Design, Fabrication, and Validation of a Portable Perturbation Treadmill for Balance Recovery Research.

Trips and falls are a major concern for older adults. The resulting injury and loss of mobility can have a significant impact on quality of life. An emerging field of study, known as Perturbation Training, has been shown to reduce injury rates associated with trips and falls in older adults. Treadmills traditionally used for Perturbation Training are large, expensive, and immobile, forcing users to travel long distances to receive care. A portable treadmill would serve a larger portion of the at-risk population than current methods. We developed a portable, low-cost, twin-belt perturbation treadmill capable of high-intensity Perturbation Training. Belt speeds are controlled by a custom mechanical and software interface, allowing operators with no programming experience to control the device. The treadmill can accommodate users up to 118 kg and provides a maximum acceleration and speed of 12 m/s2 and 3.3 m/s, respectively, under full load. The total weight is 180 kg, and the treadmill can be moved like a wheelbarrow, with handles in the back and wheels in the front. The prototype was validated with mechanical and human participant testing, showing it as a viable device for Perturbation Training. In this paper, we will go over the design, fabrication, and validation processes used to create the Portable Perturbation Treadmill.

The association of cardiometabolic multimorbidity and fear of falling among older adults: Data from the national health and aging trends study.

OBJECTIVES: Cardiometabolic diseases (CMDs) have been individually associated with fall-related outcomes, but their combined effect on fear of falling (FOF) has not been investigated. This study aims to examine the association between cardiometabolic multimorbidity and FOF in older adults. METHODS: Data from the National Health and Aging Trends Study, 4,295 community-dwelling older adults ≥ 65 years were analyzed in this longitudinal study. CMDs were assessed at baseline, including heart disease, diabetes, stroke, and hypertension. FOF was evaluated by asking participants if they worried about falling in the past month. Data were analyzed using multi-adjusted logistic regression. RESULTS: Cardiometabolic multimorbidity was associated with a higher risk of FOF. The combination of heart disease and diabetes showed the highest risk of FOF (OR = 3.47, 95 % CI: 1.63-7.40). CONCLUSIONS: These findings underscore the need for targeted interventions to mitigate the combined impact of cardiometabolic multimorbidity on FOF in older adults.

Using machine learning algorithms to detect fear of falling in people with multiple sclerosis in standardized gait analysis.

INTRODUCTION: Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system. The progressive impairment of gait is one of the most important pathognomic symptoms which are associated with falls and fear of falling (FOF) in people with MS (pwMS). 60 % of pwMS show a FOF, which leads to restrictions in mobility as well as physical activity and reduces the quality of life in general. Therefore, early detection of FOF is crucial because it enables early implementation of rehabilitation strategies as well as clinical decision-making to reduce progression. Qualitative and quantitative evaluation of gait pattern is an essential aspect of disease assessment and can provide valuable insights for personalized treatment decisions in pwMS. Our objective was to identify the most appropriate clinical gait analysis methods to identify FOF in pwMS and to detect the optimal machine learning (ML) algorithms to predict FOF using the complex multidimensional data from gait analysis. METHODS: Data of 1240 pwMS was recorded at the MS Centre of the University Hospital Dresden between November 2020 and September 2021. Patients performed a multidimensional gait analysis with pressure and motion sensors, as well as patient-reported outcomes (PROs), according to a standardized protocol. A feature selection ensemble (FS-Ensemble) was developed to improve the classification performance. The FS-Ensemble consisted of four filtering methods: Chi-square test, information gain, minimum redundancy maximum relevance and ReliefF. Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, and Support Vector Machines (SVM) were used to identify FOF. RESULTS: The descriptive analysis showed that 37 % of the 1240 pwMS had a FOF (n = 458; age: 51 ± 16 years, 76 % women, median EDSS: 4.0). The FS-Ensemble improved classification performance in most cases. The SVM showed the best performance of the four classification models in detecting FOF. The PROs showed the best F1 scores (Early Mobility Impairment Questionnaire F1 = 0.81 ± 0.00 and 12-item Multiple Sclerosis Scale F1 = 0.80 ± 0.00). CONCLUSION: FOF is an important psychological risk factor associated with an increased risk of falls. To integrate a functional early warning system for fall detection into MS management and progression monitoring, it is necessary to detect the relevant gait parameters as well as assessment methods. In this context, ML strategies allow the integration of gait parameters from clinical routine to support the initiation of early rehabilitation measures and adaptation of course-modifying therapeutics. The results of this study confirm that patients' self-assessments play an important role in disease management.

