SP - Falls

Introduction 

Older people can commonly experience reduced appetite and it can be assessed very simply by questionnaires such as the Simplified Nutritional Appetite Questionnaire (SNAQ). Decreased appetite is associated with sarcopenia and frailty, which in turn are related to falls. The aim is to assess if screening for poor appetite might aid in predicting risk of future falls by exploring association between appetite score and falls at three and six months in older people with upper limb fracture. 

Methods 

A secondary data analysis. Baseline appetite was assessed using the SNAQ, with score <14/20 defining poor appetite. Descriptive statistics summarised characteristics associated with poor appetite. Association between baseline characteristics and the presence of falls at 3 and 6 months were measured using logistic regression. 

Results 

100 participants (80% females and 20% males, median age 73 years (IQR 9.75)). 9% had poor appetite. Sarcopenia (SARC-F score ≥4), frailty (FRIED phenotype) and a higher number of comorbidities and medications were more prevalent in individuals with poor appetite. Appetite at baseline was not related to occurrence of falls at 3 and 6 months (P = 0.627, P = 0.698 respectively). Sarcopenia, number of comorbidities, EQ5D5L mobility, EQ5D5L self-care and EQ5D5L activities were associated with occurrence of falls at 3 months. There was no relationship between baseline variables and falls at 6 months. In multivariate analysis, the association between EQ5D5L activities and the presence of falls at 3-months remained (OR 3.485 (95% CI 1.463, 8.302), P= 0.005). 

Conclusion 

In this study population, poor appetite was related to higher prevalence of sarcopenia and frailty but was not predictive of future falls. Sarcopenia, comorbidities, EQ5D5L mobility and self-care were associated with falls at 3 months. Identifying individuals with sarcopenia and difficulty in performing routine activities continues to be imperative to minimise the risk of future falls.

Background

Geriatric medicine in the Emergency Department (ED) represents an advancing field that integrates the principles of geriatric care into urgent care settings. Several studies have evaluated the impact of geriatrician consultations in ED’s on reducing hospital admissions, promoting safe discharges directly from the ED, and ensuring timely admissions to geriatric wards when necessary. However, to our knowledge, there have been no studies to assess the effectiveness of this intervention amongst those patients presenting after falls.

Aim

To evaluate the impact of geriatrician reviews in ED amongst older patients presenting after falls in reducing ED 30-day readmission rates, length of stay (LOS) and disposition.

Methods

A single-centre case control study was undertaken at Monash Medical Centre ED, Victoria. Participants included patients above the age of 65 that presented after a fall from February to August 2022. A total of 1029 patients were identified, out of which 66 cases were seen by geriatricians and 139 controls who received usual care were randomly selected. Retrospective data regarding patient characteristics and outcomes were collected from electronic medical records.

Results

Most patients seen by geriatricians were multi-morbid, frail and had polypharmacy. There was a trend towards reduction in 30-day representation in the geriatrician group compared to control group (6% vs 13%, p>0.05). The geriatrician cohort had a longer LOS in ED (p=0.002). On discharge, 85% of controls were only referred to their primary care providers, whereas 35% of the geriatrician cohort were referred to hospital-led services, 18% to community-led services and 9% to ambulatory admission programmes (p<0.001). 47% of geriatrician cohort were referred to care coordinators compared to 18% of controls (p<0.001).

Conclusions

This study demonstrated that positioning geriatricians at the hospital’s front door enabled early specialist assessment for the more complex and multi-morbid older patients presenting after falls. It also demonstrated effective utilisation of out of hospital-based services and allied health referrals, which is likely to improve patient outcomes and ultimately reduces burden on primary care providers. 

