A quantitative study on the impact of a community falls pharmacist role, on medicines optimisation in older people at risk of falls.

BACKGROUND: The World Falls guidance includes medication review as part of its recommended multifactorial risk assessment for those at high risk of falling. Use of Falls Risk Increasing Drugs (FRIDs) along with polypharmacy and anticholinergic burden (ACB) are known to increase the risk of falls in older people. METHOD: The impact of a community falls pharmacist within a hospital Trust, working as part of a multi-professional community falls prevention service, was evaluated in 92 people aged 65 years or older, by analysing data before and after pharmacist review, namely: number and type of FRIDs prescribed; anticholinergic burden score using ACBcalc®; appropriateness of medicines prescribed; bone health review using an approved too; significance of clinical intervention; cost avoidance, drug cost savings and environmental impact. RESULTS: Following pharmacist review, there was a reduction in polypharmacy (mean number of medicines prescribed per patient reduced by 8%; p < 0.05) and anticholinergic burden score (average score per patient reduced by 33%; p < 0.05). Medicines appropriateness improved (Medicines Appropriateness Index score decreased by 56%; p < 0.05). There were 317 clinically significant interventions by the community falls pharmacist. One hundred and one FRIDs were deprescribed. Annual cost avoidance and drug cost savings were £40,689-£82,642 and avoidable carbon dioxide (CO2) emissions from reducing inappropriate prescribing amounted to 941 kg CO2. CONCLUSION: The community falls pharmacist role increases prescribing appropriateness in the older population at risk of falls, and is an effective and cost-efficient means to optimise medicines in this population, as well as having a positive impact on the environment.

Objective Falls Risk Assessment Using Markerless Motion Capture and Representational Machine Learning.

Falls are a major issue for those over the age of 65 years worldwide. Objective assessment of fall risk is rare in clinical practice. The most common methods of assessment are time-consuming observational tests (clinical tests). Computer-aided diagnosis could be a great help. A popular clinical test for fall risk is the five times sit-to-stand. The time taken to complete the test is the most commonly used metric to identify the most at-risk patients. However, tracking the movement of skeletal joints can provide much richer insights. We use markerless motion capture, allied with a representational model, to identify those at risk of falls. Our method uses an LSTM autoencoder to derive a distance measure. Using this measure, we introduce a new scoring system, allowing individuals with differing falls risks to be placed on a continuous scale. Evaluating our method on the KINECAL dataset, we achieved an accuracy of 0.84 in identifying those at elevated falls risk. In addition to identifying potential fallers, our method could find applications in rehabilitation. This aligns with the goals of the KINECAL Dataset. KINECAL contains the recordings of 90 individuals undertaking 11 movements used in clinical assessments. KINECAL is labelled to disambiguate age-related decline and falls risk.

Postural change, gait, and physical function in older adults.

In a more clinical setting, abrupt posture change may be used to determine the presence of orthostatic hypotension, a hemodynamic response with relationships to physical function. Certain gait features and physical function performance are also associated with risk of falling in older adults. However, the extent to which posture change is associated with subsequent gait and physical function has received little attention in the literature. This study aims to determine the effects of posture change on spatiotemporal parameters of gait and Timed Up-and-Go (TUG) performance. METHODS: Forty-two volunteers (age 73.21 ± 6.22 years) participated in the study. A custom Tekscan Strideway (Tekscan, Boston, MA.) gait system was used to measure gait velocity (VEL), cadence (CAD), stride length (SL), and percent of time spent in active propulsion (AP). Dependent t-tests were used to compare TUG time, VEL, CAD, SL and AP after at least 10 mins of seated rest and supine rest. RESULTS: Time to complete the TUG was significantly slower after supine rest compared to seated (11.47 ± 0.51 and 10.01 ± 0.33 s, respectively, p<0.001); VEL was significantly slower after supine rest compared to seated (0.888 ± 0.042 and 1.049 ± 0.033 m/s, respectively, p=0.003); CAD was significantly slower after supine rest compared to seated (111.21 ± 2.87 and 120.97 ± 2.56spm, respectively, p=0.001); and AP was significantly lower after supine rest compared to seated (56.87 ± 4.76 and 70.79 ± 4.05 %, respectively, p<0.001). No significant differences were detected in stride length between conditions. CONCLUSIONS: Among this sample of older adults, standing from a supine posture is associated with spatiotemporal gait parameters consistent with a risk for falling and aging. Additionally, TUG performance worsens significantly after supine rest. Future studies could explore the sensitivity and specificity of falls risk screening after supine rest.

