bluuebunny/crossref_metadata_2025_split huggingface dataset:
07 Examination of Reliability and Validity of Index of Postural Stability for Patients with Neurological Diseases
Authors: Mochizuki Hisashi 
Published: December 2019

Abstract

Purpose
The purpose of this study was to examine the reliability and validity of the Index of Postural Stability for patients with neurological disease.

Methods
The Index of postural stability (IPS) is a logarithmic value of the ratio between the stability limit and the area of centre of pressure (COP) in standing position, and is based on a probabilistic idea. Subjects were 75 patients with neurological disease (mean age; 63±12 years, 47 with Parkinson's disease, 9 with multiple sclerosis, 8 with Parkinsonism and others 11). Balance ability of subjects were assessed using IPS, Berg balance scale (BBS), Timed Up and Go Test(TUG), Functional Reach Test(FR), and gait ability of subjects were assessed using Functional Gait Category(FAC). IPS was assessed twice at intervals of about 30 minutes. Reliability of IPS was examined using Intraclass correlation coefficient (ICC), Bland-Altman plot and minimal detectable change (MDC). Validity of IPS was examined using correlation coefficients with BBS, TUG, FRT, and FAC.

Results
IPS showed significant and moderate correlation with BBS (r = 0.54), FR (r = 0.36), TUG (r =-0.43). IPS and FAC showed strong correlation (rs= 0.64). ICC of 2 separate measurements was 0.96. From the results of Bland-Altman plot, IPS had no additional error or proportional error (95%CI:-0.048~0.034, r=-0.0088, p=0.94). The MDC of IPS was 0.34.

Discussion
Since IPS has high reproducibility and does not have additional errors or proportional errors, and is also significantly related to other evaluation indexes of balance ability, it is considered that IPS may be a useful evaluation index of balance ability for patients with neurological diseases.
08 Evidence Base for Treatment of Osteoporosis in Older People
Authors: Masud Tahir 
Published: December 2019

Abstract
After the age of fifty years the prevalence of osteoporosis and incidence of osteoporotic fractures rise substantially with age. It is ironic however that the pivotal trials for the common drugs used to treat osteoporosis mainly recruited participants under the age of 80 years leading some to question the use of these drugs in the older population. This talk explores the evidence accumulated for the treatment of osteoporosis in the frailer older population.
The FOSIT trial showed a 47% reduction in non-vertebral fractures with alendronate in people up to 84 years, and a study in long term care in those up to 91 years showed a significant improvement in bone density at the spine and hip. A post hoc analysis of the risedronate HIP trial in people aged 70-100 years with established osteoporosis showed a 47% reduction in hip fractures. In the zoledronic acid Horizon studies fractures were significantly reduced in a population up to the age of 89 years and mortality was reduced by 28%, with half of the participants being older than 75 years. Interestingly a post hoc analysis showed that those participants who ended up having only a single infusion had a reduction of all clinical fractures at 3 years.
The Freedom trial of denosumab was performed in a population aged up to 90 years with significant fracture reduction across all age groups. Studies with the anabolic agent teriparatide showed that vertebral and non-vertebral fracture reduction occurred in both the under and over 75 age groups. Trials with the recently developed agents abaloparatide and romosozumab have shown significant fracture reductions in populations up to ages of 86 and 90 years respectively.
There is now enough evidence to suggest that the oldest old should be considered for osteoporosis treatment as well having a focus on falls reduction.
09 Characteristics of Community Fallers and the Diagnosis of Osteoporosis in the Falls Clinic of a Public Tertiary Hospital
Authors: Nadarajah Reena , Pang Gordon Hwa Mang , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Lee Fatt Soon , Yau Weng Keong 
Published: December 2019

Abstract

Introduction
Osteoporosis is a chronic asymptomatic condition. The US National Bone Health Alliance recommends that osteoporosis may be diagnosed by bone mineral density (BMD) testing, the occurrence of low-trauma fractures or through the use of fracture risk algorithms. However, osteoporosis has low screening rates despite having clear treatment benefits.

Methodology
This study aimed to describe the characteristics of patients in the falls clinic with and without osteoporosis and the ways by which diagnosis of osteoporosis was made. A retrospective, descriptive study was carried out on all patients who attended the falls clinic from January 2015 till March 2019, with data collected from its falls database.

