The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-reviewed research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project.
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

review

GLOBAL STRATEGIES FOR FALL PREVENTION IN ELDERLY POPULATION
Sushmitha P.B, Aaveril Rinita Rebello, Ghulain Jeelani Qaidri

Author affiliations:
Sushmitha P B , Post G raduate; Averil Rinita R ebello, Lecturer; Ghulam Jeelani Q aidri, P rofessor:
Department o f Hospital Administration, Yenepoya Medical College, Deralakatte, Mangalore 575018,
Karnataka

Abstract:
Background: India is in a phase o f demographic transition. It is projected that by the year 2021, the
elderly in India will number 143 million. The major area o f concern is the health o f the elderly. It is seen
that falls are one o f the major causes o f injuries and non-communicable diseases associated with old age.
Studies on falls in elderly population were reviewed to determine the prevalence, consequences, risk
factors, and interventional strategies to prevent falls.
Purpose: To study the strategies regarding prevention o f falls in elderly population.
Methods: Literature research o f relevant articles, studies, reports in Internet databases o f MEDLINE,
PubMed, Google, PMC, Science direct.
Studies and articles related to falls in elderly population published after 2012, were found using the key
words: falls, quality o f life, prevalence, consequence, injuries, risk factors, health, strategies to reduce
falls and fall management.
Approximately 2 1 number o f Journals and 10 articles regarding the topic were studied and analyzed.
Results: The magnitude o f the problem and strategies, particularly preventive strategies was
identified.It is seen that in India, prevalence o f falls among the geriatrics ranges from 14% to 53%, in
Japan it was 13.7% and in China it was 26.4%. In the US, 29 million falls were reported in the year 2014,
causing 7 million injuries.

Keywords:
Geriatric, fall prevention, fall risk assessment, risk factors

Correspondence: JK-Practitioner 2017; 22(1-21: 10-19
Dr. Ghulam Jeelani Qaidri
Professor . Dept, o f Hospital Administration ,Yenepoya Medical College , Deralakatte, Mangalore
575018. Karnataka

Indexed:
Scopus .IndMED, EBSCO, Google Scholar among others

Cite:
This article as: Sushmitha PB, Rebello AR , Qaidri GJ:Global Strategies For Fall Prevention In Elderly
Population. JK-Practitioner2017;23( 1-2): 10-19

Introduction
The major emerging demographic issue of
the 21stcentury is the aging of population.
In almost every country, the proportion of
people aged above 60 years is growing
faster than any other age group as a result of
longer life expectancy.2
The WHO proposes “active aging” which
aims to extend healthy life expectancy and
quality of life for all people as they age,
including those who are frail, disabled and
in need of care.’

A ‘senior citizen’ or ‘ older adult ‘is defined
as a person aged 60 yrs and older.’ In india,
the proportion of the population aged 60 yrs
and above was 7% in 2009 and is projected
to increase to 20% by the year 2050.1 By
2021 It is estimated to rise to about 143
Million.4
The major area of concern is the health of
elderly. The elderly are faced with multiple
medical and psychological problems.
Among them, ‘falls’ are one of the major
problem5. Falls are defined as “an untoward

10 JK-Practitioner Vol.22, No (1-2) January – June 2017

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event which result in the patient coming to
rest unintentionally on the ground or the
lower surface”/’ Falls are considered as a
non-communicable chronic disease.’They
are coded ,as W00-W19 in International
classification o f disease-10.
Falls are considered as one of the “Geriatric
Gaint”. Recurrent falls, are important cause
of morbidity and mortality in the elderly
and a marker of poor quality of life.’

