Factors contributing to falls and the effect of a multipronged approach on the incidence of falls in the older person in an outpatient setting in South India

Background: A fall is an important predictor of morbidity and mortality in an older adult. Objectives: The aim of this study was to enumerate the various factors contributing to falls and assess the effect of a multipronged approach on the incidence of falls in older individuals who are at a risk of falls. Methodology: In this prospective interventional trial, we recruited sixty subjects, who presented to the Geriatrics Outpatient department of a tertiary care hospital in South India. Using the Stop elderly accidents, deaths, and injuries protocol, we included subjects who presented with a history of fall in the year preceding the study, those with fear of fall and those who felt unsteady while standing or walking. These subjects were subjected to a detailed assessment and an individualized multipronged interventional program was initiated. The subjects were followed up telephonically after 1 and 3 months to assess compliance and the details of incident fall (if any). Results: At baseline, 48.3% had fallen in the year prior to enrolment, of whom 16.7% were recurrent fallers. Various contributory factors for falls were identified ? including older age, polypharmacy, sedatives, and anticholinergic drugs. Following a multipronged intervention, 3.6% and 5.3% of the subjects reported falls after 1 and 3 months, respectively. Subjective improvement was reported by 80% and 78.2% of the subjects at 1 and 3 months’ follow-up and the compliance with exercises during the follow-up period was good (73%). Conclusion: Identifying the subjects at risk for falls and implementing a tailored approach contributed to a reduction in the incidence of falls

Correlation Between Body Mass Index And Fear Of Fall On Functional Mobility In Elderly

Background: Functional mobility is defined as the ability of a person to move from place to place in the environment in order to participate in the activities of daily living. A person with overweight and obesity have a greater risk of experiencing mobility disability and those patients will have restrictions in activities at home, work, school and in the community thereby having a negative impact on their health related quality of life. Fear of falling in elderly is a major cause of loss of independence, which has an effect on the physical function in them. Purpose of the study: To find out the relationship between BMI and fear of fall on functional mobility in elderly Result: Out of 30 subjects, 15 subjects were overweight and 15 were normal BMI. Out of 15 overweight subjects, 53.3% were males and 46.7% were females. The mean age of overweight participants was 68.46±2.77. The mean scores for BMI were 27.82±1.56, for FOF 4.93±1.09and for FM 21.53±3.99. FOF and FM were negatively correlated with Overweight. The correlation was not significant. Out of 15 subjects with normal BMI, 53.3% were males and 46.7% were females. The mean age of participants with normal BMI was 68.86±3.62. The mean scores for BMI were 21.40±1.61, for FOF 5.93±.883and for FM 19.26±3.55. FOF and FM were positively correlated with normal BMI. The correlation was not significant. Conclusion: The overweight individual have more fear of fall (FOF) compared with individuals with normal BMI. The functional mobility (FM) is decline in overweight individuals than individuals with normal BMI. Implications: A decrease in sedentary lifestyle and regular physical activity can improve health related quality of life of elderly.

Study Of Relationship Between Fear Of Falling & Ability To Sit On & Rise From The Floor In Elderly Population

Background: Falls has been well established as one of the leading causes of mortality and morbidity among older adults.Falling in elderly persons can lead to disability, hospitalizations, and premature death. It can also lead to reduced levels of independence, poorer quality of life, and high levels of anxiety. It is proven that the elderly develop a fear of fall (FOF) due to the above mentioned consequences. They develop FOF with or without the history of fall. Increasing age is a significant predictor of FOF. FOF thus cause restriction in social participation and also restrictions in activities of daily living (ADL). Sitting on the floor is a tradition or a habit of Indians during activities like eating, praying, socializing etc., thus making it an important ADL. Thus, sitting and rising from the floor is a basic functional task for Indian population. The inability to sit and get up from the floor is closely related to the risk of falling, and if a fall has occurred, the capacity to return to an upright position is critical. Materials and Methods: The study included 210 community dwelling elderly population of an age group of 60-90 yrs, with an ability to sit on and get up from the floor. Individuals with any musculoskeletal, cardiorespiratory and neurological conditions were excluded. A physical assessment was done which included two tests. 1. Falls Efficacy Scale – International (in hindi) to assess fear of fall 2. Sitting Rising Test (SRT) to assess the ability to sit on and get up from the floor. A partial correlation analysis was conducted to find a relationship between Fear of Fall and the ability to sit on the floor after controlling for age. Alpha level is set as 0.05. Spearman’s rho test was used. Result: According to Spearman’s Rho’s Test of Correlation, Correlation between Fall Efficacy Scale – International & Sitting – Rising Test is -0.352. Thus showing that there is a Low Negative Correlation between the Fear of Fall and Ability to Sit on and Get up From the Floor. Conclusion: There is a relationship between Fear of Fall and the ability to sit on and get up from the floor in the elderly population.

Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population - A descriptive study

Background: Falls is one of the common problems faced by elderly population and in preventing falls in India, research has largely focused on identification and management of risk factors, but the circumstances of the fall and its associated factors are sparsely researched. Objectives: The primary objective is to find the prevalence of fall, investigate risk factors, and its circumstances for falls and level of functional independence in elderly population. The secondary objective is to find out fear of fall (FOF) and its association of demographic factors on elderly population. Methods: This was a cross-sectional study; 2049 elderly population of 60 years and above were recruited by one-stage cluster sampling technique within Mumbai, Panvel, and Thane cities, Maharashtra. Data were collected using a questionnaire, Fall Efficacy Scale-International, Barthel Index, and Kuppuswamy Scale. Obtained responses were analyzed using SPSS software; descriptive statistics and Chi-square test were applied. Results: The prevalence of falls in this study found as 24.98%. Demographic factors such as age group, education, marital status, and socio-economic status had demonstrated a significant association with older adults (P < 0.05); 44.92% of falls occurred in the morning, the majority of falls (65.43%) occurred indoors, 56.45% of the fallers reported to had slips, and 60.55% of the fallers had sustained injuries. From the total participants, 34.70% of the fallers reported FOF, 23.67% of the fallers expressed reduced functional activities, and 18.06% of the fallers demonstrated affection in activities of daily living. Conclusion: This study reveals fall as a significant health problem and provides insight into the influencing risk factors for falls among older adults.

Correlation between fear of fall, balance and physical function in people with osteoarthritis of knee joint.

Introduction: Osteoarthritis is a degenerative joint disease. Fear of fall and balance impairment in people with osteoarthritis of knee joint is a major cause of loss of independence, which has an effect on the physical function in them. The aim of the study was to correlate fear of fall with balance scores and with physical function in people with osteoarthritis of knee joint. Material and methods: A correlational study was conducted at college of physiotherapy where fear of fall, balance impairment and physical function were assessed in 30 subjects, both males and females, diagnosed having osteoarthritis of knee joint. Exclusion criteria were subjects with history of neurological diseases, fracture or total joint replacement within the previous 6 month or acute illness or injury on the day of the functional assessment. Outcome measure includded Fear of fall measured using falls efficacy scale-international (English) (FES), balance was measured using Berg balance scale (BBS) and physical function was assessed using modified WOMAC index (CRD pune version). Level of significance was kept at 5%. Spearman correlation was applied to find the correlation between FES and BBS and between FES and WOMAC. All the data were analyzed using SPSS16. Results: A moderate negative correlation was found between FES and BBS (r=0.520, p=0.002) and a positive moderate correlation between FES and WOMAC (r=0.666, p<0.001) which were significant. Conclusion: The study concluded that there is a correlation between fear of fall and balance and physical function in subjects with osteoarthritis of knee.

Functional Status and Health Care Utilization among Elders with Hip Fracture Surgery from a Fall / 성인간호학회지

PURPOSE: The purposes of this study were to examine 1) functional status at 2 months after hip fracture surgery 2) health care utilization after a fall episode and 3) fear of falling experienced during first 2 months after a fall episode. METHOD: With a convenient sample of 99 elderly from six university or general hospitals with hip fracture from a fall, data were collected at 2-3 days before discharge and at 2 months after hip fracture surgery. RESULT: 1) At 2 months after hip fracture from a fall, significant proportion (25.3%) of elderly was not able to walk indoors. 2) Average length of hospital stay was 27.6 days with a range of 8 to 86 days. About 51% subjects received physical therapy during hospital stay, and only 6.1% subjects received physical therapy following discharge from the hospital. 3) Significant proportion (72.7%) had fear of falling after the fall episode. About 51% reported that they restricted their activities because they had fear of falling. CONCLUSION: Fall is a dreaded event which result in loss of independence and restriction of activity. Development and application of fall prevention program is critical especially for those with risk factors of fall.