Effect of Otago exercise on fear of falling in older adults: a systematic review and meta-analysis.

BACKGROUND: Approximately 40-70% of older adults who have experienced falls develop fear of falling (FOF), with the incidence rate in nursing home residents reaching as high as 79.4%. An increasing number of studies have focused on the effect of the Otago Exercise Programme (OEP) on reducing FOF among older adults, yet comprehensive analysis is lacking due to regional and demographic variations. Therefore, this study integrates the relevant literature to provide evidence supporting interventions aimed at alleviating FOF among older adults. OBJECTIVE: To evaluate the impact of OEP on FOF in older adults through meta-analysis. METHODS: We searched ten databases using computer systems, covering all records up to May 1, 2024. Two researchers independently conducted the literature screening, bias risk assessment, and data extraction. We performed data analysis using RevMan 5.3 and Stata 15.0 software, assessed result stability through sensitivity analysis, and examined publication bias with funnel plots and Egger's test. RESULTS: Sixteen RCTs were included. Meta-analysis revealed that the OEP significantly reduced FOF among older adults [SMD = 0.96, 95%CI (0.68, 1.23), P < 0.00001]. Subgroup analysis revealed that interventions lasting more than 16 weeks [SMD = 1.12, 95%CI (0.75, 1.49), P < 0.00001], with a frequency of more than twice a week [SMD = 0.99, 95%CI (0.64, 1.35), P < 0.00001], and for older adults in community and nursing institutions [SMD = 1.03, 95%CI (0.50, 1.57), P = 0.0002] were more effective. A comparison of the 16-week and 24-week interventions revealed that the latter had better outcomes [SMD = 0.87, 95%CI (0.66, 1.08), P = 0.0004]. CONCLUSION: Current evidence indicates that OEP effectively reduces FOF among older adults. It is recommended that interventions last for more than 24 weeks, occur more than twice a week, and suitable for application among older adults in community settings or elder care institutions.

Effect of fear of falling on turning performance among patients with chronic stroke.

BACKGROUND: Turning difficulties have been reported in stroke persons, but studies have indicated that fall history might not significantly affect turning performance. Fear of falling (FOF) is common after a fall, although it can occur in individuals without a fall history. RESEARCH QUESTION: Could FOF have an impact on turning performance among chronic stroke patients? METHODS: This cross-sectional study recruited 97 stroke persons. They were instructed to perform 180° and 360° turns, and their performance was represented by angular velocity. FOF was evaluated using the Falls Efficacy Scale-International (FES-I). Falls that occurred 12 months prior to the study assessment were recorded. RESULTS: A higher FES-I score was significantly correlated with a decline in angular velocity in all turning tasks after adjustment for demographic data. The correlation remained significant after controlling for falls history. Participants with a high level of FOF exhibited significantly slower angular velocities during all turning tasks compared with those with a low level of FOF. Participants with a moderate level of FOF had a significantly slower angular velocity than did those with a low level of FOF during the 360° turn to the paretic side only. SIGNIFICANCE: A higher level of FOF, regardless of fall history, was significantly associated with a reduced angular velocity during turning. A high level of FOF affected turning performance in all tasks. Turning performance may not be affected by fall experience. Anxiety about falling may have a greater effect on turning performance than does fall history.

Erosion of Stumble Correction Evoked with Superficial Peroneal Nerve Stimulation in Older Adults during Walking.