Statistics of Geriatric F alls
Accidental fall is a major complex health
issue, threatening the independence and
quality of life and overall-well being of the
elderly/
Fall, is the second highest cause o f
accidental death for people aged 65 and
above, following traffic accidents. Death
rate from fall increases with age for both
men and women. In the age group 65-74
men have higher death rate than women, but
after the age of 75 women are more likely
than men to die as a result o f a fall/
The most prevalent fall-related injuries
among older adults are fracture of the hip,
spine, forearm, bones of the pelvis, hand
and ankle. Of these, the most serious injury
is hip fracture,a leading cause of morbidity
and excess mortality among older adults.1(1
Falls that do not result in serious injury may
still have serious consequences for an older
person, who may fear falling again, which
can lead to reduced mobility and increased
dependence through loss of confidence.”
In the United states about 30%of individuals
aged 65yrs and older fall at least once a year

and about three-fourth death due to falls
occur in 13% of the population aged 65 and
above, indicative of primary a geriatric
syndrome.10 Every 11 seconds ,an older
adult is treated in the emergency room for a
fall, every 19 minutes ,an older adult dies
from fall.”
In Japan, the prevalence o f falls is
approximately 13.7% ‘and in China, it is
approxim ately 26.4%. In India the
prevalence of falls among older adults
above 60 year and older is about 14% to
53%/
The rate of hospital admission due to falls
for people at the age of 60 and older in
Australia, Canada and the United Kingdom
of Great Britain and Northern Ireland (UK)
range from approx. 1.6 to 3.0 per 10,000

population.
According to EUNESE(European Network
For Safety among Elderly) 1 out of 10
elderly is treated at the emergency
department due to accidental fall /
Fall in hospital leads to injury in about 30%
o f cases with(l-5%)leading to serious
injury. As they occur predominantly in older
people with frailty or multiple health
problems, even minor injuries leads to
impaired rehabilitation ,loss of confidence,
fear of falling and a longer stay.10
Accidental falls in patients account for
30-40% o f reported safety incidents
(N a tio n a l P a tie n t S a fe ty A gency,
2007).They occur at a frequency of 4-14
falls per 1,000 bed-days, which equates to
about 10 falls per month on a 28-bed ward.I_
About 40% of the elderly population , living
at home, will fall at least once each year,and
about 1 in 40 of them will be hospitalized.
O f those admitted to hospital after a fall,
only about half will be alive a year
later.Repeated falls and instability are very
common precipitators of nursing home
admission.1′
Risk F actors ForFallln Older People
Falls occur more often among older adults
because fall risk factors increase with age. A
fall risk factor is something that increases a
person’s chances of falling.” Falls may
occur as a result of a complex interaction of
various risk factors. The risk factors for
older adults can be categorized into:
1) Biological
2) Behavioural
3) Environmental
4) Socio – Economic
5) Others
Biological risk factors
B i o l o g i c a l r i s k f a c t o r s e m b r a c e
characteristics o f individual that are
pertaining to the human body
* Age
Age is a non -modifiable risk factor, which
is associated with the changes in the
p hys i c a l , c o g n i t i v e , and af f e c t e d
capabilities of an healthy individual. The
older a person gets, he/she is more
vulnerable to falls. ”
• Gender
Health seeking behaviour differs according
to gender. Male have higher fatality rate,
may be due in part to the tendency of men
not seeking medical care, until a condition

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become severe, resulting in substantial
delay to the access to prevention and
management o f d isease.’
Women’s muscle mass decline faster than
that o f men, especially in the immediate few
years after menopause. Hence, women are
more likely to fall, resulting in twice more
hospitalization and emergency department
visit than men
• M u s c le w e a k n e s s or b a la n c e
problems
Among old people aged 50 and above, the
prevalence o f muscle weakness or balance
problem is more due to the vitamin D
deficiency,’ leading to low bone mineral
density. The prevalence o f vitamin D
d e f ic ie n c y in o ld e r p o p u la tio n is
approximately 91.2%, that o f osteoporosis
is approxim ately 31.2% and that o f
osteopenia is about 50.2% .’
• M edication sid e effe c ts and/or
interactions
Falls in older adults are often iatrogenic.
Over prescription o f medications causes
side effects and interaction among drugs.
Older people tend to take more drugs than
young people. Also, as people age, they
develop altered mechanisms for absorption
and metabolizing drugs. Inadequate dosage
and lack o f warning to make older people
aware about their effects may results in
elderly fall. ‘
• Health conditions
Older adults commonly have more than one
health related condition ,and their risk of
falling increases with the number o f
chronic condition such as , depression,
dem entia, u rin ary in co n tin en ce, and
c h ro n ic d is e a s e su c h as d ia b e te s ,
hypertension, etc.’ It is hypothesised that
the symptom of weakness, fatigue, syncope
.p o stu ra l h y p o ten sio n c o n trib u te to
decrease activity level and subsequent
physical deterioration that increases risk for
fall.7
• Visual Problems
The vision problems contributing to falls
includes, poor depth perception, Cataract,
and Glucoma. Impaired vision can also
result in fall. One reason is that, it may take
a w’hile for older people to adjust to see
clearly when they moved between darkness
and light.1″ ‘’
• Loss of sensation in feet Sensory
problems can cause fall too. If the senses

