bluuebunny/crossref_metadata_2025 huggingface dataset:
112 Cognitive Frailty, Physical Frailty and Loneliness Predicts the Incidence of Falls among Community-Dwelling Older Adults
Authors: Rivan Nurul Fatin Malek , Shahar Suzana , Rajab Nor Fadilah , Singh Devinder Kaur Ajit , Din Normah Che , Mahadzir Hazlina
Published: December 2019

Background

Although frailty is a well-known risk factor for falls, the concomitant effects of physical frailty and cognitive impairments or known as cognitive frailty (CF), in predicting the incidence falls is not established.

Methods

In a prospective cohort study, we examined the predictive ability of CF towards the incidence of falls among older adults from Malaysian Towards Useful Aging (TUA) study. A total of 400 participants aged > 60 years were successfully followed up at five years. Participants were interviewed on their sociodemographic data, medical and falls history. Assessments to examine cognitive function, physical functional status, psychosocial and dietary intake were conducted. Univariate analysis was performed for every variable, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls.

Results

After adjusting for the covariates, CF (Odd Ratio (OR) = 2.976, 95% Confidence Interval (CI): 1.776-4.987, p<0.05), physical frailty (OR = 2.882, 95% CI: 1.187-6.999, p<0.05), women (OR = 2.229, 95% CI: 1.362-3.648, p<0.05), and loneliness (OR = 1.329, 95% CI: 1.028-1.718, p<0.05) were the significant predictors for the incidence of falls.

Conclusion

Both cognitive and physical frailty were significant predictors of future falls among community-dwelling older adults. It is important to provide an effective intervention to prevent falls in this high-risk group of older adults.

This study was funded by the Long-term Research Grant Scheme (LGRS) provided by the Ministry of Education Malaysia (LRGS/BU/2012/UKM-UKM/K/01) and Grand Challenge Grant funded by the National University of Malaysia (DCP-2017-002/1).
113 An Online Platform for the Home Falls and Accidents Screening Tool (Home Fast)
Authors: Mackenzie Lynette , DuToit Sanet , McGrath Margaret , Fang Yihong
Published: December 2019

The Home Falls and Accidents Screening Tool (HOME FAST) is a well validated and researched tool designed to identify risk of falls in home environments for older people. The reach of the tool is limited by its availability only in paper-based form. This paper will outline the process involved in making the HOME FAST available online for health professionals, older people and their carers, and its utility in providing links to recommendations to modify home hazards, referring on to appropriate health professionals, generating reports, and communicating results with general practitioners.

An online platform is being designed for both the health professional and self-report versions of the HOME FAST which will be available for use on smartphones, tablets and computers. The program will indicate high, moderate and low falls risk. The platform will be tested by groups of health professionals, and older people throughout NSW. Once approved the online platform will be made generally available and demographic data will be collected about the person the HOME FAST is used with and common hazards they face.

Older people have been recruited through NSW council community groups and senior’s expos to trial the online HOME FAST and provide feedback through surveys, interviews and focus groups. Health professionals are being recruited through professional networks.

We anticipate collection of useful data about the home environmental risks present in the homes of older people as well as the uptake and adoption of the online HOME FAST and its potential to be used routinely in health professional practice. Findings will inform primary falls prevention in the community, how older people view the advice that is given through the on-line resources and how the home environment can be implicated in falls risk for older people living in the community.
114 Association of Trunk Muscle Function with Gait Ability of Patients with Lumbar Spinal Canal Stenosis
Authors: Shintani Takeshi , Otsuki Shingo , Hashimoto Masashi , Tagashira Satoshi , Kinoshita Kazuaki
Published: December 2019

Introduction

Lumbar spinal canal stenosis (LSCS) is not always correlated with spinal stenosis and severity of clinical symptoms. Although, it is important for trunk muscle function to enhance the dynamic stability of the lumbar spine, however few studies have reported on this. We hypothesized that trunk muscle function and gait ability of LSCS patients are related. This study aimed to clarify the association between trunk muscle function, using Side Bridge test (SB), and gait ability of LSCS patients.

Methods

The subjects were 42 patients with LSCS: 17 supported the trunk by the foot (F-group), and 25 supported the trunk by the knee (K-group) in the SB test. The SB test was performed to determine the posture holding time. Gait ability was evaluated by measuring the time of 10-m walk test (10MWT) preoperatively and 2 weeks postoperatively. The 2 weeks postoperative 10MWT was divided by the preoperative 10MWT to calculate the 10MWT change rate. The contents of this study were the relation between SB test and preoperative 10MWT, SB test and 10MWT change rate in each group. Moreover, the median value of SB test was calculated for both groups; based on these values, the patients were categorized into high-value and low-value groups. Differences between the 10MWT and 10MWT change rates of both groups were examined using Mann-Whitney U-test.

Results

There was a significant correlation between SB test and 10MWT (F-group: r=-0.63, p=0.004; K-group: r=-0.59, p = 0.002), 10 MWT change rate (F-group: r=-0.59, p=0.01; K-group: r=-0.41, p=0.04). With respect to the 10MWT, the high-value group was significantly faster than the low-value group (F-group: p=0.02, K-group: p=0.03), and with respect to the 10MWT change rate, the high-value group was significantly better than the low-value group (F-group: p=0.02, K-group: p=0.01).

