Background: Falls in people 65 years and older evaluated in the emergency department are increasing. Of all unintentional injury-related deaths among older people, 55% are due to falls. The impact of falls, especially concerning Dutch older people with the highest proportion of living independently worldwide, is unclear. Objective: To identify the influence of age, gender, health conditions, and type of fall on the severity of injury, hospital length of stay, mortality, and discharge destination. Methods: A total number of 6,084 patients from a comprehensive regional trauma care system, 65 years and older and hospitalized after a fall, were included. Groups were compared for patient-related factors and multivariable logistic regression analysis to explore the consequences. Results: Mean age was 82 years (SD = 8.3), and 70% were female. Most falls (66.4%) were due to "slipping and tripping" or "falls on the same level," 57.4% had Injury Severity Scores between 9 and 12, and 43.3% were discharged home. Higher age and type of fall increased the likelihood of severe injuries. Men experienced shorter hospital stays than women and were less frequently discharged home. Mortality was higher in males (10.8%) than in females (6.7%) and increased with the American Society of Anesthesiologists scores for preexisting health conditions. Conclusion: Advanced age, gender, type of fall, and prior health status play a significant role in the severity of injuries, length of hospital stay, 30-day mortality, and higher discharge destination to care homes in older people hospitalized after a fall.
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Background Fall prevention programs have been proven effective in reducing falls and fall-related injuries in specific target groups and settings. However, implementing these programs on a larger scale often requires adjustments for feasibility. This study assessed the effectiveness of a nationally implemented fall prevention intervention compared to usual care in community-dwelling older adults. Methods This single-blinded, multicentre randomized controlled trial included 264 community-dwelling non- and pre-frail adults, aged 65 years or older with an increased fall risk. The intervention group participated in the In Balance intervention and the control group received general physical activity recommendations. Primary outcomes were the number of falls and fall-related injuries over 12 months. Secondary outcomes included the Timed Up and Go and Four Stage Balance Test, and the 36-Item Short Form Health Survey. We imputed missing data by multiple imputation, and analysed outcomes using generalized linear- and linear mixed-effects models. Analyses were done for the total group and stratified for frailty status. Results The mean number of falls per person over 12 months was not statistically different between the intervention and control group (respectively 1.67 (SE 0.24) and 1.98 (0.37); incidence rate ratio 0.85 (95% CI 0.51-1.43)), nor the mean number of fall-related injuries (respectively 0.70 (SE 0.11) and 0.97 (0.18); incidence rate ratio 0.73 (95% CI 0.44-1.19)). Secondary outcomes also showed no significant differences between group, frailty status and over time. Conclusions Although the number of falls and fall-related injuries was lower among In Balance participants, and balance, mobility, physical function, and emotional well-being improved, these differences were not statistically significant. Impact statement The implemented In Balance program appears to be less effective than a priori assumed, possibly due to insufficient adherence to the program in practice.
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BACKGROUND: Falls and fall-related injuries among older adults are a serious threat to the quality of life and result in high healthcare and societal costs. Despite evidence that falls can be prevented by fall prevention programmes, practical barriers may challenge the implementation of these programmes. In this study, we will investigate the effectiveness and cost-effectiveness of In Balance, a fourteen-week, low-cost group fall prevention intervention, that is widely implemented in community-dwelling older adults with an increased fall risk in the Netherlands. Moreover, we will be the first to include cost-effectiveness for this intervention. Based on previous evidence of the In Balance intervention in pre-frail older adults, we expect this intervention to be (cost-)effective after implementation-related adjustments on the target population and duration of the intervention.METHODS: This study is a single-blinded, multicenter randomized controlled trial. The target sample will consist of 256 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group receives the In Balance intervention as it is currently widely implemented in Dutch healthcare, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group receives general written physical activity recommendations. Primary outcomes are the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consist of physical performance measures, physical activity, confidence, health status, quality of life, process evaluation and societal costs. Mixed model analyses will be conducted for both primary and secondary outcomes and will be stratified for non-frail and pre-frail adults.DISCUSSION: This trial will provide insight into the clinical and societal impact of an implemented Dutch fall prevention intervention and will have major benefits for older adults, society and health insurance companies. In addition, results of this study will inform healthcare professionals and policy makers about timely and (cost-)effective prevention of falls in older adults.TRIAL REGISTRATION: Netherlands Trial Register: NL9248 (registered February 13, 2021).
