The Iowa record-linkage study. I. Suicides and accidental deaths among psychiatric patients. Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). Ankle force and rate of force production increase following high intensity strength training in frail older adults Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention. Guidelines for the prevention of falls in people over 65 Geriatric comorbidities, such as falls, confer an independent mortality risk to elderly dialysis patients. Community-based intervention to optimise falls risk management: a randomised controlled trial. Incidence of injury-causing falls among older adults by place of residence: a population-based study. Circumstances and consequences of falls in independent community-dwelling older adults. Dizziness in an older community dwelling population: A multifactorial syndrome Effect of Aspirin on All‐Cause Mortality in the Healthy Elderly A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study Home environmental hazards and the risk of fall injury events among community-dwelling older persons. Study to Assess Falls Among the Elderly (SAFE) Group. The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: a randomized controlled trial. Predictors of suicide, accidental death, and premature natural death in a general-population birth cohort Preventing falls among community-dwelling older persons: results from a randomized trial. A cost-benefit analysis of three older adult fall prevention interventions. Falls and fall-related injuries in older dialysis patients. The differential influence of distinct clusters of psychiatric symptoms, as assessed by the general health questionnaire, on cause of death in older persons living in a rural community of Japan.
In a prospect i ve investigation of 5,412 formerly hospitalized psychiatric patients , 68 committed suicide and 38 died from accidental causes . Both figures are significantly in excess of expectations based on a relevant control population . Those at significant risk included men and women of all ages , except those older than 69 years . Comparison of st and ardized mortality ratios suggests relatively greater risk for women and young persons .  Risk for suicide was significant for patients of both sexes with acute schizophrenia , schizophrenia , affective disorders , and alcohol and other drug abuse , for men with neuroses , and for women with depressive neuroses .  Risk for accidental death was greatest for those aged from 30 to 49 years and for those with personality disorders Background Annually , about 30 % of the persons of 65 years and older falls at least once and 15 % falls at least twice . Falls often result in serious injuries , such as fractures . Therefore , the prevention of accidental falls is necessary . The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling . Methods / Design The study is design ed as a r and omised controlled trial ( RCT ) with an economic evaluation . Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a vali date d fall risk profile . Persons at low risk of recurrent falling are excluded from the RCT . Persons who have a high risk of recurrent falling are blindly r and omised into an intervention ( n = 100 ) or usual care ( n = 100 ) group . The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors . The transmural multidisciplinary appraoch entails close cooperation between geriatrician , primary care physician , physical therapist and occupational therapist and can be extended with other specialists if relevant . A fall calendar is used to record falls during one year of follow-up . Primary outcomes are time to first and second falls . Three , six and twelve months after the home visit , question naires for economic evaluation are completed . After one year , during a second home visit , the secondary outcome measures are reassessed and the adherence to the interventions is evaluated . Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed . Discussion Strengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention , its transmural character and the evaluation of adherence . If proven effective , implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls . Trial registration Current Controlled Trials IS RCT N11546541 OBJECTIVES The aim of the study was to determine whether cardiac pacing reduces falls in older adults with cardioinhibitory carotid sinus hypersensitivity ( CSH ) . BACKGROUND Cardioinhibitory carotid sinus syndrome causes syncope , and symptoms respond to cardiac pacing . There is circumstantial evidence for an association between falls and the syndrome . METHODS A r and omized controlled trial was done of consecutive older patients ( > 50 years ) attending an accident and emergency facility because of a non-accidental fall . Patients were r and omized to dual-chamber pacemaker implant ( paced patients )  or st and ard treatment ( controls ) . The primary outcome was the number of falls during one year of follow-up . RESULTS One hundred seventy-five eligible patients ( mean age 73 + /- 10 years ; 60 % women ) were r and omized to the trial : pacemaker 87 ; controls 88 .  