ArticlePDF AvailableLiterature Review

Critical Falls: Why Remaining on the Ground After a Fall can be Dangerous, Whatever the Fall

Authors:
Often these adults should not be exposed to potentially
hazardous diagnostic procedures, particularly when dental
screening in noninvasive physical examinations can yield
pertinent clinical information.
This study found oral health to be a low priority for
younger and less-experienced providers. Educational
efforts should focus on this demographic, who are launch-
ing their medical careers in an aging society.
Ishtpreet Uppal, MD
Natalya Bangiyeva, MD
Gisele P. Wolf-Klein, MD
Department of Medicine, North Shore-LIJ Health System
New Hyde Park, New York
Edwin Ginsberg, DMD
Department of Dental Medicine, North Shore-LIJ Health
System, Manhasset, New York
Renee Pekmezaris, PhD
Christian N. Nouryan, MA
Department of Health Services Research, North Shore-LIJ
Health System, Great Neck, New York
Renee Pekmezaris, PhD
Lisa Rosen, ScM
Feinstein Institute for Medical Research, Manhasset
New York
Renee Pekmezaris, PhD
Gisele P. Wolf-Klein, MD
Hofstra North Shore-LIJ School of Medicine, Hempstead
New York
Renee Pekmezaris, PhD
Gisele P. Wolf-Klein, MD
Albert Einstein College of Medicine, Bronx, New York
Monica Chawla, MD
Sophie Davis School of Biomedical Education
New York, New York
ACKNOWLEDGMENTS
The authors would like to recognize the efforts of Marie
Ilagan and Jill Cotroneo for administrative support.
Conflict of Interest: The editor in chief has reviewed
the conflict of interest checklist provided by the authors
and has determined that the authors have no financial or
any other kind of personal conflicts with this paper.
Author Contributions: Ishtpreet Uppal, Edwin
Ginsberg, Renee Pekmezaris, Lisa Rosen, Monica Chawla,
Natalya Bangiyeva, Christian Nouryan, and Gisele
Wolf-Klein developed the original concept and design.
Ishtpreet Uppal, Monica Chawla, and Natalya Bangiyeva
collected the data. Lisa Rosen, Renee Pekmezaris, and
Christian Nouryan analyzed and interpreted the data. All
authors made significant contributions to the drafting and
revision of the manuscript. All authors approved the final
version of the manuscript.
Sponsor’s Role: No sponsor.
REFERENCES
1. Moore MJ, Moir P, Patrick MM et al. The State of Aging and Health in
America 2004 [on-line]. Available at http://www.agingsociety.org/agingsoci-
ety/pdf/SAHA_2004.pdf Accessed November 11, 2011.
2. Beltra
´n-Aguilar ED, Barker LK, Canto MT, et al. Surveillance for dental
caries, dental sealants, tooth retention, edentulism, and enamel fluorosis
United States, 19881994 and 19992002. MMWR Surveill Summ
2005;54:143.
3. Triadafilopoulos G. Oral diseases and disorders. In: Cobbs EL, Duthie EH,
Murphy JB, eds. Geriatric Review Syllabus: A Core Curriculum in Geriatric
Medicine, 5th Ed. Malden, MA: Blackwell Publishing 2002, pp 321326.
4. Shay K, Picot BL, Picot SJ. Oral diseases and disorders. In: Resnick B,
Mitty E, eds. Assisted Living Nursing: A Manual for Management and
Practice. New York, NY: Springer Publishing Company, 2009, pp 267
276.
5. Dolan TA, Atchison K, Huynh TN. Access to dental care among older
adults in the United States. J Dent Educ 2005;69:961974.
6. Dental Diseases and Oral Health. World Health Organization [on-line].
Available at http://www.who.int/oral_health/publications/en/orh_fact_sheet.
pdf Accessed November 11, 2011.
7. Pucar A, Milasin J, Lekovic V, et al. Correlation between atherosclerosis
and periodontal putative pathogenic bacterial infections in coronary and
internal mammary arteries. J Periodontol 2007;78:677682.
8. Lockhart PB, Brennan MT, Thornhill M, et al. Poor oral hygiene as a risk
factor for infective endocarditisrelated bacteremia. J Am Dent Assoc
2009;140:12381244.
9. Barrington JW, Barrington TA. What is the true incidence of dental pathol-
ogy in the total joint arthroplasty population? J Arthroplasty 2011;26(6
Suppl):8891.
10. Yasny JS. Perioperative dental considerations for the anesthesiologist.
Anesth Analg 2009;108:15641573.
CRITICAL FALLS: WHY REMAINING ON THE
GROUND AFTER A FALL CAN BE DANGEROUS,
WHATEVER THE FALL
To the Editor: As people age, it becomes increasingly diffi-
cult for them to rise after a fall. Healthy elderly adults
require twice as long to stand up as younger patients. Those
in institutions need three to four times as long to rise as
healthy elderly adults, if they can actually do so.