doesn’t work well, for instance having
numbness in the feet may mean that they
don’t sense where they are stepping and
moving ahead may lead to fa ll.” 1
Behavioral risk factors
• Sedentary behaviour
Sedentary lifestyle with no or irregular
physical activity is commonly found in both
the developed and developing world,” 15 the
se d e n ta ry a c tiv ity in c lu d e s s ittin g ,
watching television, and computer uses for
much of the day with little or no vigorous
exercise, can have a negative health
consequence, such as falls.1’’
• Risk taking behaviour
Men are more likely to be engaged in intense
and dangerous physical activity, and risky
behaviour, such as, climbing high ladder,
standing on unsteady chair, rushing with
little attention to the environm ent. Not
using mobility devices prescribed to them
such as cane or w’alker, wearing poor fitting
shoes, walking in socks without shoes or in
slippers without a sole increases the risk of
fall.7″
• Alcohol use
Use o f excessive alcohol has been shown to
be a risk factor o f fall, consumption o f 14 or
more drink per week is associated with an
increased risk offall in older adults. ’1
Environmental risk factors
Factors related to environment are the most
common cause o f falls in older people
A high particular risk to tails are found in
hom es, irreg u lar side w alks to the
residence, loose carpets on the kitchen and
bathroom floors, loose electrical wires and
inconvenient doorsteps.’
• Flaws in facility design
Uneven or excessively high or narrow steps,
slip p e ry su rfa c e s, u nm arked edges,
discontinued or poorly fitted handrails,
loose electrical wires, and inconvenient
d o o rste p s, in ad e q u a te or e x c essiv e
lightning , are factors that leads to elderly
fall.,”
• Poorly designed public spaces
Poor surroundings around home such as
garden paths and walks that are cracked or
irregular side walks, slippery from rain,
snow, or moss and poor night lightings are
dangerous.’
Socio-economic risk factors
Socio-economic status is a key factor in
determining the quality o f life.

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Socio-economic status is often measured as
a combination of education, income and
occupation. It is commonly conceptualized
as the social standing or class o f an
individual or group.
• Low income and education level
There is a relationship between socio­
economic status and fall.1 Lower income is
associated wit increase risk of falling, older
people especially, who live alone or in rural
with unreliable and insufficient income face
an increase risk of fall.3 The negative cycle
of poverty and falls in older age is
particularly evident in rural areas and in
developing countries.
• Inadequate housing
The poor housing design and maintenance
o f house is one o f the risk factors of fall in
elderly. As high proportion of accident
occur inside the home. Falls on the level I
(tripping) accounts approximately 11% of
non fatal accidents and 2% of death in home

18,19

• Lack of social interaction
In some culture, social participation in older
adults is not seen as a virtue. The perception
is that old people are meant, “to rest”. In
practice, this result in some older people
adopting sedentary life often in isolation
due to the resignation from social,
economic and cultural participation, with a
resulting increase in the risk of falling.
Isolation and loneliness are commonly
experienced by older people particularly
among those who lose their spouse or live
alone, they are much more likely than other
group to experience disability and the
physical,cognitive,sensory limitation that
increases the risk o f fall. 11
• Limited access to health and social
services
One third of older adults age 60 yrs and
older live below poverty line, upto 65% of
older adults are economically dependent,
especially widowed women;’
Lack o f access or limited to health greatly
impacts on older health status. In India only
25% o f people have health insurance
coverage and medical expenses are
predominantly borne out of pocket ’,when
individual do not have insurance they are
less likely to participate in preventive care
and are most likely to delay medical
treatment.

