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Falls in Older Adults: Risk and Prevention
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Falls in Older Adults: Risk and Prevention

A topical collection in International Journal of Environmental Research and Public Health (ISSN 1660-4601). This collection belongs to the section "Global Health".

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Editor

Dr. Vicki Mercer

E-Mail Website
Collection Editor
Department of Allied Health Sciences, University of North Carolina at Chapel Hill, CB# 7135, Bondurant Hall 3022, Chapel Hill, NC 27599, USA
Interests: postural control; falls risk assessment and intervention; neurological rehabilitation; stroke recovery; underserved populations

Topical Collection Information

Dear Colleagues,

We are organizing a Topical Collection on “Falls in Older Adults: Risk and Prevention” in the International Journal of Environmental Research and Public Health. The publication is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Falls among older adults are a major cause of disability and death worldwide. The high incidence of falls in older adults, combined with the high susceptibility to injury of the older adult population, leads to very serious global health issues. In addition to the direct costs of medical treatment for fall-related injuries, falls can create a downward spiral that leads to decreased physical activity and increased risk for the development of chronic health conditions and loss of functional independence, thereby compounding stresses on the health care system. In short, falls can create enormous costs for health care systems and for older adults and their families.

Considerable research attention has been devoted to the problem of falls among older adults. Evidence-based programs are available for identifying falls risk factors and decreasing risk. Unfortunately, these programs have not been widely adopted, particularly in rural and other underserved areas. Innovative methods are desperately needed to bring effective fall prevention programs and strategies to the broad spectrum of older adults who are at increased risk, including those living independently in the community and those in residential care.

This Topical Collection will focus on fall risk assessment and intervention for older adults. Appropriate topics will include prevention strategies at all levels (primary, secondary, tertiary) and across the health care continuum. Research papers describing barriers to and methods of dissemination and adoption of effective interventions are especially encouraged.

Dr. Vicki Mercer
Collection Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the collection website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Epidemiology
  • Exercise interventions
  • Fall detection
  • Fall prevention
  • Fall risk factors
  • Footwear
  • Geriatrics
  • Healthcare quality improvement
  • Home safety/home modifications
  • Knowledge translation
  • Medication management/polypharmacy
  • Technology/assistive devices

Published Papers (8 papers)

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2021

Jump to: 2020, 2019

12 pages, 362 KiB  
Article
Vibration Perception Threshold and Related Factors for Balance Assessment in Patients with Type 2 Diabetes Mellitus
by Jisang Jung, Min-Gyu Kim, Youn-Joo Kang, Kyungwan Min, Kyung-Ah Han and Hyoseon Choi
Int. J. Environ. Res. Public Health 2021, 18(11), 6046; https://doi.org/10.3390/ijerph18116046 - 4 Jun 2021
Cited by 11 | Viewed by 3630
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). DPN causes a decrease in proprioception, which could reduce balance ability. We investigated the association of impaired vibration sense, based on vibration perception threshold (VPT), with assessments of balance [...] Read more.
Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). DPN causes a decrease in proprioception, which could reduce balance ability. We investigated the association of impaired vibration sense, based on vibration perception threshold (VPT), with assessments of balance and other factors affecting balance impairment and fear of falling in patients with type 2 DM. Sixty-three patients with DM aged >50 years were categorized as having normal vibration sense (NVS; n = 34) or impaired vibration sense (IVS; n = 29) according to a VPT value of 8.9 μm. The following parameters were evaluated for all patients: postural steadiness through the fall index using posturography, functional balance through the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and fear of falling through the Falls Efficacy Scale-International (FES-I). The IVS group showed a significantly greater balance impairment in fall index, BBS, and TUG, as well as greater fear of falling on the FES-I than the NVS group. The linear regression analysis showed that the fall index was associated only with the VPT, whereas BBS, TUG, and FES-I were associated with the VPT, age, and/or lower extremity muscle strength. VPT, age, and/or muscle strength were identified as predictors of balance and fear of falling in patients with type 2 DM. Therefore, along with age and lower extremity strength, the VPT can be useful for balance assessment in patients with type 2 DM. Full article
10 pages, 1475 KiB  
Article
The Association between Gait Speed and Falls in Community Dwelling Older Adults with and without Mild Cognitive Impairment
by Claire E. Adam, Annette L. Fitzpatrick, Cindy S. Leary, Anjum Hajat, Elizabeth A. Phelan, Christina Park and Erin O. Semmens
Int. J. Environ. Res. Public Health 2021, 18(7), 3712; https://doi.org/10.3390/ijerph18073712 - 2 Apr 2021
Cited by 15 | Viewed by 4190
Abstract
(1) Background: Falls are common in older adults and result in injuries, loss of independence, and death. Slow gait is associated with falls in older adults, but few studies have assessed the association between gait speed and falls among those with mild cognitive [...] Read more.
(1) Background: Falls are common in older adults and result in injuries, loss of independence, and death. Slow gait is associated with falls in older adults, but few studies have assessed the association between gait speed and falls among those with mild cognitive impairment (MCI). (2) Methods: The association between gait speed and falls was assessed in 2705 older adults with and without MCI participating in the Ginkgo Evaluation of Memory Study. Gait speed was measured via a 15-foot walk test and fall history through self-report. We used data collected at the 12-month (2001–2003) and 18-month visits (2002–2004). (3) Results: Participant average age was 78.5 years (sd = 3.2); 45% were female, and 14% had MCI at baseline. The average gait speed was 0.93 m/s (sd = 0.20). Sixteen percent (n = 433) and 18% (n = 498) reported at least one fall at the 12-month and 18-month visits, respectively. Faster gait speed was associated with decreased risk of falling (RR: 0.95, 95% CI: 0.91, 0.99) for every 10 cm/s increase in gait speed adjusted for age, gender, study arm, site, and MCI status. (4) Conclusions: The relationship between gait speed and risk of falling did not vary by MCI status (interaction p-value = 0.78). Full article
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2020

