Stability recovery performance in adults over a wide age range: A multicentre reliability analysis using different lean-and-release test protocols.

The ability to effectively increase the base of support is crucial to prevent from falling due to stability disturbances and has been commonly assessed using the forward-directed lean-and-release test. With this multicentre study we examined whether the assessment of stability recovery performance using two different forward lean-and-release test protocols is reliable in adults over a wide age range. Ninety-seven healthy adults (age from 21 to 80 years) were randomly assigned to one out of two lean angle protocols: gradual increase to maximal forward-lean angle (maximal lean angle; n = 43; seven participants were excluded due to marker artefacts) or predefined lean angle (single lean angle; n = 26; 21 participants needed to be excluded due to multiple stepping after release or marker artefacts). Both protocols were repeated after 0.5 h and 48 h to investigate intra- and inter-session reliability. Stability recovery performance was examined using the margin of stability at release (MoSRL) and touchdown (MoSTD) and increase in base of support (BoSTD). Intraclass correlation coefficients (confidence intervals at 95%) for the maximal lean angle and for the single lean angle were respectively 0.93 (0.89-0.96) and 0.94 (0.89-0.97) in MoSRL, 0.85 (0.77-0.91) and 0.67 (0.48-0.82) in MoSTD and 0.88 (0.81-0.93) and 0.80 (0.66-0.90) in BoSTD, with equivalence being revealed for each parameter between all three measurements (p < 0.01). We concluded that the assessment of stability recovery performance parameters in adults over a wide age range with the means of the forward lean-and-release test is reliable, independent of the used lean angle protocol.

Oxyfunctionalization of nonsteroidal anti-inflammatory drugs by filamentous-fungi.

AIMS: We aimed to expand the microbial biocatalyst platform to generate essential oxyfunctionalized standards for pharmaceutical, toxicological and environmental research. In particular, we examined the production of oxyfunctionalized nonsteroidal anti-inflammatory drugs (NSAIDs) by filamentous-fungi. METHODS AND RESULTS: Four NSAIDs; diclofenac, ibuprofen, naproxen and mefenamic acid were used as substrates for oxyfunctionalization in a biocatalytic process involving three filamentous-fungi strains; Beauveria bassiana, Clitocybe nebularis and Mucor hiemalis. Oxyfunctionalized metabolites that are major degradation intermediates formed by Cytochrome P450 monooxygenases in human metabolism were produced in isolated yields of up to 99% using 1 g l-1 of substrate. In addition, a novel compound, 3',4'-dihydroxydiclofenac, was produced by B. bassiana. Proteomic analysis identified CYP548A5 that might be responsible for diclofenac oxyfunctionalization in B. bassiana. CONCLUSIONS: Efficient fungi catalysed oxyfunctionalization was achieved when using NSAIDs as substrates. High purities and isolated yields of the produced metabolites were achieved. SIGNIFICANCE AND IMPACT OF THE STUDY: The lack of current efficient synthetic strategies for oxyfunctionalization of NSAIDs is a bottleneck to perform pharmacokinetic, pharmacodynamic and toxicological analysis for the pharmaceutical industry. Additionally, oxyfunctionalized derivatives are needed for tracking the fate and impact of such metabolites in the environment. Herein, we described a fungi catalysed process that surpasses previously reported strategies in terms of efficiency, to synthesize oxyfunctionalized NSAIDs.

Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty.

PURPOSE: Only few long-term data on ligament-balanced cruciate-retaining total knee arthroplasty (CR TKA) are currently available. Either a mobile- or fixed-bearing insert can be chosen, which showed good mid-term outcome and few complications and revisions. This multi-centre retrospective cross-sectional cohort study investigated the 12-year results of primary TKA using a balancing gap technique and compared survival and clinical outcome between fixed and mobile inserts. METHODS: In this retrospective cross-sectional cohort study, 557 cases of three clinics (2 Swiss, 1 Dutch) operated between 1998 and 2003 with the first series of a TKA implanted with a balanced gap technique (433 (77.7%) fixed, 124 (22.3%) mobile (anterior-posterior gliding (7-9 mm) and rotational (15°) degrees of freedom) inserts) were included for survival analysis (Kaplan-Meier, by insert type). At the 12-year follow-up (FU) examination of 189 cases, range of motion, knee society score (KSS), numeric rating scale (NRS) for pain and satisfaction were determined and radiographs were evaluated by median tests, by insert type. RESULTS: Of 521 cases available for analysis, 28 (5.4%; 11 fixed, 17 mobile bearing) were revised. Mean cumulative survival after 12.4 years was 97.0% (95% CI 94.7-98.4) for fixed bearings and 85.4% (95% CI 77.5-90.7) after 12.2 years for mobile bearings, p < 0.0001. Patients' mean age at 11.0 years FU (n = 189) was 78.0 (range 54.5-97.3) years. Mean total KSS was 157.8 (24-200) points, and mean passive flexion was 114° (45-150); no clinical score differed significantly between fixed and mobile bearings. CONCLUSION: This study showed a superior survival for fixed bearing compared with mobile bearing in a CR TKA using a ligament-balanced technique after more than 12 years. Clinical outcomes are excellent to good after long-term follow-up, and similar for fixed and mobile bearing. LEVEL OF EVIDENCE: Therapeutic studies-retrospective cohort study, Level III.