1
In another
study, 25% of elderly adults were unable to rise from an
accidental fall.
2
It has been shown that reaching the age of
80 is a risk factor independently associated with inability to
rise from the ground after a fall (adjusted relative risk
(RR) =1.6, 95% confidence interval (CI) =1.22.1).
3
This inability to rise from the ground after a fall is
dangerous because of the length of time spent lying on the
floor. This time depends on the individual’s ability to rise
after falling and on whether help is available.
4
The risk of
remaining for extended periods on the ground in elderly
adults has been associated mainly with a major injury in
individuals with reduced autonomy but also with body
temperature above 37.5°C or potassium serum level
<3.5 mmol/L.
5
Finally, a fall often results from a traumatic
functional disability that can explain the inability to rise,
but not all of these cases are always related to a trauma
itself. In addition to all of the consequences of the fall
itself, prolonged immobilization on the ground will have
many repercussions for poor prognosis for recovery.
A systematic review and meta-analysis of early mortal-
ity related to inability to rise after a fall was conducted in
elderly adults.
JAGS JULY 2012–VOL. 60, NO. 7 LETTERS TO THE EDITOR 1375
A computer search strategy on MEDLINE using the
Medical Subject Headings accidental falls and aged 80 and
over identified 3,401 articles published from 1981 to
2011; 3,333 were excluded, leaving 68 articles concerning
prospective studies about consequences and prognosis after
falls in elderly adults, to which two references from a
manual search were added to obtain 70 studies. Selecting
studies with numerical data on mortality in groups lying
or not lying on the ground for extended periods of
time, four studies were included.
3,68
A meta-analysis was
performed, and the odds ratios (ORs) and 95% CIs to
assess mortality related to inability to rise after a fall
were estimated for each study and overall. The Mantel
Haenszel fixed-effects method was used.
9
Heterogeneity
was assessed using the I²statistic.
10
One study was excluded because of a different meth-
odology that compromised the consistency of the results.
7
The OR for the association between lying on the floor for
a long time and mortality in all participants studied was
1.75 (95% CI =1.152.67) (Figure 1). This result was
moderately homogeneous (I²=33%).
The current study shows that lying on the floor for a
long period after a fall nearly doubles the risk of death.
Even a seemingly minor fall can be fatal if the person stays
lying on the ground for a long time because of pressure
ulcers, dehydration, hypothermia, rhabdomyolysis, or renal
failure, all of these disorders being likely to compromise
survival.
6
It was possible to include only four studies out of
3,401 (<0.2%) because many articles concerned the conse-
quences of traumatic falls-related injuries but not all type
of falls. Published articles on the consequences or progno-
sis of falls far too often give results in which falls are
categorized according to type (severe, repeated, injurious,
or traumatic fall), population subgroups, or place of
occurrence.
This meta-analysis can help to define the association
between early mortality and inability to rise after a fall,
but multivariate analyses could have helped to estimate the
real degree of connection. The strategy was limited and
must be used as a complement to systematic review when
studying consequences of falls, but it is too restrictive to
focus only on traumatic falls in this case, because it is diffi-
cult to say whether it is the trauma itself that is responsi-
ble for the consequences or the inability to recover.
The term “critical fall” is thus proposed to characterize
a fall with an inability to retain upright posture, whatever
the reason: trauma, feeling unwell, or lack of warning.
Orienting the characterization of falls this way seems
relevant for future studies, and being able to isolate this
group of falls with severe consequences will allow the
development of appropriate prevention strategies. Further-
more, early detection devices are crucial for the reduction
of mortality in this type of fall.
Fre
´de
´ric Bloch, MD, PhD
Department of Gerontology 1, Ho
ˆpital Broca, Paris
France
ACKNOWLEDGMENTS
Conflict of Interest: The editor in chief has reviewed the
conflict of interest checklist provided by the author and
has determined that the author has no financial or any
other kind of personal conflicts with this paper.
Author Contributions: F. Bloch is responsible for the
entire content of this paper.
Sponsor’s Role: None.
REFERENCES
1. Alexander NB, Ulbrich J, Raheja A et al. Rising from the floor in older
adults. J Am Geriatr Soc 1997;45:564569.
2. Asbjornsen G, Braathen L, Mellemstuen H. [Are old patients able to get up
from the floor?]. Tidsskr Nor Laegeforen 2000;120:31193120.
3. Tinetti ME, Liu WL, Claus EB. Predictors and prognosis of inability to get
up after falls among elderly persons. JAMA 1993;269:6570.
4. Fleming J, Brayne C. Inability to get up after falling, subsequent time on
floor, and summoning help: Prospective cohort study in people over 90.
BMJ 2008;337:a2227.
5. Ryynanen OP, Kivela SL, Honkanen R et al. Falls and lying helpless in the
elderly. Z Gerontol 1992;25:278282.