Jump to: 2021, 2019

9 pages, 338 KiB  
Article
Association between Statin Use and Balance in Older Adults
by Antoine Langeard, Kathia Saillant, Elisabeth Charlebois Cloutier, Mathieu Gayda, Frédéric Lesage, Anil Nigam, Louis Bherer and Sarah A. Fraser
Int. J. Environ. Res. Public Health 2020, 17(13), 4662; https://doi.org/10.3390/ijerph17134662 - 29 Jun 2020
Cited by 13 | Viewed by 3450
Abstract
Background: Several medications have been associated with an increased risk of balance deficits and greater likelihood to sustain a fall, representing a large health and economic issue. Statins are regularly prescribed to prevent strokes and heart attacks, but their impact on balance is [...] Read more.
Background: Several medications have been associated with an increased risk of balance deficits and greater likelihood to sustain a fall, representing a large health and economic issue. Statins are regularly prescribed to prevent strokes and heart attacks, but their impact on balance is unknown. The aim of this paper was to determine whether statin use is associated with poorer balance performances in older adults. Methods: All participants, one group taking statins (n = 34), and the other group not taking statins (n = 31), completed a balance assessment with their eyes closed and their eyes opened on a MatScan Pressure Sensing Mat. Center of Pressure (CoP) velocity, peak-to-peak distance, and standard deviation were collected in both anteroposterior (AP) and mediolateral (ML) directions. Multiple linear regression analyses were performed for each balance outcome, testing the statin use status as a predictor and controlling for appropriate factors including participants characteristics, lipid profile, and cardiovascular disease. Results: After controlling for confounding factors, statin use significantly predicted both CoP ML-Amplitude (β = 0.638, p = 0.004) and ML-Velocity (β = 0.653, p = 0.002) in the eyes-opened condition. Conclusions: The present study detected a negative association between statin use and balance control in the ML direction, suggesting that caution should be taken when prescribing statins in older adults, as this could decrease ML stability and ultimately increase fall and fracture risks. Full article
12 pages, 351 KiB  
Article
Characteristics Associated with Improved Physical Performance among Community-Dwelling Older Adults in a Community-Based Falls Prevention Program
by Gabrielle Scronce, Wanqing Zhang, Matthew Lee Smith and Vicki Stemmons Mercer
Int. J. Environ. Res. Public Health 2020, 17(7), 2509; https://doi.org/10.3390/ijerph17072509 - 6 Apr 2020
Cited by 4 | Viewed by 3396
Abstract
This was a retrospective analysis of quasi-longitudinal data from an ongoing, community-based falls prevention program. The purpose was to identify participant characteristics predicting improvement on physical performance measures associated with falls risk. Community-dwelling older adults ≥60 years old participated in a community-based implementation [...] Read more.
