Fabio Feldman

Fraser Health | FH · Clinical Quality

Purpose Model-based economic evaluations require conceptualization of the model structure. Our objectives were to identify important health states, events, and patient attributes to be included in a model-based cost-effectiveness analysis of fall prevention interventions, to develop a model structure to examine cost-effectiveness of fall prevention...

Background: Systematic reviews have established that exercise reduces falls in older adults, however the most effective types of exercise are not known. This secondary analysis determined the comparative effectiveness of fall prevention exercise approaches. Method: All fall prevention exercise interventions for older adults were identified from an...

Over 95% of hip fractures in older adults are caused by falls, yet only 1–2% of falls result in hip fracture. Our current understanding of the types of falls that lead to hip fracture is based on reports by the faller or witness. We analyzed videos of real‐life falls in long‐term care to provide objective evidence on the factors that separate falls...

Introduction Over 90% of hip fractures in older adults result from falls, and hospital patients are at especially high risk. Specific types of wearable hip protectors have been shown to reduce hip fracture risk during a fall by up to 80%, but user compliance has averaged less than 50%. We describe the development and evaluation of a “stick-on” hip...

Fractures occurring with very little trauma are often caused by osteoporosis and can lead to disability. This study demonstrates that a coordinator working with an orthopaedic team can significantly increase the number of individuals receiving appropriate treatments during their after-fracture care to prevent future fractures from occurring.Purpose...

**Up to 50 e-prints of this article are available from https://www.tandfonline.com/eprint/6VN8VISWHEZCIZXKQ9GY/full?target=10.1080/13557858.2019.1655529** Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health auth...

Objective: To generate evidence of the effectiveness of hip protectors to minimize risk of hip fracture at the time of falling among residents of long-term care (LTC) by contrasting rates of hip fractures between falls with and without hip protectors. Design: A 12-month, retrospective cohort study. We retrospectively reviewed fall incident repor...

Background Fall-related injuries exert an enormous health burden on older adults in long-term care (LTC). Softer landing surfaces, such as those provided by low-stiffness “compliant” flooring, may prevent fall-related injuries by decreasing the forces applied to the body during fall impact. Our primary objective was to assess the clinical effective...

Background: Falls are a common occurrence and the most effective quality improvement (QI) strategies remain unclear. Methods: We conducted a systematic review and network meta-analysis (NMA) to elucidate effective quality improvement (QI) strategies for falls prevention. Multiple databases were searched (inception−April 2017). We included randomise...

Over 95% of hip fractures in older adults are caused by falls. Understanding the circumstances of falls involving hip fracture should guide prevention efforts. This study examined falls captured on video in long-term care and compared the mechanics of falls that resulted in hip fracture to falls that did not. Between 2008 and 2017, we video-capture...

Older adults have potential increased risk of nutrient deficiencies because of age-related decreased dietary intake and malabsorption; it is important to ensure nutrient needs are met to avoid adverse health outcomes. B vitamins are of particular interest: vitamin B12 deficiency can cause irreversible neurodegeneration; there is mandatory folic aci...

RÉSUMÉ Chez les personnes âgées, les chutes sont associées à des causes courantes et multifactorielles, et peuvent provoquer des blessures importantes. Cette étude avant-après a évalué les impacts d’une clinique mobile de prévention des chutes ( Fall Prevention Mobile Clinic [FPMC]) pour la réduction du risque de chutes chez des personnes âgées de...

Objective: The Building Trust project aimed to understand the process of gaining access to dementia-related information, diagnosis, care and psychosocial supports by Punjabi- and Korean-speaking older adults with Alzheimer’s Disease and related dementias and their informal caregivers living in the Fraser Health region of British Columbia, Canada. M...

This study explored barriers and facilitators to adoption of compliant flooring as a fall injury prevention strategy within long-term care from the perspective of 18 long-term care senior managers. In-depth interviews were recorded, transcribed, and analyzed using the Framework Method. The most important organizational facilitators to adoption were...

Background If worn, certain models of hip protectors are highly effective at preventing hip fractures from falls in residents of long-term care, but modest acceptance and adherence have limited the effectiveness of hip protectors. Residents of long-term care are more likely to accept the initial offer of hip protectors and to adhere to recommendati...

Importance Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise. Objective To assess the potential effectiveness of interventions for preventing falls. Data Sources MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Agel...

Objectives: A regional health authority and Alzheimer Society chapter in British Columbia have valuable resources on dementia and other health and social supports, but they do not know how to adapt their policy and practice tools to address the complex problems of access for immigrant older adults and their families. Staff in immigrant-serving [IS]...

