The Dynamic Interplay of Objective and Subjective Balance and Subsequent Task Performance: Implications for Fall Risk in Older Adults.

INTRODUCTION: Falls occur in daily life when an activity results in a loss of balance that is too great to recover from. Our purpose in this study was to examine how fall risk differentiates the dynamic interplay of objective and subjective balance on a given day and subsequent task performance on that day. METHODS: For 30 consecutive days, following a baseline fall risk assessment, 41 older adults (56% female, Age M = 75.22, SD = 6.75) self-assessed balance and task performance using a smartphone. The Activity-specific Balance Confidence scale measured subjective balance. Postural sway and chair-stand performance were measured within a smartphone using accelerometry. Data were analyzed using multilevel random coefficient models. RESULTS: Tests of heterogeneity in level one residuals showed day-to-day variability in balance confidence and postural sway to be greater in individuals with higher fall risk at baseline. Baseline fall risk differentiated how the interplay of balance confidence and postural sway on a given day related to chair-stand performance on that day. For those with higher fall risk, on days that balance confidence was higher, greater postural sway was followed by greater chair-stand performance. CONCLUSION: Findings indicate that older adults, especially those with higher fall risk, may be unaware of subtle fluctuations in balance, which could lead to engaging in activities that exceed the capacity to maintain balance at that moment. Fall prevention efforts should address older adults' understanding of and responses to fluctuations of physical function in daily life.

The Developments and Iterations of a Mobile Technology-Based Fall Risk Health Application.

Falls are a prevalent and serious health concern across clinical populations. A critical step in falls prevention is identifying modifiable risk factors, but due to time constraints and equipment costs, fall risk screening is rarely performed. Mobile technology offers an innovative approach to provide personalized fall risk screening for clinical populations. To inform future development, this manuscript discusses the development and testing of mobile health fall risk applications for three unique clinical populations [older adults, individuals with Multiple Sclerosis (MS), and wheeled-device users]. We focus on key lessons learned and future directions to improve the field of fall risk mHealth. During the development phase, we first identified fall risk factors specific to each population that are measurable with mobile technology. Second, we determined whether inertial measurement units within smartphones can measure postural control within the target population. Last, we developed the interface of each app with a user-centered design approach with usability testing through iterative semi-structured interviews. We then tested our apps in real-world settings. Our cumulative work demonstrates that mobile technology can be leveraged to provide personalized fall risk screening for different clinical populations. Fall risk apps should be designed and tailored for the targeted group to enhance usefulness and feasibility. In addition, fall risk factors measured with mobile technology should include those that are specific to the population, are measurable with mobile technology, and can accurately measure fall risk. Future work should improve fall risk algorithms and implement mobile technology into fall prevention programs.

The Context of Caring and Concern for Falling Differentiate Which Mobile Fall Technology Features Chinese Family Caregivers Find Most Important.

Falls are not only a leading cause of death and disability, but also a strain on the capacity for caregivers to provide care. This study examined how the context of caregiving relates to the importance of caregiver-defined mobile fall prevention feature sets. A sample of 266 family caregivers, recruited from a Chinese social media platform, reported care for an older adult and interest in mobile fall prevention technology features. Factor analysis identified three caregiver-defined feature sets: automatic fall response, digitized fall prevention tools, and social features. Multiple regression showed caregivers' concern about falling was the most robust predictor of a feature set's importance. Poisson regression revealed that caregiver concern and assistance with instrumental activities of daily living were associated with rating more features as important. Our findings suggest that caregivers are interested in mobile fall prevention technologies that support older adults' independence while also alleviating concerns about falling.

Emergency management of avulsed permanent incisors: knowledge and attitudes of teachers in 15 Irish schools.

STATEMENT OF THE PROBLEM: Appropriate immediate management of an avulsed permanent incisor is critical because a delay in replantation significantly reduces the long-term prognosis of the tooth. PURPOSE OF THE STUDY: This study was designed to examine the knowledge and attitudes of teachers with regard to the emergency management of avulsed permanent incisors. MATERIALS AND METHODS: A total of 198 teachers in 15 schools in Balbriggan, Co. Dublin, or within a 15km radius of the town, were invited to take part in the study. Data were collected by use of a self-administered questionnaire, which had been employed in a previously published study. RESULTS: A total of 139 teachers returned the questionnaire, a response rate of 70.2%. While almost all (96.4%) of these teachers stated that they supervised children during sports or lunch break, the majority neither possessed a recognised first aid qualification (80.6%) nor had received advice on the management of an avulsed permanent incisor (74.8%). Perhaps unsurprisingly, the majority of respondents (81.3%) stated that they would not be prepared to replant a tooth avulsed by a child in their care. Reassuringly, however, 45.3% of respondents chose milk as an appropriate transport medium for the tooth. A total of 131 respondents (94.2%) expressed a desire for further information and advice. CONCLUSIONS: The majority of teachers possessed inadequate knowledge of emergency treatment of tooth avulsion. It is the authors' view that teachers and other individuals who supervise children in schools would benefit from instruction in dental first aid.