This was a retrospective analysis of quasi-longitudinal data from an ongoing, community-based falls prevention program. The purpose was to identify participant characteristics predicting improvement on physical performance measures associated with falls risk. Community-dwelling older adults ≥60 years old participated in a community-based implementation of the Otago Exercise Program (OEP). Participants with increased falls risk (n = 353) were provided with individualized exercises from OEP and were invited to return for monthly follow-up. One hundred twenty-eight participants returned for at least two follow-up visits within 6 months of their initial visit (mean time to second follow-up = 93 days with standard deviation = 43 days). Outcome measures assessed at initial and all follow-up visits included Four Stage Balance Test (4SBT), Timed Up and Go test (TUG), and Chair Rise Test (CRT). Distributions were examined, and results were categorized to depict improvement from initial visit (IVT) to second follow-up visit (F2). Key predictor variables were included in multivariable linear or logistic regression models. Improved 4SBT performance was predicted by greater balance confidence. Better TUG performance at F2 was predicted by no use of assistive device for walking, higher scores on cognitive screening, and better IVT TUG performance. Improvement on CRT was predicted by younger age and lower scores on cognitive screening. While improvements on each of the three measures were predicted by a unique combination of variables, these variables tended to be associated with less frailty. Full article
15 pages, 951 KiB  
Article
Barriers and Facilitators for Screening Older Adults on Fall Risk in a Hospital Setting: Perspectives from Patients and Healthcare Professionals
by Lotte M. Barmentloo, Manon L. Dontje, Moniek Y. Koopman, Branko F. Olij, Christian Oudshoorn, Johan P. Mackenbach, Suzanne Polinder and Vicki Erasmus
Int. J. Environ. Res. Public Health 2020, 17(5), 1461; https://doi.org/10.3390/ijerph17051461 - 25 Feb 2020
Cited by 8 | Viewed by 5145
Abstract
We aimed to gain insight into the barriers and facilitators to fall risk screening of older adults visiting the hospital as experienced by patients and healthcare professionals, and to examine the differences between chronic- and acute-care patients. We invited patients (≥ 70 years) [...] Read more.
We aimed to gain insight into the barriers and facilitators to fall risk screening of older adults visiting the hospital as experienced by patients and healthcare professionals, and to examine the differences between chronic- and acute-care patients. We invited patients (≥ 70 years) attending the nephrology and emergency department to participate in the screening. Patients and their healthcare professionals were asked to complete a self-administered questionnaire based on the “Barriers and Facilitators Assessment Instrument”. Differences in barriers and facilitators between acute- and chronic-care patients were examined with chi-square tests. A total of 216 patients were screened, and 103 completed the questionnaire. They considered many factors as facilitators, and none as barriers. Acute-care patients were more positive than chronic-care patients about healthcare worker characteristics, such as knowledge and skills. After screening, patients were more open to receiving advice regarding fall prevention. The 36 healthcare professionals considered program characteristics to be facilitators and mainly factors regarding healthcare worker characteristics as barriers to implementation. For patients, the outpatient setting seemed to be a good place to be screened for fall risk. Healthcare professionals also suggested that program characteristics could enhance implementation. However, healthcare professionals’ mindsets and the changing of routines are barriers that have to be addressed first. Full article
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2019