In healthy young adults, electrical stimulation of the superficial peroneal cutaneous nerve (SPn) innervating the dorsum of the foot has been shown to elicit functionally relevant reflexes during walking that are similar to those evoked by mechanical perturbation to the dorsum of the foot during walking and are referred to as stumble corrective (obstacle avoidance) responses. Though age-related differences in reflexes induced by mechanical perturbation have been studied, toe clearance has not been measured. Further, age-related differences in reflexes evoked by electrical stimulation of SPn have yet to be determined. Thus, the purpose of this study was to characterize age-related differences between healthy young adults and older adults with no history of falls in stumble correction responses evoked by electrical stimulation of the SPn at the ankle during walking. Toe clearance relative to the walking surface along with joint displacement and angular velocity at the ankle and knee and EMG of the tibialis anterior, medial gastrocnemius, biceps femoris and vastus lateralis were measured. The combined background and reflex toe clearance was reduced in the older adults compared with the young in mid-early swing (p = 0.011). These age-related differences likely increase fall risk in the older adult cohort. Further, age-related changes were seen in joint kinematics and EMG in older adults compared with the young such as decreased amplitude of the plantarflexion reflex in early swing in older adults (p < 0.05). These altered reflexes reflect the degradation of the stumble corrective response in older adults.

Factors associated with fear of falling and fall-related injuries among people who use wheelchairs and motorized mobility scooters: a cross-sectional study.

PURPOSE: To identify the factors associated with the fear of falling (FOF) and fall-related injuries (FRI) among full-time wheelchair and motorized mobility scooter (WC/S) users with various health conditions. METHODS: This cross-sectional study included participants (≥18 years old) who used WC/S for at least one year for ≥ 75% of mobility and had a history of ≥ 1 fall in the past three years. Logistic regression models identified factors associated with FOF (yes/no) and FRI (yes/no) during the past year. Data on demographics, prior falls, mental health, environmental accessibility, and WC/S usage were used as independent variables. RESULTS: Among 156 participants, 96% reported at least one fall within the past year, among whom 94.6% reported FOF, and 74% reported FRI within the same period. FOF was associated with fall incidence in the past year (OR = 17.75, p = 0.001). FRI was associated with higher levels of anxiety (OR = 1.15, p = 0.003) and fewer hours of WC/S use per week (OR = 0.98, p = 0.012). CONCLUSION: This study highlights the high prevalence of FOF and FRI among WC/S users who had falls. The findings emphasized the relation between prior fall experiences and FOF and underscored the significance of addressing anxiety symptoms and WC/S usage in relation to FRI.

Among individuals with a variety of health conditions who use wheelchairs and motorized mobility scooters full-time for most of their mobility and have experienced at least one fall incident within the past year, the prevalence of psychosocial and physical consequences of falls (fear of falling and fall-related injuries) is relatively high.Given the significant association between an individual's previous fall experiences and the likelihood of fear of falling, continuous screening for falls is a crucial step toward fall prevention for people who use wheelchairs and motorized mobility scooters full-time.Recognizing the importance of the unique needs of individuals who use wheelchairs and motorized mobility scooters and tailoring interventions like wheelchair skills and anxiety management education may enhance overall rehabilitation outcomes.

Fabrication of 3D chitosan/polyvinyl alcohol/brushite nanofibrous scaffold for bone tissue engineering by electrospinning using a novel falling film collector.

Despite its advantages, electrospinning has limited effectiveness in 3D scaffolding due to the high density of fibers it produces. In this research, a novel electrospinning collector was developed to overcome this constraint. An aqueous suspension containing chitosan/polyvinyl alcohol nanofibers was prepared employing a unique falling film collector. Suspension molding by freeze-drying resulted in a 3D nanofibrous scaffold (3D-NF). The mineralized scaffold was obtained by brushite deposition on 3D-NF using wet chemical mineralization by new sodium tripolyphosphate and calcium chloride dihydrate precursors. The 3D-NF was optimized and compared with the conventional electrospun 2D nanofibrous scaffold (2D-NF) and the 3D freeze-dried scaffold (3D-FD). Both minor fibrous and major freeze-dried pore shapes were present in 3D-NFs with sizes of 16.11-24.32 µm and 97.64-234.41 µm, respectively. The scaffolds' porosity increased by 53 % to 73 % compared to 2D-NFs. Besides thermal stability, mineralization improved the 3D-NF's ultimate strength and elastic modulus by 2.2 and 4.7 times, respectively. In vitro cell studies using rat bone marrow mesenchymal cells confirmed cell infiltration up to 290 µm and scaffold biocompatibility. The 3D-NFs given nanofibers and brushite inclusion exhibited considerable osteoinductivity. Therefore, falling film collectors can potentially be applied to prepare 3D-NFs from electrospinning without post-processing.

Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: a Cross-Sectional Study.

Background: Previous studies have suggested an association between falls and the presence of Multiple Long-Term Conditions (MLTC) or disabilities. However, there is limited understanding of how these factors independently or collectively contribute to the risk of falls and fear of falling among community-dwelling adults. Objective: This study examined the independent association between MLTC and the presence of disability with the risk of falls among community adults. Methods: A cross-sectional study included 324 adults (age ≥ 50). Demographic and clinical data included age, sex, body mass index (BMI), MLTC (≥ two chronic diseases) risk of fall (ie, history of fall in the previous 12-months, number of falls, and recurrent falls). The Barthel Index and Falls Efficacy Scale-International (FES-I) were used to assess disability and fear of fall, respectively. Results: MLTC (Odds Ratio (OR) 2.50, 95% Confidence Interval (CI) [1.26, 4.95], p=0.009), and disability (OR 1.71, 95% CI [1.04, 2.79], p = 0.034) were independently associated with history of falls. MLTC (Incidence Rate Ratio (IRR) 2.87, 95% CI [1.93, 4.29], p < 0.001) and disability (IRR 1.86 95% CI [1.46, 2.36], p < 0.001) were independently associated with an increased number of falls. MLTC (OR 4.50, 95% CI [1.78, 11.36], p = 0.001) and disability (OR 2.82, 95% CI [1.58, 5.05], p < 0.001) were independently associated with recurrent falls. MLTC (B = 6.45, p < 0.001) and disability (B = 3.05, p = 0.025) were independently associated with increased fear of falling. Conclusion: This study indicated that both MLTC and disability are independently associated with falls, number of falls and fear of falling in this population.

Falls prevention is more than just promoting physical health: evaluation of the group-based, out-patient prevention program 'Staying safe and active in old age - falls prevention'.

Introduction: The aim of this study was to evaluate the German falls prevention program 'Staying safe and active in old age - falls prevention', which is already established in practice. Methods: The single-arm intervention study consisted of two time points, 6 months apart, to evaluate the multifactorial falls prevention program (n = 125 at Time 2). We observed the groups and their trainers and assessed which behavior change techniques (BCTs) were used. According to our evaluation framework, changes in the following three domains were assessed: (a) fall-related variables (i.e. number of falls, fear of falling), (b) physical functioning (i.e. performance-based gait speed, coordination, self-reported leg strength, balance, as well as habitual execution of the exercises), and (c) psychosocial functioning (i.e. quality of life, activities of daily living, mobility, and loneliness). Linear mixed models were used to determine changes in each variable. Results: Demonstration of behavior was the most frequently used BCT. The program showed significant benefits for fear of falling, balance, coordination, habitual execution, and loneliness over time (Cohen's d between -0.59 and 1.73). Number of falls, gait speed, coordination (dual task), activities of daily living, and quality of life were maintained (Cohen's d between -0.26 and 0.30), whereas leg strength and mobility decreased significantly at Time 2 (Cohen's d = -0.55 and -0.36). Discussion: Group-based falls prevention programs may facilitate social integration among older adults and may also enhance and maintain physical functioning in old age.Trial registration: German Clinical Trials Register identifier: DRKS00012321.

Progressive Supranuclear Palsy Diagnosed After a Severe Fall Trauma in a Patient Who Experienced Episodes of Easy Falling.