Evaluation of left and right ventricular systolic and diastolic electromechanical synchrony in older people: a population-based observational study.

It is unknown whether physiological ageing also goes along with electromechanical asynchrony of contraction. Aim of the study was to evaluate synchrony of contraction in older people with ("non-healthy") or without ("healthy") evidence for structural cardiac disease. In 547 persons (age 76.7+/-5.5 years, 306 male, 241 female) recruited from a population-based cohort of the ActiFE-Ulm study including a random sample of people >/=65 years old living in the region of Ulm, Germany, various PW- and TDI-Doppler based markers for asynchrony were obtained by echocardiography. Within a subgroup of 84 healthy subjects, at most minimal systolic and diastolic asynchrony was found. Concerning systolic asynchrony, similar observations were made within the non-healthy subgroup. However, extent of diastolic left ventricular intraventricular asynchrony and also - by tendency - diastolic interventricular asynchrony was increased in comparison to the healthy subgroup. To conclude, no evidence that physiological ageing might go along with relevant left or right ventricular systolic or diastolic electromechanical asynchrony was found in our study. Furthermore, our population-based data support the results from other clinical studies with rather selected cohorts that structural heart diseases might go along with increased diastolic asynchrony.

Model development to study strategies of younger and older adults getting up from the floor.

BACKGROUND: Long lies after a fall remain a public health challenge. Many successful fall prevention programmes have been developed but only few of them include recovery strategies after a fall. Once better understood, such movement strategies could be implemented into training interventions. AIMS: A model of motion sequences describing successful movement strategies for rising from the floor in different age groups was developed. Possible risk factors for poor rising performance such as flexibility and muscle power were evaluated. METHODS: Fourteen younger subjects between 20 and 50 years of age and 10 healthy older subjects (60+ years) were included. Movement strategies and key components of different rising sequences were determined from video analyses. The temporal parameters of transfers and number of components within the motion sequences were calculated. Possible explanatory variables for differences in rising performance were assessed (leg extension power, flexibility of the knee- and hip joints). RESULTS: Seven different components were identified for the lie-to-stand-walk transfer, labelled as lying, initiation, positioning, supporting, elevation, or stabilisation component followed by standing and/or walking. Median time to rise was significantly longer in older subjects (older 5.7s vs. younger 3.7s; p < 0.001), and leg extension power (left p = 0.002, right p = 0.013) and knee flexibility (left p = 0.019, right p = 0.025) were significantly lower. The number of components for rising was correlated with hip flexibility (r = 0.514) and maximal power (r = 0.582). The time to rise was correlated with minimal goniometric knee angle of the less flexible leg (r = 0.527) and maximal leg extension power (r = 0.725). CONCLUSIONS: A motion sequence model containing seven different components identified by individual key-frames could be established. Age-related differences in rising strategies and performance were identified.

Validity of linear encoder measurement of sit-to-stand performance power in older people.