• Lack of community resources
Many older adults as well as their family
members and caregivers are unaware of
factors or behaviour that put them at a risk
of falling. They are also unaware of action
they can be taken to reduce risk for fall. Fall
in older age has been a neglected public
health problem in many societies,
particularly developing world.” The elderly
lack sufficient knowledge, regarding the
public health policies.7
Other risk factors
Fear of falling has been identified relatively
recently as a risk factor in the fall prevention
literature. Fear o f falling is widespread and
has been reported as the most common fear
of older adults. It is an important aspect to
consider, particularly for those who develop
fear after having fallen . Fear o f falling is
reported by a significant number o f older
persons . Specific fears vary but often
include fear o f falling again, being hurt or
hospitalized, not being able to get up after a
fall, social em barrassm ent, loss o f
independence, and having to move from
home. 1
Risk For Fall In Hospitalized Patient
Being hospitalized increases a person risk
for falls.’ This is because hospitalized
persons are often weak from their illness.
They may also be dizzy, light-headed or
unsteady from their illness, medications or
other treatment. Getting out of bed in the
hospital without asking for help is a very
common reason for falls. Walking to the
bathroom without help also puts patients at
risk for falls. 711
Fall Prevention Strategies
Fall prevention programme can be effective
in reducing the rate of falls, thereby
improving quality of life in elderly.21
If preventive measures are not taken in
immediate future, the number of injuries
caused by falls is projected to be 100%
higher by the year 2030 .
Studies have shown that, certain fall
prevention strategies can be effectively
used to reduce the rate o f falls. The
strategies are be broadly classified as
follows.
1) Systemic fall risk assessment
2) Integrated care management system
3) Exercise programme
4) Environmental -inspection & hazard

JK-Practitioner Vol.22, No (1-2) January – June 2017 13

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reduction programme
Systemic fall Risk assessment Tools
Risk assessment are the cornerstone o f any
falls preventing program because they
allow for a more efficient use o f resources
as well as focusing the attention of an
individual’s care team when they are at a
high risk o f falling.12
Some of the risk assessment tools are
• Long term care fall risk assessment

form
• Berg balance scale
• Dynamic gait index
• Mini mental status examination
Long term care fall assessment form l3’2” ‘’
There are eight subtests in the long tenn
care fall risk assessment form
1. Level o f c o n s c io u s n e s s /m e n ta l

status
2. History of fall in the past 3 month
3. Ambulation/elimination status
4. Vision status
5. Gait/balance
6. Systolic blood pressure
7. Medication
8. Predisposing disease
If the persons score is <10 he/she will be classified into the low risk group and into the high risk group if the score is> 10
Berg balance scale
The berg balance scale contains 14 task, to
be performed that are graded from 0
unable,to 4 independent with a maximum of
score 56 .The higher score indicates better
performance Berg suggested that score <45 indicates that a person is impaired with an increase risk of falls.2’"4 Dynamic gait index The dynamic gait index consists of eight subtest each tasks are scored on a 4 point scale.O (poor) & 3 (excellent) the maximum score is 24, scores <=19 are related to increased incidence o f falls in elderly people.1’"’ Mini mental status examination Mini mental status examination is an question measures that tests five areas of c o g n i t i v e f u n c t i o n s , o r i e n t a t i o n , registration, attention, and calculation, recall and language. The maximum scores is 30.A score of<=23 is an indicative of cognitive imapirement.” The Falls Risk Assessment Tool (FRAT)