What are the temporal and physical characteristics of locally applied vibration that modulate balance in older adults? - A systematic review of the literature.

BACKGROUND: Compromised balance is known to contribute to falls, which are associated with increased morbidity and mortality for older adults. Evidence suggests that the application of local vibration to the lower limbs of older adults has the potential to modulate balance. RESEARCH QUESTION: To identify the temporal and mechanical parameters of vibration applied locally to the lower limbs of older adults that modulate measures of balance, and to define the short- and long-term effects of vibration on balance in this population. METHODS: The PRISMA 2020 guidelines were used to conduct a systematic search including the PUBMED, EMBASE, and Scopus databases to identify peer-reviewed literature where vibration was applied to the lower limbs of older adults to modulate balance. Data was extracted using a study-specific data extraction form and risk of bias assessed. Where possible, effect sizes were calculated. RESULTS: Of 7777 records screened, ten randomised controlled trials and 43 prospective laboratory-based studies met the inclusion criteria. Vibration frequencies ranged from 1 to 272 Hz, most studies (n=41) used ≤100 Hz. Amplitude ranged from 0.2 to 3.0 mm, most studies (n=28) used ≤1 mm. Effects of short-term vibration (applied for seconds to hours) were measured during and/or immediately after application. Short-term suprathreshold perceived muscle/tendon vibration had a 'large' destabilising effect size on balance in healthy older adults, but little or no effect on older fallers. Short-term subthreshold vibration to the soles of the feet had a 'small' stabilising effect size. Suprathreshold muscle, tendon or sole vibration applied for 10-30 min over days to weeks improved balance measures, but most (8 of 10) had increased risk of bias. SIGNIFICANCE: The heterogeneity of methodology, populations, and vibration and balance parameters precluded conclusions about the relative effects of lower limb vibration in older adults. However, these results suggest that the application of local vibration to the lower limbs of older adults can modulate balance in the short- and long-term.

Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation.

Background: Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim: To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England. Design: Realist review and multisite case study. (1) Systematic searches to identify stakeholders' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60). Setting: Three Trusts, one orthopaedic and one older person ward in each. Results: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions: (1) Leadership: There should be a clear distinction between senior nurses' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. Study registration: This study is registered as PROSPERO CRD42020184458. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

Many accidental falls by older people in hospitals could be avoided. There are guidelines to prevent falls, but some hospitals are better at following them than others. This study aimed to find out why. First, we looked at research and hospitals' falls policies for ideas about what stops falls. With advice from service users, we tested these ideas in four hospitals in England, watching how falls were prevented on wards for older people and people who need bone care, and talking to 50 staff, 28 patients and 3 carers. We found the following: Falls leadership: wards had staff called falls link practitioners who supported falls prevention, but senior nurses, not link practitioners, made the most important decisions. Sharing responsibility: patients with falls risks were monitored to try to stop falls. Because only nursing teams were always present to monitor patients, they had most responsibility for preventing falls. This limited sharing responsibility with other staff. Computer tools: nurses used computers to record prevention work, but high workloads could make this a 'tick-box' exercise. Computer tools reminded them to do this, although tools varied. Patients had individual falls plans, but they were also ranked more generally as high or low risk of falling, with 'high-risk' patients being monitored. Patient involvement: nursing staff did not have time to explain to patients how to prevent falls, but other staff could have such conversations. Many patients had problems like dementia and found it difficult to follow safety advice, although some could take steps to keep safe, with sensitive staff support. We need to involve patients, carers and different staff in falls prevention. Hospitals could develop computer systems to support this, think how to involve more ward staff, and provide guidance on helpful ways to talk with patients about falls.