OBJECTIVE: To investigate construct validity of linear encoder measurement of sit-to-stand performance power in older people by showing associations with relevant functional performance and physiological parameters. DESIGN: Cross-sectional study. SETTING: Movement laboratory of a geriatric rehabilitation clinic. PARTICIPANTS: Eighty-eight community-dwelling, cognitively unimpaired older women (mean age 78 years). MAIN OUTCOME MEASURES: Sit-to-stand performance power and leg power were assessed using a linear encoder and the Nottingham Power Rig, respectively. Gait speed was measured on an instrumented walkway. Maximum quadriceps and hand grip strength were assessed using dynamometers. Mid-thigh muscle cross-sectional area of both legs was measured using magnetic resonance imaging. RESULTS: Associations of sit-to-stand performance power with power assessed by the Nottingham Power Rig, maximum gait speed and muscle cross-sectional area were r=0.646, r=0.536 and r=0.514, respectively. A linear regression model explained 50% of the variance in sit-to-stand performance power including muscle cross-sectional area (p=0.001), maximum gait speed (p=0.002), and power assessed by the Nottingham Power Rig (p=0.006). CONCLUSIONS: Construct validity of linear encoder measurement of sit-to-stand power was shown at functional level and morphological level for older women. This measure could be used in routine clinical practice as well as in large-scale studies. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00003622.

Temporal and kinematic variables for real-world falls harvested from lumbar sensors in the elderly population.

Automatic fall detection will reduce the consequences of falls in the elderly and promote independent living, ensuring people can confidently live safely at home. Inertial sensor technology can distinguish falls from normal activities. However, <;7% of studies have used fall data recorded from elderly people in real life. The FARSEEING project has compiled a database of real life falls from elderly people, to gain new knowledge about fall events. We have extracted temporal and kinematic parameters to further improve the development of fall detection algorithms. A total of 100 real-world falls were analysed. Subjects with a known fall history were recruited, inertial sensors were attached to L5 and a fall report, following a fall, was used to extract the fall signal. This data-set was examined, and variables were extracted that include upper and lower impact peak values, posture angle change during the fall and time of occurrence. These extracted parameters, can be used to inform the design of fall-detection algorithms for real-world falls detection in the elderly.

The association between the home environment and physical activity in community-dwelling older adults.

UNLABELLED: Physical activity (PA) decreases with increasing age despite the fact that PA exerts beneficial effects on many age-related diseases and conditions. Consequently, there is an interest in modifiable factors that may influence PA among older persons. The purpose of this study was to examine the association between PA and the home environment in well-functioning older community-dwelling persons. METHOD: This study used a person-environment (P-E) fit perspective to the home environment, operationalized by means of assessment of functional limitations in 81 community-dwelling persons (median age 79 years) as well as environmental barriers in their home environments and the nearby exterior surroundings. The interaction between functional limitations and environmental barriers generated a score expressing the magnitude of P-E fit problems in their home environment. PA was rated with a questionnaire covering household-related and recreational activities. RESULTS: We found a significant association between PA and the magnitude of P-E fit problems that explained 3.9 % of the variance of PA. The number of environmental barriers per se was not significantly associated with PA, while functional limitations explained 6.8 % of the variance of PA. CONCLUSION: In well-functioning older persons living in the community environmental aspects of housing demonstrated a weak association with PA.

Prospective evaluation of renal function, serum vitamin D level, and risk of fall and fracture in community-dwelling elderly subjects.

SUMMARY: This prospective study in elderly showed that kidney function plays a minor role in explaining the high prevalence of vitamin D deficiency seen in noninstitutionalized elderly subjects. However, 25-hydroxyvitamin D levels were clearly inversely associated with risk for first fall, which was especially seen in subjects with calcium levels above median. INTRODUCTION: Few prospective studies in elderly exist that have investigated the association of renal dysfunction and vitamin D status on risk of falls. The aim of this study is to evaluate the association of renal function with 25-hydroxyvitamin D (25-OH-D) levels and, secondly, to assess the role of both factors on the risk of falls and subsequent bone fractures. METHODS: This is a prospective population-based cohort study among noninstitutionalized elderly subjects during a 1-year follow-up. 25-OH-D levels and renal function were estimated, the latter by cystatin C-based equations. Information on falls was assessed prospectively. RESULTS: Overall, 1,385 subjects aged 65 and older were included in the study (mean age 75.6 years), of whom 9.2 % had a 25-OH-D serum level above 75 nmol/L (US units 30 ng/mL); 41.4 %, between 50 and 75 nmol/L (US units 20 to 29 ng/mL, insufficiency); and 49.4 %, <50 nmol/L (US units <20 ng/mL, deficiency). We found no association of chronic kidney disease with risk of first fall. In contrast, 25-OH-D serum categories were clearly associated with risk of first fall and we found evidence of effect modification with calcium levels. In the group with a calcium level above the median (≥ 9.6 mg/dL), subjects with 25-OH-D serum level between 50 and 75 nmol/L and with concentrations <50 nmol/L had a hazard rate ratio (HRR) of 1.75 (1.03-2.87) and 1.93 (1.10-3.37) for risk of first fall. 25-OH-D serum levels were also associated with several markers of inflammation and hemodynamic stress. CONCLUSIONS: We demonstrated an association of 25-OH-D serum levels and risk of first fall, which was especially evident in subjects with serum calcium in upper normal, independent of renal function.