Falls ( without loss of consciousness ) were reduced by two-thirds : controls reported 669 falls ( mean 9.3 ; range 0 to 89 ) , and paced patients 216 falls ( mean 4.1 ; range 0 to 29 ) . Thus , paced patients were significantly less likely to fall ( odds ratio 0.42 ; 95 % confidence interval : 0.23 , 0.75 ) than were controls . Syncopal events were also reduced during the follow-up period , but there were much fewer syncopal events than falls-28 episodes in paced patients and 47 in controls . Injurious events were reduced by 70 % ( 202 in controls compared to 61 in paced patients ) . CONCLUSIONS There is a strong association between non-accidental falls and cardioinhibitory CSH . These patients would not usually be referred for cardiovascular assessment . Carotid sinus hypersensitivity should be considered in all older adults who have non-accidental falls Background and aims : The most common cause of accidental injury and death in people over age 65 results from impacts associated with falling . Balance impaired older adults have poorer balance control than healthy young adults or healthy older adults . Lack of sufficient lower extremity strength and inability to rapidly produce muscle force may contribute to diminished balance control in the elderly . This study evaluated the effect of a 10-week high intensity strength- training program targeting key lower extremity muscles for the purpose of improving postural control in frail older adults . Methods : Thirteen experimental and fourteen control subjects , all balance impaired older adults were evaluated in response to unexpected platform perturbations that simulated slips . Results : Following strength training the experimental group was significantly stronger than the control group . Mean ankle moments improved in the experimental group following strength training during forward sway ( Right : p=0.067 , Left : p=0.009 ) and backward sway ( Right : p=0.031 , Left : p=0.058 ) . For the backward sway condition the ankle rate of torque production increased significantly in the experimental group ( Right : p=0.016 , Left : p=0.031 ) . Conclusions : Enhancement of lower extremity strength contributed to improvements in balance stability demonstrated by greater ankle force production , in response to balance threats OBJECTIVE to evaluate the impact of a staff-oriented intervention on the number of accidental falls  in residents with and without cognitive impairment . DESIGN clustered r and omised controlled trial . METHODS ten nursing wards from 7 nursing homes were r and omised in a control ( 5 wards ) and intervention ( 5 wards ) group . The nurses from the intervention group received multi-faceted training about the occurrence of accidental falls , risk factors for falls and possible environmental modifications . For each fall they were asked to record the relevant risk factors , to keep a fall diary and to evaluate fall causes and possible preventive actions . For all residents , cognition and mobility were evaluated using a  Mini-Mental State Examination ( MMSE )  and a Timed Up and Go Test ( TUGT ) . Fall rates were recorded in an identical way for 6 months before and after the start of the intervention . MAIN OUTCOME MEASURES primary outcome measure was the number of participants with at least one accidental fall requiring an intervention by a physician or a nurse during each period of recording . Secondary outcome was the number of falls for each participant during each period of recording . RESULTS the relative risk of falling at least once in people of the intervention versus the control group adjusted for the pre-intervention results was 0.46 ( 95 % CI : 0.26 - 0.79 ) . There was no difference between residents with and without cognitive impairment or impaired mobility . In those falling at least once , the difference between the average number of falls in the two intervention arms was not significant ( P = 0.10 ) . CONCLUSION a simple staff-oriented intervention had a substantial effect on the frequency of accidental falls General practice p 994 Older people frequently fall . This is a serious public health problem , with a substantial impact on health and healthcare costs.1 These guidelines translate trial evidence about prevention of falls into recommendations that can be implemented in different setting s , with the aim of reducing the rate of falls and injurious falls in people over 65 ( see boxes 2 3 ) . # # # # Summary points Multifaceted interventions reduce falls in older people ( those over 65 ) Home assessment of older people at risk of falls without referral or direct intervention is not recommended Assessment of high risk residents in nursing homes with relevant referral is effective Evidence from well design ed single trials shows that assessment and modification of risk factors of older people who have presented to an accident and emergency department after a fall and the provision of hip protectors in residents of nursing homes are effective We up date d two previous systematic review s to include any new evidence up to March 1998 . 