Effectiveness of interventions aimed at improving physical and psychological outcomes of fall-related injuries in people with dementia: a narrative systematic review

Background: The annual prevalence of falls in people with dementia ranges from 47 to 90%. Falls are a common reason for hospital admission in people with dementia, and there is limited research evidence regarding the care pathways experienced by this population. In addition to immediate management of an injury, prevention of further falls is likely to be an important part of any successful intervention. This review aims to assess the effectiveness of interventions for improving the physical and psychological wellbeing of people with dementia who have sustained a fall-related injury. Methods: Systematic review methodologies were employed utilising searches across multiple databases (MEDLINE, CENTRAL, Health Management Information Consortium, EMBASE, CINAHL, Web of Science, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro)) and citation chaining. Studies including people with a known diagnosis of dementia living in the community and who present at health services with a fall, with or without injury, were included. Outcomes of interest included mobility, recurrent falls, activities of daily living, length of hospital stay, and post-discharge residence. Results were independently reviewed and quality assessed by two researchers, and data extracted using a customised form. A narrative synthesis was performed due to heterogeneity of the included studies. Results: Seven studies were included. Interventions clustered into three broad categories: multidisciplinary in-hospital post-surgical geriatric assessment; pharmaceuticals; and multifactorial assessment. Multidisciplinary care and early mobilisation showed short-term improvements for some outcomes. Only an annual administration of zoledronic acid showed long-term reduction in recurrent falls. Conclusions: Due to high heterogeneity across the studies, definitive conclusions could not be reached. Most post-fall interventions were not aimed at patients with dementia and have shown little efficacy regardless of cognitive status. Minor improvements to some quality of life indicators were shown, but these were generally not statistically significant. Conclusions were also limited due to most studies addressing hip fracture; the interventions provided for this type of injury may not be suitable for other types of fractures or soft tissue injuries, or for use in primary care

Influence of Footwear on Gait Characteristics that are Associated With Increased Fall Risk in Older Persons

Objective: To investigate the influence of three different types of shoe models frequently worn at home, including an open heel shoe model, on gait parameters that are associated with fall risk in older persons.Methods: Twenty-five community-dwelling independent older persons were asked to walk on an electronic walkway system, the GAITRite® walkway, while wearing three different shoe models which are frequently worn at home. We measured spatial and temporal gait parameters.Results: Gait velocity and stride length were significantly reduced, and step time, stance, and double support time were significantly increased, when older persons wore an open heel shoe model compared to the high collar shoe models.Conclusion: Wearing an open heel shoe model is associated with gait parameters that are associated with fall risk, compared with a high collar shoe model, in community-dwelling older persons. With regard to falls prevention, further attention for footwear in older persons seems warranted, especially for footwear worn in and around the home.Applied Ergonomics and Desig

Drug cessation in complex older adults: time for action

general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available