Results
A total of 117 patients were included in this study. All patients had a history of fall, either single or recurrent. 43 patients had osteoporosis, of which 72.1% were female (p value &lt;0.05). In this study, age and ethnicity were not found to be risk factors for osteoporosis. Polypharmacy, having three or more comorbidities along with alcohol and smoking habits were also not significantly associated with osteoporosis. This study also showed no differences in terms of history of recurrent falls and level of mobility between the two groups of patients. Of the 43 patients with osteoporosis, six patients (14.0%) were diagnosed by BMD testing prior to their attendance at the falls clinic. 24 patients (55.8%) had a presumptive diagnosis of osteoporosis made based on prior fragility fracture, of which majority were vertebral fractures (45.8%); and the remaining 13 patients (32.0%) were diagnosed to have osteoporosis by BMD testing after their visit to the falls clinic.

Conclusion
Most patients who attended the falls clinic have had a prior fragility fracture, which could have been prevented by treatment. Screening for osteoporosis should therefore be carried out more robustly in the community to prevent injurious falls.
100 Knowledge of Nurses about the Morse Falls Scale
Authors: Ramli Roslawati , Chong Elizabeth G M , Yau Weng Keong 
Published: December 2019

Abstract

Introduction
Falls in the hospital is common. Morse Fall Scale was introduced in 2013 to Hospital Kula Lumpur as a tool for risk assessment in order that prevention strategies could be instituted in accordance to the falls risk. However, the rate of falls was on the rise in the last 5 years despite the use of the tool. The concern was that there is a lack of understanding in the use of the tool or that the scoring was not performed correctly by the nurses.

Method
A validated structured questionnaire regarding the knowledge of Morse Fall Scale was distributed to the registered nurse of the Medical Department Hospital Kuala Lumpur.

Results
209 responses to the questionnaire were collected. The average correct answers were 7 points. Almost a quarter of the nurses had less than 5 correct answers. 50% of this group of nurses has less than 5 years of working experience; most of them only had a diploma and were working in the active medical wards. 17% had full scores, in which 92 % of them had more than 5 years’ experience and had higher nursing qualifications. Overall, the nurses with longer working experience scored 1 point higher than those with a diploma. However, there is no difference in the average score with regards to their place of work, either in clinic or ward. The highest scoring (97.6%) question was the question regarding the purpose of Morse Falls Scale. The least correctly answered (41.6 %) was the question regarding the number of categories in the Morse Falls Scale.

Conclusion
The nurses with more experience understood the use of the scoring and usage of the Morse Falls Scale better. Generally, with an average score of only 7 out of 10, may reflect an inadequacy in the understanding in falls prevention.

References
1. SG Lim, SW Yam. The level of knowledge and competency in the use of the Morse Fall Scale as an assessment tool in the prevention of patient falls, IeJSME, 2016, 10(3): 14-23
2. Cruza S, AL Carvalho P, Barbosa BL. Morse fall scale user’s manual: Quality in supervision and in nursing practice. Procedia - Social and Behavioral Sciences 2015; 171: 334–9.
3. Enein NAE, Ghany ASAE, Zaghloul AA. Knowledge and performance among nurses before and after a training programme on patient falls. Open Journal of Nursing 2012; 2: 358–64.
104 Sociodemographic, Cognitive & Physical Function Characteristics among Older Adult Fallers with and without Cognitive Frailty: Preliminary Results
Authors: Murukesu Resshaya , Singh Devinder Kaur Ajit , Shahar Suzana , Subramaniam Ponnusamy 
Published: December 2019

Abstract

Introduction
Older adults with frailty and cognitive impairment are more susceptible to falls. The risk factor of falls and faller profiles among older adults in general has been established. However, information regarding potential risk factors and faller patterns among older adults with cognitive frailty is limited.

Objective
To examine the sociodemographic, cognitive and physical function characteristics of fallers with and without cognitive frailty.

Methods
A total of 133 community dwelling older adults aged 60 years and above were screened at three older adult activity centres in Kuala Lumpur. Sociodemographic details were obtained via interview. Cognitive Frailty was identified using the Clinical Dementia Rating Scale and Fried Frailty Index. Cognitive function was assessed using the Mini Mental State Examination (MMSE), Digit Span (DS) test and Ray Auditory Verbal Learning Test (RAVLT). The Senior Fitness test was used to asses physical function. Characteristics of falls were documented using a self-administered questionnaire. Data was descriptively analysed; independent T-test was used for continuous variables and chi-square test was used for categorical variables.