4 5 We electronically search ed Medline for all r and omised controlled trials and systematic review s by using the terms fall(s ) , accidental falls , fracture , elderly , aged , older , and senior . We followed up relevant references in papers , and we contacted research ers in prevention of falls for information about other trial evidence and about studies from journals not catalogued by the National Library of Medicine . For inclusion , studies had to be r and omised controlled trials of interventions design ed to minimise or prevent exposure to the risk factors for falling ( or fracture ) in people aged 65 years or over living in either community or residential care . Outcomes had to include the number of people who had fallen or the number of falls or fractures . We excluded drug or dietary treatments for the prevention of fractures . Trials that fulfilled the inclusion criteria were review ed and summarised BACKGROUND As the number of patients aged > /=65 years starting haemodialysis ( HD )  continues to increase , more patients are at risk of falls , functional decline and cognitive impairment . In an earlier prospect i ve cohort study , we showed that 44 % of elderly HD patients had more than one fall within a 1-year period . The objective of this study was to assess whether falls remained predictive of increased mortality risk even after controlling for age , comorbidity , dialysis vintage and laboratory variables . METHODS Using a prospect i ve , cohort study design , patients aged > /=65 years and on chronic HD during the period April 2002 - 2003 were recruited . Patients were followed biweekly , and falls occurring within the first year were recorded . Outcome data were collected until death , study end ( 30 December 2006 ) , transplantation or transfer to another dialysis centre . RESULTS A total of 162 patients were followed for a median of 32.7 months ( quartiles 14 - 57 ) . In a univariate Cox model with a time-dependent variable for falls status , survival was worse amongst fallers compared to non-fallers ( HR 2.13 , 95 % CI 1.32 - 3.45 ; P = 0.002 ) . After adjustment for age , dialysis vintage , comorbidity and laboratory variables , falls were a significant predictor of mortality ( HR 1.78 , 95 % CI 1.07 - 2.98 , P = 0.03 ) . Exclusion of falls associated with concurrent illnesses did not alter the results ( HR 1.63 , CI 1.02 - 2.28 P = 0.05 ) . CONCLUSIONS We conclude that the occurrence of more than one accidental fall in a community-dwelling HD patient aged > /=65 years is associated with an independent increased risk of death . As fall interventions are effective , screening HD patients for falls may be a simple measure of clinical importance BACKGROUND falls are the leading causes of accidental death and fragility fractures in older adults . Interventions that assess and reduce falls risk are underutilised . OBJECTIVE to evaluate the impact of a multifaceted community-based programme aim ed at optimising evidence -based management of patients at risk for fall-related fractures . DESIGN this was a r and omised trial performed from 2003 to 2006 . SETTING community-based intervention in Ontario , Canada . PARTICIPANTS eligible patients were community-dwelling , aged > or = 55 years and identified to be at risk for fall-related fractures . A total of 201 patients were allocated to the intervention group or to usual care .  INTERVENTION components of the intervention included assessment of falls risk , functional status and home environment , and patient education . MEASUREMENTS primary outcome was the implementation of appropriate falls risk assessment at 6 months . Secondary outcomes included falls and fractures at 6 and 12 months . RESULTS the mean age of participants was 72 years , and 41 % had fallen with injury in the previous year . Compared to usual care , the intervention increased the number of referrals made to physiotherapy [ 21 % ( 21/101 ) vs 6.0 % ( 6/100 ) ; relative risk ( RR ) 3.47 , 95 % confidence interval ( CI ) 1.46 - 8.22 ] and occupational therapy [ 15 % ( 15/101 ) vs 0 % ; RR 30.7 , 95 % CI 1.86 to > 500 ] . At 12 months , the number of falls in the intervention group was greater than in the usual care group [ 23 % ( 23/101 ) vs 11 % ( 11/100 ) ; RR 2.07 , 95 % CI 1.07 - 4.02 ] . CONCLUSIONS compared to usual care , a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls . Similar falls reduction interventions can not be recommended based on the results of this study OBJECTIVE To describe the incidence and associated factors of injury-causing falls by place of residence . DESIGN A prospect i ve population -based study . SETTING Five municipalities in northern Finl and . PARTICIPANTS All persons in the five communities aged 70 years or older living at home ( n = 1016 ) and in long-term institutionalized care ( n = 143 ) . MEASUREMENTS We recorded all fall incidents  during a 2-year period by occurrence and severity of injury , using diary reporting and regular calls and by examining the medical and nursing records of all participants . The times , places , circumstances , and medical treatment needed were recorded as well . RESULTS Men living at home experienced 71 minor injuries/1000 person years ( PY ) , 42 major soft tissue injuries/1000PY , and 12 fractures/1000PY ; women at home experienced 175 minor injuries/1000PY , 65 major soft tissue injuries/1000PY , and 33 fractures/1000PY . Institutionalized older men had 272 minor injuries/1000PY , 122 major soft tissue injuries/1000PY , and 41 fractures/1000PY ; institutionalized women had 292 minor injuries/1000PY , 131 major