Development of a standard fall data format for signals from body-worn sensors : the FARSEEING consensus.

Objective measurement of real-world fall events by using body-worn sensor devices can improve the understanding of falls in older people and enable new technology to prevent, predict, and automatically recognize falls. However, these events are rare and hence challenging to capture. The FARSEEING (FAll Repository for the design of Smart and sElf-adapaive Environments prolonging INdependent livinG) consortium and associated partners strongly argue that a sufficient dataset of real-world falls can only be acquired through a collaboration of many research groups. Therefore, the major aim of the FARSEEING project is to build a meta-database of real-world falls. To establish this meta-database, standardization of data is necessary to make it possible to combine different sources for analysis and to guarantee data quality. A consensus process was started in January 2012 to propose a standard fall data format, involving 40 experts from different countries and different disciplines working in the field of fall recording and fall prevention. During a web-based Delphi process, possible variables to describe participants, falls, and fall signals were collected and rated by the experts. The summarized results were presented and finally discussed during a workshop at the 20th Conference of the International Society of Posture and Gait Research 2012, in Trondheim, Norway. The consensus includes recommendations for a fall definition, fall reporting (including fall reporting frequency, and fall reporting variables), a minimum clinical dataset, a sensor configuration, and variables to describe the signal characteristics.

Fall detection with body-worn sensors : a systematic review.

BACKGROUND AND AIMS: Falls among older people remain a major public health challenge. Body-worn sensors are needed to improve the understanding of the underlying mechanisms and kinematics of falls. The aim of this systematic review is to assemble, extract and critically discuss the information available in published studies, as well as the characteristics of these investigations (fall documentation and technical characteristics). METHODS: The searching of publically accessible electronic literature databases for articles on fall detection with body-worn sensors identified a collection of 96 records (33 journal articles, 60 conference proceedings and 3 project reports) published between 1998 and 2012. These publications were analysed by two independent expert reviewers. Information was extracted into a custom-built data form and processed using SPSS (SPSS Inc., Chicago, IL, USA). RESULTS: The main findings were the lack of agreement between the methodology and documentation protocols (study, fall reporting and technical characteristics) used in the studies, as well as a substantial lack of real-world fall recordings. A methodological pitfall identified in most articles was the lack of an established fall definition. The types of sensors and their technical specifications varied considerably between studies. CONCLUSION: Limited methodological agreement between sensor-based fall detection studies using body-worn sensors was identified. Published evidence-based support for commercially available fall detection devices is still lacking. A worldwide research group consensus is needed to address fundamental issues such as incident verification, the establishment of guidelines for fall reporting and the development of a common fall definition.

Assessment of adaptive walking performance.

Although mostly negative aspects are reported to be associated with gait variability, irregular walking is needed when walking performance has to be adapted to specific environmental conditions. The aim of this study was to evaluate the test-retest reliability and discriminative ability of a measure to assess adaptive walking performance and to identify parameters associated with test performance in young and elderly subjects. Eighteen older (mean age 78.1 years) and 19 young women (mean age 30.8 years) were instructed to walk as precisely as possible over a defined course targeting 26 arbitrarily positioned rectangle boxes fixed on an instrumented walk way with embedded pressure sensors. ICC(1,1) of 0.79 demonstrated sufficient reliability in the cohort of older women. Targeting was significantly worse (or deviation was larger) in older women than in young women (mean 3.20cm versus 2.27cm, p=0.005). Mean gait speed of the older women was higher during the test (0.50m/s versus 0.40m/s, p=0.020), but not during unconstrained walking (1.15m/s versus 1.50m/s, p<0.001). The deviation measure classified 78% of the subjects into correct age group (sensitivity 67%, specificity 90%, p=0.003). Adaptive walking performance was associated with parameters describing physical performance as well as with cognitive executive function. This study shows that this test of adaptive walking performance is a reliable measure of irregular walking with ability to discriminate between young and older subjects. Our results suggest that older persons might try to camouflage their lack of accuracy during adaptive walking by higher gait speed.

The PRIPS study: screening battery for subjects at risk for Parkinson's disease.