Conclusion

Trunk muscle function is associated with gait ability of LSCS patients.
12 Community Dwelling Elderly’s Perception of the Environment is the Missing Link in Understanding the Dynamics of Outdoor Falls and FOF in Falls Prevention
Authors: Pijnenburg Gertrud , Musch Karlijn , Wregar Gwendolyn , Iulisca Monica
Published: December 2019

Falls amongst elderly are common and with an ageing population fall numbers are steadily rising. Consequently, governments put increasing emphasis on prevention. At the same time, international concepts like “urban vitality” and “age friendly cities” are being implemented. As a result, there is an increasing need to make public space safe and accessible to elderly. We used a mixed methods approach within an interpretative framework to research how community dwelling elderly perceive their outdoor environment in relation to falls and fear of falling (FOF) in a neighborhood in Amsterdam, the Netherlands.

Second, we determined how this perception affects outdoor mobility, behavior, activities and participation in order to conclude on the relevance of environment in falls prevention. We show that the environment has the ability to either enable or to limit seniors and determined which perceived environmental factors pose the greatest problem. However, we also argue that the influence of biopsychosocial factors is key in elderly’s perception of their surroundings. Furthermore, we discovered, through a process of interpretative theme finding, that self-perception, independence, adaptation and avoidance are important themes.

Overall, our study contributes to provide governments with insight into how elderly experience the outdoor environment, which helps them to revise and adjust public space and social policy accordingly. Furthermore, it provides the basis for further research on how environmental factors can be integrated in a multi-faceted approach to falls prevention in order to enable elderly to negotiate the city jungle.
121 A Newly-Developed Smart Insole System with Instant Reminder: Paves the Way towards Integrating Artificial Intelligence (AI) Technology to Improve Balance and Prevent Falls
Authors: Ma Christina Zong-Hao , Chung Alan Kai-Lun , Ling Yan To , Huang Zi-Hao , Cheng Connie Lok-Kan , Zheng Yong-Ping
Published: December 2019

Background

Falls in senior people have high incidence& lead to severe injuries [1]. Application of smart wearable systems (with sensors to monitor user’s balance and corresponding instant reminder to let tusers adjust posture/motion) can effectively improve static standing balance [2], reduce reaction time and body sway in response to balance perturbation [3], improve walking pattern [4], and reduce the risk of falls [5, 6]. However, previous systems have not considered the daily monitor of user’s balance and falling risks, and the personalized reminder. Artificial intelligence (AI) and big data analytics have been widely used to monitor the daily physical activity [7], while few studies have utilized them to improve balance/gait and prevent falls.

Methods

This study has optimized previous devices by integrating AI technology and developed a new smart insole system. The system consisted of insoles with embedded sensors that can capture the foot motion and plantar pressure, smart watch that connected with insoles wirelessly and then transmitted the foot motion and force data to Cloud server via Wi-Fi, central Cloud server for big data transmission and storage, workstation for big data analytics and machine learning, and user interface for data visualization (e.g. smartphone, tablet, and/or laptop).

Results & Discussion

The system transmission rate was up to 30 Hz. The collected big data contained all sensor signals captured before and after delivering reminder, and from day-to-day monitoring of users. The customized reminder varied in the type, frequency, magnitude, and amount/dosage. This AI smart insole system enabled the monitor of daily balance and falling risks and the provision of timely-updated and customized reminder to users, which could potentially reduce the risk of falls and slips. It can also act as a balance-training device.

References

1. Rubenstein.Age ageing, 2006. 35(suppl2):p.ii37-ii41.

2. Ma.Sensors, 2015. 15(12):p.31709-31722.

3. Ma&Lee.Human Movement Science, 2017. 55:p.54-60.

4. Ma.Topics in stroke rehabilitation, 2018. 25(1):p.20-27.

5. Wan.Archives of physical medicine& rehabilitation, 2016. 97(7):p.1210-1213.

6. Ma.Sensors, 2016. 16(4):p.434.

7. Badawi.Future Generation Computer Systems, 2017. 66:p.59-70.
123 Acceptability of the Ambient Intelligent Geriatric Management (AMBIGEM) System: A Technological Solution to Prevent in-Patient Falls
Authors: Dollard Joanne , Visvanathan Renuka , Hill Keith , Ranasinghe Damith , Lange Kylie , Jones Katherine , Boyle Eileen , Zhou Adele , Ng Nicholas , Wilson Anne
Published: December 2019

AmbIGeM is a technological solution to prevent in-patient falls in patients aged >65. It has been evaluated in a 100-week stepped wedge pragmatic design in two geriatric evaluation and management (GEM) wards and a general medical ward in two Australian hospitals (Visvanathan, Ranasinghe, Wilson et al., Injury Prevention, 2017,0:1). Evaluation of acceptability of the AmbIGeM system from the perspectives of patients and staff who experienced it is reported here.

30 patients completed a 24-item survey, 27 patients were interviewed, 22 staff participated in 3 focus groups and 51 staff completed a 39-item survey. Survey data were descriptively analysed, and focus group and interview data were thematically analysed.