soft tissue injuries/1000PY , and 58 fractures/1000PY . Falls causing injury to older adults in long-term institutionalized care were more evenly distributed by time of day than those that occurred at home . The majority of the injuries sustained in long-term institutionalized care were injuries to the head . The incidence rate of fall injuries requiring medical attention in women , 113/1000PY , was twice that in men , 57/1000PY . CONCLUSIONS Injury-causing falls are more frequent in older people living in long-term institutionalized care , and the time-distribution and some circumstances differ from those of injury-causing falls in home-dwelling older people BACKGROUND knowledge of the circumstances and consequences of falls in older adults is important for underst and ing the aetiology of falls as well as for effective clinical assessment and design of fall prevention strategies . Such data , however , are relatively scarce , especially in community-dwelling elders . METHOD accidental falls ( including their circumstances and consequences ) occurring in 96 male and female participants between 60 and 88 years of age were monitored prospect ively for 1 year . After the monitoring period , participants were divided into three groups based on fall status : non-fallers ( n = 46 ) ,  one-time fallers ( n = 27 ) and recurrent fallers ( n = 23 ) . Frequency distributions were created for selected circumstances and consequences of falls and the prevalence of these consequences were examined . RESULTS 50 participants ( 52 % ) fell during the 1 year period , amassing 91 falls . Trips and slips were the most prevalent causes of falls , accounting for 59 % of falls . Falls most often occurred during the afternoon and while subjects walked on level or uneven surfaces . Fallers most commonly attributed falls to hurrying too much . Fractures result ed from five of the 91 falls and eight other falls result ed in soft tissue injuries that required treatment by a physician . There were no differences between one-time and recurrent fallers in the circumstances and consequences of falls . However , several notable differences were found between men ( n = 20 ) and women ( n = 30 ) who fell . Falls by men most often result ed from slips whereas falls by women most often result ed from trips . Moreover , women and men differed in the time of the year in which falls occurred , with men falling most often during winter and women during summer . CONCLUSIONS the results of this study provide insight into the circumstances and consequences of falls among independent community-dwelling older adults and suggest some possible ways of preventing falls . Preventive services , however , should not solely target recurrent fallers , nor should the type of services necessarily differ for one-time and recurrent fallers Objectives The aim of this study was to determine the prevalence and related predictors of dizziness in a sample of community-dwelling people 65 years of age and older living in a metropolitan area in Germany . Design Prospect i ve cohort study . Setting Interdisciplinary Centre of Gerontology at the University of Erlangen-Nuremberg , Germany . Participants 6000 people aged 65 years and older recruited and r and omized from the registration office , 1801 were fully evaluated at baseline and were re-evaluated in a prospect i ve follow-up two years later . A full data set was obtained for 620 participants , of which 297 ( 47.9 % ) were females . Mean age was 73.45 ± 6.05 . 200 participants ( 32.4 % ) were 65–69 years , 315 ( 51 % ) were 70–79 years , 92 ( 14.9 % ) 80–89 years and 11 ( 1.8 % ) 90 years and older . Measurements Demographic , medical , functional and psychological factors were measured by a st and ardised question naire in 2004 . In a follow-up survey participants were reevaluated in a prospect i ve design two years later ( 2006 ) , including a dizziness question naire , containing frequency , duration , space of dizziness and releasing positions and activities . Results At the second measurement 181 persons ( 29.2 % ) reported dizziness in the last 6 months . Dizziness was age dependent , with a prevalence of 27 % in participants aged 70 years and younger , up to 54 % in the group of 90 years and older . 96 ( 68.2 % ) persons reported daily or weekly dizziness . 46 ( 27.9 % ) participants reported multiple sensations of dizziness . In 108 ( 59.7 ) persons dizziness was released by multiple positions or activities . The main predictors of dizziness were age , female gender , cardiovascular disease , osteoporosis , depression , sleep disorder , disturbance of memory , shortsightedness ( defined by glasses ) , incontinence , 3 and more medical conditions , 4 and more medications , poor health status , falls and mobility problems . We found similar risk factors for dizziness and falls . Conclusion Dizziness is a very common symptom in older community dwelling persons . Comorbidity , poor health status and mobility problems are strong medical predictors ; age and female gender and decline in mobility are important predictors as well . Our study suggests , that dizziness in older age is often caused by multifactorial medical and functional conditions . Gait disorders and mobility problems also seem to play