The Fall Risk Assessment Tool, was

developed by the Peninsula Health Falls
Prevention Service. It is a reliable and
validate tool, consists o f three section.2′
Part 1 – falls risk status;
Which evaluates the risk factors o f recent
fall, medication, psychological condition
and cognitive status.
Part 2 -ris k factor checklist;
The risk factor checklist, assess the vision,
Mobility behaviour, Activities of Daily
living, O rientation to environm ent,
N utritional status and level of continence.
Part 3 -action plan.
Based on the risk factor identified.
Theaction plan is made and interventional
strategies are developed to reduce the risk
o f falls.25
The Morse Fall Scale.
This scale is shown to be effective in
gauging the risk of falls in variety of
different settings. Briefly, this scale
evaluates a patient’s previous history of
falls, number of additional diagnosis a
patient has, which reflects the severity of
the current condition. It also evaluates if
patient can currently move without aid or
requires IVs or other therapies involving
physical impediments and his or her current
gait status and mental state.”1’
( S T R A T I F Y ) St . T h o m a s Ri s k
Assessment Tool In Falling.
St.Thom as risk o f assessm ent tool
developed in the year 1997, and is used to
identify clinical risk factors in the elderly
and to predict fall chance. A risk assessment
score range from(0-5) is designed by rating
1 for presence and 0 for absence, o f 5 fall
risk factor”” 1′
This scale has been considerably used in risk
prediction, and are termed as ‘high’
‘medium’ or ‘low’ risk of falling or ‘at risk
o f falling.12
Integrated Care Management System In
Health Care Setting
Integrated care management is a process
whereby an individual needs are assessed
and evaluated, eligibility for services is
determined, care plan are implemented
services are provided and need are
monitored and re assessed. ’1
The WHO European office for integrated
health care service defines integrated care
as ” A concept bringing together inputs,
delivery management and organisation of

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services related to diagnosis, treatment,
c a r e , r e h a b i l i t a t i o n , an d h e a lth
promotion”. ”
The goal of integrated care management is
to improve accessibility, quality of care and
financial sustainability.3132
The delivery o f the integrated services
provided to those with chronic condition
requires a paradigm shift from episodic
short term intervention, which characterize
care for acute condition, to long -term
com prehensive care for those with
continuing care needs.12
The WHO Falls Prevention Model is an
example o f such a systematic, coordinated,
and comprehensive strategy designed to
reduce the burden of one of the most
significant causes of age-related injuries
and n o n -co m m u n ica b le c o n d itio n s
associated with old age.
The WHO Falls Prevention Model provides
a comprehensive multisectoral framework
for reducing falls and fall-related injuries
among older persons.7’21
The WHO fall prevention model consists of
three pillars.
Pillar one -Building awareness of the
importance of fall prevention and
treatment among older people.
Pillar two-improving the identification
and assessment of risk factors and
determinants of falls
P i l l a r t h r e e – i d e n t i f y i n g a n d
implementing realistic and effective
intervention.
In relation to the building awareness of fall
prevention, The Center for Disease Control
and P rev en tio n ‘s Stopping E lderly
Accidents, Deaths, & Injuries (STEADI)
tools and educational materials can assist
health care providers in reducing their
patients’ risk of falling.0
In relation to the implementing and
p r o v id i n g e f f e c t iv e in t e r v e n ti o n
strategies.The National Institute on Aging
(NLA) and the Patient-Centered Outcomes
Research Institute (PCORI) are testing
evidence-based interventions that deploy
nurses or nurse practitioners as “falls care
managers.’4
Exercise Programme
Physical activity can help prevent disease
and injury. However less than 60% of older
adults engage in physical activity and

