Falls
Rachael E. Docking, Jennifer Stock in International Handbook of Positive Aging, 2017
Even with the most thorough assessment of fall risk and with the implementation of strategies to minimise falls, it is inevitable that older people will sometimes fall. If the consequences of a fall can be minimised, then the impact on the individual’s ability to live independently and positively can also be minimised. One of the most serious injuries resulting from a fall is a hip fracture and one strategy that might be effective in reducing the risk of a fracture is hip protectors. Whilst there is some evidence to demonstrate that hip protectors can be effective in reducing the seriousness of falls in care settings, the same benefit is not reported in community settings (Parker, Gillespie and Gillespei, 2006). This is believed to result from a reluctance to wear this protection at home because they can add considerable bulk under clothing (Rajendram et al., 2008). So like many of the strategies that might be introduced to minimise falls, or the consequences of falls, the individual needs to be comfortable with the intervention, be willing to use it and be knowledgeable in its use.
Falls and Balance
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
At least one third of community-dwelling older adults have one or more falls per year, according to a random sample of enrollees 65 years and older of a large health cooperative in the Seattle area.1 Persons who are frail, as defined below, are twice as likely to fall as those who took part in a six-month exercise training study.2 Although some falls may be related to environmental hazards such as throw rugs and irregular paving, as well as impaired vision and medication side effects, most falls are likely to be related to impaired balance or other physiologic deficits. These impairments in balance may be subtle and not necessarily apparent to the untrained observer or even to physicians and other health caregivers, unless they have special training or equipment. Falls aggravate the fear of falling that many older adults have, and such individuals are likely to decrease their activity after falling, even if they were uninjured.3,4 Furthermore, adults who are frail with osteoporosis or other musculoskeletal problems are, in fact, more likely to be injured if a fall occurs. Women are at an increased risk of hip fracture compared to men, a disparity that is related to differences in bone density as well as factors which contribute to musculoskeletal impairment, falls, and frailty. It is thus important to have a working concept of frailty.5
X-ray Vision: Diagnostic X-rays and CT Scans
Suzanne Amador Kane, Boris A. Gelman in Introduction to Physics in Modern Medicine, 2020
A broken bone ordinarily heals readily in a child or young adult, but for an elderly person a broken hip can precipitate a total loss of independence, depression, or even death. Many elderly women and men suffer from a bone-weakening condition, osteoporosis, making them extremely vulnerable to fractures. In the US, osteoporosis causes an estimated 1.3 million fractures per year, and its financial toll is estimated at billions of dollars each year. Prevention is acknowledged to be the most important tool in the fight against this epidemic, and x-ray measurements play an important role in identifying those most at risk.
Predictors of Fear of Falling among Iranian Older Adults with Hip Fracture and Controls
Published in Clinical Gerontologist, 2020
Robabeh Soleimani, Mir Mohammad Jalali, Ahmad-Reza Mirbolook
Hip fracture is a severe trauma in older adults, resulting in important morbidity and mortality (Magaziner et al., 2000). The majority of hip fractures are due to the physical trauma of falling often causing long-term FOF (Karinkanta, Piirtola, Sievänen, Uusi-Rasi, & Kannus, 2010). Osteoporosis is common among older adults, particularly among women and leads to bone fragility. It is expected that this risk factor rarely results in non-traumatic hip fracture among older adults (Beaudoin et al., 2019). High level of FOF may affect the rehabilitation process in older adults with a hip fracture, which leads to greater functional limitations and disability (Edgren et al., 2013). About one-fifth of older adults report FOF, which is associated with frailty, depression, and a higher risk of falling (Austin, Devine, Dick, Prince, & Bruce, 2007). Nomura (2017) found that patients with higher FOF had significantly less physical activity. It is well known that activity restriction can cause a decline in muscle strength, muscle loss and poor balance, leading to increase the risk of falling (Li, Fisher, Harmer, McAuley, & Wilson, 2003). In the other words, people with less upper and lower limb strength have less stability and flexibility to maintain their balance (Steinman, 2008).
Cut-off values and sub-items of the Berg Balance Scale for walking-aid use in hospitalized older adults with a hip fracture: a retrospective analysis
Published in Physiotherapy Theory and Practice, 2023
Sota Kobayashi, Kazuhiro Miyata, Shuntaro Tamura, Ren Takeda, Hiroki Iwamoto
In this retrospective cross-sectional study, the medical records of the older adults who were hospitalized for a hip fracture between April 2018 and June 2020 at three hospitals in Japan were collected. The inclusion criteria were: 1) the presence of a unilateral hip fracture due to a fall; 2) age ≥ 65 years; 3) hospitalized for rehabilitation within 3 months after the hip fracture; and 4) being able to walk > 15 m independently (Functional Ambulation Category ≥ 4). The exclusion criteria were: 1) the presence of a severe neurological complication due to stroke or Parkinson’s disease; 2) missing BBS data at discharge in the individual’s medical records; 3) refusal to participate in the study during the opt-out period; and 4) the individual’s fall occurred after the April 16, 2020 Covid-19 emergency declaration in Japan.
The effect of gait training with low-intensity neuromuscular electrical stimulation of hip abductor muscles in two patients following surgery for hip fracture: Two case reports
Published in Physiotherapy Theory and Practice, 2022
Kazuya Takeda, Soichiro Koyama, Koji Shomoto, Kosuke Ushiroyama, Yuki Naoi, Tomoko Nagai, Hiroaki Sakurai, Yoshikiyo Kanada, Shigeo Tanabe
Hip fracture is a common trauma in elderly adults (Bitsch, Foss, Kristensen, and Kehlet, 2004; Carroll et al., 2011). Assuming that the incidence will increase by 1% per year as the population ages, it is expected that the total global number of hip fractures will reach 8.2 million in 2050 (Sambrook and Cooper, 2006). Hip fracture itself and postoperative sequelae both cause various impairments and disabilities including pain, decreased range of motion, and impairment of gait and balance (Alley et al., 2011; Foss, Kristensen, Palm, and Kehlet, 2009; Leegwater et al., 2016; Thingstad et al., 2015). It has been reported that approximately 50% of patients with femoral head replacement surgery following hip fracture cannot regain the ability to live independently (Morrison, Chassin, and Siu, 1998). Moreover, the hip fracture itself and the postoperative sequelae are associated with a high risk of mortality (Nikkel et al., 2015) and decreased quality of life (Alexiou, Roushias, Varitimidis, and Malizos, 2018).
Related Knowledge Centers
- Femoral Neck
- Femur
- Metastasis
- Femoral Head
- Bone Fracture
- Osteoporosis
- Radiography
- Polypharmacy
- Magnetic Resonance Imaging
- CT Scan