Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

If interRAI home care information were shared with primary care providers, care provision and integration could be enhanced. The objective of this study was to co-develop an interRAI-based clinical information sharing tool (i.e., the Patient Falls Risk Report) with a sample of primary care providers. This mixed-methods study employed semi-structured interviews to inform the development of the Patient Falls Risk Report and online surveys based on the System Usability Scale instrument to test its usability. Most of the interview sample (n = 9) believed that the report could support patient care by sharing relevant and actionable falls-related information. However, criticisms were identified, including insufficient detail, clarity, and support for shared care planning. After incorporating suggestions for improvement, the survey sample (n = 27) determined that the report had excellent usability with an overall usability score of 83.4 (95% CI = 78.7–88.2). By prioritizing the needs of end-users, sustainable interRAI interventions can be developed to support primary care.

This pilot study was designed to assess the feasibility of implementing a mindfulness intervention in the prevention of falls. We employed a quasi-experimental design consisting of 22 participants from two retirement homes in Ontario partaking in the regional falls prevention class. Participants were assigned to either an eight-week intervention, comprising mindfulness exercises incorporated into the standard falls prevention class, or to the standard falls prevention class. Participants were assessed using the Tinetti Balance and Gait Scale and the Timed Up and Go (TUG) test. The mindfulness intervention showed no significant effect on TUG or balance scores; however, there was a significant effect on assessments of gait. Given the ease of implementation of mindfulness-based interventions, further research may be warranted in mindfulness as a potential modality for falls prevention.

Falls in residential long-term care (LTC) facilities continue to be a leading cause of injury for residents and cost for the health care system. Interdisciplinary clinical teams are responsible for assessing risk levels for their residents and developing appropriate care plans and interventions in response. This study compares the predictive accuracy of three separate fall risk assessment tools: the interRAI Falls Clinical Assessment Protocol (CAP), derived from the LTC Facility (LTCF) or Minimum Data Set (MDS) 2.0 assessments; the Scott Fall Risk Screen; and a modified Fall Risk Tool that was implemented as part of a provincial Fall Reduction Strategy in Nova Scotia. To conduct this retrospective cohort study, secondary data were collected from 1,553 LTC residents with interRAI assessments completed between March 1, 2015 and September 29, 2016, across Nova Scotia and New Brunswick. For each resident, data were collected regarding the three fall risk assessments, along with fall incident data for use in sensitivity, specificity, and logistic regression analyses. This study found that although all three tools had limitations with sensitivity or specificity thresholds, the interRAI Falls CAP delivered the highest accuracy with a c-statistic of 0.673, compared with the Scott Fall Risk Screen at 0.529 and the modified Fall Risk Tool at 0.609. When diseases that have been established to be a risk factor for falls were added to the model, the overall accuracy of the interRAI Falls CAP combined with those covariates increased to 0.749. These results suggest that the best practice guidelines for fall risk assessment be revisited, and that the interRAI Falls CAP could potentially be updated to include certain diseases and controls for optimal predictive ability.

The magnitude of the postprandial hypotensive (PPH) response has been shown to be an independent risk factor for falls, fractures, and death. Despite this well-established risk, meal tests are rarely done in the falls clinic setting because of logistical issues. In order to better target potential PPH patients among older falling adults, this study examines which subject characteristics are associated with larger PPH responses. A total of 52 falls clinic patients (mean age 77.8 ± 0.9 years, 29 women, 23 men) were recruited for a 90 minute meal test. Significant variables were then entered into a stepwise multivariate linear model containing age, sex, presence of diabetes, presence of hypertension, baseline systolic blood pressure (SBP), and the orthostatic drop in SBP. Although further work is required, our study suggests that men, patients with higher blood pressure, and patients with an orthostatic drop might be more likely to have higher postprandial hemodynamic responses.

Several determinants of developing fear of falling (FoF) overlap with the consequences of diabetes mellitus (DM). We compared the prevalence and severity of FoF in older adults with and without DM and identified which FoF determinants contribute to FoF severity in older adults with DM. We used Canadian baseline data from the International Mobility in Aging Study (IMIAS) which identified 141 older adults with DM (DM-group;age:68.88±2.80years) and 620 without DM (noDM-group;age:68.81±2.68years). FoF was quantified with Falls Efficacy Scale–International (FES-I). FoF determinants were evaluated in demographic/health-related, physical, psychological, and social domains. High concern of FoF was more prevalent and of higher severity in 10/16 FES-I activities in the DM-group compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history, and clinical depressive symptoms. Protocols developed for screening and interventions may reduce FoF severity in this population.