6. Bloch F, Jegou D, Dhainaut JF et al. Can metabolic abnormalities after a
fall predict short term mortality in elderly patients? Eur J Epidemiol
2009;24:357362.
7. Gurley RJ, Lum N, Sande M et al. Persons found in their homes helpless
or dead. N Engl J Med 1996;334:17101716.
8. Wild D, Nayak US, Isaacs B. Prognosis of falls in old people at home. J Ep-
idemiol Community Health 1981;35:200204.
9. Mantel N, Haenszel W. Statistical aspects of the analysis of data from ret-
rospective studies of disease. J Natl Cancer Inst 1959;22:719748.
10. Higgins JP, Thompson SG, Deeks JJ et al. Measuring inconsistency in
meta-analysis. BMJ 2003;327:557560.
SHOULD MAXIMUM CONSERVATIVE
MANAGEMENT BE THE STANDARD PARADIGM
FOR VERY ELDERLY ADULTS WITH CHRONIC
KIDNEY DISEASE OR IS THERE A ROLE FOR
DIALYSIS?
To the Editor: The incidence and prevalence of very
elderly adults reaching chronic kidney disease Stage 5
Figure 1. Meta-analysis of the association between lying on the floor for a long period and mortality. M-H =Mantel–Haenszel.
1376 LETTERS TO THE EDITOR JULY 2012–VOL. 60, NO. 7 JAGS
... Freezing of movement following a fall can impede subsequent fl oor recovery and ability to seek assistance, especially when heightened anxiety triggers freezing (Wilczyński et al., 2020). Although individuals can become injured following the fall itself, those remaining on the fl oor are at risk for dehydration, pressure ulcers, rhabdomyolysis, hypothermia, and pneumonia (Bloch, 2012). Lying on the ground after a fall for extended time approximately doubles mortality risk (Bloch, 2012). ...
... Although individuals can become injured following the fall itself, those remaining on the fl oor are at risk for dehydration, pressure ulcers, rhabdomyolysis, hypothermia, and pneumonia (Bloch, 2012). Lying on the ground after a fall for extended time approximately doubles mortality risk (Bloch, 2012). ...
Article
Although considerable research has targeted fall prevention among older adults with Parkinson's disease (PD), less is known about their ability to rise from the floor. The aim of the current exploratory study was to examine the relationship between floor rise and physical performance tests. A cross-sectional design was used. Twenty community-dwelling older adults with PD (mean age = 74.8 years, SD = 9.5 years) performed a standardized floor rise test and physical performance assessments in a structured task circuit. Mean time to rise from the floor was 14.9 seconds (SD = 7.6 seconds). Fourteen (70%) participants used a quadruped strategy to rise to stand. Supine-to-stand performance time was significantly correlated with all physical performance measures. Findings serve as a catalyst for nursing and rehabilitation professionals to examine floor rise ability, prevent adverse effects of a critical fall, and instruct fall recovery techniques in clinical settings. [Journal of Gerontological Nursing, 49(1), 50-54.].
... Auch wenn eine Definition fehlt, scheint unter einem LT vor allem eine durch längeres Liegen ausgelöste muskuläre Minderperfusion mit konsekutiver Gewebsschädigung verstanden zu werden, die zu einer Rhabdomyolyse führt [14,16]. Soweit den Autoren bekannt ist bis dato keine detaillierte Analyse und Charakterisierung einer Patientenkohorte mit LT im Kontext der klinischen Notfallversorgung in einer Notaufnahme erfolgt, obwohl in der englischen Literatur langes Liegen nach Stürzen bei älteren Patienten immer wieder als Risikofaktor für ein schlechtes Outcome diskutiert wird [2]. Ziel der vorliegenden Arbeit war es daher, aus einer Patientenkohorte mit LT die Einflussfaktoren auf Morbidität und Letalität zu identifizieren. ...
... Ein weiterer ähnlicher Begriff im Englischen bezeichnet das "long lie", worunter eine Liegedauer von mehr als einer Stunde nach Stürzen vor allem bei älteren Patienten verstanden wird [4]. Die Unfähigkeit des eigenständigen Aufstehens ist dabei als Risikofaktor für eine erhöhte Mortalität auch in einer Metaanalyse bestätigt worden [2]. In einer beispielhaften monozentrischen und prospektiven Beobachtungsstudie aus dem Jahr 2006 von 417 Patienten im Alter von mindestens 75 Jahren, die nach einem Sturzereignis in einer Notaufnahme vorstellig wurden, wurden die meisten Stürze durch Unfälle ausgelöst (65 %), während auslösende Erkrankungen seltener waren. ...
