Falls prevention

EXTRA INFORMATION

Incorporating new information in preventing falls

WHAT WE KNOW

About Our Research

Much fall prevention research has been undertaken over the past 20 years, and there is now some evidence that fall injury-related hospitalisation (predominantly hip fracture) is decreasing. However, there are still large gaps in the literature particularly around targeting appropriate populations and interventions, and incorporating new technologies in fall prevention. Prof Stephen Lord’s vision is to be at the leading edge of fall prevention research by conducting a series of inter-related innovative studies aimed at elucidating fall prevention strategies. Major planned studies will identify effective fall prevention strategies that can be readily integrated into clinical care pathways.

Current research

Motor Impairment and Fall Injury Epidemiology

Impairments in the ability to move normally and to contract muscles effectively are termed ‘motor impairments’. They are a common result of many diseases and disorders as well as ageing. These impairments can range from mild to severe. Unfortunately, the precise prevalence and burden of motor impairment is unknown. To document the prevalence of motor impairments, we are working with the 45 And Up study to add questions relating to balance and hand, upper limb and lower limb function. We will also interrogate the 45-And-Up study database to document fall-related injuries in older people and sub-groups (i.e. people with dementia) at increased fall-risk. This work will provide valuable data regarding the prevalence and physical and social impacts of motor impairments and falls. It will provide benchmarks to measure future population health interventions for improving motor functioning and preventing falls.

Fall Risk Assessments

Many fall risk assessment tools are available for use in clinical settings. However, the predictive accuracy is limited because: a) the assessments are performed under optimal circumstances dissimilar to an older person’s daily environment, b) the methods are course and subjective and c) the assessments are undertaken infrequently and therefore cannot monitor any change in status within prospective follow-up periods. For example, gait is assessed through subjective observation of gross traits of gait (e.g. shuffling, step width) as the patient walks down a corridor. In contrast, low-cost wearable inertial sensors enable objective quantification of gait characteristics during clinical assessment and can now be used a means of performing fall risk assessments remotely and regularly. The objective of this study is to build on current work to refine wearable sensor assessments and adapt them so they can be undertaken remotely by older people in their own homes through unobtrusive daily monitoring. This work has excellent prospects of producing new “gold standard” measures that can be used by therapists to (i) remotely monitor mobility and health, (ii) accurately document fall risk and (iii) measure the effectiveness of interventions in older people and those with balance disorders.

A RCT of cognitive-only and cognitive-motor training to prevent falls in older people

To date, no studies have examined the potential for cognitive or cognitive-motor training to prevent falls in older people, despite good evidence of fall-related cognitive and physical improvements following both intervention types. Building on our initial work, we have developed and validated a home-based computerised training intervention that can be delivered identically, either while seated (cognitive) or while standing and undertaking balance exercises (cognitive+motor). This unique design will allow us to assess whether cognitive and cognitive+motor training can prevent falls, as well as the neural, physiological, physical and neuropsychological mechanisms behind the intervention effects. This intervention holds promise for a cost-effective fall prevention strategy with multiple health benefits for older people.

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