bluuebunny/crossref_metadata_2025 huggingface dataset:
136 Barriers to Discussing Fall Prevention with Healthcare Professionals amongst Community-Dwelling Singaporean Older Adults
Authors: Balachandar Nivedha , Sim Silvia , Tan Pey June , Mallya Jagadish , Ismail Noor Hafizah , Chan Angelique , Wong Chek Hooi
Published: December 2019

Introduction

A multitude of modifiable factors can contribute to one’s fall risk. Healthcare professionals (HCP) are equipped to identify such factors, and make appropriate recommendations to help older adults prevent falls. However, there is limited evidence on the awareness and practice of this in Asian communities. Thus, this paper aims to understand the participation and barriers for community-dwelling Singaporeans to discuss falls with their HCPs.

Methods

A cross-sectional survey was conducted on a nationally-representative sample of Singaporeans aged ≥60 living in the community. Participants were asked if they have fallen in the past 12 months, if they discussed what they can do to avoid falls with their HCPs (doctor/nurse) and for their perceived barriers via a semi-structured questionnaire with multiple responses. Unstructured data was coded using content analysis by two researchers and pooled with structured data. Sub-group differences between fallers and non-fallers were anaylsed using chi square tests.

Results

Of 549 participants (70.6±6.9 years and 61% female), most (n=447, 81%) have never talked to their HCPs. More fallers discussed falls prevention with HCPs than non-fallers (p=0.037). The top barriers cited for discussing falls with HCPs – low perception of fall risk (55%) and misconceptions regarding falls and/or HCPs (29%) – were more prevalent amongst non-fallers (p=0.008) and fallers (p<0.001) respectively. Other barriers identified include competing priorities (8%) and actively taking alternate management to mitigate falls risk (4%).

Discussion

Fallers and non-fallers have different reasons behind not discussing falls with HCPs. Findings indicate that despite having higher fall risk, fallers may still not talk to HCPs as they are either unaware that fall risk can be mitigated, or of HCP’s role in fall prevention. Future studies should address fallers’ knowledge and attitudes to improve their participation in interventions in the community, and investigate health practitioners’ readiness to address concerns about falls.
14 Individual Environmental Assessment for Older Inpatients in Medical Wards, Ripas Hospital, Brunei Darussalam
Authors: Choo Sanny Zi Lung , Rosli Nadzirah , Teo Shyh Poh
Published: December 2019

Introduction

Falls in hospital cause significant morbidity and mortality for older patients, with 10-25% inpatient falls resulting in lacerations or fractures [Rubenstein, Age Ageing, 2006 Sep; 35Suppl 2:ii37–41]. In addition to patient individual falls risk factors, such as delirium, visual impairment and poor mobility, environmental factors should also be addressed to reduce inpatient falls risk.

Methods

An audit of the individual patient's environment or bed space was performed using the Queensland Health Individual Environment Checklist [The Victorian Quality Council Safety and Quality in Health]. Older people aged 65 years and older admitted to the medical wards in Raja Isteri Pengiran Anak Saleha (RIPAS) hospital, Brunei were included. Patients who were bed-bound or immobile were excluded from the audit.

Results

There were 30 patients included in this audit. 13 (43%) were male and 17 (57%) female. Median age was 74 years (Range 65 to 83 years). Several issues were identified from this audit: Although bedside tables and lockers were wheeled with a braking system, they were not secure enough to support a patient if they leaned against them. While 28 (93%) had functioning call bells, none of the patients were shown how to operate them. 22 (73%) did not have easy access to call-bells or night-lights. 14 (47%) did not have bedside lockers or tables within easy reach. 17 (57%) did not have mobility aids within reach or received education regarding safety with mobility aid use.

Conclusion

This audit highlighted several aspects of the individual patient environment in hospital that should be improved to reduce falls risk. For the medical wards, we recommend ensuring hospital furniture are sturdy enough in case patients lean on them and frequently checking ease of access to call-bells, night lights, walking aids and locker belongings.
142 Clinical Characteristics of Geriatric Patients on Denosumab and its Safety Outcome in Geriatric Day-Care, Hospital Kuala Lumpur
Authors: Halim Hannah Abdul , Alias Rosmaliah , Chew Chia Zin , Tiew Wah Peng , Basid Aima Nabila Abdul , Razali Rizah Mazuin
Published: December 2019

Introduction

Denosumab had shown significant effectiveness in managing osteoporosis, but there are insufficient safety data worldwide. This study aimed to identify the baseline clinical characteristics of geriatric patients receiving Denosumab and the safety outcome among this population.

Methodology

This is a descriptive and retrospective cohort study with universal sampling that reviewed medical records of all geriatric patients of 60 years and above who are on Denosumab in Geriatric Day-care, HKL from 2014 to 2018. Patients who were discharged from Geriatric follow-up and those with untraceable records were excluded.