Background: Falls in people with dementia often result in physical and psychological impacts, reducing independence and increasing healthcare costs. Falls place a significant economic burden on the healthcare system. Although individuals with dementia face a heightened risk of falling, there is limited evidence supporting effective home-based interventions for this population. Methods: A mixed-methods process evaluation was embedded within a pilot cluster randomised controlled trial, guided by a realist framework. The evaluation was conducted across six UK sites (three intervention, three control). It included fidelity checks of routine data collection, observation of intervention sessions, multidisciplinary team (MDT) meetings, and therapist supervision. Semi-structured interviews were conducted with people with dementia, caregivers, and therapists. Results: High fidelity was achieved in home assessments and intervention delivery, with participants completing an average of 15 out of 22 planned sessions. Regular home visits enhanced engagement and motivation, while MDT support boosted therapist confidence in managing complex cases. Most participants met their functional goals and reported improved confidence. However, challenges included geographical and capacity variability in service delivery and inconsistent referral pathways. Therapists’ attitudes toward advanced dementia influenced intervention delivery. The dyadic approach supported activity engagement but occasionally increased caregiver responsibilities. Conclusions: The Maintain intervention was feasible and acceptable, with preliminary evidence of improved daily living activities and quality of life. A future trial should focus on standardising MDT support, addressing falls-related anxiety, and developing sustainable post-intervention strategies. Protocol adaptations, such as video consultations, demonstrated potential to mitigate workforce challenges.

Introduction

Sarcopenia is common in patients with hip fracture, but few studies have examined whether assessment of sarcopenia improves prediction of adverse post-operative outcomes. We examined whether sarcopenia, diagnosed using handgrip strength (HGS), could predict outcomes after hip fracture.

Methods

Routinely collected data from the National Hip Fracture Database were combined with locally collected HGS data from a high-volume orthopaedic trauma unit. Patients aged ≥65years with surgically managed, non-pathological hip fracture with grip strength measured on admission were included. The European Working Group on Sarcopenia in Older People (EWGSOP2) thresholds were used to identify patients with or without sarcopenia; those unable to complete grip strength testing were also included in analyses. Outcomes examined were 30-day and 120-day mortality, residential status and mobility, prolonged length of stay (>15 days) and post-operative delirium. Binary logistic regression models were used to examine prognostic value of HGS, and discriminant ability for the Nottingham Hip Fracture Score (NHFS) alone and on adding sarcopenia status were compared using c-statistics.

Results

We analysed data from 282 individuals; mean age 83.2 (SD 9.2) years; 200 (70.9%) were female. 99 (35.1%) patients had sarcopenia and 109 (38.7%) were unable to complete testing. Sarcopenia predicted higher 120-day mortality (OR 13.0, 95%CI 1.7-101.1, p=0.014), but not 30-day mortality (OR 1.5, 95%CI 0.1-16.9, p=0.74). Patients unable to complete HGS testing had higher 30-day mortality (OR 13.5, 95%CI 1.8-103.8, p=0.012) and 120-day mortality (OR 34.5, 95%CI 4.6-258.7, p<0.001). Sarcopenia status did not significantly improve discrimination for mobility but improved prediction of 120-day residential status (c-statistic 0.89 [95%CI 0.85-0.94] for NHFS+sarcopenia vs 0.82 [95%CI 0.76-0.87] for NHFS alone) and post-operative delirium (c-statistic 0.91 [95%CI 0.87-0.94] vs 0.78 [95%CI 0.73-0.84]).

Conclusion

Sarcopenia assessment via HGS testing may provide additional prognostic information to existing risk scores in older patients with hip fracture.

Objectives: Older adults hospitalized with a hip fracture are at risk for adverse health outcomes depending on their level of frailty. This study examined how frailty levels prior to admission impacted length of stay (LOS), requirement for alternative level of care (ALC), returning home post-discharge, and mortality.

Methods: A random sample was generated from all hip fracture patients aged 65 and older admitted to a Level One Trauma Centre in New Brunswick, Canada from 2015-2019. This sample had their frailty level determined retrospectively using the Pictorial Fit-Frail Scale and the patients’ hospital electronic health record.

Results: Our study included 189 patients (mean age: 83.2 ± 8.2, 73.0% female), representing 91 not frail to mildly frail (48.2%; NF-MF), 32 moderately frail (16.9%; ModF), and 66 severely frail (34.9%; SF) patients. The ModF patients had a longer LOS (median: 20.0 days, IQR=22.5) compared to NF-MF patients (median: 11.0 days, IQR=10.0, p=0.039, Kruskal-Wallis test) and SF patients (median: 8 days, IQR=5.5, p<0.0001, Kruskal-Wallis test). More ModF patients (56.3%) required an ALC stay in acute care compared to NF-MF (30.8%) and SF (28.8%) patients (p=0.016, Chi-square test). More SF patients (28.8%) died in hospital or within six months post-discharge compared to NF-MF (8.8%) patients (p=0.005, Chi-square test). Logistic regression revealed that both NF-MF (OR=8.11, 95% CI: [3.12-21.06], p<0.001) and ModF (OR=5.18, 95% CI: [0.85-0.95], p=0.007) patients had greater odds of returning home compared to SF patients when accounting for sex, age, and time to surgery.