an important role in dizziness among older people . Therefore , interventions in dizziness should be developed in a multifactorial way . We suggest , that the interventions to be tested first , should be those that have been previously successful in older persons with gait disorders and falls BACKGROUND In the primary analysis of the Aspirin in Reducing Events in the Elderly ( ASPREE ) trial , now published in the Journal , we report that the daily use of aspirin did not provide a benefit with regard to the primary end point of disability‐free survival  among older adults . A numerically higher rate of the secondary end point of death from any cause was observed with aspirin than with placebo . METHODS From 2010 through 2014 , we enrolled community‐dwelling persons in Australia and the United States who were 70 years of age or older ( or ≥65 years of age among blacks and Hispanics in the United States ) and did not have cardiovascular disease , dementia , or disability . Participants were r and omly assigned to receive 100  mg of enteric‐coated aspirin or placebo . Deaths were classified according to the underlying cause by adjudicators who were unaware of trial‐group assignments . Hazard ratios were calculated to compare mortality between the aspirin group and the placebo group , and post hoc exploratory analyses of specific causes of death were performed . RESULTS Of the 19,114 persons who were enrolled , 9525 were assigned to receive aspirin and 9589 to receive placebo .  A total of 1052 deaths occurred during a median of 4.7 years of follow‐up . The risk of death from any cause was 12.7 events per 1000 person‐years in the aspirin group and 11.1 events per 1000 person‐years in the placebo group ( hazard ratio , 1.14 ; 95 % confidence interval [ CI ] , 1.01 to 1.29 ) . Cancer was the major contributor to the higher mortality in the aspirin group , accounting for 1.6 excess deaths per 1000 person‐years . Cancer‐related death occurred in 3.1 % of the participants in the aspirin group and in 2.3 % of those in the placebo group ( hazard ratio , 1.31 ; 95 % CI , 1.10 to 1.56 ) . CONCLUSIONS Higher all‐cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer‐related death . In the context of previous studies , this result was unexpected and should be interpreted with caution . ( Funded by the National Institute on Aging and others ; ASPREE Clinical Trials.gov number , NCT01038583 . Background Gait and balance impairments may increase the risk of falls , the leading cause of accidental death in the elderly population . Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering . A rapid step is the most important protective postural strategy , acting to recover equilibrium and prevent a fall from initiating . It can arise from large perturbations , but also frequently as a consequence of volitional movements . We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling . We describe the water-based balance training program and a study protocol to evaluate its efficacy ( Trial registration number # NCT00708136 ) . Methods / Design The proposed water-based training program involves use of unpredictable , multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses . Perturbations are made by pushing slightly the subjects and by water turbulence , in 24 training sessions conducted over 12 weeks . Concurrent cognitive tasks during movement tasks are included . Principles of physical training and exercise including awareness , continuity , motivation , overload , periodicity , progression and specificity were used in the development of this novel program . Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning . A prospect i ve , r and omized , cross-over trial with concealed allocation , assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program . A total of 36 community-dwelling adults ( age 65–88 ) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group ( no training ) . Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training . Discussion This study will determine whether a water-based balance training program that includes perturbation exercises , in a group setting , can improve speed of voluntary stepping responses and improve balance control . Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly Background A restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome . This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture . Methods A prospect i ve cohort study was conducted of patients aged 65 years or more who attended the Emergency Room ( ER ) for a hip fracture due to a fall .  The following were studied as independent factors : socio-demographic data ( age , sex , instruction level , living condition , received help ) , comorbidities , characteristics of the fracture , treatment performed , destination at discharge , health-related quality of life ( 12-Item Short Form Health Survey ) and hip function ( Short Western Ontario and McMaster Universities Osteoarthritis Index ) . As main outcome functional status was measured ( Barthel Index and Lawton Instrumental Activities of Daily Living Scale ) . Data were collected during the first week after fracture occurrence and after 6 months of follow-up . Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores . Factors associated with the outcome were studied via logistic regression analysis . Results Six months after the fall , deterioration in function was notable , with mean reductions of 23.7 ( 25.2 ) and 1.6 ( 2.2 ) in the Barthel Index and Lawton IADL Scale scores respectively . Patients whose status deteriorated were older , had a higher degree of comorbidity and were less educated than those who remained stable or improved . The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients , living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function . Conclusion In our setting , the functional prognosis of patients is determined by clinical and social factors , already present before the occurrence of the fracture . This could make it necessary to perform comprehensive assessment s for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery OBJECTIVE To determine if home environmental hazards increase the risk of fall injury events among community-dwelling older persons . DESIGN Population -based case-control study . SETTING South Miami Beach , Florida . PARTICIPANTS 270 persons aged 65 years and older who sought treatment at six area hospitals for injuries result ing from falls within the dwelling unit and 691 controls , frequency matched for sex and age , selected r and omly from Health Care Financing Administration ( Medicare ) files . MAIN INDEPENDENT VARIABLES The  home environment of each person , assessed directly by interviewers using a st and ardized instrument . RESULTS Environmental hazards were present in nearly all dwelling units . After adjusting for important confounding factors , most of these hazards were not associated with an increased risk of fall injury events among most older persons . Increasing numbers of tripping hazards , or total hazards in the dwelling unit , did not increase the risk of fall injury events , nor was there an increasing trend in risk . CONCLUSIONS Current fall-prevention strategies of finding and changing all environmental hazards in all community-dwelling older persons ' homes may have less potential effect than previously thought . The usefulness of grab bars , however , appears to warrant further evaluation OBJECTIVE To determine whether a 12-month program of regular exercise can improve balance , reaction time , neuromuscular control , and muscle strength and reduce the rate of falling in older women . DESIGN A r and omized , controlled trial of 12 months duration . SETTING Conducted as part of the R and wick Falls and Fractures Study in Sydney , Australia . PARTICIPANTS One hundred ninety-seven women aged 60 to 85 years ( mean age 71.6 , SD = 5.4 ) who were r and omly recruited from the community . OUTCOME MEASURES Accidental falls , postural sway , reaction time , neuromuscular control , and lower limb muscle strength . MAIN RESULTS Exercise and control subjects were tested before , midway through , and at the end of the trial . At initial testing , exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors . The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 ( range 26 - 82 ) . At the end of the trial , the exercise subjects showed improved performance in all five strength measures , in reaction time , neuromuscular control , body sway on a firm surface with the eyes open , and body sway on a compliant surface with the eyes open and closed . In contrast , there were no significant improvements in any of the test measures in the controls . In one test measure , hip flexion strength , the exercisers showed continued improvement throughout the study year . There was no significant difference in the proportion of fallers between the exercise and control subjects . Interesting trends were evident , however , between falls frequency and adherence to the exercise program . CONCLUSIONS These findings show that exercise can produce long-term benefits with regard to improving sensorimotor function in older persons . The findings also suggest that high compliance to an exercise program may reduce falls frequency , although further studies are required to conclusively demonstrate that exercise offers an effective means of preventing falls The objective of the study was to examine the predictive effect of prospect ively registered falls on survival within a r and omly selected group of elderly women . A longitudinal study , with 9 years follows up after 1 year prospect i ve fall registration was design ed . Persons age 75 or more living in the community . A total of 300 Norwegian women ; mean age was 80.8 participated in the study . Base-line registration s of health , functioning and medication were made .  