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

THIS WEBINAR IS BEING RECORDED. THE SLIDE DECK AND RECORDING WILL BE

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January 22, 2020 12:00 PM EST

• Dr. Aleksandra Zecevic, Alison Stirling and Hélène Gagné

Falls in Mid-Life: A Scoping Literature Review

Falls in Mid-Life

Scopin ing Lit iterature Revie iew

Aleksandra Zecevic, Daniella Bozzo, Alison Stirling & Hélène Gagné

Why falls in mid life?

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• 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

Are you working on fall prevention in midlife in your practice?

• Yes
• No
• Not applicable

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Poll Question

Are you anticipating that falls in midlife will be a focus of your work in the next year?

• Yes
• No
• Not applicable

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Poll Question

Background

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40-64 years of age

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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

Methods – Scoping Literature Review

Levac et al. (2010)

Databases: Medline, CINAHL and EMBASE Key words:

“fall*” MeSH with accidental fall “middle-aged” OR “middle age” OR “middle-age” “longitudinal” OR “cohort” studies

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(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 1 Identify research question Stage 2 Identify relevant sources

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

Stage 3 Select sources Stage 4 Chart the data

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Numerical analysis of extent, nature and distribution

• f studies

Draw Conclusions Ascertain Themes YOU are invited! Interpretation of findings Recommendations for next steps

Stage 5 Collate, summarize and report results Stage 6 Consultation with stakeholders

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

Findings

Flow Chart of Study Selection

Findings – Research studies

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Studies N=30 27 longitudinal, 3 case control Authors 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 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) Gender All studies included both genders 22 studies had >50% women 6 studies had >50% men 2 studies did not report %

Findings – Research studies (cont.)

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

THEME 1. Populations

General community dwelling Special populations

• diabetes, stroke, intellectual

disability, spinal cord injury rheumatoid arthritis, multiple sclerosis, orthostatic hypotension

General population 8.7% - 35.8%

11.4%-18% in 8 studies 21%-35.8% in 6 studies

Special populations

26% diabetes 32.3% intellectual disabilities

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THEME 2. Prevalence Rates

THEME 3. Fall-Related Injuries

1.1% General population 11.5% African American 25.6% Of fallers 15% (M) Fracture 10% (W) Fracture 42.5% Fracture 62.8% Outside 21.4% (M) Slipping 25.1% (W) Slipping 12.3% (M) Tripping 20.9% (W) Tripping

• Tripping, slipping, colliding, lost

footing on staircase (83.3% )

• Vigorous activity (M)
• Walking (W)
• Sport
• Intoxication
• Work
• Uneven surface (36.0% M, 56.2% W)
• Outdoors 69%, public places

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THEME 4. Causes of Falls

THEME 5. Risk Factors

• General Population

Extrinsic (most cited): ambulation, slipping, tripping, snow, ice, stairs, environment, no handrails, ladder use Intrinsic/behavioural: sex, alcohol, smoking, cardiovascular disease, vertigo, obesity, dizziness, fair/poor self reported health, higher levels of physical activity (outdoor falls), <5 hrs

• f sleep.
• Special Populations

Intrinsic dominant: chronic conditions, medications, obesity, substance abuse, depression, mental impairment, vision, mobility, incontinence, ADLs difficulty, epilepsy, stroke Diabetes: neuropathy, hypoglycemia Stroke: medications, mobility impairments, functionally dependent MS: standing, turning, stairs, fatigue, distraction SCI: medications Intellectual disability: female, seizures, arthritis, 4+ meds, walking aids OH: postural change in DBP

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Findings - Grey Literature (N=8)

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Documents 6 CAN (focus on Ontario), 1 AUS & 1 NZ (dissertations)

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 Prevalence (examples) 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 3,980/100,000 Grey Bruce (2012-14) for 45-64 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 Factors Risk taking behaviour, alcohol, drugs, medications, environment (snow, ice, uneven surfaces), chronic conditions, age, gender Mechanisms of Falling Slipping, tripping on the same level, stairs, steps, uneven surfaces, ladders

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Interventions

• Risk-taking behaviours (alcohol, drugs)
• Education for life-long physical activity; Safety education for sports &

recreation and for outdoors 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

Recommendations Falls Prevention General Population

• Develop interventions for middle-aged adults –attention to 55-64 yrs
• More research on middle age falls, including physical activity and falls
• Start assessments and screen balance and gait at age 45
• Target activities of daily living

Recommendations Falls Prevention Special Populations

• Prioritize prevention in stroke services (any age); for adults with

rheumatoid arthritis (any age) for younger (<65) patients with diabetes

• Develop guidelines for adults with intellectual disability
• Examine orthostatic hypotension thresholds associated with fall risk

Findings - Interventions and Recommendations

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(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

Conclusions

Take Home Message

• Explore link between mid-life falls and chronic diseases
• Determine fall prevalence, specific causes and risk

factors for falls in mid-life

• Establish consensus on definitions, units of measure

and outcomes to make findings comparable

• Consider falls and injury prevention strategies for mid-

life

Questions?

Let’s Talk!

Question 1: What kind of additional information would you need to support your work for fall prevention in mid-life?

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Let’s Talk!

Question 2: What opportunities for action such as training, practice, research or policy, do you foresee for prevention of falls in midlife?

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Let’s Talk!

Question 3: How can we all address falls in mid-life in relation to falls in later life at a program and/or provincial level?

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Let’s Talk!

Question 4: What collaborations and partnerships would be helpful to address falls in mid-life?

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Let’s Talk!

Question 5: What are the next steps and priorities for action to address falls in mid-life?

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Thank you!

For more information about:

Literature review, contact Dr. Aleksandra Zecevic (azecevi2@uwo.ca) Next steps, contact Hélène Gagné (helene.gagne@onf.org)

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Questions?

Type your questions into the Q&A box. THIS WEBINAR IS BEING RECORDED. THE SLIDE DECK AND RECORDING WILL BE

EMAILED AFTER THE WEBINAR.

STAY IN THE LOOP!

WWW.FALLSLOOP.COM WWW.JR.FALLSLOOP.COM