In patient surveys, patients were overall strongly positive, with means 8+ (on 11-point scale) on most items. In patient interviews, the AmbIGeM system was considered a good idea to prevent falls. Most patients thought the singlets comfortable and had no concerns for their privacy nor impact on normal activity. Patients and families felt reassured, although sometimes they misunderstood the purpose of AmbIGeM. In staff focus groups, staff perceived AmbIGeM beneficial in that it can detect and alert movement in patients who require supervision. In both GEM wards, AmbIGeM was considered particularly beneficial,practical and valuable to use on night shift. Factors such as perceived technical limitations (false and delayed alerts) and felt staff burden impacted on acceptability. In staff surveys, 56% agreed/strongly agreed that AmbIGeM has the capability to prevent falls while 16% disagreed/strongly disagreed, 62% thought AmbIGeM would be more user friendly if it was consistently accurate and 76% believed that AmbIGeM takes a moderate/lot of extra work.

Conclusion

AmbIGeM is largely acceptable to patients and requires further refinement for staff. Feedback is valuable to further refine the system.
124 Core Stability is Involved in the Fall Risk of Older Adults
Authors: Satoshi Tagashira , Atsushi Takashima , Takeshi Shintani
Published: December 2019

Background

Fall prevention in older adults is an important task. Lower extremity function is a main focus in fall prevention. There are few previous studies focusing on core stability. The purpose of this study was to investigate the relationship between fall risk and core stability.

Methods

The study participants were 33 community-dwelling older adults (mean age: 65±17 years old; 5 men, 28 women). The fall risk was assessed using the Fall Risk Index-21 (FRI-21). Core stability measured the retention time of Side Bridge (SB) and Front Bridge (FB). Secondary outcome measures included lower extremity muscle strength (knee extension, hip abduction) and physical function (two-step test). Statistical analysis investigated the correlation between the measurement items.

Results

We found a significant negative correlation between FRI-21 and SB (r = -0.51, p<0.01) and FRI-21 and FB (r = -0.47, p<0.01). We also found a correlation between FRI-21 and the two-step test (r = -0.40, p<0.05). There was no significant correlation between FRI-21 and lower extremity muscle strength.

Discussion

FRI and Core stability showed moderate correlation. It suggests that the core and hip muscle functions involved in posture retention are involved with fall.

Conclusion

The risk of falls in older adults was related to core stability. If the core stability of older adults improves, it may help to reduce the risk of falling. Therefore, it is useful to consider core stability in the assessment of fall risk.
125 A Novel Immersive Virtual Reality Dual Tasking Platform for Older Adults
Authors: Yap Kwee Yong Joyce , Kua Ee Chia Joanne , Tan Cai Ning , Ding Xiao Ming , Ismail Noor Hafizah Bte , Chew Oi Khuan Pamela
Published: December 2019

Dual task training benefits older adults by improving their balance and gait parameters. There is strong evidence suggesting its usefulness in reduction of falls with reduced falls risk. Current interventions for dual task training include exercises with cognitive exercises. There exists limited evidence for the use of Virtual Reality (VR) in training for dual tasking. Our study sets out to evaluate the usability and feasibility of an immersive VR dual tasking platform for older adults.

An immersive VR dual tasking training platform for older adults was developed in conjunction with the engineers for this pilot study. The cognitive task involves training of executive function through an immersive 3-dimensional game where the participants have to follow instructions to catch and avoid certain specified objects. The motor task involves walking on a motorized treadmill at a preset speed. The two tasks were incorporated into a single platform with a training protocol over twelve sessions. We evaluated for side effects from using this immersive VR device and tolerability of the training protocol.

The mean age of the participants is 62.9(±3.0)years old. Their mean comfortable gait speed is 1.27m/s. There were no falls throughout the entire training program. Participants tolerated the training protocol well with only 0.83% (1/120 training sessions) experiencing lower muscle ache/pain. The most common adverse effect from the immersive VR environment was tiredness – which made up 88% of all the adverse effects. However, this did not prevent participants from completing the training. The mean rating on the Borg Scale of perceived exertion is fairly light.

The VR platform and training protocol is safe and feasible for use in healthy older adults. We aim to conduct a clinical trial using this VR dual tasking platform in older adults to assess for clinical benefits in falls preventions, improvements in gait parameters and cognitive scores.
127 Older Adults' Knowledge and Perceptions of Falls: A Mixed Methods Study
Authors: Ng Cheah Ping , Singh Devinder Kaur Ajit , Tan Maw Pin , Kumar Saravana
Published: December 2019

Introduction

Falls is a global issue due to its devastating consequences and costs associated with fall injuries in older adults. There is limited information regarding knowledge and perceptions about falls among older individuals in Malaysia. The aim of this study was to assess knowledge and perceptions of falls among older adults.

Methods

A total of twenty-five (n=25) community dwelling older adults were invited to participate in this study (age range 61-83, median=73). Focus group discussions were conducted to explore older adults’ perceptions on falls, while the Fall Risk Assessment Questionnaire (FRAQ) was used to assess their knowledge on falls.