Results and Discussions

A total sample of 26 patients were recruited, with the mean age of 81.8 (±5.19) years old and predominantly are female (n=22). All patients were diagnosed osteoporosis based on clinical and imaging. More than three-quarter (n=23) of the subjects had bone mineral densitometry (BMD), and the mean T score is -3.02 (±0.88). Twenty-three patients had history of falls and two-third of them had fracture, predominantly lumbar fracture (n=9). The mean creatinine clearance is 33.23 (±9.78) ml/min, and the mean corrected serum calcium is normal. Six patients had history of infections mainly involving respiratory tract infection (n=4), another six patients had pre-existing dermatological and concomitant respiratory disorder respectively. Twelve patients with the aforementioned pre-existing conditions developed recurrent infections (n=9) and worsening of cutaneous reactions (n=3) post Denosumab initiation, where six of them requires rehospitalization and another three patients required Denosumab discontinuation. Hypocalcemia was not reported since there is an inadequate routine serum calcium monitoring post Denosumab.

Conclusion

Immunization, infective and electrolyte screenings are warranted to serve as structured baseline monitoring for safety profile of patients receiving Denosumab. The findings of this study are crucial to assist with the development of local Denosumab protocol to guide practitioners for the betterment of patient’s management.
149 Falls in the United States: Magnitude, Risk, Disparities, and Solutions
Authors: Smith Matthew Lee , Vieira Edgar , Herrera-Venson Angelica , Cameron Kathleen
Published: December 2019

In the United States, falls incidence rates remain steady among older adults (those age 65 years and older), which highlights the need for effective interventions to prevent falls and manage fall-related risks. Falls are the leading cause of unintentional injury and injury-related disability and deaths among older adults (29,668 deaths, 61.6/100,000, in the US in 2016), and the rate of fall-related deaths among older adults increased 31% from 2007 to 2016. In the United States, an older adult goes to an emergency room due to a fall every 11 seconds (3 million visits per year), and an older adult dies from a fall-related injury every 19 minutes. In response to this issue, the Administration for Community Living (ACL) and other governmental agencies have dedicated large sums of funding to initiate and support fall prevention and management efforts in clinical and community settings. As part of the solution, ACL supported 40 grantees to deliver eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) from 2010-2016. During that time, this ongoing initiative has reached 45,812 participants in 22 states by delivering 3,755 workshops. The majority of workshops were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). This presentation will use geographic information system (GIS) mapping to geospatially depict the dissemination of these programs as well as highlights their impact on fall-related outcomes. Additionally, models of clinical and community collaboration for fall prevention will be described, which shows the importance of leveraged resources, seamless referral systems, and timely feedback channels. Further, policy initiatives and a national network of state-based fall prevention coalitions will be described to coordinate and integrate efforts across clinical, community, corporate, and academic settings. Lastly, strategies will be shared to diversify the delivery infrastructure for fall prevention programs and incorporate technological options for isolated populations and those without access to preventive services.
152 Fall-Related Injuries – using the Nationwide Population based Danish National Health Registers
Authors: Ryg Jesper
Published: December 2019

One-third of the population ≥65 years of age fall at least once a year. Fall related injuries including fragility fractures are common causes of hospital admission and associated with high morbidity, mortality, and cost to society. The ageing population poses a significant challenge to the healthcare systems. Therefore, studies are warranted that enables focus on specific areas in need of preventive efforts.

The aim of this talk is to give an overview of the importance of falls and fractures, to review the unique possibilities of conducting epidemiological studies using nationwide population based registers, and to present results from studies on fall related injuries. Examples of presented results includes “Fall injuries requiring hospital admission”, “Cardiovascular drugs and risk of fragility fractures”, and “Subsequent fractures following first fracture admission.
154 Blood Pressure Target in Management of Postural Hypotension in Elderly: Evidence Free Zone?
Authors: Shandilya Saurabh , Prakash Anand
Published: December 2019

Optimizing of polypharmacy in the elderly patient presenting with falls requires making judgement calls between stopping or reducing anti-hypertensives with the increased risk of stroke and cardiovascular disease versus continuing the medications with the consequent orthostatic hypotension, electrolyte abnormalities and worsening of cognition due to reduced perfusion pressure in patients with dementia. The trial evidence in this cohort of patients is scant and conflicting. The Milan 75+ Cohort study published in Age and Ageing, Volume 44, Nov. 2015 by Giulia Ogliari et al showed a U shaped relationship between BP and mortality with the lowest mortality at systolic blood pressure of 165 mm Hg. The Hypertension in the Very Elderly Trial (HYVET) published in New England Journal of Medicine in March 2008 by Nigel S Beckett et al showed reduction in any cause death by 21% in the intensive treatment group, while the Cochrane Systematic Review by Vijaya M Musini et al published in 2009 showed no reduction in total mortality in the very elderly patient with increased withdrawals due to adverse effects in the treatment group.

There are questions on the applicability of trial evidence with the HYVET trial having lower level of patients with diabetes and cardiovascular disease and the SPRINT trial including mainly younger patients with good baseline renal function and little cardiovascular disease. The combination of frailty showed improved outcome in HYVET but had no effect in SPRINT trial. The number needed to treat to avoid one significant event in patients with a blood pressure of >170 is 125 for death, 67 for stroke and 48 for heart failure.