Performance of digital technologies in assessing fall risks among older adults with cognitive impairment: a systematic review.

Older adults with cognitive impairment (CI) are twice as likely to fall compared to the general older adult population. Traditional fall risk assessments may not be suitable for older adults with CI due to their reliance on attention and recall. Hence, there is an interest in using objective technology-based fall risk assessment tools to assess falls within this population. This systematic review aims to evaluate the features and performance of technology-based fall risk assessment tools for older adults with CI. A systematic search was conducted across several databases such as PubMed and IEEE Xplore, resulting in the inclusion of 22 studies. Most studies focused on participants with dementia. The technologies included sensors, mobile applications, motion capture, and virtual reality. Fall risk assessments were conducted in the community, laboratory, and institutional settings; with studies incorporating continuous monitoring of older adults in everyday environments. Studies used a combination of technology-based inputs of gait parameters, socio-demographic indicators, and clinical assessments. However, many missed the opportunity to include cognitive performance inputs as predictors to fall risk. The findings of this review support the use of technology-based fall risk assessment tools for older adults with CI. Further advancements incorporating cognitive measures and additional longitudinal studies are needed to improve the effectiveness and clinical applications of these assessment tools. Additional work is also required to compare the performance of existing methods for fall risk assessment, technology-based fall risk assessments, and the combination of these approaches.

Combining user-centered design and behavioral theory to enhance health technologies: A personas-based approach for a primary-care based multifactorial falls risk assessment tool.

INTRODUCTION: Multifactorial falls risk assessment tools (FRATs) can be an effective falls prevention method for older adults, but are often underutilized by health care professionals (HCPs). This study aims to enhance the use and implementation of multifactorial FRATs by combining behavioral theory with the user-centered design (UCD) method of personas construction. Specifically, the study aimed to (1) construct personas that are based on external (i.e., needs, preferences) and intrinsic user characteristics (i.e., behavioral determinants); and (2) use these insights to inform requirements for optimizing an existing Dutch multifactorial FRAT (i.e., the 'Valanalyse'). METHODS: Survey data from HCPs (n = 31) was used to construct personas of the 'Valanalyse.' To examine differences between clusters on 68 clustering variables, a multivariate cluster analysis technique with non-parametric analyses and computational methods was used. The aggregated external and intrinsic user characteristics of personas were used to inform key design and implementation requirements for the 'Valanalyse,' respectively, whereby intrinsic user characteristics were matched with appropriate behavior change techniques to guide implementation. RESULTS: Significant differences between clusters were observed in 20 clustering variables (e.g., behavioral beliefs, situations for use). These variables were used to construct six personas representing users of each cluster. Together, the six personas helped operationalize four key design requirements (e.g., guide treatment-related decision making) and 14 implementation strategies (e.g., planning coping responses) for optimizing the 'Valanalyse' in Dutch geriatric, primary care settings. CONCLUSION: The findings suggest that theory- and evidence-based personas that encompass both external and intrinsic user characteristics are a useful method for understanding how the use and implementation of multifactorial FRATs can be optimized with and for HCPs, providing important implications for developers and eHealth interventions with regards to encouraging technology adoption.

The Effect of Dietary Patterns on Reducing Falls and Falls Risk in Adults: A Systematic Review.