Results

Three themes emerged from the qualitative data, which were ‘Ageing and its association with falls’, ‘Reactions to a fall’ and ‘Knowledge of fall interventions’. The quantitative results showed that more than half of the participants considered themselves at the risk of falls (n=15, 60%). Older adults had better knowledge on behavioral and environmental (percentage of errors: 19.4%; 35.2%) compared to medical and medication related fall risk factors (percentage of errors: 55.2%; 57.33%).

Discussion

Older adults had both positive and negative views on ageing and falls. Some of the fall prevention strategies highlighted were in line with evidence-based recommendations. However, majority exhibit fall prevention behaviors that were largely based on their personal experiences. Older adults lacked the knowledge on medical related fall risk factors as these require understanding of various medical conditions and the related medications.

Conclusion

Education intervention emphasizing on ageing, medical and medication related fall risk factors should now be evaluated.
132 Impact of Falls Intervention Team (FIT) in Sungai Buloh Hospital
Authors: Liew Chiat Fong , Rajalingam Vijayendran , Suhaimin Farrah Wahida Md , Pirathayini Vicknesha , Sim Pearly Kim Aik , Nordin Nordiana , Mu'iz Arifin Muhamad Afiq , Selamat Hasnah , Sa'at Nadiah
Published: December 2019

Introduction

There is an exponential rise in the number of falls in medical wards, Sungai Buloh Hospital over the years. 57.7% (71/123) of the total falls in 2018 occurred in the Medical Department which raised concerns. As part of the falls reduction strategy, a Falls Prevention And Awareness program have been instituted in the department since September 2017 as well as formation of Falls Intervention Team (FIT) in March 2018. This includes: 1. Education: regular Continuous Medical Education (CME) , and Continuous Nursing Education (CNE): Checklist, Morse Falls Scale, and Falls Prevention Flipchart.

2. Identification: wristband , bed-tagging, and board-tagging of high risk patients.

3. Prevention: Targeted intervention implemented based on risk factors.

Objectives

The primary objective of this study was to assess the knowledge on falls education, identification and prevention upon introduction of FIT.

Methods

Audits were done upon initiation of FIT and the following 12 months later in all 11 Medical wards. They were based on the above 3 components using a standard audit form HSB-MED –022. Paired T test was used in analysis in SPSS version 23.

Results

There is an increment of awareness in education by 32% (p < 0.00). Identification of those at high risk of falls has also increased by 11% (p < 0.023, Wilcoxon Signed ranks test). Audit on prevention also revealed an increment of awareness by 14% over 12 months period (p < 0.038).

The highest numbers of falls were seen in the wards with the lowest implementation of risk education and identification.

Conclusion

Despite the rising trend of the number of falls, FIT has proven to raise awareness, improved falls education, identification and prevention among healthcare personnel in medical wards in our setting.
133 Factor’s Contrubuting for Non-Compliance Physiotherapy Sesions among Geriatric Patient at Physiotherapy Fall Intervention Program
Authors: Embong Julaida , Lim L K , Lee F S , Adha M Nawawi , Rajadurai S , Fadzil N A A , Manap N S , Chong E G M , Yau W K
Published: December 2019

Introduction

Current world is going through an increase in ageing population with one in eight people in the world are aged 60 or over. By 2025, 15 % of Malaysia population will be aged above 60 years old. Physiotherapy playing a major role in facilitates healthy ageing process. However, compliance to physiotherapy session is still low among geriatric population.

A defaulter was defined as a patient who presented for less than 6 visits during the whole period.

Method

A Retrospective study will calling patient after patient did not turn up the physiotherapy appointment and interview was done on appointment with the doctor together. This study was conducted at Geriatric Clinic, Hospital Kuala Lumpur. Physiotherapy session records were tracked to get there number of defaulters in Physiotherapy Geriatric clinic during 2017 & 2018.

Result

Reasons for defaulting the therapy session was gained via phone call interview and during Geriatrician appointment. Total of 223 samples were tracked and interviewed in this study. The result reveals 73% of the patients defaulted in 2017 and 51% in 2018 respectively. Lack of facilities comprises 22% of factors for non-compliance. Meanwhile other factors such as human resource and functional capabilities contribute 14% and 19% respectively for patient’s non-compliance.

Conclusion

As conclusion, clinic need to take steps such as call to remind their appointment and provide proper home education to increase patient’s compliance. Together with in poor compliance which was successfully brought down by taking into consideration patient factors. This may be the best compromise until which time where special parking lots, improved transportation services or adequate skilled facilities in the periphery are made available to the patients.
135 Gendered Differences in Effect of Falls-Related Threat Appraisal on Attitudes Towards Exercise amongst Community-Dwelling Older Singaporeans
Authors: Sim Silvia YH , Tan Pey June , Ismail Noor Hafizah , Mallya Jagadish , Chan Angelique , Wong Chek Hooi
Published: December 2019

Introduction

Previous studies have established that perceived threat can function as motivation to adopt protective health behaviours (Rogers, 1975; Tannenbaum, 2015 etc). However, while perceived falls-related threat improves intention and participation in falls prevention programmes (Yardley et al, 2007; Dorresteijn et al, 2012), some studies have also found that for women, perceived falls-related threat doubles as a barrier to exercise (Sandlund, 2008; Bruce et al, 2002; Cousins, 2000). The evidence is less clear for men. This paper seeks to analyse gendered differences in how falls-related threat appraisal affects perceived importance of exercise.