In this context issues such as patient preference, degree of frailty, cognitive impairment, and life expectancy have to be taken in account before deciding on the suggested treatment for the individual patient.
156 One Toy, Many Games: Whiztoys for Exercise Enablement and Cognitive Enhancement
Authors: Hsu Yeh-Liang
Published: December 2019

Non-pharmacological intervention has been is an important approach for dementia care. Many studies showed that physical activity (PA) programs for older adults could integrate challenging cognitive activities (CA) to improve cognitive health. Combined PA + CA programs should be promoted as a modality for preventing as well as treating cognitive decline in older adults.

“Serious games” use technology to combine multimedia, entertainment, and experience, to design “games that do not have entertainment, enjoyment, or fun as their primary purpose.” Recommendations for designing serious games for people with dementia include (1) Interventions should be supervised to support people with dementia to help them understand the instructions and the technology of the games; (2) Serious games should be well adapted to the target population and their individual impairments, capacities, and interests; (3) Interventions should be played in groups in order to guarantee enjoyment and commitment to the games and to foster social behavior and interaction.

Under these principles, the Gerontechnology Research Center of Yuan Ze University has been developing a serious game platform “WhizToys”. WhizToys is in the form of puzzle floor mats, and can be freely assembled into different shapes. The older adults play games by stepping on the floor mats. Integrating with mobile phone Apps showing various games, such as matching game, chasing game, piano game etc., WhizToys combines physical exercise with cognitive training and multi-sensory stimulation. Standard tests such as “timed up and go (TUG)” are converted into games. The results of the games can be transmitted and recorded in the cloud for future reference. Caregivers can choose suitable games or adjust difficulty levels of the games from the App, according to the needs, experience and ability of the older adults. The user experience of WhizToys will also be shared in the presentation.
159 Reactive Balance Training for Preventing Falls in Older People
Authors: Sturnieks Daina , Okubo Yoshiro , Brodie Matthew , Lord Stephen
Published: December 2019

Appropriately timed and directed balance responses are crucial for avoiding a fall. These responses, including feet-in-place adjustments of the centre of mass, stepping and gait adaptations, may be initiated voluntarily to proactively avoid falling or induced reactively in response to sudden external perturbations to balance. Despite good evidence that poor reactive balance responses contribute to falls and injuries, traditional fall prevention interventions have ignored this skill. Reactive balance (or perturbation) training intervention methods are emerging and show promise for preventing falls in older people, some evidence suggesting a 50% reduction in falls. We recruited 44 older adults into a parallel, blinded randomized controlled trial, comparing 3 sessions of reactive balance training (exposure to trips and slips) to one session of sham training. The primary outcome was falls following laboratory-induced trips and slips (>30% body weight in harness). Relative to the control group, the intervention group experienced fewer total falls (rate ratio [RR]=0.40, 95% confidence interval [CI]=0.22-0.76), slip falls (RR=0.33, 95% CI=0.12-0.90) and trip falls (RR=0.49, 95% CI=0.21-1.12). These results will be discussed in the context of other current evidence for reactive balance training and suggestions made for how such interventions might influence the future of fall prevention.
163 Thai Traditional Game-Based Exercise for Gait and Balance of People with Parkinson's Disease
Authors: Khongprasert Surasa , Sooksai Keerati
Published: December 2019

Falls and recurrent falls are serious complications for people with PD. Poor standing balance, impaired ambulation, impaired lower-limb motor planning, postural instability and falling in previous year are associated with falling in PD. Exercise based computer game (Exergaming) have been used for motor rehabilitation to promote gait and balance and can encourage therapeutic activity. However, many commercially available games are not affordable for some people with Parkinson’s Disease. The aim of this study was to evaluate the effectiveness of Thai Traditional game (TTG) based exercise on gait and balance in people with Parkinson’s Disease. A total of 22 participants with PD (mild –moderate severity) were randomly assigned to either a TTG group or a control group. Participants in TTG completed 1 hour, 3 sessions a week for 10 weeks. The TTG comprises 10 games involved instruction in sit to standing, slow and fast walking speed, turning, weight shifting, reaching, obstacle stepping, cognition, clapping and singing. Gait and balance were assessed before and after the training sessions. Measures included the Berg Balance Scale (BBS), Balance platform, Timed Up and Go (TUG) and The GaitRite walkway. Participants in TTG groups showed significantly improved BBS, TUG, gait velocity and sagittal mean sway with eyes open (p <0.05). Thai Traditional Game based exercise incorporated therapeutic movement could lead improvement in gait and balance and participants seem to enjoy playing as an activity while maintaining their functionality. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.
24 An Observational Study on Orthostatic Hypotension in Geriatric Inpatients in Hospital Sungai Buloh: A Pilot Study
Authors: Sahadivanaidu Kavitha , Ghapar Amirul Asyraff Ab , Shariff Siti Mallisa Md , Nicholas Hee Ken Y , Nordin Nordiana
Published: December 2019

Introduction

Orthostatic hypotension (OH) is known to be prevalent in hospitalized elderly patients. This study aims to describe the prevalence of OH in our local setting and the associations with other risks.