Progressive supranuclear palsy (PSP) is characterized by parkinsonism, downward gaze disorder, and a tendency to fall due to degeneration of the basal ganglia, the brain stem, and the cerebellum. We report a case of PSP that was diagnosed following a traumatic hemopneumothorax caused by a fall while descending stairs. A 79-year-old man experienced lightheadedness and frequent falls for two years. He fell on stairs at home and was transferred to our hospital due to mobility issues. He was hospitalized and treated for traumatic hemopneumothorax. Neurological examination revealed vertical ocular motility disorder, positive Myerson's sign, increased muscle stiffness, and increased limb tendon reflexes. Brain MRI showed a hummingbird sign. In this case, a midbrain area of 58.1 mm2 was consistent with PSP. He had no medication history that could have caused falls. He was diagnosed with PSP based on clinical and imaging findings, and treatment with levodopa was initiated. Two months later, walking showed limited improvement, and living at home became difficult. He was discharged to a care facility. PSP is a risk factor for frequent falls in the elderly. PSP usually requires three to four years for diagnosis, although falls appear earlier than in other forms of degenerative parkinsonism. Additionally, PSP often results in repeated dynamic falls due to a decreased perception of danger associated with reduced frontal lobe function. As a result, the severity of trauma from falls in PSP tends to be higher than in other neurodegenerative diseases. Therefore, early diagnosis of PSP may help improve patients' quality of life and prevent trauma. Despite frequent falls over two years, the cause was not thoroughly investigated until the patient experienced severe trauma. The lesson from this case is the importance of a thorough neurological examination and sagittal MRI for elderly patients experiencing repeated falls, to consider the possibility of PSP. Furthermore, quantitative evaluation of MRI enhances the diagnostic accuracy of PSP.

Physical and mental health predicts better adherence to exercise intervention in older women: A post-hoc analysis.

Background: Adherence to exercise is crucial for promoting health and maintaining functioning. Aims: To investigate predictors of adherence to exercise in the initially free supervised fall prevention RCT and its low-cost, self-sustained continuation among elderly women. Methods: In the 2-year Kuopio Fall Prevention Study RCT, 457 women (aged 71-84) were offered a free initial 6-month supervised weekly training program (gym, Tai Chi) in the municipal facilities. Women's adherence during this period was categorized into high (≥80 %) and low (<80 %). In the next six months, their free access to the premises continued without supervision. For the second year, low-cost access was offered with unsupervised independent training in these facilities. The second-year adherence was based on purchasing(yes/no) a gym card to continue exercising. Information on baseline health, functioning, and lifestyle was obtained by mailed questionnaires and physical tests. Results: For the first six months, over 60 % of the women had high adherence. Only 26 % continued into the second year. For both follow-up years, active training history was related to better adherence. Initial predictors were related to mental health i.e. having less often fear of falls limiting one's mobility, ability to cope with external, not internal hostility, and being in a loving relationship. In the second year, predictors were related to younger age, having less frequent fear of falls, better functional capacity i.e. better strengths (grip and leg extension) and faster Timed "Up and Go" -test. Conclusion: Better mental and physical health, better functional capacity and active training background were associated with higher adherence to exercise intervention in older women.

Functional clinical motor performance tests to assess potential fall risks in patients with haemophilia: A case-control study.

INTRODUCTION: Patients with haemophilia (PwH) are at increased risk of falls due to haemophilic arthropathy. Yet, studies on clinical tests associated with the risk of falling are scarce in PwH. AIMS: (1) To evaluate the feasibility of different clinical motor performance tests associated with the risk of falling in PwH; (2) to evaluate PwH's performance of these tests compared to a control group; (3) to identify possible influencing factors that affect performance. METHODS: Twenty-nine severe and moderate PwH (57.0 years, IQR: 48.0-61.5) and 29 healthy age- and BMI-matched control participants (CG) performed 13 different clinical tests (SPPB, timed up and go, push and release, functional reach, single-leg stance, knee and grip strength). Haemophilia joint health score (HJHS), kinesiophobia (TSK-11), subjective physical performance (HEP-Test-Q), falls efficiency (FES-I) and falls were assessed. RESULTS: No adverse events occurred. PwH showed impaired performance in all clinical tests, a lower falls efficiency and a higher HJHS than CG. PwH with higher HJHS, lower HEP-Test-Q and higher TSK-11 scores showed higher deficits. Largest discrepancies were observed in the single-leg stance with eyes open and knee extensor strength, where orthopaedically majorly affected PwH showed worse performance compared to minorly affected PwH and the CG, respectively. The prevalence of ≥1 fall in the last year was 27.6% (PwH) and 10.3% (CG). CONCLUSION: These clinical tests are feasible in PwH. Impaired joint status, a high kinesiophobia and low physical performance impair performance. These tests can be used by clinicians for gaining specific information on functional motor abilities of patients.

