Assessment and Management of Fall Risk in Primary Care Settings

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’).

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.

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.

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.

Falls are the leading cause of injuries in the US for older adults. Follow-up after an ED-related fall visit is essential to initiate preventive strategies in these patients who are at very high risk for recurrent falls. It is currently unclear how frequently follow-up occurs and whether preventive strategies are implemented. Our objective is to determine the rate of follow-up by older adults who sustain a fall related head injury resulting in an ED visit, the rate and type of risk assessment and adoption of preventive strategies.

This 1-year prospective observational study was conducted at two South Florida hospitals. All older ED patients with an acute head injury due to a fall were identified. Telephone surveys were conducted 14 days after ED presentation asking about PCP follow-up and adoption of fall prevention strategies. Clinical and demographic characteristics were compared between patients with and without follow up.

Of 4951 patients with a head injury from a fall, 1527 met inclusion criteria. 905 reported follow-up with their PCP. Of these, 72% reported receiving a fall assessment and 56% adopted a fall prevention strategy. Participants with PCP follow-up were significantly more likely to have a history of cancer or hypertension.

Only 60% of ED patients with fall-related head injury follow-up with their PCP. Further, 72% received a fall assessment and only 56% adopted a fall prevention strategy. These data indicate an urgent need to promote PCP fall assessment and adoption of prevention strategies in these patients.

Unilateral and bilateral peripheral vestibular hypofunction (UVH and BVH) often complains of dizziness, gaze, and balance disturbances. There is a lack of evidence on exercise intervention in UVH and BVH patients. To investigate the effect of an eight-week supervised multicomponent exercise program in people suffering from UVH or BVH in comparison with a control group doing conventional vestibular rehabilitation at home.

This longitudinal, controlled, randomized, prospective, single-blinded, two-arm, parallel intervention study will include 66 adults (≥18 years old) with chronic UVH or BVH. Participants will be randomly assigned to an exercise intervention group or an attention control group. Participants will be assessed at baseline, after a two-month intervention period, and after a six-month follow-up. The primary variable will be the balance, measured by the dynamic posturography sensory organization test and the Modified Dynamic Gait Index test. Secondary outcome variables will include cardiorespiratory fitness (peak cardiopulmonary exercise test), body composition (bioimpedance and anthropometric variables), physical activity level and sleep quality (accelerometry), health-related quality of life (Dizziness Handicap Inventory questionnaire), emotional state (Beck Depression and Anxiety Inventory questionnaires), and blood pressure monitoring.

This study will try to answer whether in people with UVH/BVH, an adjuvant program of multicomponent exercise will help the prognosis of this population.

ClinicalTrials.gov, identifier [NCT05192564]. Verification date: April 2023.

Appropriate care and rehabilitation following surgery for fragility hip fractures in older adults is associated with better outcomes and a greater likelihood of achieving pre-injury functioning. Clinical guidelines specifically for the post-operative care and rehabilitation of patients with hip fractures are scarce; as such, country-specific protocols benchmarked against established guidelines are essential given the wide variation in cultures and beliefs, clinical practice and diverse healthcare systems in Asia. We aimed to provide clinically relevant recommendations for post-operative fragility hip fracture care and rehabilitation to improve patient outcomes and prevent subsequent fractures in Thailand.

A targeted literature review was conducted to identify key evidence on various elements of post-hip fracture care and rehabilitation. Further discussions at a meeting and over email correspondence led to the development of the recommendations which amalgamate available evidence with the clinical experience of the multidisciplinary expert panel.

Our recommendations are categorized by one period domain – acute post-operative period, and five major domains during the post-operative period – rehabilitation, optimization of bone health, prevention of falls, nutritional supplementation, and prophylaxis for venous thromboembolism. A multidisciplinary approach should be central to the rehabilitation process with the involvement of orthopedists, geriatricians/internists, physiatrists, physical and occupational therapists, endocrinologists, pharmacists and nursing staff. Other key components of our recommendations which we believe contribute to better functional outcomes in older patients undergoing hip fracture surgery include comprehensive pre-operative assessments, early surgery, goal setting for recovery and rehabilitation, early mobilization, medication optimization, tailored exercise plans, adequate coverage with analgesia, assessment and appropriate management of osteoporosis with due consideration of the fracture risk, fall prevention plans, and nutritional assessment and support. Patients and their caregivers should be a part of the recovery process at every step, and they should be counseled and educated appropriately, particularly on the importance of adherence to their rehabilitation plan.

We have provided guidance on the critical domains of clinical care in the post-operative setting to optimize patient outcomes and prevent fracture recurrence. Our recommendations for post-operative care and rehabilitation of older adults with hip fracture can serve as a framework for hospitals across Thailand.

To verify the treatment fidelity and satisfaction with a multifactorial intervention based on case management in community-dwelling older people with falls history and related sociodemographic and clinical factors.

This is a single-center, randomized, parallel-group controlled clinical trial. 62 community-dwelling older people with falls history were distributed into two groups. The Intervention Group (IG) underwent a case management involving multidimensional evaluation, explanation of the risk factors for falls identified, implementation of an intervention proposal based on the identified risks, elaboration of an individualized falls intervention plan, implementation, monitoring and review of the intervention plan. The Control Group (CG) was accompanied by a monthly phone call. After 16 weeks, the volunteers answered two closed questionnaires about treatment fidelity or non-fidelity to intervention (IG) and satisfaction with intervention (both groups). In addition, the frequency of intervention, adherence to each recommendation of the case management and satisfaction with general care were evaluated.

There was good treatment fidelity based on case management, as well as good adherence to recommendations. In addition, the satisfaction of both groups was positive, although the IG had a better score (p<0.05). There was a significant influence of monthly income and general health on treatment fidelity (IG). Also, age, years of schooling, general health and physical mobility significantly influenced satisfaction with the IG. There was a significant influence of number of falls on satisfaction with monitoring conducted in the CG.

Clinical and sociodemographic factors can influence treatment fidelity and satisfaction of older people with falls history to a falls prevention program.

Balance deficiencies are common among aging adults. Musculoskeletal injuries such as lateral ankle sprains (LAS) also contribute to compromised balance; potentially amplifying the postural insufficiencies in these age groups with a history of LAS. Yoga has emerged as an effective balance training intervention for aging adults; but limited application exists in these age cohorts with LAS history. This study may provide important guidance for the implementation of this intervention in these populations.

In this cohort design study, middle-age and older adults with a history of LAS completed an 8-week beginner-level yoga class. Balance was measured before and after the yoga intervention statically (force plate) and dynamically (star excursion balance test [SEBT]) using single-limb balance tasks.

Following the yoga intervention, older adults improved static postural control in the anterior-posterior direction, as well as dynamic postural control in selected reach directions of the SEBT relative to the middle-age adults.

This is an important step in exploring how to help the aging population that likely has amplifications in balance deficiencies due to a common musculoskeletal injury, LAS. While more work is needed to determine how to optimize and document balance improvements in aging adults with LAS history, yoga appears to be a promising form of intervention, particularly for older adults.