BACKGROUND AND PURPOSE: Screening batteries to narrow down a target-at-risk population are essential for trials testing neuroprotective compounds aiming to delay or prevent onset of Parkinson's disease (PD). METHODS: The PRIPS study focuses on early detection of incident PD in 1847 at baseline PD-free subjects, and assessed age, male gender, positive family history, hyposmia, subtle motor impairment and enlarged substantia nigra hyperechogenicity (SN+). RESULTS: After 3 years follow-up 11 subjects had developed PD. In this analysis of the secondary outcome parameters, sensitivity and specificity of baseline markers for incident PD were calculated in 1352 subjects with complete datasets (10 PD patients). The best approach for prediction of incident PD comprised three steps: (i) prescreening for age, (ii) primary screening for positive family history and/or hyposmia, and (iii) secondary screening for SN+. CONCLUSION: With this approach, one out of 16 positively screened participants developed PD compared to one out of 135 in the original cohort. This corresponds to a sensitivity of 80.0%, a specificity of 90.6% and a positive predictive value of 6.1%. These values are higher than for any single screening instrument but still too low for a feasible and cost-effective screening strategy which might require longer follow-up intervals and application of additional instruments.

Proposal for a multiphase fall model based on real-world fall recordings with body-fixed sensors.

Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses.The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals.

Smartphone-based solutions for fall detection and prevention: the FARSEEING approach.

Falls are not an inevitable consequence of aging. The risk and rate of falls can be reduced. Recent improvements in smartphone technology enable implementation of a wide variety of services and applications, thus making the smartphone more of a digital companion than simply a communication tool. This paper presents the results obtained by the FARSEEING project where smartphones are one example of intervention in a population-based scenario. The applications developed take advantage of the smartphone-embedded inertial sensors and require that subjects wear the smartphone by means of a waist belt. The uFall Android application has been developed for monitoring the user's motor activities at home. The application does not require any direct interaction with the user and it is also capable of running a real-time fall-detection algorithm. uTUG is a stand-alone application for instrumenting the Timed Up and Go test, which is a test often included in fall risk assessment protocols. The application acts like a pocket-sized motion laboratory, since it is capable not only of recording the trial but also of processing the data and immediately displaying the results. uTUG is designed to be self-administrable at home.

Physical activity of moderately impaired elderly stroke patients during rehabilitation.

In older adults, physical activity (PA) is promoted for public health preventive effort. It is also a major target in the rehabilitation process. Existing assessment tools in the clinical routine do not include any aspects of PA or participation and are often prone to floor or ceiling effects. The aim of this study was to document the process of rehabilitation by activity monitoring without floor or ceiling effects. Ninety-two stroke patients of a geriatric rehabilitation unit (mean age 82 years, ±6.21 years, 61% women) were included in an observational study to assess physical capacity (balance, chair rise, gait speed) and PA at admission and two weeks thereafter. PA was measured through an ambulatory activity monitor based on accelerometers and gyroscopes and showed no floor or ceiling effects. Floor effects were however documented for measures of physical capacity (admission 5-11%; follow-up 2-9%) and ceiling effects were registered for the balance test (admission 17.4%; follow-up 22.8%). Improvements were documented for measures of physical capacity as well as for PA (all p < 0.001). We conclude that the assessment of PA by activity monitoring is a valuable measure to document objectively the process of rehabilitation without floor or ceiling effects.

Robotic-assisted rehabilitation of proximal humerus fractures in virtual environments: a pilot study.

BACKGROUND AND OBJECTIVE: With the growing incidence of upper arm fractures among older people, innovative treatment strategies will be needed in geriatric rehabilitation. A pilot study was designed to test the feasibility of robotic-assisted rehabilitation after proximal humeral fractures. PATIENTS AND METHODS: Within a sample of 8 older patients (79.5 ± 6.12 years), functional ability, quality and range of movement, self-rated impairment, quality of life, and user satisfaction were measured in an observational pre-/postdesign. During rehabilitation robotic-assisted training was applied. RESULTS: Training motivation and acceptance were high in this sample, showing improvements in functional ability (p = 0.03), quality of movement (p = 0.02), range of motion, self-evaluation (p = 0.01), and quality of life. CONCLUSION: This pilot study highlights the possible implementation of robotic-assisted rehabilitation after proximal humeral fractures in geriatric rehabilitation. The measurement and training protocol was suitable to document progress in rehabilitation.