Article
Full-text available
Zusammenfassung Hintergrund Bisher fehlen Versorgungsdaten für Patienten mit Liegetrauma (LT). Methode Deskriptive retrospektive Analyse aller rettungsdienstlich mit einem LT der Notaufnahme des Universitätsklinikums Köln von 07.2018 bis 12.2020 zugeführten Patienten. Ergebnis Insgesamt konnten 50 Patienten mit LT (Altersmedian 76 Jahre, Liegedauer im Median 13,5 h) im Untersuchungszeitraum identifiziert werden. Die zugrunde liegende Ursache für das LT war in 40 % primär neurologisch (ischämischer Schlaganfall: 20 %, intrakranielle Blutung: 16 %, Epilepsie: 4 %), in 12 % eine Intoxikation und in 10 % ein häusliches Trauma. Häufige assoziierte Diagnosen waren Infektionen (52 %), Traumafolgen (22 %), Exsikkose (66 %), akute Nierenfunktionsstörung (20 %), schwere Rhabdomyolyse (Kreatininkinase ≥ 5000 U/l, 21 %) und schwere Hypothermie < 32 °C (20 %). Insgesamt wurden 69 % der Patienten auf einer Intensivstation aufgenommen und die Krankenhausletalität betrug 50 %. Schlussfolgerung Das LT beschreibt einen Patientenzustand, bei dem infolge vielfältiger Ursachen plötzlich die eigenständige Mobilisierung und ein selbstständiges Hilfeholen verhindert werden und dadurch weitere Gesundheitsschäden entstehen. Bei diesem Syndrom sind Gewebsschäden als Folge des Liegens keine notwendige Voraussetzung für das Vorliegen eines LT. Aufgrund der hohen Morbidität und Letalität sollten diese Patienten in einem nichttraumatologischen Schockraum aufgenommen werden.
... TUA and TOG care markers showed an average 29-minute decrease, indicating that much faster assistance to help fallers recover to a comfortable position could be provided, instead of relying on regular care rounds only. There is extensive literature about the additional critical comorbidities that are related to the long lie [21] and inability to get up [22], including metabolic and physical consequences (dehydration, hypothermia, rhabdomyolysis, renal failure, pressure ulcers [23]), psychological complications (post-fall syndrome with fear of falling again [24] and activity limitation [16]), higher risk for recurrent falls [4], and loss of autonomy [16]. Lying on the floor after a fall for a long period of time was also found to nearly double the risk of death in elderly adults [23]. ...
... There is extensive literature about the additional critical comorbidities that are related to the long lie [21] and inability to get up [22], including metabolic and physical consequences (dehydration, hypothermia, rhabdomyolysis, renal failure, pressure ulcers [23]), psychological complications (post-fall syndrome with fear of falling again [24] and activity limitation [16]), higher risk for recurrent falls [4], and loss of autonomy [16]. Lying on the floor after a fall for a long period of time was also found to nearly double the risk of death in elderly adults [23]. On average, the RTN resulted here in assigning a "fall incident" to staff as a red flag priority among their other ongoing care tasks, accounting for the substantial reduction in TUA and in TOG. ...
Article
Full-text available
Background Lying on the floor for a long period of time has been described as a critical determinant of prognosis following a fall. In addition to fall-related injuries due to the trauma itself, prolonged immobilization on the floor results in a wide range of comorbidities and may double the risk of death in elderly. Thus, reducing the length of Time On the Ground (TOG) in fallers seems crucial in vulnerable individuals with cognitive disorders who cannot get up independently. Objective This study aimed to examine the effect of a new technology called SafelyYou Guardian (SYG) on early post-fall care including reduction of Time Until staff Assistance (TUA) and TOG. Methods SYG uses continuous video monitoring, artificial intelligence, secure networks, and customized computer applications to detect and notify caregivers about falls in real time while providing immediate access to video footage of falls. The present observational study was conducted in 6 California memory care facilities where SYG was installed in bedrooms of consenting residents and families. Fall events were video recorded over 10 months. During the baseline installation period (November 2017 to December 2017), SYG video captures of falls were not provided on a regular basis to facility staff review. During a second period (January 2018 to April 2018), video captures were delivered to facility staff on a regular weekly basis. During the third period (May 2018 to August 2018), real-time notification (RTN) of any fall was provided to facility staff. Two digital markers (TUA, TOG) were automatically measured and compared between the baseline period (first 2 months) and the RTN period (last 4 months). The total number of falls including those happening outside of the bedroom (such as common areas and bathrooms) was separately reported by facility staff. Results A total of 436 falls were recorded in 66 participants suffering from Alzheimer disease or related dementias (mean age 87 years; minimum 65, maximum 104 years). Over 80% of the falls happened in bedrooms, with two-thirds occurring overnight (8 PM to 8 AM). While only 8.1% (22/272) of falls were scored as moderate or severe, fallers were not able to stand up alone in 97.6% (247/253) of the cases. Reductions of 28.3 (CI 19.6-37.1) minutes in TUA and 29.6 (CI 20.3-38.9) minutes in TOG were observed between the baseline and RTN periods. The proportion of fallers with TOG >1 hour fell from 31% (8/26; baseline) to zero events (RTN period). During the RTN period, 76.6% (108/141) of fallers received human staff assistance in less than 10 minutes, and 55.3% (78/141) of them spent less than 10 minutes on the ground. Conclusions SYG technology is capable of reducing TOG and TUA while efficiently covering the area (bedroom) and time zone (nighttime) that are at highest risk. After 6 months of SYG monitoring, TOG was reduced by a factor of 3. The drastic reduction of TOG is likely to decrease secondary comorbid complications, improve post-fall prognosis, and reduce health care costs.