Falls are a common cause of morbidity and mortality in older adults. While research has explored the relationship between older care recipient falls and caregiver health, there has been little investigation of the relationship between caregiving tasks and falls in older caregivers. This study assessed associations between falls and caregiving frequency and type of caregiving tasks among informal older caregivers. Data from the Canadian Community Health Survey on Healthy Aging (Public Use Microdata File 2008–2009) (n = 2,934) were examined, using descriptive and logistic regression analyses. Higher frequency of caregiving was positively associated with falls, although those who performed household chores were less likely to report falling in the past year. Results suggest there may be an association between factors related to caregiving and falls in older caregivers. More research using longitudinal and experimental data is needed to better understand the relationship between caregiving tasks and falls in older caregivers.

Compliant flooring aims to prevent fall-related injuries among high-risk older adults in long-term care, but uptake of compliant flooring in this setting is limited. We hosted a one-day stakeholder symposium to identify advantages and disadvantages of implementing compliant flooring in long-term care and the most pressing directions for future research from the perspective of key stakeholders. Twenty-three stakeholders representing health care, industry, and research attended the symposium. Attendees believed the most important advantages of compliant flooring were reducing injuries in residents who have fallen, potential benefits to care staff, and potential increases in quality of life for residents. Attendees perceived the most significant disadvantages of compliant flooring were financial considerations, lack of research evidence, and challenges with installation. Attendees indicated a need for additional research on cost-effectiveness and clinical effectiveness. While stakeholders perceived compliant flooring to add value to long-term care, there are significant informational and financial barriers to uptake.

This prospective, observational study characterizes the circumstances that led to falls in long-term care (LTC) residents and describes the characteristics of residents who fractured following a fall. Staff recorded the location of the fall, time of day, activity the participant was doing prior, and if an injury occurred. Descriptive statistics were used to describe the falls, and a generalized linear model was used to determine differences between the circumstances. Of the 101 LTC residents who participated, 41 per cent experienced at least one fall. Residents were significantly more likely to have fallen in the bedroom and while walking. Of the 17 falls resulting in fractures, most occurred in the bedroom and bathroom, during the early morning; most residents who fractured were female with cognitive impairment. To monitor falls comprehensively, ambulatory monitoring that avoids privacy issues in bedrooms or bathrooms may be needed. Interventions should target walking or the bedroom setting.

Few studies have focused on falls among home care (HC) clients with neurological conditions. This study identified factors that increase risk of falling among HC clients with no recent history of falls, and explored whether risk profiles varied among those with dementia or parkinsonism compared to those without selected neurological conditions. A retrospective cohort design was used and analysis of data from community-based HC clients across Ontario was conducted on a sample of ambulatory clients with dementia, parkinsonism, or none of the selected neurological conditions. Data were obtained from the Resident Assessment Instrument for HC (RAI-HC) assessment. The outcome used in multivariable analyses was whether clients fell during follow-up. Unsteady gait was a strong predictor of falls across all three groups. Co-morbid parkinsonism most strongly predicted falls in the dementia group. Clients with borderline intact to mild cognitive impairment had higher odds of falling within the parkinsonism and comparison groups.

To address the issue of falls, which are increasing as the population ages, an intelligent video-monitoring system is being developed. The aim of the study is to explore caregivers’ perceptions of and receptiveness to a prototype of this fall detection system. A cross-sectional mixed-method study was carried out with individual interviews of 18 caregivers. Statistical frequencies and content analysis were conducted (SPSS and N’Vivo). The results show that most participants (n = 15/18) liked the intelligent video-monitoring system and were willing to use it. They would worry less if they could be alerted if a care recipient fell, but they were concerned about privacy and cost. Participants had a positive perception of the system and expressed their wishes regarding the kind of alert and the person to contact in case of a fall.

This study sought to ascertain whether occupational noise-induced hearing loss (NIHL) increased the risk of falls requiring hospitalization among retired workers. The study population consisted of males (age ≥ 65) with an average occupational noise exposure of 30.6 years and whose mean bilateral hearing loss was 42.2 dB HL at 3, 4, and 6 kHz. Seventy-two retired workers admitted to hospitals after a fall were matched with 216 controls from the same industrial sectors. Conditional logistic regression models were used to estimate the risk (odds ratio; [OR]) of falls leading to hospitalization by NIHL categories. Results showed a relationship between severe NIHL (≥ 52.5 dB HL) and the occurrence of a fall (OR: 1.97, CI95%: 1.001–3.876). Reducing falls among seniors fosters the maintenance of their autonomy. There is a definite need to acquire knowledge about harmful effects of occupational noise to support the prevention of NIHL and ensure healthier workplaces.

This grounded-theory study explored the perceptions of Chinese older people, living in England, on falls and fear of falling, and identified facilitators and barriers to fall prevention interventions. With a sample of 30 Chinese older people, we conducted two focus groups and 10 in-depth interviews in Mandarin or Cantonese. Interview transcripts, back translated, were analyzed using N6. Constant comparative analysis highlighted a range of health-seeking behaviors after a fall: Chinese older people were reluctant to use formal health services; talking about falls was avoided; older people hid falls from their adult children to avoid worrying them; and fatalistic views about falls and poor knowledge about availability and content of interventions were prevalent. Cost of interventions was important. Chinese older adults valued their independence, and cultural intergenerational relations had an impact on taking action to prevent falls. Cultural diversity affects older adults’ acceptance of fall prevention interventions.