Falls  which occurred during a 1-year period after baseline were registered as well as the date of death within a 9-year period after the end of the fall registration period . Half of the women reported one or more falls ( 1–11 ) . Eighty-six women ( 28.7 % ) experienced only one fall and 65 ( 21.7 % ) had at least two . During the 9-year follow-up period , 41.7 % died . Cox regression analyzes demonstrated that frequent falling , old age and a self-reported worsening of health were significantly associated with mortality during the follow-up period . Their relative risks of death when experiencing at least two falls was 1.6 ( 95 % CI 1.1–2.4 ) , P = 0.04 , when compared with no falls . Older fallers appear to have markedly increased mortality . Since falls are common among elderly people , this is a relevant fact for public health policy . Increasing age , poor self-rated health and high frequency of falls predict independently mortality in our 9 years follow up study . Because women represent the largest proportion of the elderly and falls are amendable , fall preventive may have the potential for significant impact on increasing year of life BACKGROUND Falls occur frequently in older people and strongly affect quality of life . Guidelines recommend multifactorial , targeted fall prevention . We evaluated the effectiveness of a multifactorial intervention in older persons with a high risk of recurrent falls . METHODS A r and omized controlled trial was conducted from April 3 , 2005 , to July 21 , 2008 , at the geriatric outpatient clinic of a university hospital and regional general practice s in the Netherl and s. Of 2015 persons identified , 217 persons aged 65 years or older were selected to participate . They had a high risk of recurrent falls and no cognitive impairment and had visited the emergency department or their family physician after a fall . The geriatric assessment and intervention were aim ed at reduction of fall risk factors . Primary outcome measures were time to first and second falls after r and omization . Secondary outcome measures were fractures , activities of daily living , quality of life , and physical performance . RESULTS Within 1 year , 55 ( 51.9 % ) of the 106 intervention participants and 62 ( 55.9 % ) of the 111 usual care ( control ) participants fell at least once . No significant treatment effect was demonstrated for the time to first fall ( hazard ratio , 0.96 ; 95 % confidence interval , 0.67 - 1.37 ) or the time to second fall ( 1.13 ; 0.71 - 1.80 ) . Similar results were obtained for secondary outcome measures and for per- protocol analysis . One intervention participant died vs 7 in the control group ( hazard ratio , 0.15 ; 95 % confidence interval , 0.02 - 1.21 ) . CONCLUSION This multifactorial fall-prevention program does not reduce falls in high-risk , cognitively intact older persons . Trial Registration is rct n.org Identifier : IS RCT N11546541 BACKGROUND Whether putative suicide risk factors , such as conduct and emotional disorders , are specific to suicide or are general associations of a continuum between subintentional and intentional self-destruction is not clear . We undertook an investigation of this issue in a UK population -based birth cohort . METHODS Using competing-risks analysis , we examined links between prospect ively collected childhood and adolescent temperamental and behavioural variables and the risk of natural , accidental , and suicidal death , occurring between the ages of 16 and 50 years . Of the 5362 members of the cohort , full data were available for 3591 . A panel of psychiatrists scored deaths on likely suicidal intention . These scores were used in a weighted logistic regression to examine independence of risk factors for (sub)intentional self-destruction . FINDINGS There were 167 deaths among the risk-set between the 16th and 50th birthdays . 120 were due to natural causes ; of the other 47 , the panel of psychiatrists judged that 36 were accidental deaths and 11 were suicides ( certainty rating > or = 51 % ) . Adolescent emotional instability and conduct problems had different associations with the various causes of premature death , being lowest for natural death ( odds ratio 1.0 [ 95 % CI 0.8 - 1.2 ] and 1.2 [ 1.0 - 1.5 ] ) , intermediate for accidental death ( 1.1 [ 0.8 - 1.5 ] and 1.3 [ 1.0 - 1.7 ] ) , and highest for suicidal death ( 2.0 [ 1.2 - 3.6 ] and 1.8 [ 1.3 - 2.5 ] ) . Emotional instability ( boys 1.3 [ 1.0 - 1.7 ] , girls 1.4 [ 1.0 - 1.9 ] ) increased risk for subintentional or intentional self-destruction , as did low anxiety in adolescence ( 1.7 [ 1.3 - 2.5 ] ) and nocturnal enuresis at age 4 ( 1.4 [ 1.2 - 1.7 ] ) in boys , and conduct problems in girls ( 1.4 [ 1.0 - 2.0 ] ) . INTERPRETATION Suicide shares important risk factors with other causes of premature death . These findings suggest an aetiological continuum of self-destruction from subintentional to intentional . Research on premature mortality associated with psychological disorder should include all causes of death A r and omized trial of falls prevention program that addressed home safety , exercise , and behavioral risks was conducted with 3,182 independently living HMO members age 65 and older . The intervention decreased the odds of falling by 0.85 , but only reduced the average number of falls among those who fell by 7 % . The effect was strongest among men age 75 and older . The likelihood of avoiding falls requiring medical treatment was not significantly affected by the intervention . We conclude that the intervention dose was not of sufficient intensity or duration to have a marked protective effect on older persons . Future research should focus on more intensive intervention approaches because serious falls do not appear to be amendable to low-intensity environment/behavioral efforts INTRODUCTION One out of three persons aged 65 and older falls annually and 20 % to 30 % of falls result in injury . The purpose of this cost-benefit analysis was to identify community-based fall interventions that were feasible , effective , and provided a positive return on investment ( ROI ) . METHODS A third-party payer perspective was used to determine the costs and benefits of three effective fall interventions . Intervention effectiveness was based on r and omized controlled trial results . National data were used to estimate the average annual benefits from averting the direct medical costs of a fall . The net benefit and ROI were estimated for each of the interventions . RESULTS For the  Otago Exercise Program delivered to persons aged 65 and older , the net benefit was $ 121.85 per participant and the ROI was 36 % for each dollar invested . For Otago delivered to persons aged 80 and older , the net benefit was $ 429.18 and the ROI was 127 % . Tai chi : Moving for Better Balance had a net benefit of $ 529.86 and an ROI of 509 % and Stepping On had a net benefit of $ 134.37 and an ROI of 64 % . CONCLUSIONS All three fall interventions provided positive net benefits . The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs . These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment Dialysis patients are increasingly older and more disabled . In community-dwelling seniors without kidney disease , falls commonly predict hospitalization , the onset of frailty , and the need for institutional care . Effective fall prevention strategies are available . On the basis of retrospective data , it was hypothesized that the fall rates of older ( > or = 65 yr ) chronic outpatient hemodialysis ( HD ) patients would be higher than published rates for community-dwelling seniors ( 0.6 to 0.8 falls/patient-year ) . It also was hypothesized that risk factors for falls in dialysis out patients would include polypharmacy , dialysis-related hypotension , cognitive impairment , and decreased functional status . Using a prospect i ve cohort study design , HD patients who were > or = 65 yr of age at a large academic dialysis unit were recruited . All study participants underwent baseline screening for fall risk factors . Patients were followed prospect ively for a minimum of 1 yr . Falls were identified through biweekly patient interviews in the HD unit . A total of 162 patients ( mean age 74.7 yr ) were recruited ; 57 % were male . A total of 305 falls occurred in 76 ( 47 % ) patients over 190.5 person-years of follow-up ( fall-incidence 1.60 falls/person-year ) . Injuries occurred in 19 % of falls ; 41 patients had multiple falls . Associated risk factors included age , comorbidity , mean predialysis systolic BP , and a history of falls . In the HD population , the fall risk is higher than in the general community , and fall-related morbidity is high . Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required OBJECTIVES To examine the influence of distinct clusters of psychiatric symptoms on subsequent cause-specific mortality in older persons living in the community . DESIGN A prospect i ve cohort study over 7.5 years . SETTING Otsuki-town , Kochi prefecture , Japan . PARTICIPANTS Nine hundred eighty community-dwelling persons , aged 65 to 84 in 1991 . MEASUREMENTS  Psychiatric symptoms  at baseline were measured using the 30-item version of the General Health Question naire ( GHQ-30 ) . A factor analysis was performed on the responses of all 980 subjects . The relationships between subscale scores on the identified factors and causes of deaths occurring over 7.5 years in 817 respondents with no physical disability at baseline were assessed using a proportional hazards model adjusted for age , gender , chronic conditions under treatment , regular physical activity , and availability of close or casual neighbors . RESULTS The factor analysis identified three clusters of psychiatric symptoms : depression , apathy/anergia , and anxiety . In the proportional hazards model , which included three GHQ subscales depicting these factors simultaneously , the depression subscale was associated with increased mortality from cerebrovascular disease ( multivariate adjusted hazard ratio per unit increase in the st and ard score on the depression subscale=2.04 , 95 % confidence interval (CI)=1.17 - 3.55 ) , and the apathy/anergia subscale was associated with increased mortality from noncancer and noncardiovascular causes ( multivariate adjusted hazard ratio per unit increase in the st and ard score on the apathy/anergia subscale=1.71 , 95 % CI=1.25 - 2.34 ) . The anxiety subscale was not associated with any cause of death . CONCLUSION Depressive symptoms and symptoms indicating apathy/anergia have differential influences on subsequent causes of death in older persons living in the community . Identification of specific psychiatric symptom clusters may contribute to the prevention of deaths from specific causes in older population
ORs were generally higher for recurrent fallers than for all fallers .
This meta- analysis provides comprehensive evidence -based assessment of risk factors for falls in older people , confirming their multifactorial etiology .
Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling
BACKGROUND Falls are the main cause of accidental death in persons aged 65 years or older .