Bifocals and Falls - NYTimes.com

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By KAREN STABINER

The first reader to weigh in on a recent post about new fall-prevention guidelines was “h” from Chicago, who wrote: “I also wonder about bifocals causing falls. This is why I’m sticking to two pairs of glasses for now.”

That’s good advice, it turns out.

In a study published last year in the medical journal BMJ, Australian researchers found a decrease in the number of falls among people who switched to single-vision eyeglasses for outdoor activities and stairs.

The results, said the researchers, “demonstrated how multifocal glasses can impair visual abilities needed for detecting obstacles and judging depth.”
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Popular Sleep Medicine Puts Older Adults At Risk For Falls, Cognitive Impairment

Adults who take one of the world's most commonly prescribed sleep medications are significantly more at risk for nighttime falls and potential injury, according to a new study by the University of Colorado at Boulder.

The study, which involved 25 healthy adults, showed 58 percent of the older adults and 27 percent of the young adults who took a hypnotic, sleep-inducing drug called zolpidem showed a significant loss of balance when awakened two hours after sleep. The findings are important because falls are the leading cause of injury in older adults, and 30 percent of adults 65 and older who fall require hospitalization each year, said CU-Boulder Associate Professor Kenneth Wright, lead study author.

Source: Kenneth Wright - University of Colorado at Boulder

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RealCareNowTV: Staying Balanced and Avoiding Falls

Take Up Tai Chi And And Cut Back On Meds To Reduce Risk Of Falling, Elderly Advised

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Written by: Catharine Paddock, PhD

Taking up Tai Chi and cutting back on medication could form part of a multiple intervention approach to helping elderly people reduce their risk of falling, according to recently updated guidelines from the American Geriatrics Society and the British Geriatric Society, summarized this month in the Journal of the American Geriatrics Society.

In their first update since 2001, the guidelines for preventing falls in the elderly now recommend that interventions be "multifactorial" and include an exercise component and assess feet, footwear, fear of falling, ability to go about daily living, and other factors.

The guidelines also say that fall screening and prevention should be a routine part of healthcare for the elderly.

The new panel that updated the guidelines included members from previous panels and new members with considerable expertise, both in practical and published work, in preventing falls and caring for older people.

Dr Mary Tinetti of Yale University School of Medicine in New Haven, Connecticut in the US, was one of the panel co-chairs. She told the press that:

"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence."

"Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes," she added.

The panel searched and reviewed the literature published between May 2001 and April 2008 for systematic literature reviews, meta-analyses, randomized controlled trials of fall prevention interventions, controlled before-and-after studies, and cohort studies.

They also reviewed randomized controlled trials published between April 2008 and July 2009 and found no reason to change their conclusions and recommendations.

The new guidelines say that doctors should decide whether to assess risk of falling by first asking patients if they have fallen recently or are unsteady when walking.

If patients say they have not experienced a fall recently and are not unsteady when walking then they do not need a risk assessment.

But if they answer yes, then doctors should go ahead with a risk assessment and look for other known problem areas like muscle weakness, poor balance or blood pressure that drops too much on standing.

If this risk assessment shows these problems, patients should then receive interventions as advised in the guidelines.

Tinetti said that they found the most effective fall prevention trials were those involving multiple interventions instead of only one.

She said while previous studies had suggested it is more effective to focus on single interventions, they are confident a multiple intervention approach is better because they looked not only at what was recommended but also what was actually carried out.

"We're confident that multifactorial interventions is the best course of action," stressed Tinetti.

The new guidelines suggest not only that doctors should design "multifactorial" interventions, but these also:

• Include exercise for balance, gait and strength training. A good example is Tai chi or physical therapy.


• Include "environmental adaptation" to reduce factors that increase risk of falling in the home and when carrying out daily activities.


• Include cataract surgery where needed, but not as an individual approach.


• Aim to reduce medication regardless of number of drugs prescribed: this is a departure from the 2001 guideline which said this need only apply to patients on four or more drugs.


• Pay particular attention to drugs that affect the brain, for instance sleeping pills and antidepressants.


• Focus on raising low blood pressure and managing heart rate and rhythm abnormalities.

Tinetti said:

"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice."

"By making fall prevention part of the clinical care of older adults this trend can continue," she added.

"Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons."
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.
Journal of the American Geriatrics Society, Volume 59, Issue 1, pages 148-157, published online 13 January 2011.
DOI: 10.1111/j.1532-5415.2010.03234.x

Additional source: Wiley-Blackwell (press release, 13 Jan 2011).

Vitamin D and Exercise May Help Prevent Falls in Elderly

By Christine S. Moyer, amednews staff.

Prescribing a vitamin D supplement and recommending exercise for patients 65 and older could reduce their risk of falling, according to a recent evidence review.

