Review January 22, 2020 12:00 PM EST Dr. Aleksandra Zecevic, Alison - PowerPoint PPT Presentation

Falls in Mid-Life: A Scoping Literature Review January 22, 2020 12:00 PM EST Dr. Aleksandra Zecevic, Alison Stirling and Hélène Gagné T HIS WEBINAR IS BEING RECORDED . S TAY IN THE L OOP ! T HE SLIDE DECK AND RECORDING WILL BE WWW . FALLSLOOP . COM EMAILED AFTER THE WEBINAR . WWW . JR . FALLSLOOP . COM

Falls in Mid-Life: A Scoping Literature Review January 22, 2020 12:00 PM EST Dr. Aleksandra Zecevic, Alison Stirling and Hélène Gagné T HIS WEBINAR IS BEING RECORDED . S TAY IN THE L OOP ! T HE SLIDE DECK AND RECORDING WILL BE WWW . FALLSLOOP . COM EMAILED AFTER THE WEBINAR . WWW . JR . FALLSLOOP . COM

Falls in Mid-Life Scopin ing Lit iterature Revie iew Aleksandra Zecevic, Daniella Bozzo, Alison Stirling & H é l è ne Gagn é

Why falls in mid life? Question in Loop on falls in mid-life followed by a webinar • Public health concern • Lifespan approach but focus on both ends of spectrum • Ontario Neurotrauma Foundation commissioned this • scoping review to examine current knowledge, identify gaps, implication for practice and next steps 2

Poll Question Are you working on fall prevention in midlife in your practice? • Yes • No • Not applicable 3

Poll Question Are you anticipating that falls in midlife will be a focus of your work in the next year? • Yes • No • Not applicable 4

Background 40-64 years of age 5

Methods – Scoping Literature Review Levac et al. (2010) Stage 1 Identify research question Stage 2 Identify relevant sources Stage 3 Select sources Stage 4 Chart the data Stage 5 Collate, summarize and report results Stage 6 Consultation with stakeholders 6

Stage 1 Identify research question (a) What is known about the characteristics of falls in mid-life? (b) How falls in mid-life relate to falls later on in life? Stage 2 Identify relevant sources Databases: Medline, CINAHL and EMBASE Key words: “fall*” MeSH with accidental fall “middle - aged” OR “middle age” OR “middle - age” “longitudinal” OR “cohort” studies 7

Stage 3 Select sources INCLUSION CRITERIA EXCLUSION CRITERIA 2000-2019 Work related falls 40-64 years of age Sport related falls English language Case studies Longitudinal studies Falls assessment tools Prevalence rates, risk factors, falls descriptions Feasibility of tools Community dwelling No access to original article Stage 4 Chart the data 8

Stage 5 Collate, summarize and report results Numerical analysis of Ascertain extent, Draw Themes nature and Conclusions distribution of studies Stage 6 Consultation with stakeholders YOU are invited! Interpretation of findings Recommendations for next steps 9

Findings Flow Chart of Study Selection CINAHL, MEDLINE, EMBASE (n = 6,499) Excluded duplicates (n = 1,363) Records after duplicates removed (n = 5,136) Titles excluded on initial inclusion/exclusion criteria (n = 4,850) Titles (n = 286) Titles excluded if: assessments tools, tools feasibility, no original (n = 146) Abstracts (n = 140) Abstract excluded (n = 110) Full text Added grey literature sources (n = 30) Full-text excluded: foreign (n = 8) language, no prevalence rates or Added articles from hand searches risk factors (n = 12) (n = 12) Total included (n= 38) 10

Findings – Research studies N=30 Studies 27 longitudinal, 3 case control 28 groups of authors, 10 countries, 13 from USA Niino et al., 2000; Talbot et al., 2005; Wilson et al., 2005; Li et al., 2006; Kerse et al., 2008; Wagner et al., 2009, Hong et Authors al., 2010; Kool et al., 2010a; Kool et al., 2010b; Mertz et al., 2010; Beynon et al., 2011; Williams et al., 2012; Hsieh et al., 2012; Wu et al., 2012; Muraki et al., 2013; Stanmore et al., 2013; Mazumder et al., 2014; Pfortmueller et al., 2014; Caban- Martinez et al., 2015; Lu et al., 2015; Saunders et al., 2015; Verma et al., 2016; Bhangu et al., 2017; Juraschek et al., 2017; Timsina et al., 2017; Essien et al., 2018; Peeters et al., 2018; Shah et al., 2018; Axmon et al., 2019; Peeters et al., 2019. Year Range 2000-2019 # of Participants 101 - 414,044 Age Range 15-95 (our focus 40-64) All studies included both genders 22 studies had >50% women Gender 6 studies had >50% men 2 studies did not report % 11