Methods

Secondary data analysis was conducted on data from the National KAP Study in Singapore, where a cross-sectional survey was conducted on community-dwelling Singaporeans aged ≥60 (N=549). Sub-group analyses were conducted for men (n=212) and women (n=337). Multiple logistic regressions were conducted to assess the effect of threat appraisal on perceived importance of strength and balance exercise, controlling for potential confounders. Perceived falls-related threat was assessed two ways: (a) Concern about falling, measured by the Falls Efficacy Scale – International (FES-I) and (b) Perceived chance of sustaining severe injuries if one fell.

Results

For women, concern about falling is not significantly related to perceived importance of exercise (p=0.08). However, perceived chance of sustaining injuries has a small positive relationship with perceived importance of exercise (OR:1.4; 95%CI:1.1-1.8; p<0.01). The reverse is true for men – concern about falling has a positive relationship with perceived importance of exercise (OR: 2.6; 95%CI: 1.3-5.4, p<0.01), while perceived severity of injury is not significantly related to perceived importance of exercise (p=0.94).

Conclusion

The results suggest that men and women appraise falls-related threat differently and this affects their attitudes towards exercise. However, more research is needed to elucidate the mechanisms behind this difference. This will have implications on targeting health messages for men and women.
138 The use of Fall Risk-Increasing Drugs among Older People in Nursing Home
Authors: Omar Marhanis Salihah , Shiow-Ling Lee
Published: December 2019

Medication use has been one of the modifiable risk factors in causing falls. Falls are the leading cause of injury among older people. The incidence of falls will greatly impact the independence of the older people to carry out normal activity. This study aimed to determine the prevalence of drugs causing falls and the fall risk status among older people residing in nursing homes. A cross-sectional study was conducted among residents in 27 long term care facilities in Malaysia from March 2018 until November 2018 using a researcher-assisted questionnaire. In this study, 212 elderly residents were recruited and further categorized into frail (6.6%, n=14), pre-frail (57.5%, n= 122) and robust (35.8%, n=76). The frailty status was found to be significantly associated with the risk of falling (p < 0.001). Of all residents recruited, 68.4% (n=145) were taking at least one FRIDs or orthostatic drugs. Antipsychotics and calcium channel blockers were the most frequently used FRIDs. Length of stay in facilities (<1 year), frailty status, number of medication, use of CCB or RAS inhibitors are associated with an increased risk of falling (p<0.05). Therefore majority of the older people residing in nursing homes were prone to the use of fall-risk medications, particularly ODs. Frail older people had a greater risk in falling compared to those who were non-frail.
139 Assessment of Nurses’ Attitude and Perception on Patient Safety in a Teaching Hospital
Authors: Krishnasamy Karthikayini , Hashim Afzawahiza , Sivanandy Palanisamy
Published: December 2019

Introduction

Patient safety issues have become a major concern in healthcare organizations that lead to undesired events and reduce patients’ quality of life (QoL). Around 10% of patients affected by serious medical errors during treatment, among these 14% result in death and 70% in disability. Nurse-led services are paramount in the treatment and have vital role in minimizing patient safety issues. Hence, a study was aimed to analyse the nurses’ attitude and perception on patient safety and, to determine the potential predictors for patient safety outcome dimensions.

Method

A quantitative descriptive cross-sectional study was conducted at a 900 bed teaching hospital. Random sampling technique was adopted to select nurses with more than 6 months of working experience in the hospital. Hospital Survey On Patient Safety (HSOPS) tool was used in this study, it had 42 items with 12 dimensions.

Results

Out of 390 questionnaires distributed, 360 were returned with complete details and the response rate was 92%. Among the safety culture dimensions, only two items scored more than 75% of positive response rate (PRR) which were ‘Organizational learning-continuous improvement’ (PRR 84%) and ‘Teamwork within unit’ (PRR 80%). The ‘Communication openness’ and ‘Hospital handoffs and transition’ scored a very low PRR which were 43% and 37% respectively, as most of the nurses felt that sharing information or issues with colleagues may be held against them. Reporting of errors were very low in the current set-up as most of the nurses reported 1-2 adverse events in a year which was noted as highest among all specialties.

Conclusion

The current level of patient safety in this teaching hospital need an immediate attention as most of the patient safety domains scored a very low PRR. Safety measures need to be taken before the issues reaches worst situation and adverse impact on patients’ health related QoL.
140 Midodrine Hydrochloride in the Management of Elderly Patients with Neurocardiogenic Syncope: A Prospective Observational Study
Authors: Teo Angelene , Vilches-Moraga Arturo , Staniland John
Published: December 2019

Background

Midodrine hydrochloride is an alpha-1 agonist that has been used in the management of syncope in patients with orthostatic hypotension, vasovagal syncope and vasodepressor carotid sinus syndrome when non-pharmacological means have failed. However, there are very limited information about its use, tolerability and side effects among the elderly population.