Methodology

This is a pilot observational study recruiting all patients admitted to the geriatric ward between January to March 2019. Data including the postural blood pressure (BP), demographics, comprehensive geriatric assessment were collected into a case report form, and subsequently analysed via SPSS Ver. 23.

Results

27/69 were included in this study. Malays predominated this cohort (40.7%) with a mean age of 75.04, comprising of 77.8% males. The prevalence of OH was 22.2%; with the Chinese topping the highest prevalence (44.4%). There is a 100% male predominance of OH; making 28.5% of the male population; seen equally amongst those <85. There was no correlations of OH with existing comorbids except atrial fibrillation (AF) (p<0.024) and syncope (p<0.007).There was no significant association of OH with symptoms, length of stay, Mini Mental State Exam (MMSE), Lawton instrumental activities of daily Living (iADL) and MBI (Modified Barthels Index). However, its observed that 50% OH patients were asymptomatic although 83.3% did have prolong hospitalisation. 66% of them were functionally impaired. There is no significant association between presence of OH with existing medications.

Conclusion

OH is common and usually asymptomatic. This study describes a strong association between AF and syncope with OH. As this is a pilot study of a small cohort, a larger number of populations are needed in order to understand the prevalence in this setting. However, we recommend routine measurements of postural blood pressure in hospital settings to detect OH cases.
25 A Retrospective Audit of Heart Failure Care in Older Patients at Campbelltown Hospital, NSW, with Reference to the 2017 ACCF/AHA Guideline
Authors: Hsu Allan , Verick Dev , Blackwell Matthew , Hohenberg Mark
Published: December 2019

Aim

To determine if the management of a cohort of inpatients in our facility is compliant with the best practice guideline for heart failure from the American College of Cardiology 2017 management guideline and whether there were differences between younger and older patients.

Method

A retrospective ‘snapshot’ audit assessing all patients admitted to Campbelltown Hospital (CTN) with any ICD-10 heart failure code against the ACCF/AHA Guideline. Demographic data was collected; statistical analysis was performed using SPSS®.

Results

Sixty-three patients met inclusion criteria with a median age of 77 years and 83% from a private residence. A majority were frail (71%) and we found 87% presented with New York Heart Association class II or III heart failure symptoms. No patients received all the therapeutic options recommended by the guideline in our study. The majority if not all patients received basic investigations such as blood pathology and imaging. Compliance was found to be lower for echocardiography, iron replacement where required and use of the angiotensin blocker class of drugs. Comparing older and younger patients, there was a trend for older patients to be less likely to receive more advanced investigations and appropriate medications. Older patients in general have poorer outcomes comparing the younger.

Conclusion

Our study demonstrates an opportunity to improve compliance with the best practice guidelines for the management of heart failure. A robust coordinated approach, which is institution-centred, is required to improve compliance which has been shown to improve patient and health system outcomes.
29 Association between Risk of Falling and History of a Previous Falls over Four Years’ Annual Follow-up
Authors: Tan Guo Jeng , Mat Sumaiyah , Tan Maw Pin
Published: December 2019

Introduction

Falls in older persons lead to psychological as well as physical effects resulting in loss of quality of life, functional impairment and institutionalization. Previous studies have established falls in the previous 12 months as a risk factor for subsequent falls, but few have evaluated sequentially. This study aims to determine the sequential trend of 12-month retrospective fall recall over a four-year follow-up period.

Methods

The Promoting Independence in our Seniors with Arthritis (PISA) study recruited individuals aged >=60 years followed up over four year. Participants were asked about presence of any fall in the preceding 12 months during each annual visit. Assessment performed during each visit included weight and the Knee Injury and Osteoarthritis Outcome Score (KOOS), hand grip strength, timed-up-and-go test, functional reach and Hospital Anxiety and Depression Scale.

Results

Falls data were available for 218, 156, 117 and 100 individuals with 22.5%, 23.1%, 24.7% and 29.3% reporting falls at the first, second, third and fourth visits respectively. The mean age (standard deviation) at recruitment was 66.9 (7.1) years and 166 (74.1%) were women. The odds ratio (OR) (95% confidence interval, CI) for falls in the first, second and third years for fallers at recruitment were 2.45 (1.07-5.59), 3.55 (1.49-8.84) and 1.14 (0.43-3.05) respectively. Fallers at the second follow-up, were more likely to falls during second [OR (95%CI) = 2.41(1.94-12.90)] and third years [5.20 (1.91-14.13)]. Faller at the third visit for falls were more likely to fall in the third yaer [OR (95%CI) = 3.88(1.55-9.69)].