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BACKGROUND: Physical activity may be both a risk and protective factor for falls and fall-related fractures. Despite its positive effects on muscle and bone health, physical activity also increases exposure to situations where falls and fractures occur. This paradox could possibly be explained by frailty status. Therefore, the aim of this study was to investigate the associations between physical activity and both falls and fractures, and to determine whether frailty modifies the association of physical activity with falls, and fractures.METHODS: Data of 311 community-dwelling participants aged 75 years or older from the Longitudinal Aging Study Amsterdam, who participated in a three-year longitudinal study with five nine-monthly measurements between 2015/2016 and 2018/2019. Their mean age was 81.1 (SD 4.8) years and frailty was present in 30.9% of the participants. Physical activity in minutes per day was objectively assessed with an inertial sensor (Actigraph) for seven consecutive days. Falls and fractures were assessed every nine months using self-report during an interview over a follow-up period of three years. Frailty was determined at baseline using the frailty index. Associations were estimated using longitudinal logistic regression analyses based on generalized estimating equations.RESULTS: No association between physical activity and falls was found (OR = 1.00, 95% CI: 0.99-1.00). Fall risk was higher in frail compared to non-frail adults (OR = 2.21, 95% CI: 1.33-3.68), but no effect modification was seen of frailty on the association between physical activity and falls. Also no relation between physical activity and fractures was found (OR = 1.00, 95% CI: 0.99-1.01). Fracture risk was higher in frail compared to non-frail adults (OR = 2.81, 95% CI: 1.02-7.75), but also no effect modification of frailty was present in the association between physical activity and fractures.CONCLUSIONS: No association between physical activity and neither falls nor fractures was found, and frailty appeared not to be an effect modifier. However, frailty was a risk factor for falls and fractures in this population of older adults. Our findings suggest that physical activity can be safely recommended in non-frail and frail populations for general health benefits, without increasing the risk of falls.
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Background: There are indications that older adults who suffer from poor balance have an increased risk for adverse health outcomes, such as falls and disability. Monitoring the development of balance over time enables early detection of balance decline, which can identify older adults who could benefit from interventions aimed at prevention of these adverse outcomes. An innovative and easy-to-use device that can be used by older adults for home-based monitoring of balance is a modified bathroom scale. Objective: The objective of this paper is to study the relationship between balance scores obtained with a modified bathroom scale and falls and disability in a sample of older adults. Methods: For this 6-month follow-up study, participants were recruited via physiotherapists working in a nursing home, geriatricians, exercise classes, and at an event about health for older adults. Inclusion criteria were being aged 65 years or older, being able to stand on a bathroom scale independently, and able to provide informed consent. A total of 41 nursing home patients and 139 community-dwelling older adults stepped onto the modified bathroom scale three consecutive times at baseline to measure their balance. Their mean balance scores on a scale from 0 to 16 were calculated—higher scores indicated better balance. Questionnaires were used to study falls and disability at baseline and after 6 months of follow-up. The cross-sectional relationship between balance and falls and disability at baseline was studied using t tests and Spearman rank correlations. Univariate and multivariate logistic regression analyses were conducted to study the relationship between balance measured at baseline and falls and disability development after 6 months of follow-up.
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Background: Steady-state gait characteristics appear promising as predictors of falls in stroke survivors. However, assessing how stroke survivors respond to actual gait perturbations may result in better fall predictions. We hypothesize that stroke survivors who fall have a diminished ability to adequately adjust gait characteristics after gait is perturbed. This study explored whether gait characteristics of perturbed gait differ between fallers and non fallers. Method: Chronic stroke survivors were recruited by clinical therapy practices. Prospective falls were monitored over a six months follow up period. We used the Gait Real-time Analysis Interactive Lab (GRAIL, Motekforce Link B.V., Amsterdam) to assess gait. First we assessed gait characteristics during steady-state gait and second we examined gait responses after six types of gait perturbations. We assessed base of support gait characteristics and margins of stability in the forward and medio-lateral direction. Findings: Thirty eight stroke survivors complete our gait protocol. Fifteen stroke survivors experienced falls. All six gait perturbations resulted in a significant gait deviation. Forward stability was reduced in the fall group during the second step after a ipsilateral perturbation. Interpretation: Although stability was different between groups during a ipsilateral perturbation, it was caused by a secondary strategy to keep up with the belt speed, therefore, contrary to our hypothesis fallers group of stroke survivors have a preserved ability to cope with external gait perturbations as compared to non fallers. Yet, our sample size was limited and thereby, perhaps minor group differences were not revealed in the present study.
