SP - Falls

Background: Foot pain in older adults may reduce physical activity, resulting in impaired mobility and an increased risk of falls. Orthotics, both with and without a metatarsal pad, may provide foot pain relief and improved stability. Objective: Compare the use of Aetrex orthotics with and without a metatarsal pad in decreasing pain and fear of falling in older adults. Methods: 206 participants over 60 years old were randomised into the intervention group, who received Aetrex L2305 Orthotics with a metatarsal pad, or the control group, who received Aetrex L2300 Orthotics with no metatarsal pad. At baseline and 6-week follow-up, musculoskeletal pain was reported via Numerical Rating Scales (NRS), foot pain and functionality via the Foot Health Status Questionnaire (FHSQ), and fear of falling via the Short Falls Efficacy Scale International. Results: Both groups reported significant improvements in pain in the back, hips, knees, ankles, and feet using the NRS (P < 0.001). Using the FHSQ, foot pain significantly improved in both the intervention (x̄= 18.47 ±20.58, P < 0.001) and control group (x̄= 17.21 ±18.74, P < 0.001). Function also improved significantly in both groups (x̄= 18.35 ±20.67, P < 0.001 and x̄ = 15.07 ±20.15, P < 0.001, respectively), as did fear of falling (x̄= 1.55 ±3.79, P < 0.001 and x̄= 1.23 ±3.53, P < 0.001, respectively). No statistically significant difference was observed between groups for any outcome (P > 0.05). Conclusion: Aetrex orthotics, with and without metatarsal pads, decrease pain and fear of falling in older adults.

Introduction The occurrence of falls in adults 65+ years remains a common and costly issue worldwide. Exercise programmes that improve strength and challenge balance have been shown to be the most effective intervention for reducing falls in community-dwelling older adults, such as the 6-month Falls Management Exercise (FaME) programme. Despite the pre-existing evidence base, the adoption of the FaME programme has been limited. Perspectives of multiple key stakeholder groups and providers of the FaME programme could future inform more successful adoption and implementation of fall prevention programmes such as FaME. 

Methods Stakeholders and providers involved in local community fall prevention pathways were purposefully recruited from three geographical areas across England. Twenty-five semi-structured interviews were conducted to gain a broad understanding of factors affecting the adoption, implementation and spread of FaME. Data were analysed using an inductive thematic approach and mapped to the Consolidated Framework for Implementation Research (CFIR). 

Results Data from 25 participant interviews and document analysis revealed 11 themes organised within five CFIR domains – the innovation (3), outer setting (3), inner setting (1), characteristics of individuals (1) and process (2). 

Conclusion(s) The adoption, implementation and spread of FaME into community settings is complex and faces multiple health system challenges. For adoption and implementation to be facilitated, FaME programmes must demonstrate effectiveness and fit the local needs of those receiving the intervention. For spread to occur, influential commissioners must support wider programme roll out, whilst also securing sufficient expert capacity to deliver the programme. Further monitoring of the programme is recommended to determine effectiveness of provision for older adults. The tailoring of future implementation strategies may help to increase the national availability of FaME classes across the UK for those at greatest risk of falls.

Introduction

In the UK, concerns regarding the safe use of bedrails, especially in nursing homes and a person’s own home, prompted a National Patient Safety Alert in August 2023. A scoping review was conducted to identify and map the literature relating to bedrail use in hospital and community settings and identify future areas of research. 

Methods

The scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted using MEDLINE, EMBASE, EMCARE, COCHRANE, BASE, CINAHL, and Google Scholar. Two reviewers independently contributed to screening. Data extraction included reason and prevalence of use, causes of harm and alternatives to bedrails. Findings were reported narratively. 