... Auch wenn eine Definition fehlt, scheint unter einem LT vor allem eine durch längeres Liegen ausgelöste muskuläre Minderperfusion mit konsekutiver Gewebsschädigung verstanden zu werden, die zu einer Rhabdomyolyse führt [14,16]. Soweit den Autoren bekannt ist bis dato keine detaillierte Analyse und Charakterisierung einer Patientenkohorte mit LT im Kontext der klinischen Notfallversorgung in einer Notaufnahme erfolgt, obwohl in der englischen Literatur langes Liegen nach Stürzen bei älteren Patienten immer wieder als Risikofaktor für ein schlechtes Outcome diskutiert wird [2]. Ziel der vorliegenden Arbeit war es daher, aus einer Patientenkohorte mit LT die Einflussfaktoren auf Morbidität und Letalität zu identifizieren. ...
... Ein weiterer ähnlicher Begriff im Englischen bezeichnet das "long lie", worunter eine Liegedauer von mehr als einer Stunde nach Stürzen vor allem bei älteren Patienten verstanden wird [4]. Die Unfähigkeit des eigenständigen Aufstehens ist dabei als Risikofaktor für eine erhöhte Mortalität auch in einer Metaanalyse bestätigt worden [2]. In einer beispielhaften monozentrischen und prospektiven Beobachtungsstudie aus dem Jahr 2006 von 417 Patienten im Alter von mindestens 75 Jahren, die nach einem Sturzereignis in einer Notaufnahme vorstellig wurden, wurden die meisten Stürze durch Unfälle ausgelöst (65 %), während auslösende Erkrankungen seltener waren. ...
Article
Full-text available
Hintergrund: Charakterisierung von Patienten mit Liegetrauma („LT“) und daraus resultierend Versuch einer ersten Defnition des bisher nicht defnierten klinischen Bildes. Methode: Retrospektive Analyse aller Patienten, welche zwischen 07/2018 und 12/2020 mit der Diagnose „Liegetrauma“ in der Notaufnahme des Universitätsklinikums Köln vorgestellt worden sind. Ergebnisse: Es wurden 50 Patienten (männlich: 58%) mit einem durchschnittlichen Alter von 74±14 Jahren (Median: 76 Jahre, Spannweite: 36– 103 Jahre) in die Analyse eingeschlossen. Fast alle Patienten (95%) wurden zu Hause aufgefunden und nur ein kleiner Teil (14%) der Patienten war <60 Jahre. Die erfasste Liegedauer betrug 23±26 h (Median 13,5 h, Spannweite: 9–96 h). Die initiale GCS lag im Mittel bei 9±5 Punkten, 48% der Patienten waren bei Übernahme endotracheal intubiert und 20% ausgeprägt hypotherm (Temperatur <32 °C). In 40% der Fälle konnte das Indexereignis auf eine primär zerebrale Ursache zurückgeführt werden (ischämischer Schlaganfall: 20%, intrakranielle Blutung: 16%, Epilepsie: 4%). Weitere häufge Ursachen des LT waren Intoxikationen (12 %) oder Trauma (10 %). Bei annähernd jedem zweiten Patienten konnte ergänzend eine Infektion (Pneumonie 36%, Harnwegsinfekt 12 %) dokumentiert werden und etwa jeder fünfe Patient (22%) benötigte aufgrund eines Traumas eine chirurgische Mitbetreuung. Bei Übernahme wiesen 66% der Patienten eine Exsikkose auf und 20% entwickelten eine akute Nierenfunktionsstörung. 58% der Patienten zeigten eine deutliche Erhöhung der Kreatininkinase (>1000 U/L). Rund 70% der Patienten mussten intensivmedizinisch weiterbetreut werden. Die mittlere Intensivaufenthaltsdauer betrug 10±10 d (Median: 5 d, Spannweite 1–35 d) und die innerklinische Mortalität lag bei 50%. Zusammenfassung: Patienten mit LT benötigten in dieser Kohorte häufg eine intensivmedizinische Behandlung und wiesen eine hohe Krankenhausmortalität auf. Aufgrund der vielen assoziierten Diagnosen und des schlechten Behandlungsergebnis erscheint eine interdisziplinäre Schockraumversorgung von Patienten mit Liegetrauma sinnvoll. Basierend auf den Erkenntnissen dieser Untersuchung beschreibt das Liegetrauma „ein komplexes klinisches Bild, indem durch vielfältige Ursachen plötzlich das eigenständige Mobilisieren und Hilfe holen verhindert wird und hierdurch weitere Gesundheitsschäden entstehen“.
