Falls in Mid-Life: A Scoping Literature Review

January 22, 2020 12:00 PM EST

Dr. Aleksandra Zecevic, Alison Stirling and Hélène Gagné

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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-LifeScoping Literature Review

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 CRITERIA2000-201940-64 years of ageEnglish languageLongitudinal studiesPrevalence rates, risk factors, falls descriptions Community dwelling

EXCLUSION CRITERIAWork related fallsSport related fallsCase studiesFalls assessment toolsFeasibility of toolsNo access to original article

Stage 3 Select sources

Stage 4 Chart the data

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Numerical analysis of

extent, nature and distribution of 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)

FindingsFlow Chart of Study Selection

Findings – Research studies

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Studies N=3027 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 genders22 studies had >50% women6 studies had >50% men2 studies did not report %

Findings – Research studies (cont.)

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Populations

19 general community dwelling population11 special populations:

2 studies diabetes, stroke, intellectual disability, spinal cord injury1 rheumatoid arthritis, multiple sclerosis, orthostatic hypotension

Data SourcesPopulation administrative databases (14)Medical records/hospital registries (6)Data collected by authors (10)

AnalysesDescriptive statistics (10)Logistic regression models (9)Both (11)

Prevalence reporting

falls/person-yearfalls/100 person-yearsfalls/1,000 persons-monthfalls /1,000 person-yearsfalls/100,000 populationfalls/100,000 person-yearfalls/1,000 population20 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 hrsof 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 visits2,353/100,000 ON (2012-14) for 45-642,072/100,000 ON (2014&15) for 45-542,553/100,000 ON ((2014&15) for 55-592,733/100,000 ON (2014&15) for 60-643,980/100,000 Grey Bruce (2012-14) for 45-64

Hospitalizations201/100,000 ON (2012-14) for 45-64118, 206, 296/100,000 ON (2014&15) for 45-54, 55-59 & 60-64319/100,000 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