Objectives

We aim to document effectiveness of Midodrine in patients who have been diagnosed with neurocardiogenic syncope assessed and managed at a specialist falls and syncope outpatient unit. We monitored for changes in patients' symptoms, adverse reactions reported and optimum drug dosages that have shown benefit in this cohort of patients.

Methods

A prospective observational study of 33 subjects aged between 68 and 94 (mean age 79) who have been started on Midodrine therapy following positive tilt table test or confirmed diagnosis of symptomatic orthostatic hypotension despite conservative managements. They have been followed up for a mean of 2.9 years.

Results

81% of patients( n=27) reported significant improvement in their symptoms. Although 7 patients reported adverse reactions to Midodrine, the majority of the patients tolerated the therapy well and continued on the treatment except for one patient who experienced gastrointestinal discomfort and withdrew completely.

Commonest side effects are pruritus and piloerection, but they are not amenable to treatment due to underlying mechanism of action of Midodrine on hair follicles. The dosage varies from 2.5mg to 10mg, taken at 8am, 12pm and 5pm due to risk of nocturnal supine hypertension. Higher dose did not correlate with higher possibility of experiencing side effects.

Conclusion

Midodrine appears to be effective, safe and well tolerated among the elderly population. It should be considered in the management of patients with neurocardiogenic syncope when non-pharmacological means have failed, irrespective of age. This observational study requires further confirmation by randomised control studies with larger sample size.
141 Fall-Risk Increasing Drugs use in Elderly with Fall-Related Fractures
Authors: Low Chin Yeong , Omar Marhanis Salihah , Mahadzir Hazlina , Yin Mei Kuen
Published: December 2019

Introduction

Elderly populations are at the highest risk of fatal falls and fracture is one of the fall-related injuries which results in high morbidity and mortality. A group of drugs have been identified as the fall risk increasing drugs (FRIDs) and listed as one of the modifiable extrinsic risk factors for falls. This study aimed to determine the use of FRIDs in fall-related fractures among elderly patients.

Method

Patients aged 65 years and above admitted to a tertiary teaching hospital due to falls were included. Falls were identified through a case-mix system using the ICD-10 codes of W01 and W18 (fall at the same level). Patient medical records were reviewed retrospectively and drugs use before the falls were analysed.

Results

Among the patients included (n=124), majority of them had fall-related fractures (83.1%) and hip fractures were among the highest type of fractures (67%). The older old (≥ 80 years) had recorded a significant higher incidence of hip fractures compared to the younger individuals (p=0.009). About 75% of the patients with fall-related fractures had recorded use of at least one FRID before the admission. The younger individuals had significantly higher use of FRIDs compared to the older old, particularly the anti-hypertensive drugs (p=0.017). Most of them (>80%) still received FRIDs at discharge and deprescribing was commenced in less than one quarter of the patients. Furthermore, 32.6% of them had either an addition of new FRIDs or increased of the FRIDs dose at discharge.

Conclusion

In conclusion, fracture was the major reason of admissions among the elderly with falls. The older old recorded higher incidence of fall-related hip fractures. There was high usage of FRIDs before and after fall-related fractures. Deprescribing was not widely practiced in the elderly after the fall incidence.
143 Medications Related Fall Incidents among Older Adults at a Teaching Hospital
Authors: Sivanandy Palanisamy , Krishnasamy Karthikayini , Tan Maw Pin
Published: December 2019

Background

The drugs prescribed for hypertension, hyperglycaemia, and mental disorders affects patients’ mental and postural stability, and ends up in fall related incidents in over 60% cases. Hence, a study was aimed to review the drugs prescribed in older patients with at-least one episode of fall incidents.

Method

A retrospective study was carried out at a 1000 bedded teaching hospital using electronic big data system to record patients’ information.

Results

Out of 135 patients who had fall incident(s) during the study period, 69 were male and 66 were female. Majority (n=77; 57%) of the patients were older than 60 years of age and have had at least one co-morbid conditions. Most of the fall incidents have occurred during their inpatient period and at the time of using toilets (67%) and at bedside (22%). Around 42% of the fall incidents were moderate to severe and sadly one patient died due to large subdural hematoma and intra-parenchymal bleeding secondary to fall. Corticosteroids (36%), diuretics (27%), antihypertensives (26%), antidiabetics (25%) and other class of drugs (45%) were commonly prescribed in the patients; and these drugs were given either alone or in combination with other drugs. These drugs have high impact on fall incidents as it may lower the blood volume, blood pressure and blood sugar; it may in turn cause postural instability. Most of the fall incidents where noticed in patients who had diuretics plus antihypertensives (26%), antihypertensives plus antidiabetics (22%), antihypertensives plus antidiabetics plus antihyperlipidemic agents (18%) and corticosteroids (15%) concurrently and at irregular dosing interval.