Results
Prevalence of falls was 21.1% (n=28). Within fallers, 42.9% (n=12) were cognitively frail and 57.1% (n=16) were not. Fallers with cognitive frailty were significantly older (mean age = 72.31±5.29) (p&lt;0.001), had lower MMSE scores (p&lt;0.01), lower 2 Minute Step test scores (p&lt;0.001) and lower Lawton Instrumental Activities of Daily Living scores (p&lt;0.05). Descriptively, fallers with cognitive frailty were mostly recurrent fallers (67%), sustained falls outdoors due to ‘slip and fall’ and majority sought medical attention after the fall(s).

Conclusion
Fallers with cognitive frailty were older and had lower physical and cognitive function as compared to those without. There is a need to further understand the relationship between falls and cognitive frailty in order to provide holistic fall prevention and management strategies.

Acknowledgement of grant
UKM(DCP-2017-002/2) and Ministry of Higher Education(LRGS/BU/2012/UKM-UKM/K/01).
106 Responding to the First Fall to Prevent the Second: Successful RCT in Reducing Falls using a Person Centred Approach for Older Fallers Presenting to Emergency Departments
Authors: Hill Keith , Barker Anna , Cameron Peter , Flicker Leon , Arendts Glenn , Brand Caroline , Morello Renata , Etherton-Beer Chris , Forbes Andrew , Haines Terence , Hill Anne-Marie , Hunter Peter , Lowthian Judith , Nyman Samuel , Redfern Judith , Smit DeVilliers , Waldron Nicholas , Boyle Eileen , McDonald Ellen , Ayton Darshini 
Published: December 2019

Abstract

Background
The majority of older people who fall and present to Emergency Departments (EDs) are reported not to receive guideline level care to reduce future risk of falls. The aim of this randomized controlled trial was to evaluate whether RESPOND, a 6-month telephone-based patient-centred program had an effect on falls and fall injuries in older people presenting to ED after a fall.

Methods
541 older fallers who presented to a WA or Victorian ED were recruited (inclusion criteria: discharged home &lt;72 hours, could walk without hands-on assistance, use a telephone, and no cognitive impairment (MMSE&gt;23). Intervention participants (n=263, mean age=73) received the RESPOND intervention, comprising (1) home-based risk assessment; (2) six months telephone-based education, coaching, goal setting and support for evidence-based risk factor management; and (3) linkages to existing services; while controls (n=260, mean age=73) received usual care. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy and quality of life.

Results
Falls rate was significantly lower in the RESPOND group (incidence rate ratio 0.65 [95%CI 0.43-0.99]; p=0.042). Although there was no significant difference in fall injuries (p=0.374), the rate of fractures was significantly lower in the RESPOND group (p=0.03). There were no significant group differences in other secondary outcomes.

Conclusion
The RESPOND falls prevention program reduced falls and fractures, in older people presenting to the ED with a fall. Key learnings for translation include: potential scalability and sustainability of a patient-centred and predominantly telephone-based program.
111 Disparities between Actual and Perceived Fall Risk Affect Participation in 5 Fall Prevention Interventions
Authors: Tan Pey June , Sim Silvia , Ismail Noor Hafizah , Mallya Jagadish , Chan Angelique , Wong Chek Hooi 
Published: December 2019

Abstract

Introduction
Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore.

Methods
This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities and knowledge that the intervention is to prevent falls.

Results
Final analysis included 549 older adults (mean age 70.6±6.9 years, 61% females). Majority (46%) were in the Vigorous group (no falls, low fear), 35% Anxious (no falls, high fear), 11% Frail Aware (falls, high fear) and 8% Stoics (falls, low fear). Only those in Anxious and Frail Aware group were significantly more likely to have talked to a healthcare professional on strategies to avoid falls [OR 1.8 (1.1-3.1) and 3.2 (1.6-6.4) respectively] and made home modifications [OR 1.9 (1.3-2.8) and 2.0 (1.1-3.6)] after adjustments. No association was found for participation in exercise, medication review and falls education.

Discussion
Individual profiles with high fear-of-falling component have different help-seeking behaviours compared to those with low fear regardless of history of falls. However, individuals in Frail Aware group have higher likelihood to uptake the interventions compared to Anxious group. Future research should examine other drivers of behaviour that will influence participation in other interventions.
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

Abstract

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 &gt; 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&lt;0.05), physical frailty (OR = 2.882, 95% CI: 1.187-6.999, p&lt;0.05), women (OR = 2.229, 95% CI: 1.362-3.648, p&lt;0.05), and loneliness (OR = 1.329, 95% CI: 1.028-1.718, p&lt;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

Abstract
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

Abstract

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

Abstract
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.