... Further investigation of this topic is warranted as remaining on the ground for an extended period of time, defined as a long lie period, 54 can result in serious physical injuries, including pressure ulcers, dehydration, hypothermia, and even death. 55 Previous research has shown that a long lie period was associated with the development of a FOF in older adults. 56,57 Along with previous evidence, our findings highlight the importance of developing recovery strategies to minimize the development of FOF and avoid any adverse consequences of falls among wheelchair users who need assistance when a fall occurs. ...
Article
Objective To examine the differences in community participation and quality of life (QOL) among people who use wheelchairs full time with and without fear of falling (FOF). Design Cross-sectional study design Setting University research laboratory Participants Data from 85 people who use a manual or power wheelchair full time living with various health conditions, and have a history of at least one fall in the past 12 months (age=45.4±15.8 years, disability duration=21.5±13.6 years, manual wheelchair user, n= 46, 54%) were analyzed. Intervention Not applicable Main Outcome Measures To quantify FOF, participants responded (yes/no) to the question: “Are you worried or concerned that you might fall?” Community participation and QOL were indexed by the Community Participation Indicator (CPI) and the World Health Organization Quality of Life-Brief version (WHOQOL-BREF), respectively. A Multivariate Analysis of Variance (MANOVA) was performed to examine the differences in CPI and WHOQOL-BREF scores among wheelchair users who reported FOF and no FOF. Results A total of 54 participants (63.5%) reported that they were worried or concerned about falling. The MANOVA revealed significant differences in overall CPI (F (2,82) = 4.714, p=0.012, Wilks’ λ = 0.897), and WHOQOL-BREF (F (4,63) = 3.32, p=.016, Wilks’ λ = .826) scores. Participants who reported a FOF, demonstrated significantly lower CPI and WHOQOL-BREF scores compared to those who did not report a FOF. Conclusion FOF and associated activity curtailment are prevalent and may be a factor influencing full time wheelchair users’ community participation, and QOL. Prospective research is needed to better understand how FOF influences community participation and QOL among people who use wheelchairs full time. Findings would support the development of interventions, specifically for people who use wheelchairs full time, to reduce FOF and improve community participation and QOL.
... Studies have reported instructions which dictate rising at a self-selected pace to "as quickly as possible" when instructed to stand [32][33][34]. The test has gained momentum in clinical usefulness to prevent the adverse effects of a critical fall where seniors are on the floor for several hours [35]. Slower floor rise ability has been linked to all time mortality in older adults over 50 years of age [36]. ...
Article
Full-text available
Purpose of Review This review will outline seminal and contemporary balance and gait measures most commonly used with geriatric clients, along with the administration procedures, clinical utility, and psychometric qualities that support their use. Recent Findings Ten balance and five gait performance tests were reviewed. Balance instruments range from the simple to the complex. These tools quantify older adults’ ability to maintain postural stability during tasks that manipulate sensory conditions and functional activities, and challenge their base of support. Gait assessment is common in geriatric rehabilitation. Frail clients who ambulate with an assistive device can benefit from a more basic locomotion test, whereas seniors at higher mobility levels should be challenged with tasks superimposed on the gait sequence. Recent adaptations of traditional tests include surface changes, technology application, and clinical utility with subsets of older adults such as those with lumbar surgery and postural tremor. Timed floor rise ability more thoroughly addresses the fall risk dimension. Summary Balance and gait assessments quantify physical performance in older adults and are utilized to establish interventions to improve mobility, reduce fall risk, and increase balance confidence. A wide variety of outcome measures exists in geriatric rehabilitation, though tests should be tapered for the functional level of the client. Practitioners should consider test administration for older adults with atypical diagnoses, along with flooring changes, technology adaptation, and timed supine to stand ability. Future research should revisit commonly accepted threshold scores for fall risk.
... Fall Detection Technology can help prevent long lies by raising alerts that someone has fallen. There is on average a 15% likelihood of a long lie resulting from a fall for those aged 65 years and over (Bloch, 2012;Tinetti, Liu and Claus, 1993;Wild, Nayak and Isaacs, 1981). It is also reported that half of the seniors who fall cannot get up on their own and a lie time of more than 72 hours increases their mortality by 67% (Gurley et al. 1996). ...