Findings – Research studies (cont.) 19 general community dwelling population 11 special populations: Populations 2 studies diabetes, stroke, intellectual disability, spinal cord injury 1 rheumatoid arthritis, multiple sclerosis, orthostatic hypotension Population administrative databases (14) Data Sources Medical records/hospital registries (6) Data collected by authors (10) Descriptive statistics (10) Analyses Logistic regression models (9) Both (11) falls/person-year falls/100 person-years falls/1,000 persons-month Prevalence falls /1,000 person-years reporting falls/100,000 population falls/100,000 person-year falls/1,000 population 20 studies did not define, used % 12

THEME 1. THEME 2. Populations Prevalence Rates General community dwelling General population Special populations 8.7% - 35.8% • diabetes, stroke, intellectual 11.4%-18% in 8 studies disability, spinal cord injury 21%-35.8% in 6 studies rheumatoid arthritis, multiple sclerosis, orthostatic hypotension Special populations 26% diabetes 32.3% intellectual disabilities 13

THEME 3. Fall-Related Injuries 1.1% General population THEME 4. 11.5% African American Causes of Falls 25.6% Of fallers 15% (M) Fracture • Tripping, slipping, colliding, lost 10% (W) Fracture footing on staircase (83.3% ) 42.5% Fracture • Vigorous activity (M) 62.8% Outside • Walking (W) 21.4% (M) Slipping • Sport 25.1% (W) Slipping • Intoxication 12.3% (M) Tripping • Work 20.9% (W) Tripping • Uneven surface ( 36.0% M, 56.2% W) • Outdoors 69%, public places 14

THEME 5. Risk Factors • General Population • Special Populations Extrinsic (most cited): ambulation, Intrinsic dominant: chronic conditions, slipping, tripping, snow, ice, stairs, medications, obesity, substance abuse, environment, no handrails, ladder use depression, mental impairment, vision, mobility, incontinence, ADLs difficulty, epilepsy, Intrinsic/behavioural: sex, alcohol, stroke smoking, cardiovascular disease, vertigo, obesity, dizziness, fair/poor self reported health, higher levels of Diabetes: neuropathy, hypoglycemia physical activity (outdoor falls), <5 hrs Stroke: medications, mobility impairments, of sleep. functionally dependent MS: standing, turning, stairs, fatigue, distraction SCI: medications Intellectual disability: female, seizures, arthritis, 4+ meds, walking aids OH: postural change in DBP 15

Findings - Grey Literature (N=8) 6 CAN (focus on Ontario), 1 AUS & 1 NZ (dissertations) Documents Kool, B. 2009; Ontario Injury Prevention Resource Centre, 2009, 2015, 2016, 2018a, 2018b; Li, H. 2016; Grey Bruce Health Unit, 2017. Year Range 2009-2018 ED visits 2,353/100,000 ON (2012-14) for 45-64 2,072/100,000 ON (2014&15) for 45-54 2,553/100,000 ON ((2014&15) for 55-59 2,733/100,000 ON (2014&15) for 60-64 Prevalence 3,980/100,000 Grey Bruce (2012-14) for 45-64 (examples) Hospitalizations 201/100,000 ON (2012-14) for 45-64 118, 206, 296/100,000 ON (2014&15) for 45-54, 55-59 & 60-64 319/100,000 Grey Bruce (2012-14) for 45-64 Risk taking behaviour, alcohol, drugs, medications, environment Risk Factors (snow, ice, uneven surfaces), chronic conditions, age, gender Mechanisms of Slipping, tripping on the same level, stairs, steps, uneven surfaces, Falling ladders 16

Findings - Interventions and Recommendations Risk-taking behaviours (alcohol, drugs) • Education for life-long physical activity; Safety education for sports & • recreation and for outdoors Interventions Example – safe ladder use campaign Safety measures and environment modifications for hazards in daily • living. Prevention for outdoor falls (e.g., sidewalls, ramps, surfaces) Social support for rehabilitation after a fall • Develop interventions for middle-aged adults – attention to 55-64 yrs • Recommendations • More research on middle age falls, including physical activity and falls Falls Prevention Start assessments and screen balance and gait at age 45 • General Population Target activities of daily living • Prioritize prevention in stroke services (any age); for adults with • Recommendations rheumatoid arthritis (any age) for younger (<65) patients with diabetes Falls Prevention • Develop guidelines for adults with intellectual disability Special Populations Examine orthostatic hypotension thresholds associated with fall risk • 17

Conclusions (a) What is known about the characteristics of falls in mid-life? There seems to be two populations of mid-life fallers ● Causes are more extrinsic for general population and more ● intrinsic for special populations Fall prevalence for middle-aged adults is similar to older adults but ● causes and location of falls differ Sharp increase in prevalence of falls in middle-age (women ● especially) (b) How falls in mid-life relate to falls later on in life? Chronic conditions start developing in the mid-life and may ● predispose middle-aged adults to increasing risks of falling in old age 18