Conclusion

Falls in the preceding 12 months was associated with increased risk of falls in the subsequent two years. Faller at recruitment, however. were no longer at increased risk of falls at the third year of follow-up. This has implications for resource planning in terms to determine whether intervention is still useful with long waiting lists in overcrowded public health facilities.
33 Cognitive Domain Associations with Balance Performance in Community – Dwelling Older People with Cognitive Impairment
Authors: Taylor Morag , Lord Stephen , Toots Annika , Jacqueline Close
Published: December 2019

Aims

Investigate the relationship between global cognition and cognitive domain function and balance performance in a large sample of older people with cognitive impairment.

Methods

Three hundred and nine community-dwelling older people (mean age=82 years; 47% female) with cognitive impairment were recruited for the iFOCIS fall prevention randomised controlled trial. Baseline assessments completed before randomisation were used for analyses and included the Addenbrooke’s Cognitive Examination-III (ACE-III; global cognitive function) and its individual cognitive domains (attention; memory; verbal fluency; language; visuospatial ability) and executive function, further examined using the Frontal Assessment Battery (FAB). Balance performance was derived by averaging postural sway on floor and foam, maximal balance range (reverse z-score) and co-ordinated stability z-scores. With balance performance as the dependent variable, global cognition and each cognitive domain were entered into multivariate linear regression models.

Results

Mean (± standard deviation) ACE-III and FAB scores were 62.8±19.2 and 11.4±4.6 respectively. In linear regression analyses adjusted for covariates, global cognitive function and each cognitive domain were significantly associated with balance performance. Executive function (verbal fluency; β=-.248, p<0.001, adjusted R2=0.376) and visuospatial ability (β=-.250, p<0.001, adjusted R2=0.381) had the strongest and memory the weakest (β=-.119, p=0.018, adjusted R2=0.334) association with balance. Visuospatial ability remained significantly associated with balance performance when adjusted for attention, memory, language, verbal fluency and the FAB. Executive function (verbal fluency) remained significantly associated with balance when adjusted for attention, memory, language and visuospatial ability. Conversely, attention, memory, and language did not withstand adjustment for visuospatial ability or executive function.

Conclusions

Poorer global cognition and performance in each cognitive domain were associated with poorer balance performance in this large sample of community-dwelling older people with cognitive impairment. Visuospatial ability and executive function were independently associated with balance, highlighting the role higher-level cognitive processes and spatial perception and processing play in postural control.
36 Altered Prefrontal Cortex Responses in Older Adults with Subjective Memory Complaints and Dementia During Dual-Task Gait: An Fnirs Study
Authors: Teo Wei-Peng , Rantalainen Timo , Macpherson Helen
Published: December 2019

In this study, we investigated the effects of walking during single-task and dual-task gait (STG and DTG) conditions, on left prefrontal cortex (LPFC) activation in older adults with subjective memory complaints (SMC) and Dementia.

A total of 72 older adults (aged 65-94 yrs; 33 Healthy; 28 SMC; 11 Dementia) were recruited from the community and assisted living facilities. A portable 7m zeno walkway gait analysis mat was used to measure stride, velocity, length and duration during 4 passes of STG and DTG each. A portable single-channel functional near-infrared spectroscopy (fNIRS) device (Portalite, Artinis Medical Systems) was placed over the LPFC to measure changes in oxyhaemoglobin response (O2Hb) during STG and DTG. One-way analysis of variance (ANOVA) with bonferroni post-hoc t-test for multiple comparisons was used to determine differences between groups.

Our results showed that stride velocity, duration and length during STG (all p<0.05) and DTG (all p<0.000) were significantly impaired in the Dementia group compared to Healthy and SMC groups, while no significant differences were observed between Healthy and SMC groups. For STG, a greater increase in O2Hb (p<0.05) was observed in the Dementia group compared to the Healthy and SMC groups, while no differences were observed between Healthy and SMC. However, a significant increase and decline in O2Hb was observed during DTG in the SMC and Dementia groups respectively, compared to Healthy.

Our findings indicate an altered pattern of cerebral haemodynamic response of the PFC in people with SMC and Dementia that may be indicative of cognitive demands of gait. Our findings may have implications for the use of DTG and fNIRS as a potential early biomarker for cognitive declines in older adults.
43 State Mental Energy Influences Posture During Vision-Occluded States
Authors: Boolani Ali , Yager Chelsea , Smith Matthew Lee , Mondal Sumona , Sathiyakumar Thevasha , Senarathna Dinushani , Teymouri Seema , Vogel-Rosbrook Christina , Alvarez Julieth , Taladay Phylicia , Martin Rebecca
Published: December 2019

Background

Fatigue has been postulated to influence postural control, which may lead to an increased risk for falling among older adults.1 Mental and physical energy and fatigue have recently been reported to be four distinct mood states.2,3 Thus, to test Grobe’s1 theory of the influence of fatigue on postural control, we must examine all four mood states.

Objective

This study examined the influence of mental and physical energy and fatigue on postural control.

Methods

Adults (N=133, Males=50, Females=83, Age=25.8±7.96, BMI=24.8±3.8) aged 18-69 years were recruited from the community and asked to complete a series of surveys that measured their current mental and physical energy and fatigue states. After the completion of the surveys, subjects were instructed to complete the modified Clinical Test of Sensory Interaction in Balance (mCTSIB) using the APDM mobility monitors. Necessary assumptions were verified, and four multivariate multiple regression models were developed.