Research
Full-text available
National Disability Authority - Ireland - Research Promotion Scheme Investigation into Fall Detection Technologies in the Smart Home and their impact on Lifetime Communities. ... Available online at http://nda.ie/Publications/Others/Research-Promotion-Scheme/Investigation-of-the-Universal-Design-of-Fall-Detection-Technologies-in-the-Smart-Home-and-their-Impact-on-Lifetime-Communities1.pdf
Article
Falls are a significant cause of disability internationally. The purpose of this exploratory study was to examine the effectiveness of a community fall prevention program, Stepping On (SO), using nine student physical therapists and program faculty in a rural setting. A mixed-methods design was utilized. Students partnered with older adults to master exercises, demonstrate floor recovery techniques, and manage community navigation in line with program fidelity. A descriptive survey assessed program outcomes. Students participated in a follow-up focus group to discuss perspectives on their role in the program. One hundred and seventeen community-dwelling older adults (mean age: 75.2 ± 8.5) completed the program. Participants who lived alone were likely to limit their activities because of fear of falling (p = .045). Following SO most subjects (87.7%) described having a better understanding of falls and their causes, with a plan to arise from the floor (82.6%). Focus group themes underscored students' opportunity to facilitate, reinforce safety during mobility activities, and motivate participants. Furthermore, an increased awareness of other professions' contribution to fall prevention was noted. Following a community fall prevention program, older adults have a better understanding of fall prevention and plan for floor recovery. In turn, student coaching skills are reinforced.
Article
Resumen Las caídas de las personas ancianas son un auténtico problema de salud pública debido a su prevalencia en países de nuestro entorno. Cualquier caída en esta población debe tratarse como una afección potencialmente grave y con un posible riesgo de recidiva. El simple envejecimiento en sí mismo es un factor de riesgo de caída, al que se añaden otras enfermedades responsables de discapacidad que aumentan el riesgo de caída. Los factores extrínsecos también pueden favorecer las caídas: obstáculos, prendas de vestir o calzado inadecuados, efectos de los medicamentos. La mayoría de las caídas no dan lugar a un traumatismo físico importante, pero las consecuencias secundarias a menudo tienen relación con estar mucho tiempo en el suelo. Una caída también puede provocar un traumatismo psicológico que puede contribuir a la emergencia de un síndrome poscaída. Finalmente, la caída así como las heridas que resultan de ella son factores de declive funcional posterior, con un riesgo de institucionalización. El mecanismo de la caída es de carácter multifactorial en el 60% de los casos y requiere un tratamiento múltiple. Conviene descartar una causa curable de la caída, con mucha frecuencia de origen cardíaco o neurológico, pero, en términos de prevención, sólo las intervenciones que comprenden un diagnóstico de los factores de riesgo individuales y una intervención que combine una corrección de estos factores de riesgo con acondicionamiento del entorno se han mostrado eficaces. Actualmente, el interés y la eficacia de enfoques multidisciplinarios y multifactoriales para la prevención de las caídas ya no necesitan comprobación. Esto puede contribuir eficazmente a la disminución del número de caídas en las personas ancianas.
Preprint
Continuous in-home monitoring of older adults living alone aims to improve their quality of life and independence, by detecting early signs of illness and functional decline or emergency conditions. To meet requirements for technology acceptance by seniors (unobtrusiveness, non-intrusiveness, privacy-preservation), this study presents and discusses a new smart sensor system for the detection of abnormalities during daily activities, based on ultra-wideband radar providing rich, not privacy-sensitive, information useful for sensing both cardiorespiratory and body movements, regardless of ambient lighting conditions and physical obstructions (through-wall sensing). The radar sensing is a very promising technology, enabling the measurement of vital signs and body movements at a distance, and thus meeting both requirements of unobtrusiveness and accuracy. In particular, impulse-radio ultra-wideband radar has attracted considerable attention in recent years thanks to many properties that make it useful for assisted living purposes. The proposed sensing system, evaluated in meaningful assisted living scenarios by involving 30 participants, exhibited the ability to detect vital signs, to discriminate among dangerous situations and activities of daily living, and to accommodate individual physical characteristics and habits. The reported results show that vital signs can be detected also while carrying out daily activities or after a fall event (post-fall phase), with accuracy varying according to the level of movements, reaching up to 95% and 91% in detecting respiration and heart rates, respectively. Similarly, good results were achieved in fall detection by using the micro-motion signature and unsupervised learning, with sensitivity and specificity greater than 97% and 90%, respectively.
Article
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Infective endocarditis (IE) often is caused by bacteria that colonize teeth. The authors conducted a study to determine if poor oral hygiene or dental disease are risk factors for developing bacteremia after toothbrushing or single-tooth extraction. One hundred ninety-four participants in a study were in either a toothbrushing group or a single-tooth extraction with placebo group. The authors assessed the participants' oral hygiene, gingivitis and periodontitis statuses. They assayed blood samples obtained before, during and after the toothbrushing or extraction interventions for IE-associated bacteria. The authors found that oral hygiene and gingival disease indexes were associated significantly with IE-related bacteremia after toothbrushing. Participants with mean plaque and calculus scores of 2 or greater were at a 3.78- and 4.43-fold increased risk of developing bacteremia, respectively. The presence of generalized bleeding after toothbrushing was associated with an almost eightfold increase in risk of developing bacteremia. There was no significant association between any of the measures of periodontal disease and the incidence of bacteremia after toothbrushing. The oral hygiene or disease status of a tooth was not significantly associated with bacteremia after its extraction. Bacteremia after toothbrushing is associated with poor oral hygiene and gingival bleeding after toothbrushing. Improvements in oral hygiene may reduce the risk of developing IE.