Fear of Falling: Exploring Associated Factors among Elderly Residents in the Rural Communities of Vietnam.

This research aimed to explore factors associated with the fear of falling (FOF) among community-dwelling older adults in Vietnam. A cross-sectional study was conducted in five communes in Soc Son, Hanoi, Vietnam, from March to June 2017. We recruited a total of 487 participants, which provided sufficient data for analysis. The outcome variable was fear of falling. Several covariates, including demographics, medical history, general health status, geriatric syndromes, eye diseases, assessment of fall risk environment, timed up-and-go test, and number of standing up in 30 s, were collected. A multivariable logistic regression model was performed to determine predictors associated with FOF. The results showed that 54.6% of the participants had FOF. Furthermore, the logistic multivariable regression model revealed several factors associated with FOF among participants in the research sites, including polypharmacy status (OR: 1.79; 95%CI 1.07-2.99), higher scores in quality of life according to the EQ-5D-5L index (OR:6.27; 95%CI: 2.77-14.17), and having fallen during the past 12 months (OR:4.4; 95%CI: 2.39-8.11). These findings contribute to a comprehensive understanding of the intricate relationship between FOF and several associated factors, notably polypharmacy status, quality of life, and having a fall during the past 12 months.

Perspectives and experiences of community-dwelling older adults who experience falling: A qualitative meta-synthesis.

Objectives: This study aimed to systematically review and synthesize the perspectives and experiences of community-dwelling older adults who experience falling, to inform the subsequent development of fall prevention and management interventions, and to provide recommendations for healthcare policy and practice. Methods: The review was a qualitative meta-aggregation study following the JBI qualitative systematic review methodology. Databases searched included Medline (through PubMed), CINAHL, PsycINFO, Embase, and the Web of Science. Peer-reviewed articles published in the English language from January 2010 to May 2023 were retrieved. The JBI Qualitative Assessment and Review Instrument (JBI-QARI) was used to assess the quality of the methodology. The ConQual ranking system was used to establish confidence in the synthesized findings. The protocol was registered with PROSPERO (CRD 42023421789). Results: This review included ten qualitative studies with an overall quality score of 60%-90%. Data extracted from eligible studies resulted in 59 findings, which were then aggregated into seven categories based on the similarity in meaning. Three synthesized findings were generated and rated as moderate for synthesized finding 2 and low for synthesized finding 1 and 3 on the ConQual score. Synthesized finding 1: Older adults experience physical injuries and pain, restricted daily activities, and limitations in social activities, reduction or loss of in independence, and have feelings of fear and helplessness. Synthesized finding 2: After experiencing a fall, older adults reflect on the cause of the fall and recognize and interpret the risk factors. Synthesized finding 3: Older adults' reflections on the causes and impact of falls reveal both positive and negative reactions. They perceive a number of strategies for coping with falls and their consequences, such as using assistive devices, correcting risk factors, seeking medical help, and receiving ongoing physical and psychological attention. Conclusions: Healthcare providers should pay attention to the feelings and experiences of older adults after falling, as well as their reflection on the causes and impacts of falling, and develop tailored plans for intervention. There is also a need for longitudinal studies to examine the longer-term impact of falls on older adults to provide insights into the stability and changes in their reflections, perceptions, attitudes, and preventive behaviors over time.

Fear of falling, quality of life, and daily functional activity of elderly women with and without a history of falling: a cross-sectional study.