Jump to: 2021, 2020

12 pages, 301 KiB  
Article
Association between Recent Falls and Changes in Outdoor Environments near Community-Dwelling Older Adults’ Homes over Time: Findings from the NHATS Study
by Sungmin Lee, Chanam Lee and Marcia G. Ory
Int. J. Environ. Res. Public Health 2019, 16(18), 3230; https://doi.org/10.3390/ijerph16183230 - 4 Sep 2019
Cited by 21 | Viewed by 4497
Abstract
Neighborhood environments have been increasingly associated with incidents of falling and the fear of falling. However, little is known about the causal impact of neighborhood environments on falling. This study identifies whether changes in outdoor environmental attributes over a one-year period are associated [...] Read more.
Neighborhood environments have been increasingly associated with incidents of falling and the fear of falling. However, little is known about the causal impact of neighborhood environments on falling. This study identifies whether changes in outdoor environmental attributes over a one-year period are associated with the occurrence of recent falls among community-dwelling older adults aged 65 and older in the United States. Data were obtained from 4802 adults aged 65 years or older from the National Health and Aging Trends Study (NHATS). Logistic regression analyses were performed to identify neighborhood risk factors linked to the odds of experiencing recent falls at the one-year follow-up. Almost one in ten subjects (9.7% of 4802 subjects) who had not fallen before reported experiencing recent falls after one year. After adjusting for sociodemographic, health, and walking-related behavioral covariates, these subjects were more likely to reside in areas with higher environmental barriers on sidewalks/streets and uneven walking surfaces or broken steps, compared to non-fallers. Our findings suggest that safe and well-maintained outdoor environments may help prevent falls among community-dwelling older adults who engage in outdoor activities. Clinical and environmental interventions for promoting both safe walking and safe environments are warranted. Full article
12 pages, 483 KiB  
Article
Factors Associated with Participation of Community-Dwelling Older Adults in a Home-Based Falls Prevention Program
by Branko F. Olij, Lotte M. Barmentloo, Dini Smilde, Nathalie van der Velde, Suzanne Polinder, Yvonne Schoon and Vicki Erasmus
Int. J. Environ. Res. Public Health 2019, 16(6), 1087; https://doi.org/10.3390/ijerph16061087 - 26 Mar 2019
Cited by 6 | Viewed by 4232
Abstract
This observational study was conducted to determine which factors are associated with frequent participation in a home-based exercise program. The effects of frequent participation on health-related outcomes over time are investigated, as well. Community-dwelling adults aged ≥65 years participated in a twelve-week home-based [...] Read more.
This observational study was conducted to determine which factors are associated with frequent participation in a home-based exercise program. The effects of frequent participation on health-related outcomes over time are investigated, as well. Community-dwelling adults aged ≥65 years participated in a twelve-week home-based exercise program. The program consisted of an instruction book with exercises that were performed individually at home. Frequent participation was classified as performing exercises of the instruction book daily or a few days a week during the study period. A logistic regression analysis was performed to determine the association between factors (i.e., demographic and health-related characteristics) and frequent participation. Furthermore, to investigate the effects of frequent participation on health-related outcomes, generalized linear and logistic regression models were built. A total of 238 participants (mean age 81.1 years (SD ± 6.7), 71% female) were included in the study. Frequent participation during the study period was indicated by fifty-two percent of participants. Analyses showed that a higher degree of pain (OR: 1.02, 95% CI: 1.–1.04) was associated with frequent participation. In addition, the effect of frequent participation over time was a significant improvement in current health perceptions (B: 4.46, SE: 1.99). Full article
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13 pages, 765 KiB  
Article
Evaluation of Implementing a Home-Based Fall Prevention Program among Community-Dwelling Older Adults
by Branko F. Olij, Vicki Erasmus, Lotte M. Barmentloo, Alex Burdorf, Dini Smilde, Yvonne Schoon, Nathalie van der Velde and Suzanne Polinder
Int. J. Environ. Res. Public Health 2019, 16(6), 1079; https://doi.org/10.3390/ijerph16061079 - 26 Mar 2019
Cited by 13 | Viewed by 6864
Abstract
We aimed to describe and evaluate the implementation of a home-based exercise program among community-dwelling adults aged ≥65 years. In an observational study, the twelve-week program was implemented in a community setting. The implementation plan consisted of dialogues with healthcare professionals and older [...] Read more.
We aimed to describe and evaluate the implementation of a home-based exercise program among community-dwelling adults aged ≥65 years. In an observational study, the twelve-week program was implemented in a community setting. The implementation plan consisted of dialogues with healthcare professionals and older adults, development of an implementation protocol, recruitment of participants, program implementation, and implementation evaluation. The dialogues consisted of a Delphi survey among healthcare professionals, and of individual and group meetings among older adults. The implementation of the program was evaluated using the framework model RE-AIM. In the dialogues with healthcare professionals and older adults, it was found that negative consequences of a fall and positive effects of preventing a fall should be emphasized to older adults, in order to get them engaged in fall prevention activities. A total of 450 older adults enrolled in the study, of which 238 started the program. The process evaluation showed that the majority of older adults were recruited by a community nurse. Also, a good collaboration between the research team and the local primary healthcare providers was accomplished, which was important in the recruitment. Future fall prevention studies may use this information in order to translate an intervention in a research project into a community-based program. Full article
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