bluuebunny/crossref_metadata_2025_split 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

Abstract

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&lt;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

Abstract

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

Abstract

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

Abstract
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

Abstract
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

Abstract
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 &gt;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

Abstract
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

Abstract
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 (&gt;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

Abstract
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 &lt;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

Abstract

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 &lt;85. There was no correlations of OH with existing comorbids except atrial fibrillation (AF) (p&lt;0.024) and syncope (p&lt;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

Abstract

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

Abstract

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 &gt;=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.