Background: This study aimed to evaluate the fear of falling, quality of life, and daily functional activity of older women aged 60 years or older with or without a history of falling. Materials and methods: Two hundred older adult women were recruited for the cross-sectional study in Iran. This cross-sectional study collected data from July to August 2023 through convenience sampling. The researchers collected data using a five-part questionnaire, that collected information that included demographic characteristics, the Fall Efficacy Scale in the Elderly-International Version (FES-I), 12-item Quality of Life assessment (SF-12), Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Results: FES-I score in older women with a history of falls was significantly higher than those without a history of falls [median: 38.0, interquartile range (IQR): 31.5-44.0 versus median: 22.0, IQR: 20.0-30.0; P<0.001]. The median quality-of-life score using the SF-12 was significantly lower in women with a history of falls than in those without a history of falls (median: 25.0, IQR: 21.0-30.0 versus median: 35.0, IQR: 31.0-39.0; P<0.001). The ADL scores were significantly lower among women with a history of falls than those without (P<0.001). A similar result was obtained for IADL scores (P<0.001). Conclusion: Overall, this study's findings highlight the adverse impact of a history of falls on three key factors: fear of falling, quality of life, and daily functional activity (including both basic and instrumental activities). The findings delineate that, ultimately, the history of falls can serve as a valuable indicator for better understanding trends in elderly care and addressing the associated challenges.

Relationship among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis.

OBJECTIVE: Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis. METHODS: A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1 year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I. RESULTS: A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed. CONCLUSION: FOF was associated with the incidence of falls in patients on hemodialysis. IMPACT: The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.

Artificial intelligence based on falling in older people: A bibliometric analysis.

Objectives: This study aimed to analyze publications on artificial intelligence (AI) for falls in older people from a bibliometric perspective. Methods: The Web of Science database was searched for titles of English-language articles containing the words "artificial intelligence," "deep learning," "machine learning," "natural language processing,", "neural artificial network," "fall," "geriatric," "elderly," "aging," "older," and "old age." An R-based application (Biblioshiny for bibliometrics) and VOSviewer software were used for analysis. Results: Thirty-seven English articles published between 2018 and 2024 were included. The year 2023 is the year with the most publications with 16 articles. The most productive research field was "Engineering Electrical Electronic" with seven articles. The most productive country was the United States, followed by China. The most common words were "injuries," "people," and "risk factors." Conclusion: Publications on AI and falls in the elderly are both few in number and the number of publications has increased in recent years. Future research should include relevant analyses in scientific databases, such as Scopus and PubMed.

Clinical observation of male bulbar urethral strictures resulting from straddle injuries associated with falling from heights and riding activities.

OBJECTIVES: To retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities. METHODS: The study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery. RESULTS: The clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18-59) and 26.8 ± 4.4 (riding group, aged 19-35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05. CONCLUSIONS: Male bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.

Super-Droplet-Repellent Carbon-Based Printable Perovskite Solar Cells.

Despite attractive cost-effectiveness, scalability, and superior stability, carbon-based printable perovskite solar cells (CPSCs) still face moisture-induced degradation that limits their lifespan and commercial potential. Here, the moisture-preventing mechanisms of thin nanostructured super-repellent coating (advancing contact angle >167° and contact angle hysteresis 7°) integrated into CPSCs are investigated for different moisture forms (falling water droplets vs water vapor vs condensed water droplets). It is shown that unencapsulated super-repellent CPSCs have superior performance under continuous droplet impact for 12 h (rain falling experiments) compared to unencapsulated pristine (uncoated) CPSCs that degrade within seconds. Contrary to falling water droplets, where super-repellent coating serves as a shield, water vapor is found to physisorb through porous super-repellent coating (room temperature and relative humidity, RH 65% and 85%) that increase the CPSCs performance for 21% during ≈43 d similarly to pristine CPSCs. It is further shown that water condensation forms within or below the super-repellent coating (40 °C and RH 85%), followed by chemisorption and degradation of CPSCs. Because different forms of water have distinct effects on CPSC, it is suggested that future standard tests for repellent CPSCs should include rain falling and condensate formation tests. The findings will thus inspire the development of super-repellent coatings for moisture prevention.