PURPOSE OF REVIEW: Falls are a major global public health issue and the second cause of unintentional injury death. Nutrition may be an important factor for falls prevention in adults, but most previous studies examined the associations between single nutrients and falls. The use of dietary patterns is an alternative method to measure whole diet and its relationship with health outcomes. Therefore, we aimed to systematically review all evidence relating to dietary pattern impacts on falls and/or falls risk in adults. RECENT FINDINGS: This systematic review was registered on the PROSPERO (CRD42020171987). Four databases (Medline, Embase, Cochrane Library, CINAHL Complete) were used for searching potential articles on 18th December 2021 and updated the search on 10th July 2023. We included any quantitative study reporting associations between dietary patterns and falls and/or falls risk in healthy adults ≥ 18 years and publishing in English as full text and peer-reviewed. Of 2866 potential articles, five studies (two cross-sectional, three cohorts) were included for the evidence synthesis. The risk of bias was low in cohort studies. Dietary patterns were derived using both "a priori" or "empirical" approaches, and self-report questionnaires used for falls/falls risk in most studies. Associations between dietary patterns and falls/falls risk were inconsistent results by sex and study design. The effect of dietary patterns on reducing falls/falls risk is not clear in the included studies, so this association needs to be confirmed in future research.

Fall risk prediction ability in rehabilitation professionals: structural equation modeling using time pressure test data for Kiken-Yochi Training.

Background: Falls occur frequently during rehabilitation for people with disabilities. Fall risk prediction ability (FRPA) is necessary to prevent falls and provide safe, high-quality programs. In Japan, Kiken Yochi Training (KYT) has been introduced to provide training to improve this ability. Time Pressure-KYT (TP-KYT) is an FRPA measurement specific to fall risks faced by rehabilitation professionals. However, it is unclear which FRPA factors are measured by the TP-KYT; as this score reflects clinical experience, a model can be hypothesized where differences between rehabilitation professionals (licensed) and students (not licensed) can be measured by this tool. Aims: To identify the FRPA factors included in the TP-KYT and verify the FRPA factor model based the participants' license status. Methods: A total of 402 participants, with 184 rehabilitation professionals (physical and occupational therapists) working in 12 medical facilities and three nursing homes, and 218 rehabilitation students (physical and occupational therapy students) from two schools participated in this study. Participant characteristics (age, gender, job role, and years of experience and education) and TP-KYT scores were collected. The 24 TP-KYT items were qualitatively analyzed using an inductive approach based on content, and FRPA factors were extracted. Next, the correction score (acquisition score/full score: 0-1) was calculated for each extracted factor, and an observation variable for the job role (rehabilitation professional = 1, rehabilitation student = 0) was set. To verify the FRPA factors associated with having or not having a rehabilitation professional license, FRPA as a latent variable and the correction score of factors as an observed variable were set, and structural equation modeling was performed by drawing a path from the job role to FRPA. Results: The results of the qualitative analysis aggregated patient ability (PA), physical environment (PE), and human environment (HE) as factors. The standardized coefficients of the model for participants with or without a rehabilitation professional license and FRPA were 0.85 (p < 0.001) for FRPA from job role, 0.58 for PA, 0.64 for PE, and 0.46 for HE from FRPA to each factor (p < 0.001). The model showed a good fit, with root mean square error of approximation < 0.001, goodness of fit index (GFI) = 0.998, and adjusted GFI = 0.990. Conclusion: Of the three factors, PA and PE were common components of clinical practice guidelines for fall risk assessment, while HE was a distinctive component. The model's goodness of fit, which comprised three FRPA factors based on whether participants did or did not have rehabilitation professional licenses, was good. The system suggested that rehabilitation professionals had a higher FRPA than students, comprising three factors. To provide safe and high-quality rehabilitation for patients, professional training to increase FRPA should incorporate the three factors into program content.

The Belgian physiotherapy reimbursement criteria for fall prevention fails in screening appropriately fall-prone community-dwelling older adults.

