Recent Publications in Falls Prevention

Medication use, falls, and fall-related worry in older adults in the United States
Watanabe JH.
Consult. Pharm. 2016; 31(7): 385-393.

OBJECTIVE: To compare the prevalence of falls and fall-related concerns of medication users versus nonusers in U.S. seniors. DESIGN: Cross-sectional study.
SETTING: The National Health and Aging Trends Study.
PARTICIPANTS: U.S. nationally representative sample of Medicare beneficiaries in 2011.
OUTCOMES: Comparing subjects who used medications with subjects who did not in the past month, the outcomes were percentages of subjects who experienced 1) a fall in the past month, 2) worry about falling in the past month, 3) being limited by this worry in the past month, 4) a fall in the past year. RESULTS: A greater percentage of medication users experienced falls and fall-related outcomes, compared with non-medication users. Among medication users, 10.29% had a past month fall, compared with 5.42% of non-medication users; 27.69% of medication users worried in the past month about falling, compared with 9.15% of non-medication users; 40.96% of medication users were limited by this worry, compared with 21.21%; 22.82% of medication users had a fall in the past year, compared with 13.15% of non-medication users. CONCLUSION: Seniors who use medications are more likely to fall and to be concerned about falling. Pharmacist involvement in fall prevention continues to be essential.

Quality of standing balance in community-dwelling elderly: age-related differences in single and dual task conditions
Coelho T, Fernandes Â, Santos R, Paúl C, Fernandes L.
Arch. Gerontol. Geriatr . 2016; 67: 34-39.

AIM: To examine the relationship between age and quality of standing balance in single and dual task conditions. METHODS: A cross-sectional study was conducted using a sample of 243 community-dwellers aged ≥65 years. Quality of standing balance was assessed by measuring the center of pressure (COP) sway with a pressure platform. Measurements were performed under single task (orthostatic position) and dual task (orthostatic position while performing a verbal fluency task) conditions. RESULTS: The mean age of the participants was 79.1(±7.3)years and 76.1% were women. Older age was associated with an increased COP sway, mainly in the medial/lateral (ML) direction. Most COP sway parameters were higher under dual task conditions than under single task. After controlling for the effect of the number of words enunciated in dual task conditions, only the differences in COP sway parameters in the ML direction remained significant. There was no significant interaction between age group (65-79; ≥80 years) and condition, which indicates that differences in COP sway caused by performing a secondary task were similar for younger and for older participants. CONCLUSION: Age did not seem to influence significantly the decline in the quality of standing balance triggered by performing a concurrent cognitive task. However, older age was consistently associated with poorer standing balance, both in single and in dual task conditions. Therefore, performing a secondary task may lead older individuals to reach their postural stability limits and, consequently, to fall.

Manual and cognitive dual-tasks contribute to fall-risk differentiation in posturography measures
Sample RB, Jackson K, Kinney AL, Diestelkamp W, Smoot Reinert S, Bigelow KE.
J. Appl. Biomech. 2016; ePub(ePub): ePub.

Falls occur in 33% of older adults each year, some leading to moderate to severe injuries. To reduce falls and fall related injuries, it is important to identify individuals with subtle risk factors elevating their likelihood of falling. The objective of this study was to determine how postural sway measures differed between fallers and non-fallers under standard and dual-task conditions. Quiet-standing posturography measures were collected from 150 older adults during standard, cognitive, manual and cognitive+manual tasks, and analyzed through traditional and non-linear analyses. Of the traditional measures, M/L sway range and 95% confidence ellipse sway area showed statistically significant differences in all four test conditions between fallers and non-fallers. Although the manual dual-task showed the most stable balance, effect sizes demonstrated larger differences between fallers and non-fallers. Non-linear analysis revealed M/L sample entropy and M/L α-scaling exponent differentiating between fallers and non-fallers with the cognitive task demonstrating larger differences. Based on the results, it is recommended to: 1) apply M/L sway range and 95% confidence ellipse area, 2) utilize the manual task to differentiate between fallers and non-fallers when using traditional analyses, and 3) utilize the cognitive task and M/L alpha and M/L sample entropy when using non-linear analyses.