Conclusion

Regular monitoring of prescription drugs and its complications are of at most important to prevent future fall related incidents. Hence, an efficient and continuous medication review is warranted in an emergency basis to make the drugs safer to the patients.
146 Prevalence and Associated Factors for Falls among Medical Patients in an Outpatient Clinic Setting
Authors: Ali Rosmahani Mohd , Su-Ying Evelyn Aun , Nordin Nordiana , Lee Christopher KS
Published: December 2019

Background

Falls is a major public health concern. In the older population, it is a risk factor for disability, frailty and further disability. However, most data is focused in Nursing Home residence and non-Asian population. Furthermore, despite Orthostatic Hypotension (OH) often attributed to falls, there is little data in the Malaysian population.

Objective

To identify the prevalence of fall and associated factors among medical patients in the outpatient clinic. Also to determine incidence of orthostatic hypotension and associated factors in the outpatient clinic. This is done through a series of tests that includes blood pressure measurement.

Design

Cross-sectional study was performed in an outpatient medical clinic. Analysis was performed with independent sample t-test for continuous data and chi-square test for categorical data.

Setting

Medical Outpatient Clinic in Hospital Sg Buloh.

Results

A total 352 patients were recruited. 191 (54.3%) reported having history of falls and 51 patients (14.52%) had evidence of orthostatic hypotension (OH). Majority of falls occurred at home (42.9%). Mean age for fallers are 45.37 ( SD 14.859) and for non-fallers are 48.39 (SD 13.12). Those on calcium channel blockers and ACE inhibitors/Angiotensin Receptor blockers is associated with history of falls (p-value <0.05). Those with Diabetes Mellitus are associated with more OH (p-value 0.04). Certain medications, notably anti-platelet, insulin and oral hypoglycemic agents is also associated with OH.

Conclusion

Those who are single are associated with history of falls. Calcium channel blocker and ACEi/ARB are associated with those with history of prior falls. Amongst medical conditions, only diabetes is associated with OH.

The findings so far provided a platform for improving understanding factors for falls in the outpatient setting. As the numbers are relatively small, we hope to continue the study. This will hopefully be able to give insight on possible factors associated in falls in our community.
148 Inpatient Medications and Occurrence of FALL in Hospital Sungai Buloh, Malaysia
Authors: Shariff Siti Mallissa Mohd , Sa'at Nadiah , Nordin Nordiana
Published: December 2019

Introduction

It is important to identify whether the fallers were taking the drug that is associated with fall since drug is potentially a modifiable factor. This study is conducted to determine whether inpatient medications are associated with fall.

Methodology

This is a cross sectional study involving fallers in our hospital in 2018 (excluding Pediatric fallers). Data were collected from Falls Incident Reporting Form (HSB-MED-FORM-018 Pin. 1/18), and analyzed via SPSS version 23.

Results

In 2018, a total of 113 patients experienced inpatient fall. Medical department topped as the highest number of falls in the hospital [70 (61.9%)]. 82 (72.6%) were male and only 36 (32.7%) of the fallers were more than 65 years old. Of those fallers, 63 (55.8%) were taking at least one high risk medication. Nearly half (42.9%) of them took 2 or more high risk agents. Only 12 (10.6%) fallers were on polypharmacy (use of >5 medications). However, there is no significant association between high risk medication and polypharmacy (p=0.580). The most commonly prescribed class of drug associated with fall is antihypertensive, diuretics and anticonvulsant. The use of anticonvulsant in patient aged more than 65 is associated with fall (p=0.041). Of the 113 falls analyzed, 54 (52.2%) resulted in no injury and the rest resulted in an injury involving swelling, skin tear, laceration and other injury.

Conclusion

We found out from this cohort that the use of antihypertensive is likely to induce inpatient fall incidents. We also discovered that elderly is at a higher risk of falling when prescribed with CNS drugs. Intervention to prevent falls should focus on withdrawing the high risk drug and reducing the total number of drugs. We would like to propose that the form to be improvised in order to get more findings on drugs causing fall.
15 The Outcome of Post Fall Intervention Analysis in Medical Department, Sungai Buloh Hospital
Authors: Liew Chiat Fong , Rajalingam Vijayendran , Suhaimin Farrah Wahida Md , Pirathayini Vicknesha , Sim Pearly Kim Aik , Mu'iz Arifin Muhamad Afiq , Selamat Hasnah , Sa'at Nadiah , Nordin Nordiana
Published: December 2019

Introduction

Incident reporting form does not capture the exact mechanism of falls. With the increment in the number of falls in Medical Department, Falls Intervention Team (FIT) was formed in March 2018.

Objectives

The objective of this study was to analyse factors that lead to falls in medical wards based on falls incident reporting form (HSB-MED-FORM-017) and post fall investigation form (HSB-MED-FORM-023).

Methods

There were 82 incidents in the Medical Department since March 2018 till now. However 26/82 data were missing (excluded), only 56 post fall investigation forms were analysed. Data were cross-tabulated via Chi square in SPSS version 23.

Results

33/56 fallers were among the younger age group (< 65 years), majority being males (82%). Most fallers were categorized with high risk (36/56) according to Morse Fall Scale. The common falls area is within the 4 bedded cubicle (82%) which is away from nursing counter. The commonest location is bedside (40/56, 71%). Most of the falls (22/56, 39%) occurred during night shift (9pm – 7am). Majority of the falls happened while patients were trying to get out the bed (20/56). Falls while going to and in the toilet (21/56), were associated with the younger age group < 65 (18/21, p < 0.005). 18/21 (85%) in the elderly group (age > 65) fell due to extrinsic factors, (p < 0.016). However there was no correlation in age for intrinsic factor and environment as the cause for falls. Faller who needs supervision assistance is closely related to extrinsic factor for falls (p < 0.058). The commonest cause of falls in this cohort is due to intrinsic factor (51/56, 91%).