OBJECTIVES: The incidence of falling in older adults has remained unchanged over the past decades, despite evidence-based prevention initiatives. Therefore, it is appropriate to reflect on the current screening approach for preventive initiatives. The objective of this study was to determine whether the multifactorial algorithm proposed by Lusardi et al. (2017) exhibits superior predictive validity compared to the currently employed algorithm by the Belgian National Institute for Health and Disability Insurance (NIHDI). METHODS: The current study includes a secondary analysis of data collected from a falls-related study in the Department of Rehabilitation Sciences at Ghent University to compare the predictive validity of the two algorithms. Sensitivity, specificity, positive and negative predictive value and area under the curve (AUC) were calculated to ascertain which algorithm is more accurate. RESULTS: The database included a total of 94 community-dwelling older adults (mean age 76 years ±7.4, 35% male). Thirty-nine participants experienced at least one fall in the 8 month follow up. Lusardi's approach has a higher sensitivity score (89.7% compared to 10.3%) and negative predictive value (89.9% compared to 61.1%), but a lower specificity score (61.8% compared to 100%) and positive predictive value (62.2% compared to 100%) than the NIHDI approach. The AUC is 0.76 for Lusardi's approach and 0.55 for the NIHDI approach. CONCLUSION: The use of the multifactorial algorithm proposed by Lusardi et al. may be significant and more accurate in identifying adults at risk to falls. Further research is needed particularly with a larger, more heterogenous group of older adults.

Nurses' perspectives on inpatient falls in a large academic hospital in South Africa.

BACKGROUND: Falls risk assessment tools, including the Morse Falls Scale, have been used for years, and yet falls remain key adverse events in hospitals. Nurses are key role players in falls prevention and can champion patient safety. OBJECTIVES: The aim of the study was to explore ward nurses' attitudes, knowledge and practices regarding the use of falls risk assessment tools, institutional falls policy and falls prevention. METHODS: A survey design was used. All permanent ward nurses were eligible to participate, and a convenience sample was used. RESULTS: Nurses endorsed the Morse Falls Scale, recommended by institutional policy, as effective in reducing falls and indicated that incident reporting measured progress on monitoring fall events. Falls prevention training was scanty; however, nurses were keen for further education of falls. CONCLUSION: Effective falls risk management needs to extend beyond promulgating policy and actively address nursing and patient education.Contribution: This study adds to the sparse literature regarding nursing practice and falls prevention in a developing country. Recommendations for change have been made.

'I don't want to impose on anybody': Older people and their families discuss their perceptions of risk, cause and care in the context of falls.

BACKGROUND: Falls in hospitalised patients remain an ongoing challenge for healthcare systems internationally. Limited research exists on the perspectives of older people on falls risk, cause and care. OBJECTIVES: This study explored the experiences of patients and their families after a fall in a healthcare facility. METHODS: Semi-structured interviews were conducted with patients and families to explore the experience of having a fall. Data were analysed thematically. RESULTS: The themes that emerged from the 14 interviews included the following: explanations; physical environment; communication; experiences of care; perceptions of risk; ageism; feelings towards the fall; and independence and dignity. CONCLUSIONS: This research emphasises the diversity in older people's experiences after experiencing a fall. Falls prevention should be incorporated as one part of healthy, dignified ageing. IMPLICATIONS FOR PRACTICE: Falls prevention and management strategies should be multifactorial, including enhanced communication with the patient and their families. When engaging in education and awareness, falls prevention should be positioned as one component of independent and dignified healthy ageing.

Falls risk perception measures in hospital: a COSMIN systematic review.

Falls prevention in hospital continues to be a research priority because of the poor health outcomes and financial burdens that can arise. Recently updated World Guidelines for Falls Prevention and Management strongly recommend evaluating patients' concerns about falling as part of a multifactorial assessment. The aim of this systematic review was to evaluate the quality of falls risk perception measures for adults in a hospital setting. This review was conducted using the Consensus-based Standards for the selection of health Measurement Instruments guidelines and provides a comprehensive summary of these instruments, including psychometric properties, feasibility and clinical recommendations for their use. The review followed a prospectively registered protocol, in which a total of ten databases were searched between the years 2002 and 2022. Studies were included if the instruments measured falls risk perception and/or other psychological falls constructs, if they were conducted in a hospital setting and if the target population contained hospital inpatients. A total of 18 studies met the inclusion criteria, encompassing 20 falls risk perception measures. These falls risk perception instruments were grouped into five falls-related constructs: Balance Confidence, Falls Efficacy/Concern, Fear of Falling, Self-Awareness and Behaviour/Intention. Two of the patient reported outcome measures (PROMs) received Class A recommendations (Falls Risk Perception Questionnaire and the Spinal Cord Injury-Falls Concern Scale); however, this rating is only applicable for the populations/context described in the studies. Thirteen PROMs received Class B recommendations, solidifying the need for further validation studies of these PROMs.