Results

Analyses yielded a significant association between posture and state mental energy (p=.048), but only when subjects were standing with their eyes closed while on a foam surface. Increased feelings of mental energy were associated with decreased total frequency dispersion (b=-358.62) and increased jerk in the coronal plane (b=11.78). No other associations were found.

Discussion

Results of our study suggest that as mental energy decreases there is a concomitant decrease in postural control when subjects are placed in conditions where they are unable to rely on visual feedback on unstable surfaces to maintain balance. Progressive increases in postural instability lead to increased risks of falls, most commonly in the elderly population. Falls are a significant risk factor for mortality. This study supports the clinical recommendation either to: (1) improve integration of vestibular and somatosensory input into postural control; or (2) train compensatory strategies for low lighting environments during episodes of decreased mental energy.
44 Association between Falls and Cognitive Frailty among Community Dwelling Older Adults: A Cross Sectional Study
Authors: Murukesu Resshaya Roobini , Singh Devinder Kaur Ajit , Mokhtar Noor Izyani , Ing Janet Bong May , Subramaniam Ponnusamy , Rasdi Hanif Farhan Mohd , Rivan Nurul Fatin Malek , Shahar Suzana
Published: December 2019

Introduction

The presence of either frailty or cognitive impairment have been determined as precursors of falls among older adults. However, the association between falls and cognitive frailty has yet to be established.

Objective

To investigate the association between falls and cognitive frailty among community dwelling older adults.

Methods

A total of 246 Malaysian community dwelling older adults aged 60 years and above residing in the state of Selangor participated in this cross-sectional study. Sociodemographic details and clinical characteristics including the history of falls were obtained via interview. The presence of cognitive frailty was identified using the Clinical Dementia Rating Scale and Fried Frailty Index. Data analysis was carried out via binary logistic regression.

Results

The prevalence of falls and cognitive frailty in this study were 21.2% and 21.9% respectively among community dwelling older adults (mean age 72.39±5.40). No significant relationship between falls and cognitive frailty [OR:1.187, 95% C.I: 0.493-2.856, p=0.702] was demonstrated. However, older women [OR:2.663, 95% C.I, 1.136-6.239, p=0.024] and the presence of multi-morbidities [OR: 1.431, 95% C.I, 1.026-1.997, p=0.035] were significantly associated with falls which corroborates with existing literature.

Conclusion

Cognitive frailty was not a significant risk factor of falls among community dwelling older adults in this study. Further research is required in prospective, longitudinal, population-based studies to confirm this result.
53 The Development and Education of Fall Prevention Program Through the Multidisciplinary Approach
Authors: Kim Mi Hyun , Go Chang Hee , Lee Jung Min , Kang Ji-Young , Lim Jae-Young
Published: December 2019

Introduction

To reduce the rate of falls in the rehabilitation ward, fall prevention program was developed and educated for physical and occupational therapists, which increased the attitude towards falls and knowledge towards fall prevention activities.

Method

Participants of this study include 17 therapists currently employed at a university-affiliated hospital located in Gyeongg-do, South Korea. Systematic protocol for fall prevention with the emphasis in the roles of rehabilitation teams was developed. This standardized protocol consists of educating therapists with adequate assistive device use, safe ambulation techniques, and client-centered transfer techniques. The therapists then record the paitent's status related to fall prevention and or risks, which is then shared with other medical professionals including registered nurses and medical doctors. Paper-based questionnaires regarding 9 questions on attitude towards falls and 12 questions on knowledge towards fall prevention activities were done by the participants after the education of systematic protocol. The rate of falls was then compared with the change of attitudes in participants. Rate of falls was calculated by dividing the number of fall by the patient bed days and multiplying by 1000.

Result

After the education of fall prevention program, the mean score of attitude towards falls significantly increased (t=-3.99, p=0.001). The mean score of knowledge towards fall prevention activities significantly increased (t=-4.79, p<0.001). The rate of falls decreased from 4.2 to 1.4. The effectiveness of systematic protocol regarding therapists' change in attitude and the resulting change in rate of falls was mainly seen in patients' ward. The decline in rate of falls was observed when patients transferred from bed to wheelchair.

Conclusion

In order to effectively convey the fall prevention education program, the multidisciplinary approach showed promising results in this study. Implications for future research include translation of this program to the community, such as long term care facility.
54 Patient Safety Culture at a Teaching Hospital in Kuala Lumpur
Authors: Krishnasamy Karthikayini , Tan Maw Pin , Zakaria Mohd Idzwan
Published: December 2019

Introduction

Patient safety, such as inpatient falls, is a global problem, accounting for increasing compensation costs from our healthcare facilities. The aim of this study was to evaluate the patient safety culture among healthcare providers.