Reference values and early determinants of intra-abdominal fat mass in primary school children.

BACKGROUND: Intra-abdominal fat (IAF) is a valuable predictor of cardiovascular morbidity. However, neither reference values nor determinants are known in children. METHODS: IAF was assessed as sonographically measured intra-abdominal depth in 1,046 children [median age 7.6 years, interquartile range (IQR) 7.2-7.9; 54% boys] of the URMEL-ICE study. RESULTS: The intraclass correlation coefficient for intraobserver agreement was 0.93. The median IAF showed a significant gender difference (boys: 54.6 mm, IQR 50.1-59.3, vs. girls: 51.7 mm, IQR 46.3-56.4; p < 0.001). Age- and gender-specific centiles were generated. IAF showed a positive correlation to systolic blood pressure [regression coefficient (ß) = 0.24 mm Hg/mm; p < 0.001] and a negative correlation to HDL cholesterol (ß = -0.01 mmol/l/mm; p < 0.001). IAF showed a positive association with increased paternal and maternal BMI (ß = 0.28 mm/kg/m(2) and 0.27 mm/kg/m(2); p < 0.001), increased weight gain in the first 2 years of life (ß = 3.04 mm; p < 0.001), and maternal smoking during pregnancy (ß = 2.4 mm; p = 0.001). Increased parental education was negatively associated with IAF (maternal: ß = -0.65 mm/degree; p = 0.004, and paternal: ß = -0.61 mm/degree; p = 0.002). CONCLUSION: Sonography was a reliable tool to estimate IAF. Factors influencing IAF included rapid infant weight gain, smoking during pregnancy, and parental BMI and education. Since IAF showed an association with cardiovascular risk factors even in prepubertal children, it might become a valuable predictor of cardiovascular vulnerability.

Comparison of acceleration signals of simulated and real-world backward falls.

Most of the knowledge on falls of older persons has been obtained from oral reports that might be biased in many ways. Fall simulations are widely used to gain insight into circumstances of falls, but the results, at least concerning fall detection, are not convincing. Variation of acceleration and maximum jerk of 5 real-world backward falls of 4 older persons (mean age 68.8 years) were compared to the corresponding signals of simulated backward falls by 18 healthy students. Students were instructed to "fall to the back as if you were a frail old person" during experiment 1. In experiment 2, students were instructed not to fall, if possible, when released from a backward lean. Data acquisition was performed using a tri-axial acceleration sensor. In experiment 1, there was significantly more variation within the acceleration signals and maximum jerk was higher in the real-world falls, compared to the fall simulation. Conversely, all values of acceleration and jerk were higher for the fall simulations, compared to real-world falls in experiment 2. The present findings demonstrate differences between real-world falls and fall simulations. If fall simulations are used, their limitations should be noted and the protocol should be adapted to better match real-world falls.

Availability and use of hip protectors in residents of nursing homes.

SUMMARY: Potential predictors of availability and use of hip protectors were studied in residents of 48 nursing homes. The likelihood of being offered a hip protector was reduced in men, in residents with very low or very high care needs, in residents with migration background, and in recipients of welfare aid. INTRODUCTION: The purpose of this study is to analyze potential predictors of availability and use of hip protectors in residents of nursing homes. METHODS: In 48 German nursing homes, individual information on availability and use of hip protectors was collected from all institutionalized residents (3,924 residents; 78.2% women). Information on nursing home characteristics was obtained by telephone interview. The effect of individual variables and of nursing home characteristics on hip protector availability and use was estimated using multilevel logistic regression analyses. RESULTS: The prevalence of hip protectors being made available was 10.0% in women and 6.2% in men. Sixty-four percent of those with a hip protector used it during the 4 weeks prior to the examination. The likelihood of being offered a hip protector was reduced in men (odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43; 0.83), in residents with very low or very high care needs (OR, 0.32; 95% CI, 0.18; 0.56 and OR, 0.55; 95% CI, 0.38; 0.79, respectively), in residents with a migration background (OR, 0.30; 95% CI, 0.09; 0.99), and in recipients of welfare aid (OR, 0.60; 95% CI, 0.44; 0.81). Nursing home characteristics such as the size of the nursing home or staff participation rate in training measures had no effect on hip protector availability and use. CONCLUSION: Predictors of hip protector availability were sex, the degree of care need, migration status, and welfare aid. The lower availability of hip protectors in residents with welfare aid and migration status may be an indicator for health inequality in the German health system.