bluuebunny/crossref_metadata_2025_split huggingface dataset:
141 Fall-Risk Increasing Drugs use in Elderly with Fall-Related Fractures
Authors: Low Chin Yeong , Omar Marhanis Salihah , Mahadzir Hazlina , Yin Mei Kuen 
Published: December 2019

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

Setting
Medical Outpatient Clinic in Hospital Sg Buloh.

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

Conclusion
Those who are single are associated with history of falls. Calcium channel blocker and ACEi/ARB are associated with those with history of prior falls. Amongst medical conditions, only diabetes is associated with OH.
The findings so far provided a platform for improving understanding factors for falls in the outpatient setting. As the numbers are relatively small, we hope to continue the study. This will hopefully be able to give insight on possible factors associated in falls in our community.
148 Inpatient Medications and Occurrence of FALL in Hospital Sungai Buloh, Malaysia
Authors: Shariff Siti Mallissa Mohd , Sa'at Nadiah , Nordin Nordiana 
Published: December 2019

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract
In the UK each year there are over 250,000 emergency hospital admissions due to falls, costing £4.4 billion for falls-related fractures alone. To help reduce pressure on the NHS, the UK Fire Service are now providing home safety checks which include a review of falls hazards, provision of falls and loneliness advice and in some cases, immediate provision of aids such as grab rails. It is yet to be seen whether this will translate into a reduction in falls but it appears that the trust people place in the Fire Service is resulting in an uptake of falls prevention advice.
Although we have reasonably good evidence that multifactorial falls interventions reduce the rate of falls, they are resource intensive and do not reduce the risk of falls. In contrast, exercise interventions reduce both the rate and the risk of falls and can be delivered in a group setting; however uptake and adherence is low. In an attempt to encourage local care providers to invest in falls prevention exercise, Public Health England created a Return-of-Investment tool (available online) for local commissioners to calculate the anticipated cost savings by investing in falls prevention exercise programmes.
A recent, novel approach to falls prevention developed in the UK is a Massive Open Online Course (MOOC). This is a free, open-access, online course open to anyone with access to the Internet. The purpose of the ‘Ageing Well: Falls’ MOOC is to educate people about falls prevention and empower them to take action. In five years, the course has educated over 10,000 people from over 100 countries worldwide. One survey revealed that 95% of learners felt more empowered to manage their falls risk, with an increase in confidence to engage in falls prevention behaviours but also an increase in confidence to seek help for falls.
153 Polypharmacy and Falls: A Global Phenomenon
Authors: Palanisamy Sivanandy , Pin Tan Maw , Karthikayini K , Prakash Anand 
Published: December 2019

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

Abstract
Polypharmacy refers to the numerical value of medications used by a patient and is typically described as the concurrent use of five or more medications per day, but the definition is variable and there is no global consensus. Polypharmacy is unfortunate consequence of rapid advancement of medicine. Polypharmacy could be appropriate or problematic. Problematic polypharmacy can arise if the medicines are used without good evidence and in this situation risk of harm outweighs benefit. While there might be clinical indication for the medications to treat co-morbidities of a given patient, polypharmacy in older persons are associated with negative outcomes such as falls, adverse drug events and increased healthcare utilisation. This is mainly due to the physiological changes in this population which increases their risk of adverse drug events as well as the problems associated with remembering, managing and administering the medications appropriately. Hence, researchers and clinicians around the world have been actively looking at ways to reduce polypharmacy and optimise drug therapy in older persons to improve clinical, economic and social outcomes. To date, medication review by pharmacists in various settings has been the most researched and documented evidence in tackling this issue. Medication review refers to the structured evaluation of a patient’s medication with the aim to reach agreement with the patient about drug therapy, optimising the impact of medication, and minimising the number of drug-related problems. This session aims to summarise the available evidence on various types and outcomes of medication review with the aim to optimise polypharmacy among older persons around the world and provide a practical recommendation in tackling the phenomena.
157 Diabetes Self-Management Training with a Mobile APP among Older Adults in Taiwan: Comparative and Longitudinal Program Effectiveness
Authors: Wu Shinyi 
Published: December 2019