The review, published in the Dec. 21, 2010, issue of Annals of Internal Medicine, was commissioned by the U.S. Preventive Services Task Force to help the agency update its recommendation for preventing falls in the elderly. Before the guidelines are published, a draft will be posted for public comment online.

The task force does not have recommendations on primary care physicians counseling patients on fall prevention. But in 1996, the task force reviewed the effectiveness of counseling to prevent household and recreational injuries, including falls, by age group.

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Low Sodium May Boost Fracture Risk from MedPage Today

By Michael Smith, North American Correspondent, MedPage Today

Low serum sodium may be a risk factor for fractures in the elderly, a researcher said here.

In a long-running cohort study in Holland, mild hyponatremia was associated with an increased risk of nonvertebral fractures and prevalent vertebral fractures, according to Carola Zillikens, MD, of Erasmus Medical Center in Rotterdam.

The condition is usually considered benign, but cross-sectional studies have shown it can lead to gait instability, falls, and fractures, Zillikens reported at the annual meeting of the American Society for Bone and Mineral Research.

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AFA Offering Free Copies of New 'Preventing Falls' DVD

 

National Falls Prevention Awareness Day is an initiative of the Falls Free Coalition, of which AFA is a member, and is observed on the first day of fall each year to increase public awareness about how to prevent and reduce falls among older adults.

 

In line with this objective, AFA's "Preventing Falls" DVD provides insight into why dementia intensifies the incidence of falls and offers practical strategies from experts and family caregivers, including communication techniques, home modifications and lifestyle changes. It was funded in part with a grant from Novartis Pharmaceuticals.

 

For a free copy, call AFA at (toll-free) 866-AFA-8484.

Speak Up: Reduce Your Risk of Falling | Joint Commission

There are NO copyright or reprinting permissions required for the Speak Up materials or copy. In references to the materials or copy, we do ask that The Joint Commission be credited as the source for the materials or copy. For more information see "About the Speak Up Program."

To order Speak Up materials call 1-877-223-6866, or visit the JCR Web Store.

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Speak Up: Reduce Your Risk of Falling | Joint Commission

PHI – Training | Fall Prevention Awareness

Uniquely designed for adult learners, the Fall Prevention Awareness training curriculum helps home health aides reduce falls and minimize injury to their clients by increasing their awareness of the risk factors for common falls and by enhancing their communication skills.

Specifically, participants build on their existing knowledge and skills by strengthening their “observe, record, report” skills and by developing communication skills that help them address with their clients how to reduce the risk of falling.

This curriculum — a joint project between PHI and NCOA — consists of two three-hour in-service trainings. In addition, each session includes optional pre- and post-testing as well as warm-up and closing activities that can add an additional hour to the training. A complete facilitator guide and handouts for all sessions can be downloaded below.

This project was funded by the U.S. Department of Labor Education and Training Administration.

Download:

• Introduction
  Cover, Table of Contents, Introduction (pdf 180 KB)
• Session 1: Recognizing Risk Factors for Falling
  Five activities plus ten handouts (pdf 777 KB)
• Session 2: Enhancing Skills to Address Risk Factors
  Seven activities plus nine handouts (pdf 341 KB)
• Appendix A
  Session 1 Review: Game Materials (pdf 112 KB)
• Appendix B
  Pre/Post-Tests: Sessions 1 and 2 (pdf 63 KB)
• Appendix C
  Workshop Evaluation Form (pdf 1.2 MB)
• Appendix D
  Simulation Scenarios (pdf 88 KB)

Anxiety May Make Falls More Likely - NYTimes.com

Image via CrunchBaseby Paula Spann

Of course older people worry, legitimately, about falling. But can exaggerated anxiety about falling — even if physiological tests show your risk to be low — increase the probability that you’ll actually fall?

A team at Neuroscience Research Australia has found that it can. Conversely, older people who are physically at high risk, but don’t perceive much danger, fall less often than would be expected.
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Fall-Prevention Program Fails from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

A multidisciplinary program to prevent recurrent falls among older people failed to reduce fall rates, according to results of a clinical trial from the Netherlands.

The randomized, controlled clinical trial, conducted among more than 200 people ages 65 and older who had suffered a previous fall, found no statistically significant differences in fall rates within a year between the intervention group and those who received the usual care, Oscar de Vries, MD, of VU University Medical Center in Amsterdam, and colleagues reported in the July 12 issue of the Archives of Internal Medicine.
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Princeton Hospital Test New Room for Patient Care - WSJ.com

By SUZANNE SATALINE

The room's soft white lighting illuminates a wall of etched glass and blond wood. There's hand-laid tile in the shower and the couch unfolds, letting family members stay. Even the shape of this hospital room is quirky, with walls that hide wires and tubing and slant so the occupant will better see the leafy treetops through large windows.

It's peaceful, perhaps practical, and it could be the hospital patient room of the future.