Background Although a fall is a necessary prerequisite to a fall-related injury, previous studies suggest that frequent fallers are at lower injury risk for a given fall. We tested the hypotheses that differences in protective responses or the circumstances of falls underlie differences in injury risk with fall frequency. Methods We analyzed video...

Objectives: Falls are a major health concern for older adults. Understanding sex differences in fall circumstances may guide the design of fall management plans specifically to men and women. In this study, analyzed real-life falls captured on video to compare scenarios leading to falls between men and women in 2 long-term care (LTC) facilities....

Objective Identification of the factors that influence sedentary behaviour in older adults is important for the design of appropriate intervention strategies. In this study, we determined the prevalence of sedentary behaviour and its association with physical, cognitive, and psychosocial status among older adults residing in Assisted Living (AL)....

Introduction: Falls are a major health concern for both older men and women. However, few studies have examined sex differences in the circumstances of falls. We analyzed real-life falls captured on video to compare scenarios leading to falls between men and women in two long-term care (LTC) facilities. Methods: Between 2008 and 2016, we video-capt...

Hip fractures are a major threat to healthy aging, often triggering declines in health, mobility, quality of life, and even death. Wearable hip protectors represent a promising strategy to prevent hip fractures, but uncertainty surrounding their efficacy exists due to poor user adherence. In long-term care (LTC), adherence may depend on the commitm...

Background: If worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid...

Background Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake. Methods Informed by the Arksey and O’Malley framework and guided by a R...

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Purpose We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing inde...

Objective: To examine risk factors associated with head impact during falls in older adults in long-term care (LTC). Setting: Two LTC facilities in British Columbia, Canada. Participants: 160 LTC residents. Design: Prospective cohort study. Main measures: Between 2007 and 2014, we video captured 520 falls experienced by participants. Each...

Objective: The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). Background: Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing...

Background. A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence o...

Preliminary clinical findings suggest that compliant flooring may reduce the incidence and severity of fall- related injuries in long-term care (Knoefel et al., 2013) and acute-care settings (Drahota et al., 2013). However, there is concern that manoeuvring wheeled equipment on compliant flooring could expose care staff to potentially harmful pushi...

In response to high rates of work-related musculoskeletal injury (MSI) in long-term care (LTC), decision makers have implemented minimal-lift policies to reduce strain arising from resident transferring, often advocating the use of lifting devices. Floor-based lifts, in particular, are widely used in LTC, even though users are known to experience p...

Hip fracture risk is increased by landing on the hip. We examined factors that contribute to hip impact during real-life falls in long-term care facilities. Our results indicate that hip impact is equally likely in falls initially directed forward as sideways and more common among individuals with dependent Activities of Daily Living (ADL) performa...

Response to Davis and Uthus Dear Editor: The letter by Davis and Uthus suggests that erroneous conclusions might be made regarding the effect of selenium supplementation on fasting plasma total homocysteine (tHcy) concentrations if other dietary factors are not taken into account. In support of this view they cite work in which they found an intera...

Hip protectors represent an attractive strategy for reducing hip fractures among high-risk fallers in long-term care facilities. However, clinical studies yield conflicting results regarding their clinical value. This is mainly due to poor acceptance and adherence among users in wearing these devices. As a result, there is an urgent need to identif...

Objective Incident reports guide fall prevention efforts in long-term care (LTC) facilities, often based on descriptions of how falls occurred. The validity of these reports is poorly understood. We examined agreement on fall characteristics between fall incident reports and analysis of video footage of real-life falls in LTC. Design/Setting/Parti...

RÉSUMÉ Les objectifs de cette étude en trois phases étaient (1) de caractériser les opportunités existantes dans les programmes de loisirs pour les locataires résidant avec aide à la vie autonome (AVA)* et (2) de recueillir les perceptions sur les facteurs qui influent sur la planification et la prestation des programmes. Au cours d'une collaborati...

Purpose: Falls and their associated injuries represent a significant cost and care burden in long-term care (LTC) settings. The evidence base for how and why falls occur in LTC, and for the design of effective interventions, is weakened by the absence of objective data collected on falls. Design and methods: In this article, we reflect on the po...

Objectives To report 25 hydroxyvitamin D (25OHD) concentrations, an indicator of vitamin D status, in older adults living in residential care 1 year after a protocol of weekly 20,000 IU of vitamin D was started.DesignCross-sectional.SettingFive residential care facilities in British Columbia, Canada.ParticipantsResidents aged 65 and older from five...