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Objective: This exploratory study investigated to what extent gait characteristics and clinical physical therapy assessments predict falls in chronic stroke survivors. Design: Prospective study. Subjects: Chronic fall-prone and non-fall-prone stroke survivors. Methods: Steady-state gait characteristics were collected from 40 participants while walking on a treadmill with motion capture of spatio-temporal, variability, and stability measures. An accelerometer was used to collect daily-life gait characteristics during 7 days. Six physical and psychological assessments were administered. Fall events were determined using a “fall calendar” and monthly phone calls over a 6-month period. After data reduction through principal component analysis, the predictive capacity of each method was determined by logistic regression. Results: Thirty-eight percent of the participants were classified as fallers. Laboratory-based and daily-life gait characteristics predicted falls acceptably well, with an area under the curve of, 0.73 and 0.72, respectively, while fall predictions from clinical assessments were limited (0.64). Conclusion: Independent of the type of gait assessment, qualitative gait characteristics are better fall predictors than clinical assessments. Clinicians should therefore consider gait analyses as an alternative for identifying fall-prone stroke survivors.
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This article will discuss the role of environmentalism in environmental education (EE) and education for sustainable development (ESD) in the context of ecopedagogy. Ecopedagogy calls for the remaking of capitalist practices and seeks to re-engage democracy to include multispecies interests in the face of our current global ecological crisis. In this article, the written reports by international business students on the documentary film If a Tree Falls about a radical environmental movement will be discussed. The aim of this article is to reflect upon the question of whether confrontational questions posed by radical environmentalism can move students to re-examine certain central assumptions within their own society and education. The analysis of students’ individual writing assignments after viewing the film is placed in the context of the discussion about the aims of education in relation to environmental advocacy. This case study seeks to provide an example of how environmental advocacy and the objective of pluralistic education can be combined as mutually supportive means of achieving both democratic learning and learning for environmental sustainability. https://doi.org/10.1177/0973408215569119 https://www.linkedin.com/in/helenkopnina/
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Abstract Introduction Stroke survivors often fall during walking. To reduce fall risk, gait testing and training with avoidance of virtual obstacles is gaining popularity. However, it is unknown whether and how virtual obstacle crossing is associated with fall risk. Aim The present study assessed whether obstacle crossing characteristics are reliable and assessed differences in stroke survivors who prospectively experienced falls or no falls. Method We recruited twenty-nine community dwelling chronic stroke survivors. Participants crossed five virtual obstacles with increasing lengths. After a break, the test was repeated to assess test-retest reliability. For each obstacle length and trial, we determined; success rate, leading limb preference, pre and post obstacle distance, margins of stability, toe clearance, and crossing step length and speed. Subsequently, fall incidence was monitored using a fall calendar and monthly phone calls over a six-month period. Results Test-retest reliability was poor, but improved with increasing obstacle-length. Twelve participants reported at least one fall. No association of fall incidence with any of the obstacle crossing characteristics was found. Discussion Given the absence of height of the virtual obstacles, obstacle avoidance may have been relatively easy, allowing participants to cross obstacles in multiple ways, increasing variability of crossing characteristics and reducing the association with fall risk. Conclusion These finding cast some doubt on current protocols for testing and training of obstacle avoidance in stroke rehabilitation.
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This article presents and discusses student assignments reflecting on the documentary film If a Tree Falls, written as part of the Business Ethics and Sustainability course at The Hague University of Applied Sciences. This article follows two lines of inquiry. First, it challenges mainstream environmental education, supporting critical pedagogy and ecopedagogy. These pedagogies, which advocate pedagogy for radical change, offer a distinct and valuable contribution to sustainability education, enabling students to critically examine normative assumptions, and learn about ethical relativity, and citizenship engagement from environmentalists. The discussion of “lessons of radical environmentalism” is pertinent to the question of what types of actions are likely to achieve the widely acceptable long-term societal change. While this article focuses on student reflection on a film about radical environmentalism, this article also discusses many forms of activism and raises the question of what can be considered effective activism and active citizenship in the context of the philosophy of (environmental or sustainability) education in connection didactics and curriculum studies. Second, this article argues for the need for reformed democracy and inclusive pluralism that recognizes the needs of nonhuman species, ecocentrism, and deep ecology. The connection between these two purposes is expressed in the design of the student assignment: It is described as a case study, which employs critical pedagogy and ecopedagogy. https://doi.org/10.3390/educsci9040284 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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