The smart-home study: A feasibility study to pilot the use of smartphone technology to identify environmental falls risk factors in the home.

Introduction: While occupational therapy home assessments are effective to identify environmental falls risk factors, patients may not receive these services due to workforce distribution and geographical distances. Technology may offer a new way for occupational therapists to conduct home assessments to identify environmental fall risks. Objectives: To (i) explore the feasability of identifying environmental risk factors using smartphone technology, (ii) develop and pilot a suite of procedures for taking smartphone images and (iii) examine the inter-rater reliability and content validity between occupational therapists when assessing smartphone images using a standardised assessment tool. Method: Following ethical approval a procedure was developed and participants recruited to submit smartphone images of their bedroom, bathroom and toilet. Two independent occupational therapists then assessed these images using a home safety checklist. Findings were analysed using inferential and descriptive statistics. Results: Of 100 volunteers screened, 20 individuals participated. A guideline for instructing patients to take home images was developed and tested. Participants averaged 9.00 minutes (SD 4.401) to complete the task, whilst occupational therapists took approximately 8 minutes to review the images. The inter-rater reliability between the two therapists was 0.740 (95% CI: 0.452-0.888). Conclusion: The study found that use of smartphones was to a large extent feasible and conclude that the use of smartphone technologies is a potential complimentary service to traditional home visits. The effective prescription of equipment in this trial was identified as a challenge. The impact on costs and potential falls incidents remains uncertain and more research is warranted in representative populations.

Can handgrip strength measurements predict postural balance performance in older women?

OBJECTIVES: The link between handgrip strength and postural balance in older adults is not well understood. This study aimed to examine the correlations between postural balance performance and handgrip peak force and rate of force development (RFD) measurements in older women. METHODS: Twenty older women (67 ± 5 years) participated in this study. Handgrip contractions were used to assess peak force, peak RFD, and RFD at 0-100 (RFD100) and 0-200 (RFD200) ms. Postural balance was evaluated using a commercially designed balance testing device, which provides a measurement of static stability based on the sway index. RESULTS: There were significant correlations between sway index and handgrip peak force (r = -0.497, P = 0.026), peak RFD (r = -0.552, P = 0.012), RFD100 (r = -0.539, P = 0.014), and RFD200 (r = -0.499, P = 0.025). Stepwise multiple regression analysis indicated that handgrip peak RFD was the single best predictor of sway index (R2 = 0.305). The other variables, including peak force, did not add any unique variance to the stepwise prediction model. CONCLUSION: These findings suggest that handgrip strength, and in particular peak RFD, may be an effective parameter at predicting postural balance performance in older women.

Differential Item Functioning of the Mini-BESTest Balance Measure: A Rasch Analysis Study.

The Mini-Balance Evaluation Systems Test (Mini-BESTest), a 14-item scale, has high content validity for balance assessment. This study further examines the construct validity of the Mini-BESTest with an emphasis on its measurement invariance. The Mini-BESTest was administered to 292 neurological patients in two sessions (before and after rehabilitation) and evaluated with the Rasch analysis (Many-Facet Rating Scale Model: persons, items, sessions). Categories' order and fit to the model were assessed. Next, maps, dimensionality, and differential item functioning (DIF) were examined for construct validity evaluation. DIF was inspected for several clinically important variables, including session, diagnosis, and assistive devices. Mini-BESTest items had ordered categories and fitted the Rasch model. The item map did not flag severe construct underrepresentation. The dimensionality analysis showed that another variable extraneous to balance affected the score of a few items. However, this multidimensionality had only a modest impact on measures. Session did not cause DIF. DIF for assistive devices affected six items and caused a severe measurement artefact. The measurement artefact caused by DIF for diagnosis was negligible. The Mini-BESTest returns interval measures with robust construct validity and measurement invariance. However, caution should be used when comparing Mini-BESTest measures obtained with and without assistive devices.

