The OEP may reduce falls by improving cognitive performance.

Dialysis patients are increasingly older and more disabled. In community-dwelling seniors without kidney disease, falls commonly predict hospitalization, the onset of frailty, and the need for institutional care. Effective fall prevention strategies are available. On the basis of retrospective data, it was hypothesized that the fall rates of older (>65 yr) chronic outpatient hemodialysis (HD) patients would be higher than published rates for community-dwelling seniors (0.6 to 0.8 falls/patientyear). It also was hypothesized that risk factors for falls in dialysis outpatients would include polypharmacy, dialysis-related hypotension, cognitive impairment, and decreased functional status. Using a prospective cohort study design, HD patients who were >65 yr of age at a large academic dialysis unit were recruited. All study participants underwent baseline screening for fall risk factors. Patients were followed prospectively for a minimum of 1 yr. Falls were identified through biweekly patient interviews in the HD unit. A total of 162 patients (mean age 74.7 yr) were recruited; 57% were male. A total of 305 falls occurred in 76 (47%) patients over 190.5 person-years of follow-up (fall-incidence 1.60 falls/person-year). Injuries occurred in 19% of falls; 41 patients had multiple falls. Associated risk factors included age, comorbidity, mean predialysis systolic BP, and a history of falls. In the HD population, the fall risk is higher than in the general community, and fall-related morbidity is high. Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required.

As the dialysis population ages, their limitations in performing daily activities affect the well-being of the patients as well as increase the burden on caregivers and the use of health services. In this cross-sectional study, we measured the proportion of patients 65 years and older undergoing chronic outpatient hemodialysis who needed help with day-to-day activities and identified the clinical characteristics of this population at most risk. Their dependence in performance of basic self-care tasks and instrumental activities such as driving were measured by the Barthel and Lawton Scales. Associations between disability in four basic activities to age, gender, education, multiple prescription drug needs, diabetes, cognition, depressive symptoms, and physical performance were examined using logistic regression. Of the 162 mostly male participants averaging 75 years old, eight had no disability, 69 had only instrumental dependence, and 85 had combined disability. Multiple prescription drug needs, poor timing in 'up-and-go' mobility performance, and education level were associated with basic dependency. Our study shows that the disability in self-care is common among older patients on hemodialysis. Strategies are needed to routinely identify those older dialysis patients at risk of functional impairment and to limit their disabilities.

IMPORTANCEWhether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown.OBJECTIVE To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall. DESIGN, SETTING, AND PARTICIPANTSA 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic.INTERVENTIONS Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months. MAIN OUTCOMES AND MEASURESThe primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention. RESULTS Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported.CONCLUSIONS AND RELEVANCE Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.

We conclude that the occurrence of more than one accidental fall in a community-dwelling HD patient aged >/=65 years is associated with an independent increased risk of death. As fall interventions are effective, screening HD patients for falls may be a simple measure of clinical importance.

We conclude that this group of community-dwelling fallers, who presented for ED care with a clinical profile suggesting a high risk of further falls and fracture, did not receive Guideline care and worsened in their fall risk profile by 29.5%. This gap in care, at least in one centre, suggests further investigation into alternative approaches to delivering Guideline standard health service.

Older adults have long periods of sedentary time with minimal activity. Results are a call to action to encourage people to sit less and move more.

Falls are very common amongst seniors on hemodialysis. Further prospective study of the incidence and risk factors for falls in this population is needed to allow targeted interventions.