Conclusions: A patient’s level of frailty prior to hospital admission impacts various health outcomes following a hip fracture and may provide helpful information for guiding treatment as well as discussions about health care.  

Introduction

Fall-related injuries such as fractures are on the rise as the older adult population grows in New Brunswick, Canada. These injuries can lead to hospitalization and transitions in care that are complicated for patients and families. The objective was to investigate the impact of patient navigators (PNs) working alongside the healthcare team on patient and family experiences, as compared to the usual standard of care (SOC), for adults aged 65 and older admitted with a fracture to an Orthopedic Unit at one hospital in New Brunswick.

Methods

A concurrent embedded mixed methods design, in which the quantitative randomized control trial had an embedded qualitative component. The results for the family caregiver qualitative component, which used an interpretive description approach, are presented.

Results

Semi-structured interviews were conducted and thematically analyzed for 15 family caregivers (8 PN group, 7 SOC group). The SOC caregivers, six women and one man, had a mean age of 64.6 years (SD=6.9 years). The mean age of the 8 women in the PN group was 61.3 years (SD=10.1). All participants in both SOC and PN groups self reported their ethnicity as white. Thematic analysis found that SOC group caregivers discussed patients relying on support from family and friends throughout their care journey, whereas caregivers in the PN group predominantly discussed finding PNs supportive and helpful. Both groups discussed the ongoing stress that they felt throughout the care journey of the patient for which they cared for; however, for the PN group this topic was less prevalent.

Conclusions

This study provides an understanding of the positive impacts a patient navigator can have on older adult inpatient care and transitions in care. Patient Navigators were shown to be helpful to families, particularly those of patients with higher care needs and fewer family supports.

Abstract Content - Introduction Falls are the leading cause of preventable death in older adults and can also lead to psychological consequences, including concerns about future falls. Although literature traditionally focuses on those over 65 yrs, recent research shows adults as young as 50 yrs could be at risk. Most falls occur at home and are often due to environmental hazards. Despite evidence supporting a 38% reduction in falls through home modifications, their efficacy in not fully understood. Exploring barriers and facilitators to home modifications aimed at reducing falls and concerns about falling, could better inform future interventions. Methods As part of a mixed-methods systematic review, six electronic databases were searched on February 4th 2024: Scopus, PubMed, CINAHL, MEDLINE, SportsDiscus and Psycinfo. The search explored studies on home modifications for adults over 50 living at home, without residential health or rehabilitation services, specifically aimed at reducing falls incidences and concerns about falling. Barriers and facilitators to home modifications were explored from the perspectives of fallers, those at risk of falling, families, caregivers and key stakeholders. Results Thirteen of the 31 papers included in the full systematic review were focused on barriers and facilitators to home modifications. For barriers, five themes were identified: cost; stigma associated with ageing and disability; lack of awareness; fear of change and professional incompetence and inconsistency. Five themes were identified for facilitators: support from family and caregivers; early planning; involvement in decision making professional collaboration and enhanced caregiver well-being. Conclusion These findings underscore the need for multi-faceted approaches to home modifications, addressing both practical and psychological issues. Only three studies included adults 50+ yrs, with little known about the barriers and facilitators for this age onwards. Future interventions should encompass a person-centered approach, focus on increasing affordability, raising early awareness, fostering supportive networks, and ensuring high-quality professional services.