Abstract
Diabetes is a prevalent chronic disease and a major medical disability worldwide. It affects 1 in 5 older people in Taiwan. Use of mobile computing technology has become increasingly prevalent among older adults but its potential to improve diabetes self-management and social integration is only begun to be realized.
This presentation will introduce the Intergenerational Mobile Technology Opportunities Program (IMTOP) designed to motivate and train older adults with diabetes to use mobile technology for diabetes self-management. The IMTOP curriculum taught participants about diabetes self-management combined with tablet and Internet skill training. Patients were taught a diabetes self-management app to activate self-monitoring and behavior change. College students participated as volunteer tutors to provide intergenerational and technological support. The program was delivered in 8 weekly sessions of 2-hour long small group classes. To understand the program effects, a wait-list control trial with 350 age 55+ adults with diabetes was conducted in 2 Taiwanese hospital outpatient settings. Patients were assessed at baseline and every 4 months for up to 12 months post intervention. After participating in the intervention, the pre-post changes for the intervention group were significantly better than the waitlist group at 4-month in terms of physical health status, diabetes self-care, use of mobile technology, and overall quality of life. In addition, the intervention group was less depressed compared to its counterpart. The longitudinal effects were evaluated using linear mixed-effects models including contrasts compared mean estimates at each follow-up to the baseline. The results indicate a stable overtime improvement in overall diabetes self-care (p&lt;.0001). Specifically, patients reported more blood-glucose testing, foot-care, and risk reduction (all with p&lt;.0001), specific diet (p=.04), and reduced frequency of smoking (p=.03). Both the WHO-QOL physical health (p=.03) and self-rated general health (p=.001) were enhanced. The findings support the effectiveness of IMTOP intervention for older adults with diabetes.
16 Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review with Stakeholders’ Consultation
Authors: Ainuddin Husna Ahmad , Romli Muhammad Hibatullah , Salim Mazatulfazura S F , Hamid Tengku Aizan Tengku Abd , Mackenzie Lynette 
Published: December 2019

Abstract

Introduction
Stroke is a serious problem in Southeast Asia. Falls are common among stroke survivors especially within one-year post-stroke and the implication is devastating. Rehabilitation for stroke survivors is important especially to prevent falls. However, literature in Southeast Asia pertaining to the topic is sparse. This study aims to systematically identify literature related to stroke and falls in Southeast Asia.

Methods
This scoping review followed Levac, Colquhoun and O’Brien’s framework. Systematic searching was conducted on four databases (MEDLINE, CINAHL, Scopus, ASEAN Citation Index) on August 2019. Generation of review question and keyword, and selection criteria were developed according to the Patient Intervention Comparison and Outcome (PICO) method. Consultation via several focus group discussions with stakeholders (i.e. stroke survivors, caregivers and therapists) were conducted and integrated with the synthesis of the review.

Results
Initial search yielded 2412 articles after removing the duplicates; however, only 19 were accepted in the final analysis. Most of the articles focused on physical rehabilitation and using conventional therapies. While the literatures may reflect the practice in Southeast Asia, stakeholders perceived that the literature is inadequate to show the true practice, lack to inform and missed several aspects such as functional, cognitive and psychological intervention in managing falls. Home hazards are considered as contributing factors but not deemed important.

Discussion
Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Only several articles were mainly written by physiotherapists while others are from medical physicians and engineers but negligible from other healthcare practitioners (i.e. occupational therapists, speech therapists, psychologists) or other disciplines interested with falls.

Conclusion
Falls prevention among stroke survivors received lack of attention and just an indirect goal in stroke rehabilitation. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
160 Gait Adaptability in Older People and People with PD
Authors: Lord Stephen , Caetano Joana , Menant Jasmine 
Published: December 2019

Abstract
The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This presentation will present findings from a series of studies that have investigated cognitive, physical and psychological factors associated with gait adaptability required for obstacle and stepping target negotiation in older people and people with Parkinson’s disease (PD). The first studies involved fifty healthy older adults (mean±SD: 74±7 years). The gait adaptability protocol required them to either (a) avoid an obstacle at usual step distance or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. The primary findings were that gait adaptability was significantly associated with high risk of falls and that executive function, increased concern about falling and weaker quadriceps strength contributed significantly to this relationship. The second studies involved 54 people with PD (mean±SD: 67±67 years) who also completed the gait adaptability protocol. In this group, superior executive function, effective reactive balance and good muscle power were associated with successful gait adaptability. Furthermore, executive function and reactive balance appeared to be particularly important for precise foot placements; and cognitive capacity for step length adjustments for avoiding obstacles. These findings help elucidate mechanisms for why older people and people with PD fall. Training gait adaptability directly, as well as addressing the above associated factors through cognitive, behavioural and physical training may maximise fall prevention efficacy for these populations.