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German adaptation of the Activities-specific Balance Confidence (ABC) scale for the assessment of falls-related self-efficacy - German Language

Schott.N. Z Gerontol Geriatr. 2008 Mar 11. Epub ahead of print. The present study investigates the psychometric properties and the factorial structure of the German adaptation of the Activities-Specific Balance Confidence (ABC) scale (Powell and Myers, 1995) for the evaluation of falls-related self-efficacy in community- dwelling older adults. The German adaptation of the ABC using a forward-backward procedure was administered to 113 older adults (age 68.9 +/- 8.5 years). The following internationally accepted instruments were used for validation: The Short Form Health Survey SF 36, the Geriatric Depression Scale (GDS), the Trail Making Test and the Letter Number Sequencing Test, and motor tests (balance, strength, mobility). The internal consistency (0.91- 0.95) as well as the test-retest reliability of the subscales was excellent (0.94-0.98). The correlation coefficients with the validation instruments ranged between 0.33 and 0.58. Significant differences in the ABC-D scores were found in older adults with and without falls. Older adults with a recent fall history scored lower on the ABC-D than older adults without a recent fall history. To conclude, the German version of the ABC has properties analogous to the original English version and is apparently useful in assessing falls-related self-efficacy.

Correlates of fear of falling - German Language

Schott. N. Zeitschrift fur Sportpsychologie, 2007; 14(2), 74-86. The present study investigated relations in older adults between fear of falling (assessed with the Survey of Activities and Fear of Falling in the Elderly, SAFE), functional balance and mobility (Timed-Up-and-Go-Test, TUG; gait speed), and physical functioning (SAFE activities; SAFE activity reductions; SF-36). It also examined whether fall-related self-efficacy (Activities-Specific Balance Confidence ABC Scale) acts as a mediator in a structural equation model. Participants were 91 individuals (17 men and 74 women aged 60-93 years) with no current history of falls. Results showed that fear of falling correlated significantly with fall self-efficacy ( = -.0.931; t = -8.117, p < 0.001), indicating that individuals with low levels of fear reported higher fall-related efficacy. Moreover, fear of falling had a highly significant effect on physical functioning ( = -0.432, t = -2.686, p =.007). Self-efficacy was associated with better functional balance and mobility ( = 0.482, t = 2.050, p = .040), but not with physical functioning ( = 0.118, t = 0.916, p = .359). Fall-related self-efficacy mediated the effects of fear of falling on functional balance and mobility. It is concluded that the significant impact of functional and behavioral characteristics on activity-related fear of falling emphasizes the need for interventions enhancing fall-related self-efficacy to lessen activity-related fear of falling in older adults.

Falls in older adults: Risk factors, Assessment, Prevention. A Review - German Language

Schott N, Kurz AK. Zeitschrift fur Sportpsychologie, 2008; 15(2), 45-62. Falls are a common and complex geriatric syndrome that causes considerable mortality, morbidity, functional deterioration, fear of falling, and premature nursing home admissions. Falls have multiple causes and predisposing risk factors, which make their diagnosis, treatment, and prevention a difficult challenge. In recent years, much attention in research and health care has focused on identifying effective interventions to prevent falls and fall-related injuries among older adults. In particular, there have been a number of randomized controlled trials and systematic reviews investigating the effectiveness of various packages of falls interventions. This article provides a brief overview of the epidemiology of falls, their major causes and risk factors, their assessment, the types of fall prevention interventions available, and a review of the latest evidence on the efficacy of these interventions.

Pavements changing colour to warn pedestrians about ice?

French company Eurovia is aiming to provide some warnings that are decidedly more real-time, with it now testing a process that\'ll actually change the color of roads as the temperature dips into freezing territory. That\'s, of course, not an entirely new process (we\'ve already seen spoons that change color based on temperature), but Eurovia is apparently fine tuning things to hold up to the wear and tear it\'ll see on roads, and working to ensure that it turns color early enough so the salt trucks can be deployed before the roads get too dicey. While there\'s no word as to when we might see a wide-scale deployment, the company did test it with five patches over a 50 kilometer stretch of road in France this winter, and it sees no shortage of benefits to the technology in the future, adding that it could also be used to warn pedestrians to watch their steps on sidewalks.

The effect of bedrails on falls and injury: a systematic review of clinical studies

Frances Healey, David Oliver, Alisoun Milne and James B. Connelly. Age and Ageing 2008 37(4):368-378. Background: around one-fourth of all falls in healthcare settings are falls from bed. The role of bedrails in falls prevention is controversial, with a prevailing orthodoxy that bedrails are harmful and ineffective. Objective: to summarise and critically evaluate evidence on the effect of bedrails on falls and injury Design: systematic literature review using the principles of QuoRoM guidance. Setting and Subjects: adult healthcare settings Review Methods: using the keyword, bedrail, and synonyms, databases were searched from 1980 to June 2007 for direct injury from bedrails or where falls, injury from falls, or any other effects were related to bedrail use. Results: 472 papers were located; 24 met the criteria. Three bedrail reduction studies identified significant increases in falls or multiple falls, and one found that despite a significant decrease in falls in the discontinue-bedrails group, this group remained significantly more likely to fall than the continue-bedrails group; one case-control study found patients who had their bedrails raised significantly less likely to fall; one retrospective survey identified a significantly lower rate of injury and head injury in falls with bedrails up. Twelve papers described direct injury from bedrails. Discussion: it is difficult to perform conventional clinical trials of an intervention already embedded in practice, and all included studies had methodological limitations. However, this review concludes that serious direct injury from bedrails is usually related to use of outmoded designs and incorrect assembly rather than being inherent, and bedrails do not appear to increase the risk of falls or injury from falls.

Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention.

Age Ageing. 2008 May;37(3):306-10 Authors: Bouwen A, De Lepeleire J, Buntinx F OBJECTIVE: to evaluate the impact of a staff-oriented intervention on the number of accidental falls in residents with and without cognitive impairment. DESIGN: clustered randomised controlled trial. METHODS: ten nursing wards from 7 nursing homes were randomised in a control (5 wards) and intervention (5 wards) group. The nurses from the intervention group received multi-faceted training about the occurrence of accidental falls, risk factors for falls and possible environmental modifications. For each fall they were asked to record the relevant risk factors, to keep a fall diary and to evaluate fall causes and possible preventive actions. For all residents, cognition and mobility were evaluated using a Mini-Mental State Examination (MMSE) and a Timed Up and Go Test (TUGT). Fall rates were recorded in an identical way for 6 months before and after the start of the intervention. MAIN OUTCOME MEASURES: primary outcome measure was the number of participants with at least one accidental fall requiring an intervention by a physician or a nurse during each period of recording. Secondary outcome was the number of falls for each participant during each period of recording. RESULTS: the relative risk of falling at least once in people of the intervention versus the control group adjusted for the pre-intervention results was 0.46 (95% CI: 0.26-0.79). There was no difference between residents with and without cognitive impairment or impaired mobility. In those falling at least once, the difference between the average number of falls in the two intervention arms was not significant (P = 0.10). CONCLUSION: a simple staff-oriented intervention had a substantial effect on the frequency of accidental falls. PMID: 18385186 [PubMed - indexed for MEDLINE]

A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities.

Aging Clin Exp Res. 2008 Feb;20(1):67-75 Authors: Rosendahl E, Gustafson Y, Nordin E, Lundin-Olsson L, Nyberg L BACKGROUND AND AIMS: Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities. METHODS: Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean+/-SD score on the Mini-Mental State Examination was 17.8+/-5.1 (range 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively. RESULTS: During the 6-month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03. CONCLUSIONS: In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance. PMID: 18283231 [PubMed - indexed for MEDLINE]

Square-stepping exercise versus strength and balance training for fall risk factors.

Aging Clin Exp Res. 2008 Feb;20(1):19-24 Authors: Shigematsu R, Okura T, Sakai T, Rantanen T BACKGROUND AND AIMS: Feasible and lowcost exercise programmes targeting fall risk factors may decrease the risk of falling in older adults. The purpose of this study was to compare the effects of square-stepping exercise (SSE) training, which is a new and low-cost method designed to improve lower-extremity functional fitness, with strength and balance (SB) training. METHODS: The study included 39 community-dwelling adults aged 65 to 74 years. The participants were randomized to either group SSE (n=20) or SB (n=19). They engaged in 70- min group exercise sessions twice a week for 12 weeks. The efficacy of the program was measured with both a 9- item test battery for assessment of physical performance and self-reported scales (fear of falling, pleasure in exercise, perceived health status). Fall incidence was followed up for 14 months. RESULTS: The results of a 2-way ANOVA revealed that the time effect in 7 of the 9 performance tests was significant, although group-by-time interactions were not. No significant changes were observed in the self reported scales. During the 14-month follow-up period, 7 falls in 6 participants in the SSE group and 12 falls in 11 participants in the SB group were reported. The incidence rate per person in the SSE group (30.0%) was not significantly different from that in the SB group (57.9%). The rate of falls per trip [falls/(falls + trips)] in the SSE group (17.1%) was significantly lower than in the SB group (50.0%). CONCLUSIONS: SSE is as equally effective as SB training in improving lower-extremity functional fitness. SSE may also be recommended for older adults, due to its low cost and effectiveness. PMID: 18283224 [PubMed - indexed for MEDLINE]

Preclinical disability as a risk factor for falls in community-dwelling older adults.

J Gerontol A Biol Sci Med Sci. 2008 Mar;63(3):314-20 Authors: Clough-Gorr KM, Erpen T, Gillmann G, von Renteln-Kruse W, Iliffe S, Beck JC, Stuck AE BACKGROUND: Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults. METHODS: Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1-2.5), task difficulty (OR = 1.7, 95% CI, 1.1-2.6) and history of falls (OR = 4.7, 95% CI, 3.5-6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0-3.0) and without history of falls (OR = 1.8, 95% CI, 1.1-3.0). CONCLUSIONS: This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for intervention. PMID: 18375881 [PubMed - indexed for MEDLINE]

IAGG Gerontology - Paris 5-9 July 2009

Every four years, the World Congress of Gerontology and Geriatrics represents a unique and irreplaceable event attended by experts from around the world to discuss the latest findings in the field of ageing. The 19th congress, which is taking place in Paris in 2009, is particularly important, as it coincides with an ideological u-turn.