Abstract Content - Introduction. When required to multitask while walking, older adults (OA) will walk slower and use maladaptive stepping strategies such as cross-steps that may increase the risk of falling. However, most studies to date have been limited to steady-state straight-line walking, which requires limited to no visual planning, which is unrepresentative of common outdoor environments. Therefore, this study aimed to (i) investigate the impact of dual-tasking during walking of complex routes, and (ii) assess if such impact can be reduced when older adults deliberately preview their route to improve planning. Methods. We aim to recruit 45 community-dwelling OA. Preliminary results are reported for 19 (13F & 6M) community-dwelling OA without neurological or musculoskeletal diagnosis (Mean age = 75.7, range = 64–84). Participants walked along different winding paths on an 8-meter-long walkway under three conditions for 6 trials per condition: Single-task (ST), Dual-task (counting backwards) without previewing their route (DT) and Dual-task with deliberate previewing of the walking route (DTP). For each condition, we recorded walking speed, stepping errors (deviations from the pathway), and cross-steps. Results. Participants walked significantly slower during the DT condition (M=58.3 cm/s, SD=15.4) vs. ST condition (M=82.6 cm/s, SD=12.6; p<.001). during the dt condition participants also made more errors (m="1.3/trial," sd="1.4;" p=".029)" and frequent cross-steps compared to ST (no noted; m="0.4" />trial, SD=0.4). However, when allowed to preview their route prior to dual-tasking (DTP condition), participants walked faster (M=69.9 cm/s, SD=18.7; p=.002) and with fewer errors (M=0.1/trial, SD=0.1; p=.006). Conclusions. The imposition of an attentional load during adaptive walking reduces speed and increases the likelihood of potentially risky stepping strategies. Taking the time to deliberately preview the walking route seems to reverse some of these negative changes, and particularly to allow older adults to walk faster with fewer stepping errors.

Introduction

Stair falls cause approximately 230,000 injuries and 500 fatalities each year (Roys, 2001). Falls cost the NHS £4.6 million every day (AgeUK, 2010), and approximately £2 billion each year (GOV.UK, 2022), with falls on stairs accounting for the majority of these costs. However, the evidence about how to reduce stair falls is unclear. The aim of this systematic review was to establish which interventions are effective or show greatest potential to improve safety on stairs and reduce falls.

Methods

Five databases were searched: Medline, Scopus, Web of Science, PubMed and CINAHL. Papers were included if they were interventions or provided proof-of-principle to inform an intervention design. Papers were excluded if participants were under the age of 18, or were diagnosed with any clinical condition (disease outside that which we can expect from healthy ageing).

Results

No study reported fall occurrence as an outcome measure. Step-edge highlighters were the only intervention tested in real-world environments, as well as laboratories, and showed good proof of principle, feasibility and acceptability. Five intervention types were found that reduced fall risk in laboratory trials: lighting, horizontal-vertical illusions in ascent, stair dimensions (riser, going and pitch), avoiding multi-tasking and handrail use. These were successful in reducing mechanical demand (reducing or redistributing joint moments) and improving stepping behaviours associated with fall risk (reductions in magnitude and variability of foot clearances and overhang on the step).

Conclusion

This review has established there is no definitive evidence that any intervention reduced fall rates, but that some interventions show good proof-of-principle and feasibility: step-edge highlighters flush to the step edge, increased lighting levels, horizontal-vertical illusions in ascent, use of handrails, avoiding multi-tasking, riser heights 10.2-19cm, going lengths 22.5-32.5cm and reduced pitch angles. Future research must translate these interventions into real world settings and evaluate effectiveness to reduce fall rates.

Introduction: Concerns about falling (CaF) is a psychosocial concept, precipitating a spiral of increasing inactivity, social isolation and falls, and is common in those who have experienced, or are at risk of, a fall. One method of assessing CaF is the Falls Efficacy Scale International version (FES-I),with previous studies finding associations between higher FES-I scores and poor scoring on commonly used clinical assessments of functional mobility and balance (Gait speed (GS), Timed up and Go test (TUG), and Five time sit to stand (FTSS)). Using the FES-I to predict poor functional mobility and balance has the potential to identify those at risk before an initial fall, at which point an intervention may be provided.

Methods: A prospective study was carried out over 24 weeks, in which 119 participants were recruited from the North Tyneside Community Falls Prevention Service (NTCFPS). Participants completed questionnaires and underwent physical testing whilst attending the falls clinic (baseline) and at week 24, completing bi-weekly falls diaries throughout. Participants were users of the NTCFPS, and residents of North Tyneside.

Results: Findings showed (i) the FES-I had a limited ability to predict poor scores on GS, TUG and FTSS; (ii) attending referred Age UK strength and balance classes was significantly associated with improvements in FES-I score and FTSS; (iii) CaF at the outset of Age UK training was not significantly associated with clinically significant improvements in GS, FTSS and TUG.

Conclusions: Whilst the predictive capabilities of the FES-I were limited, the measure showed an ability to track improvements in participants CaF in the short to medium term. Further work is needed to explore the measures applications within the general population of community dwelling older adults, rather than a cohort of falls service users.