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      New horizons in falls prevention and management for older adults: a global initiative

      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 3 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 1 , 1 , 32 , 44 , the Task Force on Global Guidelines for Falls in Older Adults
      Age and Ageing
      Oxford University Press (OUP)

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          Abstract

          Background

          falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries.

          Methods

          a steering committee was assembled and 10 working Groups were created to provide preliminary evidence-based recommendations. A cross-cutting theme on patient’s perspective was also created. In addition, a worldwide multidisciplinary group of experts and stakeholders, to review the proposed recommendations and to participate in a Delphi process to achieve consensus for the final recommendations, was brought together.

          Conclusion

          in this New Horizons article, the global challenges in falls prevention are depicted, the goals of the worldwide task force are summarised and the conceptual framework for development of a global falls prevention and management guideline is presented.

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          Most cited references40

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          Risk factors for falls among elderly persons living in the community.

          To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
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            Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.

            (2011)
            The following article is a summary of the American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010). This article provides additional discussion of the guideline process and the differences between the current guideline and the 2001 version and includes the guidelines' recommendations, algorithm, and acknowledgments. The complete guideline is published on the American Geriatrics Society's Web site (http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/). © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
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              Medical Costs of Fatal and Nonfatal Falls in Older Adults

              To estimate medical expenditures attributable to older adult falls using a methodology that can be updated annually to track these expenditures over time.
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                Author and article information

                Journal
                Age and Ageing
                Oxford University Press (OUP)
                0002-0729
                1468-2834
                September 2021
                September 11 2021
                May 26 2021
                September 2021
                September 11 2021
                May 26 2021
                : 50
                : 5
                : 1499-1507
                Affiliations
                [1 ]Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
                [2 ]Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
                [3 ]Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
                [4 ]Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
                [5 ]Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, Michigan, USA
                [6 ]Unit Digital Geriatric Medicine, Medical Faculty of the University of Heidelberg, Germany
                [7 ]Department of Geriatrics, Montpellier University Hospital and MUSE, Montpellier, France
                [8 ]Department of Medicine (Neurology) and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
                [9 ]Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
                [10 ]Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
                [11 ]National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
                [12 ]Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Victoria, Australia
                [13 ]Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
                [14 ]Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University de Caldas, Manizales, Colombia
                [15 ]Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
                [16 ]Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
                [17 ]Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
                [18 ]Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
                [19 ]Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
                [20 ]Department of Medical Gerontology, Mercers Institute for Ageing, St James Hospital, Dublin 8, Ireland
                [21 ]Hinda and Arthus Marcus Institute for Aging Research, Hebrew SeniorLife, and Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
                [22 ]School of Medicine, University of Nottingham, Nottingham, UK
                [23 ]Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
                [24 ]School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
                [25 ]Faculty of Pharmacy, Université de Montréal, and Department of Pharmacy, McGill University Health Center, Montreal, QC, Canada
                [26 ]University College London, London UK
                [27 ]Population Health Sciences, Faculty of Life Sciences and Medicine, King's College, London, UK
                [28 ]Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
                [29 ]Department of Geriatric Medicine, University Hospitals, Leuven, Belgium
                [30 ]Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
                [31 ]Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
                [32 ]Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
                [33 ]Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
                [34 ]Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
                [35 ]School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
                [36 ]Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario London, ON, Canada
                [37 ]Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
                [38 ]Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
                [39 ]School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
                [40 ]Manchester University NHS Foundation Trust, Manchester, UK
                [41 ]Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
                [42 ]Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
                [43 ]Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
                [44 ]Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
                Article
                10.1093/ageing/afab076
                34038522
                fc0951ca-2771-4a9b-903f-ad854a7e7815
                © 2021

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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