lower mild injurious fall rates (IRR= 0.95; 95% CI: [0.91, 0.99]; p= 0.014). Formal mediation analyses showed that improved DSST was a significant mediator of the effect of OEP on the rate of mild injurious falls (95% CI: -0.15, 0.00; p= 0.036). Improved processing speed may be a mechanism by which exercise reduces mild injurious falls.

Predictors for functional decline after an injurious fall: a population-based cohort study

Background The functional consequences of injurious falls are well known. However, studies of the factors that can modify trajectories of disability after an injury from a fall are scarce. Aims We aimed to investigate whether sociodemographic and health-related factors may impact this association. Methods The study population consisted of 1426 community-dwelling older adults (≥ 60 years) from the SNAC-K cohort study in Stockholm, Sweden. Functional status over 12 years of follow-up was assessed using the number of limitations in basic and instrumental activities of daily living. Sex, cohabitation status, physical activity, and self-rated health were assessed at baseline. Injurious falls were defined as falls requiring healthcare and were assessed over 3 years starting at baseline. Data were analyzed using linear-mixed effects models. Results The fastest increase in the number of disabilities was observed in those who had endured an injurious fall and were living alone (β coefficient = 0.408; p < 0.001), been physically inactive (β coefficient = 0.587; p < 0.001), and had poor self-rated health (β coefficient = 0.514; p < 0.001). The negative impact of these factors was more pronounced among fallers compared to non-fallers. Discussion Living alone, being physically inactive, and having poor self-rated health magnifies the negative effect of an injurious fall on functional status. Among individuals who endure an injurious fall, the heterogeneity in long-term functional status is substantial, depending on the individuals’ characteristics and behaviors. Conclusions These findings emphasize the need for a person-centered approach in care provision and can guide secondary prevention within health care.

Novel Digital Gait Kinematic Solution to Improve Frailty

Introduction: Frailty effects a person’s health and correlates with mobility and falls. Intervention studies that focus on exercise have demonstrated improved mobility and functional ability in some frailty groups. This study tested a personalised intervention programme automatically generated from digital gait data on frail older people under the care of the North East London Foundation Trust, Community Hospital setting. Methods: One hundred and twenty one people, average age 79, who suffered an injurious fall and were under the care of the Community Hospital, completed the personalised intervention programme. Objective gait kinematic data, obtained using GaitSmartTM automatically generated a personalised exercise programme. Each participant received four tests, approximately 3 weeks apart and was provided with a copy of their report plus personalised exercises. Frailty was measured using the Edmonton Frailty Scale (EFS), fear of falling was measured using the Falls Efficacy Scale-International (FES-I) and speed was determined from the gait data (GS). Results: Five parameters were analysed for all 121 participants at the start and end of the intervention: EFS; FES-I; GS; speed; walking aid. There was a statistically significance between the start and end (p<0.001) for all the parameters. Conclusion: The results demonstrate that addressing frailty using a digital gait solution that sets exercises based on the gait kinematic data, did reverse frailty. This four session programme has shown to improve frailty levels and fear of falling. It also reduced the reliance on walking aids and increased average walking speed from 0.46 to 0.62 m/s.

Association Between Characteristics of Injurious Falls and Fall Preventive Interventions in Acute Medical and Surgical Units

Background Hospital falls remain common and approximately 30% of falls in hospital result in injury. The aims of the study were the following: (i) to identify the association between fall interventions present at the time of the injurious fall and injurious faller characteristics and (ii) to identify the association between fall preventive interventions present at the time of the injurious fall and the injurious fall circumstances. Methods Secondary data analysis of deidentified case series of injurious falls across 24 acute medical/surgical units in the United States. Variables of interest were falls prevention interventions (physical therapy, bed alarm, physical restraint, room change, or a sitter) in place at the time of fall. Data were analyzed using logistic regression and hazard ratios. Results There were 1,033 patients with an injurious fall, occurrence peaked between Day 1 and Day 4, with 46.8% of injurious falls having occurred by Day 3 of admission. Injurious fallers with a recorded mental state change 24 hours prior to the fall were more likely to have a bed alarm provided (adjusted odds ratio [OR] 2.56, 95% confidence interval [CI] 1.61, 4.08) and receive a physical restraint as fall prevention interventions (adjusted OR 6.36, 95% CI 4.35, 9.30). Injurious fallers restrained fell later (stay Day 6) than those without a restraint (stay Day 4) (p = .007) and had significantly longer lengths of stay (13 days vs 9 days). Conclusions On medical/surgical units, injurious falls occur early following admission suggesting interventions should be commenced immediately. Injurious fallers who had a physical restraint as an intervention had longer lengths of stay.

Determinants, circumstances and consequences of injurious falls among older women living in the community

ObjectiveTo identify the risk factors of women who fell with injury relative to women who did not fall or fell without injury and to describe the circumstances and consequences of injurious and non-injurious falls.MethodsWe analysed 5074 older women from the Objective Physical Activity and Cardiovascular Health Study who prospectively tracked their falls using a 13-month calendar. Women with a reported fall were phone interviewed about fall-related details, including injuries. Risk factors were identified from surveys and clinical home visits. Logistic regression models were used to calculate adjusted ORs and 95% CIs for injurious falls relative to not falling or falling without injury. Circumstances of injurious and non-injurious falls were compared.ResultsAt least one fall was experienced by 1481 (29%) participants. Of these, 1043 were phone interviewed, of whom 430 (41%) reported at least one injurious fall. Relative to not falling, the risk factor most strongly associated with experiencing an injurious fall was having fallen ≥2 times (OR 4.0, CI 2.7 to 5.8) in the past year. Being black was protective for fall-related injury (OR 0.6, CI 0.4 to 0.9). No strong associations in risk factors were observed for injurious relative to non-injurious falls. Injurious falls were more likely to occur away from and outside of the home (p<0.05). Over half of those who injured self-managed their injury.ConclusionFalling repeatedly is a powerful risk factor for injurious falls. Those who have fallen more than once should be prioritised for interventions to mitigate the risk of an injurious fall.