A prospective analysis examining frailty remission and the association with future falls risk in older adults in England.

BACKGROUND: Previous research has shown older adults experience dynamic changes in frailty status. This study aimed to determine the occurrence of sustained frailty remission and how remission is associated with falls risk. METHODS: Participants who contributed data to the analysis were in the English Longitudinal Study of Ageing from Waves 1 to 8 (2002-2017). Frailty was defined across waves using the frailty index and categorised into robust, pre-frail and frail. We classified participants who improved their frailty category from Wave 1 (2002) to Wave 2 (2004) and sustained/improved category again into Wave 3 (2006) and compared them with those who were either robust or frail across Waves 1-3. Cox proportional hazard modelling was used to determine the risk of incident falls reported at Waves 4-8, with results expressed as hazard ratios and 95% confidence intervals. RESULTS: Of 2,564 participants, 389 (15·2%) improved frailty category and sustained this during Waves 2-3, 1,489 (58·1%) remained robust and 686 (26·8%) remained frail during Waves 1-3. During the 10-year period (Waves 4-8), a total of 549 participants reported a fall. Compared with those who remained frail during Waves 1-3, those who with sustained frailty remission had a lower risk of future falls (HR 0·41; 95% CI = 0·36-0·45). CONCLUSIONS: Frailty remission is possible and can be sustained across 5 years. There is a lower risk of future falls in those who sustain frailty remission compared with those who remain frail.

Exploring assessment of balance using virtual reality in patients at risk of chemotherapy-induced peripheral neuropathy.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity for people treated for cancer. Impaired balance and falls are functional consequences of CIPN. Virtual reality (VR) technology may be able to assess balance and identify patients at risk of falls. AIMS: To assess the impact of potentially neurotoxic chemotherapy on balance using VR, and explore associations between VR balance assessment, falls and CIPN. METHODS: This prospective, repeated measures longitudinal study was conducted at two Australian cancer centres. Eligible participants were commencing adjuvant chemotherapy containing a taxane for breast cancer, or oxaliplatin for colorectal cancer (CRC), per institutional guidelines. Balance assessments using VR were conducted at baseline, end of chemotherapy and 3 and 6 months after completion of chemotherapy. Participants also completed a comprehensive CIPN assessment comprising clinical and patient-reported outcomes, and recorded falls or near falls. RESULTS: Out of 34 participants consented, 24 (71%) had breast cancer and 10 (29%) had CRC. Compared to baseline, balance threshold was reduced in 10/28 (36%) evaluable participants assessed at the end of chemotherapy, and persistent in 7/22 (32%) at 6 months. CIPN was identified in 86% at end of chemotherapy and persisted to 6 months after chemotherapy completion in 73%. Falls or near falls were reported by 12/34 (35%) participants, and were associated with impaired VR balance threshold (P = 0.002). CONCLUSIONS: While VR balance assessment was no better at identifying CIPN than existing measures, it is a potential surrogate method to assess patients at risk of falls from CIPN.

The Role of Daily Step Count in Determining Risk Factors for Falls.

Falls risk is often assessed without considering exposure to risk. We examined the risk factors associated with falls in those with greater and lower levels of daily step count. Falls were recorded over 12 months using bimonthly calendars in community-dwelling older people (mean age 72.0, SD 6.9). Daily step count was measured using a pedometer worn consecutively for 7 days. A cut score of <5,575.5 steps/day was used to identify people with lower step count. Negative binominal models were used to identify cognitive, medical, and sensorimotor factors associated with falls in those with higher versus lower levels of daily step count. In those with lower daily step count, poorer executive function, slower gait speed, and lower steps per day were associated with increased falls risk. In those with higher step count, only mood was associated with increased falls risk. Considering daily step count is important when assessing falls risk in older people.