Purpose: Falls are the leading cause of injury for residents living in longterm care (LTC) facilities, representing a significant cost burden and compromising the independence and autonomy of the older person1,2. Research into the causes of falls in LTC is limited by inaccurate reporting procedures3. To overcome these limitations, innovative method...

Background Older adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be...

Background: Falls cause more than 60% of head injuries in older adults. Lack of objective evidence on the circumstances of these events is a barrier to prevention. We analyzed video footage to determine the frequency of and risk factors for head impact during falls in older adults in 2 long-term care facilities. Methods: Over 39 months, we captured...

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Background: Falls cause more than 60% of head injuries in older adults. Lack of objective evidence on the circumstances of these events is a barrier to prevention. We analyzed video footage to determine the frequency of and risk factors for head impact during falls in older adults in 2 long-term care facilities. Methods: Over 39 months, we captu...

Purpose – Despite the growing area of research involving falls in the residential care setting, the link between contextual and environmental factors in falls is poorly understood. This paper aims to draw upon existing research being undertaken in long-term care (LTC) in Metro Vancouver, Canada, with a particular focus on identifying contextual fac...

To support an aging population there has been a move towards developing surveillance technologies that observe the movements, behaviours and health status of older people. These technologies are meant to support health and independence within the context of limited resources. Although there have been studies about the development of new devices and...

The purpose of this study was to examine long-term care (LTC) resident and staff perceptions on the decision to use hip protectors and identify the factors that influence attitudes toward hip protector use. Staff (N = 39) and residents (N = 27) at two residential care facilities in British Columbia, Canada were invited to participate in focus group...

Background: Falls are a leading cause of morbidity and mortality in older adults. Although numerous trials of falls prevention interventions have been completed, there is extensive variation in their intervention components and clinical context, such that the key elements of an effective falls prevention program remain unclear to patients, clinici...

Background Falls are the number one cause of injuries in older adults, and are particularly common in long-term care (LTC). Lack of objective evidence on the mechanisms of falls in this setting is a major barrier to prevention. Video capture of real-life falls can help to address this barrier, if valid tools are available for data analysis. To addr...

Background Falls in elderly people are a major health burden, especially in the long-term care environment. Yet little objective evidence is available for how and why falls occur in this population. We aimed to provide such evidence by analysing real-life falls in long-term care captured on video. Methods We did this observational study between Apr...

Background Hip protectors (HP) represent an attractive strategy for reducing hip fractures in high-risk elderly individuals. However, clinical studies have yielded conflicting results regarding their clinical effectiveness. This is mainly due to poor compliance (acceptance and adherence) among users. As a result, there is an urgent need to identify...

Wearable hip protectors (padded garments) represent a promising strategy to decrease impact force and hip fracture risk during falls, and a wide range of products are currently marketed. However, little is known about how design features of hip protectors influence biomechanical effectiveness. We used a mechanical test system (simulating sideways f...

IntroductionThe purpose of this study was to addresses a gap in the fall prevention literature with a focus on Assisted Living Residences (ALRs) – a new community housing option for a rapidly growing number of older persons that are at high risk falls. The result of the 1-year collaborative study was the development of Best Practice Guidelines for...

To compare the accuracy of perceived postural limits between older fallers with good working memory and those with poor working memory. Cross-sectional study. Research laboratory. Thirty-three community-dwelling older adults with a history of falls. Not applicable. We measured the accuracy of perceived postural limits by using the perceived reach t...

Fall-related injuries result in significant physical and psychological suffering to the affected individuals. The physical environment is considered to have an important role in falls. To conduct extensive review of and synthesize related literature, and to develop a conceptual framework to explain the relationship among falls, the physical environ...

Hip fracture is rare in young adults, despite evidence that the energy available in a fall is sufficient to fracture the young proximal femur. This might be explained by protective responses that allow young individuals to avoid hip impact during sideways falls. To test this hypothesis, we conducted experiments with 44 individuals (31 women and 13...

Falls are a major cause of injury in the elderly, and risk for falls depends on frequency of imbalance episodes. Improved techniques are required for determining how risk for imbalance during daily activities depends on behavioural (e.g., risk taking) versus neuromuscular factors. We developed a novel technique to determine whether differences exis...

The goal of this study was to determine whether differences exist between young and elderly adults in cautiousness or tendency to approach imbalance during a forward reaching task. Young (n = 26) and elderly (n = 25) adults participated in trials that required them to reach forward as quickly as possible to contact a target that moved back and fort...