The staff at the University Medical Center at Princeton will soon assign one patient at a time to this newly built room, designed partly with staff input, housed on a post-surgical floor. Designed using research funded with a $2.8 million grant from the Robert Wood Johnson Foundation, the room has ushered Princeton into the growing field of health-care design.

Architects and health-care centers are seeking to prove that a room's layout and accessories can help patients heal faster and cut down on mishaps and staff error, as some research has shown.

"Once we put patients in here, we'll see if everything is right," says Susan G. Lorenz, Princeton's chief nursing officer, who helped design the room.

More hospitals have started to rethink how patient rooms can improve the occupant's health. They're seeking to reduce the spread of infections, the rise in patient falls, and the healing benefits of outdoor views. Patient falls are common in hospitals, and 10% of fatal falls by older adults happen there, according to data compiled by the Institute for Healthcare Improvement. Single rooms are becoming standard, Ms. Lorenz said, because research shows that the privacy reduces infection rates and enhances communication between staff and patients.

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PHI – Training | Fall Prevention Awareness

Uniquely designed for adult learners, the Fall Prevention Awareness training curriculum helps home health aides reduce falls and minimize injury to their clients by increasing their awareness of the risk factors for common falls and by enhancing their communication skills.

Specifically, participants build on their existing knowledge and skills by strengthening their “observe, record, report” skills and by developing communication skills that help them address with their clients how to reduce the risk of falling.

This curriculum — a joint project between PHI and NCOA — consists of two three-hour in-service trainings. In addition, each session includes optional pre- and post-testing as well as warm-up and closing activities that can add an additional hour to the training. A complete facilitator guide and handouts for all sessions can be downloaded below.

This project was funded by the U.S. Department of Labor Education and Training Administration.

Download:
PHI – Training |  Fall Prevention Awareness

Falls and Follow-Ups: Medical Attention After a Fall Critical to Senior Health

Falling down is hazardous to a senior citizen's health. Yet fewer than half of all seniors see a doctor after a fall. And those who don't seek medical attention are far less likely to engage in any of the six widely recommended activities — such as a review of their medications or getting a cane or walker — that might prevent repeated falls, according to a new policy brief from the UCLA Center for Health Policy Research.

In the study, researchers, using data from the 2007 California Health Interview Survey, found that even though 91 percent of California seniors reported seeing a doctor in the past year, a fall was rarely the reason for the visit. In fact, less than half (46.6 percent) of seniors who had fallen more than once reported a fall as the reason for a doctor's appointment.

Those who did not seek medical help were less likely to engage in activities that might prevent future falls — only about 31 percent did two or more follow-up activities to prevent falls. In contrast, 73 percent of seniors who did seek medical care after a fall engaged in two or more follow-up activities.

"Following up with a doctor after a fall is critical to senior health," said UCLA Center for Health Policy Research associate director Steven P. Wallace, lead author of the policy brief. "The safeguards we discuss are some of the best ways of preventing additional falls and the disastrous health consequences associated with falls."
Falls among the elderly are a widespread problem. More than half a million older Californians (565,000) fell more than once in 2007 — about 100,000 more than reported multiple falls in 2003, according to the California Department of Public Health and the Office of Statewide Planning and Development.

Falls are directly linked to declining health among older Americans: More than 1,400 California seniors died due to injuries from falls in 2007, and approximately 67,000 more were hospitalized.
National guidelines issued by the American Geriatrics Society and other organizations recommend the following activities for reducing the risk of falling among older adults with a history of falls: (1) an evaluation by a health professional with counseling on how to reduce falls, (2) a review of medications, (3) home modifications, (4) exercise and/or (5) physical therapy, and (6) using a cane or walker if needed.
The study's authors recommended a number of ways to encourage seniors and health care providers alike to prevent multiple falls, including:
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Switching Glasses when Outdoors May Reduce Falls - in Ophthalmology, Ophthalmology from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

A second pair of distance-only glasses for older bifocal or progressive lens wearers may help prevent falls in some high-risk populations, according to results of a randomized trial.

For older adults at elevated fall risk, replacing multifocal glasses with single-vision ones for walking and outdoor activities led to a significant 40% reduction in incidence rate compared with the control group (1.26 versus 2.16 falls per person over 13 months) among those with an above-average level of outdoor activity, found Stephen R. Lord, PhD, of the University of New South Wales in Sydney, Australia, and colleagues.

The intervention also led to a nonsignificant 8% reduction in falls among older adults at elevated fall risk overall (1.54 versus 1.66 per person over 13 months), the researchers found.

However, these results came at the expense of a nonsignificant 29% increase in falls with intervention versus usual care among those with little outdoor activity (1.81 versus 1.36 per person) as well as a rise in nonfall-related injuries, they reported online in BMJ.