Results 

A total of 33 papers were included. Bedrails were widely used across hospital settings and nursing homes. No studies examined bed rail use in a person’s own home. Bed rails were primarily prescribed as a falls prevention device, despite the absence of empirical evidence supporting their effectiveness. In the UK, bedrail use appeared to be influenced by local culture and practice rather than policy. Self-reported use of bedrails as patient restraints in the UK, perhaps indicates inadequate legal literacy among equipment prescribers. Bedrails were found to be safe when used appropriately. There is concern that bedrail use is increasing with increasing patient dependency and advances in bed technology but authors express apprehension that it may be ethically impossible to design a randomised controlled trial to address patient safety concerns. 

Conclusion

Empirical data supporting bedrails as a falls prevention device are lacking. Additionally, there is a dearth of evidence reporting the opinions of users or inquiries regarding bedrails in a person’s own home. Therefore, clinicians are advised to consider bedrail prescriptions with a sense of responsibility and inquisitive inquiry to support both ethical and lawful use. 

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

Highly challenging, regular strength and balance exercise classes (SBE) reduces fall risk but there are few options for long-term continuation. SBE could be delivered by the voluntary sector, but care is needed to ensure good fidelity. The feasibility of delivering evidence-based SBE outside the governance of health services is unclear. A voluntary sector-led weekly SBE class ‘Strong and Steady (S&S)’, led by a level 4 qualified postural stability and funded via grants and fees, was set up in December 2022 alongside an existing community coffee morning.

Methods

Baseline measures and adherence were collected for all who commenced S&S. Two classes were observed using a standardised fidelity checklist. Interviews and focus groups were undertaken with class participants, a previous participant, the exercise instructor and lead volunteer.

Results

Since December 2022, 24 participants aged 59-95 (63% female) self-referred to S&S. Baseline measures, collected in 100% of assessments, (timed up and go, four-step balance scale and 60-second sit-to-stand) indicated performance slightly below age-matched norms with the exception of falls efficacy (FES-I). Three participants dropped out (1 died) and adherence was 67%. Fidelity in both observed classes was good (mean score 21/24). Four themes emerged from thematic analysis of all the interviews and focus groups: 1. S&S was associated with a range of benefits to health and wellbeing that contributed to participant uptake, adherence and to staff satisfaction. 2. Limiting class size is necessary to maintain fidelity and safety. 3. The social element of the class was a key driver in participation. 4. The participants of S&S had high levels of self-efficacy and motivation to participate in exercise

Conclusion

Delivering SBE via the voluntary sector is feasible and can be delivered with good fidelity. The provision tends to attract people who have high levels of self-efficacy and motivation to exercise.

One in four seniors fall annually, leading to unnecessary hospitalizations and decreased independence, with existing in-person fall prevention programs limited by access, scheduling, and cost. KINIMA Seniors is a newly developed automated interactive exercise and movement app providing real-time visual and audio feedback to assess and reduce risk of falls in seniors, using our proprietary augmented reality motion capture system. KINIMA Seniors introduces an innovative, scalable solution through a mobile app, assessing and reducing fall risks without the need for on-body sensors. It allows seniors to engage in exercises that enhance strength, balance, and gait, displayed alongside a virtual trainer with visual and audio cues for improving physical performance.

Methods:

20 sessions lasting 45 minutes were conducted over 10 weeks in 4 US Senior Centers using the KINIMA Seniors interactive movement platform. During the 1st and last sessions, the KINIMA system's computer vision data capture technology was employed to assess our 4 measures related to the risk of falls, and these measurements were compared with human observer-derived data in both the initial and final assessments. 26 participants completed the sessions with 4 dropouts. Assessment measures were: 1) One-Legged Stance test (left and right), 2) # of Leg Lifts in 30 seconds (left and right), 3) # of Sit to Stand repetitions in 30 seconds, 4) Timed Up and Go.

Results:

This study demonstrated improved fall risk outcomes were achieved in pre/post measures, technical feasibility, likeability of our automated exercise features, and accuracy of automated fall risk measures.

Conclusion:

KINIMA Seniors can deliver a cost-effective and scalable offering for fall prevention targeting enterprises that cater to seniors, such as senior day centers, senior living, and physical therapy. This technology facilitates independent aging in place and also offers a personalized exercise regimen with performance tracking to significantly enhance quality of life.