Validação de face, conteúdo e semântica da escala de avaliação do risco de quedas em pessoas idosas que vivem na comunidade / Face, content and semantic validation of the scale for assessing the risk of falls in community-dwelling elderly people / Validación facial, de contenido y semántica de la escala de evaluación del riesgo de caídas en ancianos residentes en la comunidad

Introdução: quedas em pessoas idosas constituem um sério problema de saúde e geram muitas preocupações para estudiosos e clínicos da geriatria e gerontologia. Objetivo: avaliar a validade de face e de conteúdo e a validade semântica de uma escala de avaliação do risco de quedas em idosos que vivem na comunidade. Método: trata-se de um estudo do tipo metodológico, com realização das seguintes etapas: validade de face e de conteúdo e análise semântica. Na análise de validade de face e de conteúdo, foram convidados sete juízes especialistas na área de saúde da pessoa idosa e do método em questão. Concernente à análise semântica, a referida escala foi aplicada em 20 idosos selecionadas por conveniência. Resultados: dos sete juízes contatados, cinco retornaram com os instrumentos. Na análise de aparência, cinco itens receberam concordância inferior a 80%. Na análise semântica, apenas dois itens foram identificados como de difícil compreensão pelas pessoas idosas. A segunda versão da escala apresentava 43 itens e, após avaliação dos juízes, passou a compor 44 itens. Conclusão: a escala apresenta validade de face, de conteúdo e semântica para o contexto atual e para a população-alvo estudada, sendo importante sua revisão e adequação em momentos pósteros a fim de acompanhar os avanços científicos da geriatria e gerontologia.

Introduction: falls in elderly people constitute a serious health problem and generate many concerns for scholars and clinicians in geriatrics and gerontology. Objective: to evaluate the face and content validity and semantic validity of a scale to assess the risk of falls in community-dwelling elderly people. Method: this is a methodological study, with the following stages: face and content validity and semantic analysis. For the face and content validity analysis, seven judges, experts in the area of elderly health and the method in question, were invited. Regarding the semantic analysis, the scale was applied to 20 elderly people selected by convenience. Results: of the seven judges contacted, five returned with the instruments. In the appearance analysis, five items received less than 80% agreement. In the semantic analysis, only two items were identified as difficult to understand by the elderly. The second version of the scale had 43 items and, after the judges' evaluation, it became 44 items. Conclusion: the scale presents face, content and semantic validity for the current context and for the target population studied, being important its revision and adequacy in later moments in order to follow the scientific advances in geriatrics and gerontology.

Introducción: las caídas en ancianos constituyen un grave problema de salud y generan muchas preocupaciones a los estudiosos y clínicos en geriatría y gerontología. Objetivo: evaluar la validez facial y de contenido y la validez semántica de una escala para evaluar el riesgo de caídas en ancianos residentes en la comunidad. Método: se trata de un estudio metodológico, con las siguientes etapas: validez facial y de contenido y análisis semántico. Para el análisis de la validez facial y de contenido se invitó a siete jueces, expertos en el ámbito de la salud de las personas mayores y en el método en cuestión. En cuanto al análisis semántico, la escala se aplicó a 20 ancianos seleccionados por conveniencia. Resultados: de los siete jueces contactados, cinco devolvieron los instrumentos. En el análisis de apariencia, cinco ítems recibieron menos del 80% de acuerdo. En el análisis semántico, sólo dos ítems fueron identificados como difíciles de entender por las personas mayores. La segunda versión de la escala tenía 43 ítems y, tras la evaluación de los jueces, pasó a tener 44 ítems. Conclusión: la escala presenta validez facial, de contenido y semántica para el contexto actual y para la población objetivo estudiada, siendo importante su revisión y adecuación en momentos posteriores para acompañar los avances científicos en geriatría y gerontología.