Fall-related injuries among Canadian seniors, 2005–2013: an analysis of the Canadian Community Health Survey

T., M.; Chang, Vicky C.; Kuran, Natasha; Thompson, Wendy

doi:10.24095/hpcdp.35.7.01

Cited by 52 publications

(32 citation statements)

References 36 publications

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“…Each year, 1 in 3 adults older than 65 years (older adults) fall, and half of these older adults seek treatment at a hospital emergency department (ED) . Most of these falls occur at home on level ground . The American College of Emergency Physicians Geriatric Emergency Department Guidelines advise that emergency physicians use a “head‐to‐toe” examination to identify traumatic injuries in older adults who have fallen .…”

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confidence: 99%

Clinical Predictors of Intracranial Bleeding in Older Adults Who Have Fallen: A Cohort Study

Wit

Parpia

Varner

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Emergency department (ED) visits among older adults are frequently instigated by a fall at home. Some of these patients develop intracranial bleeding. The aim of this study was to identify the incidence of intracranial bleeding and the associated clinical features in older adults who present to the ED after falling. DESIGN: Prospective cohort study. SETTING: Three Canadian EDs. PARTICIPANTS: A total of 2 176 patients age 65 years or older who presented to the ED with a fall were assessed, and 1753 were included. Inclusion criteria were a fall on level ground, off a bed, chair, or toilet, or from one or two steps within 48 hours. MEASUREMENTS: Emergency physicians recorded predefined clinical findings on initial assessment. The primary outcome was intracranial bleeding, diagnosed either by computed tomography at the index visit or within 42 days. Associations between baseline clinical findings and the presence of intracranial bleeding were assessed with multivariable logistic regression. RESULTS: A total of 1753 patients (median age = 82 y) were enrolled, of whom 39% were male, 35% were on antiplatelet therapy, and 25% were on an anticoagulant. The incidence of intracranial bleeding was 5.0% (95% confidence interval [CI] = 4.1-6.1). Overall, 76 patients were diagnosed at the index ED visit, and 12 were diagnosed during follow-up. Multivariable regression identified four clinical variables that were independently associated with intracranial bleeding: new abnormalities on neurologic examination (odds ratio [OR] = 4.4; 95% CI = 2.4-8.1), bruise or laceration on the head (OR = 4.3; 95% CI = 2.7-7.0), chronic kidney disease (OR = 2.4; 95% CI = 1.3-4.6), and reduced Glasgow Coma Scale from normal (OR = 1.9; 95% CI = 1.0-3.4). CONCLUSION: The incidence of intracranial bleeding in our study was 5.0%. We found significant associations between intracranial bleeding and four simple clinical variables. We did not find significant associations between intracranial bleeding and antiplatelet or anticoagulant use. J Am Geriatr Soc 68:970-976, 2020.

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confidence: 99%

Clinical Predictors of Intracranial Bleeding in Older Adults Who Have Fallen: A Cohort Study

Wit

Parpia

Varner

et al. 2020

J American Geriatrics Society

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“…The absence of such pumping while assuming upright posture could lead to a substantial drop in blood pressure (orthostatic hypotension). Orthostatic hypotension is quite prevalent among elderly, patients with neurodegenerative diseases, and in astronauts, therefore, making it one of the major causes of fall in such population groups56789101112.…”

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confidence: 99%

Skeletal Muscle Pump Drives Control of Cardiovascular and Postural Systems

Verma

Garg

et al. 2017

Sci Rep

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The causal interaction between cardio-postural-musculoskeletal systems is critical in maintaining postural stability under orthostatic challenge. The absence or reduction of such interactions could lead to fainting and falls often experienced by elderly individuals. The causal relationship between systolic blood pressure (SBP), calf electromyography (EMG), and resultant center of pressure (COPr) can quantify the behavior of cardio-postural control loop. Convergent cross mapping (CCM) is a non-linear approach to establish causality, thus, expected to decipher nonlinear causal cardio-postural-musculoskeletal interactions. Data were acquired simultaneously from young participants (25 ± 2 years, n = 18) during a 10-minute sit-to-stand test. In the young population, skeletal muscle pump was found to drive blood pressure control (EMG → SBP) as well as control the postural sway (EMG → COPr) through the significantly higher causal drive in the direction towards SBP and COPr. Furthermore, the effect of aging on muscle pump activation associated with blood pressure regulation was explored. Simultaneous EMG and SBP were acquired from elderly group (69 ± 4 years, n = 14). A significant (p = 0.002) decline in EMG → SBP causality was observed in the elderly group, compared to the young group. The results highlight the potential of causality to detect alteration in blood pressure regulation with age, thus, a potential clinical utility towards detection of fall proneness.

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“…All phases of the gait cycle, including stance and swing, plus inter limb coordination appear to be influenced by the length, velocity and stretch sensitivity of spindle afferents, Since defects in this process may explain the presence of a heightened fall risk in individual's with neuromuscular deficiencies and others [66,67] , as well as why walking trajectories of fallers who have tripped are more extensive than those who have slipped [68] , this paper examined what we know about muscle spindle activity in the context of locomotion for purposes of advancing our understanding of the nature of falls injuries among older adults and others. Although the current hypothesis has not been put to any adequate test, the available data do imply that an improved understanding of the link between muscle afferents, and their behavior as this affects locomotor activity can potentially help to predict who is at risk, and explain why exercise can reduce falls injuries in some cases, but not others.…”

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confidence: 99%

Muscle Spindles and Locomotor Control-An Unrecognized Falls Determinant?

Marks

2015

International Journal of Orthopaedics

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BACKGROUND: Historically, evidence muscle spindles might be involved in locomotion was provided by their presence in tetrapod antigravity muscles associated with posture and locomotion. Later, Brodal (1962) noted muscle spindles in all muscles of locomotion. To unravel the complexity of the muscle spindle and its role in human locomotor control many investigators have since conducted lesion and/or anaesthesia studies in subhuman species and human contexts. QUESTIONS: How strong is the evidence linking muscle spindles to normal human locomotion and its control? Can a case be made for an association between muscle spindle dysfunction and falls injuries? METHODS: All relevant publications in the leading electronic databases were searched using the key terms muscle afferents, falls, gait, locomotion, muscle spindles. There were numerous related listings, but here only selected reports are examined and discussed because the articles had to be linked in some way to the key question driving the research. RESULTS: Evidence supports a key role for muscle spindles in the control of human locomotion, and by analogy to falls related injuries. CONCLUSION: Future work to explore the role of muscle spindles in the context of falls that occur when walking is warranted.

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Fall-related injuries among Canadian seniors, 2005–2013: an analysis of the Canadian Community Health Survey

Abstract: Introduction: We describe the epidemiology and trends of fall-related injuries among Canadian seniors aged 65 years and older by sex and age, as well as the circumstances and consequences of their injuries.

Cited by 52 publications

References 36 publications

Clinical Predictors of Intracranial Bleeding in Older Adults Who Have Fallen: A Cohort Study

Clinical Predictors of Intracranial Bleeding in Older Adults Who Have Fallen: A Cohort Study

Skeletal Muscle Pump Drives Control of Cardiovascular and Postural Systems

Muscle Spindles and Locomotor Control-An Unrecognized Falls Determinant?

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