Sturz- und Frakturprävention auf der Grundlage des Nationalen Expertenstandards Sturzprophylaxe

Heinrich, Sven; Weigelt, Isabel; Rapp, Kilian; Becker, Clemens; Rißmann, Ulrich; König, Hans‐Helmut

doi:10.1007/s00391-011-0243-9

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…Falls are also associated with high costs. For Germany, Heinrich et al estimated overall attributable costs between 2.1 and 3.8 billion Euros per year [9]. Due to these serious health and economic consequences, the identification of treatable risk factors for falls of older people is important.…”

Section: Introductionmentioning

confidence: 99%

Association between anemia and falls in community-dwelling older people: cross-sectional results from the KORA-Age study

et al. 2014

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BackgroundFalls and fractures are among the principal causes of disability, and mortality of older people. Therefore, identifying treatable risk factors for falls in this population is very important. Here we evaluate the association between anemia and falls in community-dwelling people aged 65 years and older.MethodsIn 2009 967 community-dwelling people aged 65 years and older were included as part of the KORA-Age study. History of falls was assessed via questions derived from the National Health and Nutrition Examination Survey questionnaire. A non-fasting venous blood sample was obtained from all study participants. Anemia was defined as a hemoglobin level below 12 g/dL in women and below 13 g/dL in men according to the WHO criteria. Different logistic regression models were computed including relevant confounders such as sex, age, and disability to estimate Odds Ratios (OR) for falls.ResultsIn the total sample there was no significant association between anemia and falls neither in the unadjusted (OR 1.35; 95% CI 0.87-2.09) nor in the multivariable-adjusted models (OR 1.06; 95% CI 0.66-1.70). The association between continuous hemoglobin levels and falls was significant in the unadjusted model (OR per 1 SD decrease 1.36; 95% CI 1.14-1.64), but after adjustment for age and sex the association was attenuated and lost its significance (OR 1.13; 95% CI 0.92-1.38). In age- and sex-stratified analyses, no significant associations between anemia or hemoglobin levels and falls could be found. However, in joint analysis in the total sample a significantly, more than two-fold increased risk was observed after multivariable adjustment in persons with anemia and disability (OR 2.10; 95% CI 1.12-3.93) in comparison to persons without anemia and disability.ConclusionsIn the present study we have not found an independent association between hemoglobin levels or anemia and falls in older people from the general population. Because there was an additive effect of anemia and disability on the occurrence of falls, blood count should be measured in disabled older men and women to identify persons, who are at particular high risk for falls.

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Section: Introductionmentioning

confidence: 99%

Association between anemia and falls in community-dwelling older people: cross-sectional results from the KORA-Age study

et al. 2014

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“…Therefore, fall-related injuries in the elderly population are an important economic as well as social problem (Blake et al 1988;Tinetti et al 1988;Etman et al 2012). In Germany, for example, hip fractures of nursing home residents are estimated to cost about 8,160 Euros each, and the overall costs of falls amongst the elderly account for about 2.1-3.4 billion Euros per year (Heinrich et al 2012). …”

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confidence: 99%

Exercise of mechanisms of dynamic stability improves the stability state after an unexpected gait perturbation in elderly

Bierbaum

Peper

Arampatzis

2012

AGE

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Unexpected changes during gait challenge elderly individuals to a greater degree than young adults. However, the adaptive potential of elderly seems to be retained, and therefore, the training of the mechanisms of dynamic stability as well as muscle strength training may improve the dynamic stability after unexpected perturbations. Thirty-eight subjects (65-75 years) participated in the study, divided into two experimental groups (stability training group, ST, n014 and mixed training group, MT, n014) and a control group (CG, n010). Both experimental groups performed exercises which focused on the mechanisms of dynamic stability. Additionally, the MT group executed a training to improve muscle strength. Session volume and duration were equal for both groups (14 weeks, twice a week,~1.5 h per session). Pre-and post-intervention, subjects performed a gait protocol with an induced unexpected perturbation. Post-intervention, the margin of stability was significantly increased after the unexpected perturbation in the ST group, indicating an improvement in stability state (pre, −30.3 ± 5.9 cm; post, −24.1 ± 5.2 cm). Further, both intervention groups increased their base of support after the intervention to regain balance after gait perturbation, whereas only the ST group showed a statistically significant improvement (ST pre , 90.9± 6.6 cm, ST post , 98.2±8.5 cm; MT pre , 91.4±6.2 cm; MT post , 97.9±12.7 cm). The CG showed no differences between pre-and post-measurements. The exercise of the mechanisms of dynamic stability led to a better application of these mechanisms after an unexpected perturbation during gait. We suggest that the repeated exercise of the mechanisms of dynamic stability contributes to significant improvements in postural stability. Additional strength training for healthy elderly individuals, however, shows no further effect on the ability to recover balance after unexpected perturbations during gait.

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“…They were asked about the availability of fall and fracture prevention classes, the acquisition of hip protectors, and if recommendations about environmental adaptations were routinely offered to their residents. This and additional information was used to calculate the incremental costs of the program during the first 18 months of the implementation [ 16 ]. At the same time, a nursing scientist visited 48 randomly selected participating LTCFs for 1 day and collected information from 4000 residents about each resident’s participation in exercise classes and about each resident’s availability and use of hip protectors [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Long-term evaluation of the implementation of a large fall and fracture prevention program in long-term care facilities

et al. 2018

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BackgroundFalls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3–9 years after start of implementation.MethodsData from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied.ResultsThe program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected.ConclusionsThe program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.

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Sturz- und Frakturprävention auf der Grundlage des Nationalen Expertenstandards Sturzprophylaxe

Cited by 11 publications

References 19 publications

Association between anemia and falls in community-dwelling older people: cross-sectional results from the KORA-Age study

Association between anemia and falls in community-dwelling older people: cross-sectional results from the KORA-Age study

Exercise of mechanisms of dynamic stability improves the stability state after an unexpected gait perturbation in elderly

Long-term evaluation of the implementation of a large fall and fracture prevention program in long-term care facilities

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