Worldwide, falls among older people are a public health concern because of their frequency and adverse consequences in terms of morbidity, mortality, and quality of life, as well as their impact on health system services and costs. This epidemiological review outlines the public health burden of falls and fall-related injuries and the impact of population aging. The magnitude of the problem is described in terms of the classification of falls and measurement of outcomes, including fall incidence rates across settings, sociodemographic determinants, international trends, and costs of falls and fall-related injuries. Finally, public health approaches to minimize falls risk and consequent demand on health care resources are suggested.

This article presents an overview of the psychosocial factors that influence older people’s participation in physical activity interventions to prevent falls. The importance of psychosocial factors is stressed inasmuch as interventions will be rendered useless if they do not successfully gain the active participation of older people. The theory of planned behavior is used as a framework for the review on how knowledge (a prerequisite), attitudes, subjective norms (the social context), and perceived behavioral control (confidence) promote or inhibit the intention to carry out activities to prevent falls. The review is supplemented with evidence for self-identity to influence intention, and the article concludes with a discussion of the recommendations made by the Prevention of Falls Network Europe for engaging older people in falls prevention.

This paper analyses data pertaining to falls from a 1995 random survey of 1,285 seniors living in the Capital Regional District of British Columbia. In the preceding six months, 211 (16.5%) people reported falling at least once. The overall rate for women was 18.6 per hundred compared with 13.3 for men. The study also examined relationships between falling and an array of demographic, health, psychological and psychosocial variables. The likelihood of falling increased directly with age and chronic illness, as well as indirectly with age, SES, and gender via chronic illness (i.e. older, poorer women tend to have more chronic illness which then leads to a higher incidence of falling). In turn, falling was directly related to increased dependence, and through it indirectly related to health satisfaction, mental health and a measure of life satisfaction.

A comparative analysis of injury mortality in 24 developed countries during the period 1985–1989 shows the importance of this cause of death among the elderly. One out of four men and one out of two women who dies from injury is aged 65 and over. There is an over-representation of the elderly among injury-related deaths and the risk of death is still increasing after age 65. Some differences can be noted for the elderly as compared to other age groups: a lower male excess mortality ratio and a much larger proportion of violent deaths related to accidental falls. Among developed countries, a wide scope of variations exists in age groups and cause-specific patterns. Hierarchical clustering is used to obtain different aggregations of countries, based on the level, the structure and the causes of violent mortality. Although the classification of countries varies according to a chosen criteria, we often find aggregations of countries belonging to the geographical area.

This paper examines factors associated with falling among approximately 3,100 individuals aged 65 and older who were participants in the 1994 National Population Health Survey (NPHS). The intent of the NPHS is to monitor the health of Canadians and risk factors that affect their health. Several factors were identified as increasing the risk of falling, such as advanced age, being female, certain medical conditions, medication use and impaired mobility. The results from this survey, conducted on a national level, confirm the findings of many studies utilizing smaller samples within individual communities. Continuation of the NPHS will aid in offering longitudinal data with respect to falls, and allow for establishing a temporal order prior to the fall event, in order to provide more definitive evidence with respect to risk factors for falls.

The purpose of the present research was to examine the perceptions of risk regarding falling held by older adults and their adult children. Using a focused ethnographic approach, older adults and adult children were interviewed in depth. Thematic analysis was conducted to identify themes within groups and to compare the perspectives of older adults and adult children. Findings highlighted differences in perceptions and approaches to action between older adults and their adult children. There were three approaches to action adopted by these families, which focused around whose actions were dominant: parents' actions, shared actions, and children's secret actions. The results emphasize the value placed on independence by older adults and the impact of multiple family relations taking action to prevent falls. The present study points to the importance of including multiple family perspectives in research concerning injury prevention for older adults.

Visual requirements for a simple walking task were evaluated for young and elderly persons to determine if, with normal aging, elderly subjects require more visual information. Ten young adults and 10 elderly people were asked to complete a simple walking task within predetermined pathway boundaries under two conditions of visual restriction. In the reactive condition, subjects automatically received a 200 ms flash of visual information at the halfway point of the walkway. For the predictive condition, subjects did not receive any visual information during the walking trial, but were equipped with an emergency button that would provide 200 ms of visual information whenever they needed it. For both experimental conditions, subjects received additional flashes of visual information if they stepped out of the walkway boundaries. Results showed that older persons stepped out of bounds more often in the reactive condition and gave themselves more visual cues than the younger subjects in the predictive condition. The relative importance of vision during locomotion seems to be higher in the elderly population when compared to young adults.