Method

An online survey was developed within the hospital staff portal at the University of Malaya Medical Centre, with a dialogue box appearing on the launching of the portal website inviting the members of staff to participate in the survey. The survey contained a safety assessment questionnaire (SAQ) which measures the patient safety culture. The SAQ consists of 36 items measuring the six domains: teamwork climate, job satisfaction, safety climate, stress recognition, working conditions, and perception of management. Each domain is assigned a percentage score, and comparisons of scores according to healthcare disciplines were then made.

Results

5275 (80%) responded to the online SAQ which was sent out to all 6562 healthcare professionals employed, by the hospital. The teamwork and safety climate was poor among supporting staff, with scores of 56.7 and 59.8 respectively. Job satisfaction (62.9), perception of ward management (56.8), and hospital management (53.2), and working conditions (44.7) were less among the clinicians. Stress recognition (36.5) was in alarmingly low among the nurses.

Conclusion

A comprehensive unit-based safety programme will be conducted in response to the SAQ findings, and should incorporate objective falls the outcome in order to convince the hospital hierarchy of the need for urgent solutions to lower the rates of inpatient falls.
57 The Use of the Physiological Profile Assessment to Improve Prediction of Fragility Fractures in Community-Dwelling Older People
Authors: Harvey Lara , Taylor Morag , Delbaere Kim , Lord Stephen , Brodaty Henry , Kochan Nicole , Sachdev Perminder , Mitchell Rebecca , Close Jacqueline
Published: December 2019

Introduction

The Physiological Profile Assessment (PPA) is a validated composite measure of sensorimotor function, known to predict falls with 75% accuracy. This work aimed to investigate whether PPA is also associated with fragility fractures.

Method

Participants were 489 community-dwelling older people (age=70-90) enrolled in the longitudinal population-based Sydney Memory and Ageing Study. Participants underwent comprehensive assessments at enrolment, including the 5-item PPA (visual contrast sensitivity, lower limb proprioception, knee extension strength, simple reaction time and postural sway). Participant records were linked to emergency department, hospital and death records (2005-2014) to identify fragility fractures following baseline assessment, with median follow-up duration of 7.5 years. Negative binomial regression, with observation time as the offset, was used to assess factors associated with fractures.

Results

At baseline assessment, 281 (57.5%) participants were assessed as having low/mild fall risk [PPA<1] and 208 (42.5%) as moderate/marked/very marked fall risk [PPA score >1]. Over the study period, 72 (14.7%) individuals sustained 1 fracture, and a further 39 (8.0%) sustained 2 or more fractures.

Univariate analysis showed that increasing age (Incidence Rate Ratio (IRR) 1.1, 95%CI 1.0-1.1, p=0.0026), being female (IRR 1.8, 95%CI 1.3-2.8, p=0.0033), having osteoporosis (IRR 1.7, 95%CI 1.1-2.6, p=0.0340) and moderate/marked/very marked PPA (IRR 1.8, 95%CI 1.2-2.7, p=0.0025) were associated with fractures. In the multivariate analysis, only moderate/marked/very marked PPA (IRR 1.6, 95%CI 1.1-2.5, p=0.0159) and being female (IRR 1.8, 95%CI 1.1-2.8, p=0.0121) remained independently associated with fractures.

Conclusion

These findings show that people at increased risk of falls based on the Physiological Profile Assessment are also at increased risk of future fragility fractures regardless of the presence of osteoporosis. Early identification of this high risk population provides the opportunity to intervene with evidence based strategies to minimize falls risk as well as considering pharmacological management of bone health.
60 Obesity in Older Adults in the Epic Norfolk Study is Associated with Reduced 20-Year Falls Hospitalization
Authors: Kioh Sheng Hui , Sumaiyah Mat , Myint Phyo , Tan Maw Pin
Published: December 2019

Background

One in three older adults fall each year leading to increased disability, hospitalizations and mortality. Recent studies suggested an increased risk of falls among obese individuals which may correlate with increased rates of falls hospitalizations. However, there is not much information supporting the hypothesis that obesity may influence the risk of falls related hospitalizations.

Aims

To prospectively investigate whether body mass index (BMI) is a predictor for falls hospitalization by age group in the population of the EPIC-Norfolk Study.

Methods

Body height and weight were measured at baseline and BMI calculated. Falls hospitalization status over 20 years’ follow-up was ascertained using data linkage with centralized NHS records. Participants were categorized into the four BMI groups: underweight (BMI <18.5kg/m2 ), normal (18.5 ≤ BMI < 25.0 kg/m2), overweight ( 25.0 ≤ BMI < 30.0 kg/m2 ) and obese ( BMI ≥ 30.0kg/m2 ), and according to three age groups ( < 55 years, 55-64 years, ≥ 65 years).

Results

Data from 25636 individuals, (54.7%) women and (45.3%) men, mean age 59.2 ± 9.3 years, were included. For individuals within the under 55-year age group at baseline, individuals who were overweight (HR = 1.25; 95% CI= 1.01-1.56) and obese (HR = 1.54; 95% CI= 1.17-1.81) were at higher risk of falls hospitalization compared with those with normal BMI. As for individuals aged ≥ 65 years at recruitment, individuals who were obese were less likely to be hospitalized after a fall (HR = 0.85; 95% CI= 0.74 – 0.97) compared to those with normal BMI.