Thus, patient selection with appropriate assessment and counseling may be key.

"Clinicians should be conservative in eyewear prescription, particularly in frail older people who do not often leave their homes," they wrote in the paper.
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In Elderly Men, Age, Ethnicity And Environment Impact On Risk Of Falls

from Medical News Today

Falls and fall prevention are a major concern for the elderly and people with osteoporosis, a common chronic disease which causes weak and fragile bones. People with osteoporosis are at increased risk of fracture, even after a minor fall from standing height. A study presented at the World Congress on Osteoporosis 2010 (IOF WCO-ECCEO10) shows that among elderly men the risk of falling, and thereby breaking a bone, is influenced by age. Most significantly, it also suggests that ethnicity and environment play a role in the risk of falling.


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Multiple Benefits To Surgery Reported For Patients With Advanced Osteoarthritis

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(Medical News Today) Total knee replacement (TKR) successfully relieves pain and improves function in patients with advanced knee arthritis, according to a study presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The surgery also significantly improves dynamic balance among elderly patients.

Impaired balance and increased tendency to fall are common complaints among the elderly suffering from severe osteoarthritis (worn cartilage). The purpose of the study was to determine whether TKR had any effects on balance measures, in correlation with functional balance and quality of life. This is especially important because falls are the leading cause of injury for senior adults in the U.S., and hip fractures that result from falls can be lethal for elderly patients.

"Balance is critical to the elderly, especially those with knee problems. This study reinforced our hypothesis about how an osteoarthritic patient's function is compromised not only due to pain, but also by balance," said Leonid Kandel, MD, study author and orthopaedic surgeon, Department of Orthopaedic Surgery, Hadassah Mount Scopus Hospital, Jerusalem, Israel.

The study examined 63 patients, with a mean age of 73, who had total knee replacements and participated in follow-up evaluations after one year. The study measured accurately static and dynamic balance with a new computerized system called the Balance Master. The study found:
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Knee Replacement In Elderly Patients Shown To Improve Balance

from Medical News Today

Total knee replacement (TKR) successfully relieves pain and improves function in patients with advanced knee arthritis, according to a study presented today at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The surgery also significantly improves dynamic balance among elderly patients.

Impaired balance and increased tendency to fall are common complaints among the elderly suffering from severe osteoarthritis (worn cartilage). The purpose of the study was to determine whether TKR had any effects on balance measures, in correlation with functional balance and quality of life. This is especially important because falls are the leading cause of injury for senior adults in the U.S., and hip fractures that result from falls can be lethal for elderly patients.
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Older Adults And Babies Most Vulnerable To Preventable Head Injuries Suffered At Home

from Medical News Today

Accidental falls are the leading cause of non-fatal injury among Americans of all ages according to the American Association of Neurological Surgeons (AANS). And among Americans age 65 and older, falls are the leading cause of fatal injuries. Among older adults, traumatic brain injury (TBI) causes nearly 50 percent of fall-related fatalities. In children ages 4 and younger, TBI is the primary cause of fall-related death and severe injury. In 2008, nearly 8.6 million Americans suffered accidental falls according to the Centers for Disease Control and Prevention. U.S. Consumer Product Safety Commission statistics indicate that an estimated 1.5 million people are treated for head injuries and nearly 12,000 are treated for neck fractures every year at U.S. hospital emergency rooms.

"Many head injuries occur at one's residence - whether it is a home or a nursing facility - and involve falling and bumping one's head, resulting in mild concussions to severe and even fatal TBIs, said Gail L. Rosseau, MD, a Chicago neurosurgeon and an AANS spokesperson. According to the AANS, people ages 65 and older and babies/toddlers under the age of 4 are the most vulnerable.

Among people ages 55 and older, 129,015 were treated for head injuries related to flooring. And in that same age demographic, there were 22,347 head injuries attributed to wheelchairs and 16,075 attributed to canes, crutches, and walkers. Most of the head injuries related to these products occur as the result of falling and hitting one's head on the floor, while a lesser number involve trauma to the head when it strikes a piece of furniture or part of the home structure, such as a door or countertop.

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Trial Of Vitamin D Supplementation To Reduce Falls In Nursing Care Facilities

from Medical News Today

Giving people living in nursing facilities vitamin D can reduce the rate of falls, according to a new Cochrane Review. This finding comes from a study of many different interventions used in different situations. In hospitals, multifactorial interventions and supervised exercise programs also showed benefit.

Older people living in nursing facilities or who have been admitted to hospital are much more likely to suffer a fall than those living in the community. In these settings, falls fairly often result in head injuries and fractures, with rates of hip fracture more than ten times higher in nursing facilities than in the community. It is important to try to prevent falls to avoid unnecessary stress for older people and their families, and to reduce pressure on staff and resources. However, prevention is complicated as falls usually happen for several or many different reasons.

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