Book
This third and final volume in the acclaimed Fish Diseases and Disorders trilogy addresses infectious diseases of finfish and shellfish caused by viruses, bacteria and fungi. Topics covered include infectious pancreatic necrosis virus, infectious hematopoictic necrosis virus, viral diseases of cold and warm-water fish, rickettsial and chlamydial infections, furunculosis, motile aeromonads, vibriosis, flavobacterial diseases and shellfish diseases. Written by experts in each discipline and updated throughout to reflect new developments in the field, including new chapters on alphaviruses, oncogenic viruses and genomics and proteomics, this is a must-have reference for fish health specialists and veterinarians, microbiologists, zoologists and researchers and students in aquaculture.
Article
Objective. —To identify the predictors and prognosis associated with inability to get up after falling.Design. —Cohort study with a mean 21-month follow-up.Setting. —General community.Subjects. —1103 New Haven, Conn, residents aged 72 years and older who were able to follow simple commands and walk unassisted.Main Outcome Measures. —Self-reported inability to get up without help after falls not resulting in serious injury; activity restriction and hospitalization after a fall; death; and placement in a nursing home.Results. —Inability to get up without help was reported after 220 of 596 noninjurious falls. Of 313 noninjured fallers, 148 (47%) reported inability get up after at least one fall. Compared with nonfallers, the risk factors independently associated with inability to get up included the following: an age of at least 80 years (adjusted relative risk [RR], 1.6; 95% confidence interval [Cl], 1.2 to 2.1); depression (RR, 1.5; Cl, 1.1 to 2.0); and poor balance and gait (RR, 2.0; Cl, 1.5 to 2.7). Previous stroke (RR, 1.6; Cl, 1.0 to 2.4) and sedative use (RR, 1.5; Cl, 0.9 to 2.2) did not achieve significance. Among fallers, older age and poor balance and gait were associated marginally with inability to get up. Compared with fallers who were able to get up, fallers who were unable to get up were more likely to suffer lasting decline in activities of daily living (35% vs 26%). Fallers who were unable to get up were more likely to die, to be hospitalized, and to suffer a decline in activities of daily living for at least 3 days, and were less likely to be placed in a nursing home than were fallers who were able to get up, but these trends were not statistically significant.Conclusions. —The risk factors for inability to get up were similar to those for falling, although certain factors imparted a particular risk of inability to get up without help. The frequency of inability to get up and the short- and long-term morbidity associated with this inability suggest the need for preventive and treatment efforts.(JAMA. 1993;269:65-70)
Article
One million total joint arthroplasties (TJAs) are performed annually in the United States. The incidence of oral disease has not been documented in this population. To understand the scope of disease, a descriptive longitudinal population-based study sought to define the true incidence of dental pathology in the TJA population. One hundred consecutive TJA patients from a dedicated arthroplasty practice were sent for dental clearance, including oral examination, cleaning, radiographs, and treatment of active decay. The incidence of pathology was documented. Of 10 patients, 23 (23%) were treated before being cleared for arthroplasty. Sixty-six procedures were performed--2.9 problems per patient. No patient developed TJA infection. Routine preoperative dental clearance revealed 23% incidence of pathology, and no patient developed TJA infection.
Article
Chronic infections, such as periodontitis, have been associated with an increased risk for atherosclerosis and coronary artery disease. The aim of this study was to investigate biopsy samples of coronary and internal mammary arteries for the presence of putative pathogenic bacteria (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Tannerella forsythensis), Chlamydia pneumoniae, and human cytomegalovirus (CMV). Patients with a diagnosis of coronary artery disease were included in the study. Fifteen coronary arteries with atherosclerosis and 15 internal mammary arteries without clinically assessable atherosclerotic degeneration were investigated. Both groups of specimens were obtained during coronary artery bypass grafting surgery. In all cases, the coronary and mammary artery specimens were taken from the same patient. The detection of periodontal pathogens, C. pneumoniae, and CMV was done by polymerase chain reaction analysis. Bacterial DNA was found in nine of 15 (60%) coronary artery biopsy samples: P. gingivalis in eight (53.33%), A. actinomycetemcomitans in four (26.67%), P. intermedia in five (33.33%), and T. forsythensis in two (13.33%) samples; CMV was detected in 10 (66.67%) samples, and C. pneumoniae was detected in five (33.33%) samples. Some of the samples contained more than one type of bacteria. Periodontal pathogens were not detected in internal mammary artery biopsies, whereas CMV was present in seven (46.67%) samples and C. pneumoniae was present in six (40%) samples. The absence of putative pathogenic bacteria in internal mammary arteries, which are known to be affected rarely by atherosclerotic changes, and their presence in a high percentage of atherosclerotic coronary arteries support the concept that periodontal organisms are associated with the development and progression of atherosclerosis.