Conclusions

The relationship between obesity and falls hospitalization over 20 years differed between those aged <55years and 65years, with an increased risk observed for those <55years and reduced risk in those 65years. The underlying rationale for this finding will need to be evaluated in future studies.
70 Benefits and Potential Pitfalls of Exercise for Falls and Frailty
Authors: Skelton Dawn
Published: December 2019

Group and home-based exercise programmes, delivered by trained professionals to those living in the community reduce rate of falls and risk of falling and are considered more cost effective than multifactorial or multi-component falls prevention strategies. However, the dose of highly challenging balance and progressive strength training needed to not only improve risk factors but also reduce falls means that most patients do not receive the required dose. The same can be said for interventions aimed at sarcopenia and frailty. What does this mean for their outcomes and would we do this with medications? The importance of exercise in the rehabilitation of a frailer older person for many outcomes should not be overlooked and the challenge now is to improve provision of effective interventions within practice, both in terms of linking falls prevention with bone health, increasing uptake and adherence to exercise interventions and in terms of exercise delivery. This lecture will present the evidence on falls prevention but highlight the difficulties in engaging frailer older people, who may be sarcopenic, have multiple co-morbidities and be fearful of activity in evidence based exercise. Unfortunately, frailer older people sit more and the growing evidence that sedentary behaviour has poor outcomes irrespective of activity, suggests this is a good place to start with frail fallers. Sit less, move more and progress to being strength and balance training to reduce fear of falling and progress on to meeting the physical activity guidelines for health.
71 Discriminative Ability of a Falls Screening Mobile Application in Identifying Fallers among Community Dwelling Older Adults: Preliminary Results
Authors: Goh Jing Wen , Singh Devinder Kaur Ajit , Shahar Suzana
Published: December 2019

Introduction

Early falls screening among community dwelling older adults is important as a part of falls prevention strategy. Falls Screening Mobile Application (FallSA) was demonstrated to be accepted, reliable and valid to be used for self-risk assessment among community dwelling older adults in an earlier study. However, its discriminative ability is unknown. We aimed to examine the discriminative ability of FallSA in classifying fallers and non-fallers among community dwelling older adults.

Methodology

A total of 182 community dwelling older adults with mean age of 71.42 ± 5.1 participated in this cross sectional study. Participants demographic and falls history data were obtained. Participants with one or more falls were categorized as fallers. FallSA was used to identify participants falls risk. Independent t-test was used to compare falls risk score among fallers and non-fallers for its discriminative ability.

Results

Approximately 20% participants were categorized as fallers. Majority of the fallers were females (66.7%), had lower physical activity level and higher scores of geriatric depression scales compared to non-fallers. There was a significant (p< 0.01) different in the FallSA score between fallers (7.33±1.77) and non-fallers (4.34±1.72).

Conclusion

Our study results showed that FallSA could be used to discriminate fallers and non-fallers in community dwelling older adults. Further studies are in progress to determine the predictive validity of FallSA.
74 A Community approach to Otago Exercise: The Singapore Experience
Authors: Tay Mary Ann , Ismail Noor Hafizah Bte , Mei Lynn Lee Mei , Daoang Cheryl Marcos
Published: December 2019

Background

Exercise is vital towards combating sarcopenia, frailty and falls risks. Singapore’s older adults often gather at senior activity centres (SAC) for group exercises. These exercises are usually seated, low in intensity and non-progressive, posing little challenge and benefit to strength and balance.

Method

Aiming to provide evidence-based exercises to these older adults, we implemented a train-the-trainer (TTT) model to upskill community staff and volunteers to conduct the Otago Exercise Programme (OEP). Our physiotherapists conducted four classroom training days using the Later Life Training OEP course as foundation, adding modules on planning, assessment and safety considerations for group exercise. Thereafter, each leader was supplemented with an average of four On-Job-Training (OJT) sessions to provide guidance to screen participants, initiate and progress the OEP exercises suitably and safely.

Results

38 centre staff and volunteers from 13 SAC’s, were trained. Among 33 qualified community exercise leaders, 19 successfully conducted exercise classes while others were unable to commit due to various reasons. 174 older adults participated in the Otago exercises, conducted 1-2 times a week across 6 months. Participants’ outcomes reported from five of these centres showed an average of 76% attendance rate. 77% of the participants improved or maintained their Short Physical Performance Battery (SPPB) score. Participants reported that their physical function and balance improved after the OEP, enabling them to walk and climb stairs better. The OJT helped to uphold the fidelity of OEP and supported the community exercise leaders in implementing the programme. However, challenges working with centre staffs and volunteers in the community included steep learning gradient, openness to feedback, availability and turnover.

Conclusion

Community exercise leaders may be trained to conduct OEP in a group setting for older adults safely and effectively. However, OJT is essential to guide the leaders in adhering to exercise principles and safe practices.