Conclusion

FIT has benefitted the department in understanding falls incidences and characteristics. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.
151 Falls in the United Kingdom: Magnitude, Risk, Disparities, and Solutions
Authors: Frith James , Robinson Lisa , Newton Julia
Published: December 2019

In the UK each year there are over 250,000 emergency hospital admissions due to falls, costing £4.4 billion for falls-related fractures alone. To help reduce pressure on the NHS, the UK Fire Service are now providing home safety checks which include a review of falls hazards, provision of falls and loneliness advice and in some cases, immediate provision of aids such as grab rails. It is yet to be seen whether this will translate into a reduction in falls but it appears that the trust people place in the Fire Service is resulting in an uptake of falls prevention advice.

Although we have reasonably good evidence that multifactorial falls interventions reduce the rate of falls, they are resource intensive and do not reduce the risk of falls. In contrast, exercise interventions reduce both the rate and the risk of falls and can be delivered in a group setting; however uptake and adherence is low. In an attempt to encourage local care providers to invest in falls prevention exercise, Public Health England created a Return-of-Investment tool (available online) for local commissioners to calculate the anticipated cost savings by investing in falls prevention exercise programmes.

A recent, novel approach to falls prevention developed in the UK is a Massive Open Online Course (MOOC). This is a free, open-access, online course open to anyone with access to the Internet. The purpose of the ‘Ageing Well: Falls’ MOOC is to educate people about falls prevention and empower them to take action. In five years, the course has educated over 10,000 people from over 100 countries worldwide. One survey revealed that 95% of learners felt more empowered to manage their falls risk, with an increase in confidence to engage in falls prevention behaviours but also an increase in confidence to seek help for falls.
153 Polypharmacy and Falls: A Global Phenomenon
Authors: Palanisamy Sivanandy , Pin Tan Maw , Karthikayini K , Prakash Anand
Published: December 2019

The incidence of falls increases over the age of 60 as they consume more medications compared to other age groups. Polypharmacy is a global challenge for all the health care sectors, particularly in the high income group countries where populations is getting older and are living with multiple chronic medical conditions. Middle and lower income group countries are not immune either. Multi-morbidity is managed by multiple specialists as per disease-specific guidelines and each specialist has conflict of interest to their own specialty. This produces polypharmacy and adversely affects the outcome and care. As the age increases, the physical, physiochemical and biological functions of body decreases. In order to optimise the body function and underlying disease condition, people consume more medications and suffer with multiple drug related adverse events. Fall is one of the major adverse events that greatly affect patients’ quality of life. Even though several medications attribute to falls, the incidence is more common in drugs used to treat psychological, mental, and emotional disorders. Antihypertensives and antidiabetics also increase falls related events. Studies have proved, the medication review plays vital role in fall prevention as the dose of medications can be modified according to the relative risk of fall. Several studies showed the medication related fall incidence is more than 60 percent and it can be prevented by prescription screening before the drug(s) being administered to the patient. Another study reported that the avoidable falls incidence due to medication usage is 20%. Pharmacists can play vital role in scrutinising the prescription, guide prescriber on appropriate drug and dose selection, and alert healthcare professionals. Prevention is better than cure, hence a team work from prescribers, pharmacists, nurses and patients are essential to reduce the number of falls and to improve the quality of life.
155 Polypharmacy Burden: How to Optimise, a Practical Approach
Authors: Sellappans Renukha , Prakash Anand , Sundus Ahlam
Published: December 2019

Polypharmacy refers to the numerical value of medications used by a patient and is typically described as the concurrent use of five or more medications per day, but the definition is variable and there is no global consensus. Polypharmacy is unfortunate consequence of rapid advancement of medicine. Polypharmacy could be appropriate or problematic. Problematic polypharmacy can arise if the medicines are used without good evidence and in this situation risk of harm outweighs benefit. While there might be clinical indication for the medications to treat co-morbidities of a given patient, polypharmacy in older persons are associated with negative outcomes such as falls, adverse drug events and increased healthcare utilisation. This is mainly due to the physiological changes in this population which increases their risk of adverse drug events as well as the problems associated with remembering, managing and administering the medications appropriately. Hence, researchers and clinicians around the world have been actively looking at ways to reduce polypharmacy and optimise drug therapy in older persons to improve clinical, economic and social outcomes. To date, medication review by pharmacists in various settings has been the most researched and documented evidence in tackling this issue. Medication review refers to the structured evaluation of a patient’s medication with the aim to reach agreement with the patient about drug therapy, optimising the impact of medication, and minimising the number of drug-related problems. This session aims to summarise the available evidence on various types and outcomes of medication review with the aim to optimise polypharmacy among older persons around the world and provide a practical recommendation in tackling the phenomena.