strength training.
FallScape
Programme has been developed and tested
with support for national institute on aging
started in 2004.35
FallScape is a customized program for
anyone who has experienced a fall or
regular loss o f balance; regardless of
w alking ability, m edical condition,
mobility, cognitive or fitness level.
FallScape consists of one or two training
sessions with a set o f brief (less than 1 min.)
Multimedia vignettes that are selected
specifically to help an individual prevent
falls in their own unique situation.
FallScape is offered in-home or community
space. Research shows that Participants
achieve maximum benefit with the addition
o f this multimedia training.35’36
The Otago Exercise Program
Developed by the New Zealand fall
prevention research group in the late
1990’s35’39
The Otago Exercise Program is a series of
17 strength and balance exercises delivered
by a Physical Therapist at home, that
reduces falls between 35% and 40% for frail
older adults. ” This evidence-based program
calls for Physical Therapists to assess,
coach and progress patients over the course
of six months to one year.’6’38
Stay Active and Independent for Life
(SAIL)
Stay Active and Independent for Life
(SAIL) is a strength, balance and fitness
program for adults 65 and older.
Implemented in the year 2006,32 the
program focuses on most important
activities, that adults can do to stay active
and reduce their chance o f falling like,
performing exercises that improve strength,
balance and fitness. SAIL exercises can be
done standing or sitting. The primary target
audiences are older adults (65+) and people
with a history of falls. The SAIL program is
able to accommodate people with a mild
level of mobility difficulty (e.g. people who
are occasional cane users)35’36
Stepping On
Stepping on is a group program that helps
older people reduce their risk of falling,
there by improving their quality of life36.
Developed by Dr. lindy Clemson in
Australia, It was brought U.S and adopted

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for U.S audience by Dr.Jane .E.Machoney
o f University o f Wisconsin.1
About 30% of older people who fall lose
their self-confidence and start to go out less
often. Inactivity leads to social isolation and
loss o f muscle strength and balance,
increasing the risk o f falling. Stepping On
aims to break that cycle, engaging people in
a range o f relevant falls prevention

, • 35,40strategies.
Tai Chi for Arthritis
In 1997, Dr. Paul Lam Led a team o f Tai
Chai and medical specialist to create this
programme.”
Many studies have shown Tai Chi to be one
o f the m ost effective exercises for
preventing falls. Tai Chi for Arthritis helps
people with arthritis to im prove all
m uscular strength, flexibility, balance,
stamina, and more.
Environmental Inspection And Hazard
Prevention Programme
Precautionary measures to be followed in
the hospital settings includes ”

need to talk to the h ealth care
professionals, about the medication,
side effects o f the medication which
could make elderly dizzy, unsteady on
their feet.

2. Advice the elderly to seek help to get out
o f the bed and whenever they are
moving, especially if they are not feel ing
well, advice them to use their call
buttons in the hospital.

3. Noticing whether they’re holding onto
walls, furniture or someone else while
walking or if they appear to have
difficulty walking or arising from a chair

4. Advice the elderly to use cane, walker or
other device to make walker safer.

5. Advice them to wear comfortable rubber-
soled, low -heeled slippers or shoes that
fit properly.

6. Advice the elderly to check for a clear
and safe pathway before they walk ,ask
them to avoid walking on wet or
cluttered floors.

Measures To Be Followed By The
Caretaker To Avoid Fall In Elderly After
Discharge Or Follow Up Care At Home
Setting
There are many simple and inexpensive
ways to make a home safer. If you’re

providing care or planning on providing
care to someone in the home, it’s important
to make modification o f home. Special
attention to the bedroom, bathroom, and
equiments should me more emphasised.” ”
Safety in the Bedroom
Install night lights, Avoid raised rugs or
unsecured rugs that could cause slipping,
Get bed rails if the patient is at risk to fall out
o f bed, Place a bell or other summoning
device in the bedroom that the patient can
use to call for assistance. 20,43
Safety in the Bathroom
Install grab bars in the tub/shower and near
the toilet, place non-skid mats in the shower
and on bedroom floors, installraised toilet
seat for easy on and off the toilet, hang up
night lights.,
Safety Elsewhere in the Home:
Put handrails in the hallways, entryways,

and stairs. Clear paths around furniture and
in hallways. Install a ramp on entryways
and stairs, A medical alert system if the
patient will need to activate help quickly, A
medical alert system if the patient will need
to activate help quickly. Put a fully charged
cordless phone w ithin reach o f the

, 7.20.42patient.
Equipment Safety
If your loved one uses a walker or cane,
make sure there is room in the hallways and
room to allow its use, 1 f your loved one uses
a wheelchair and he is at risk o f falling out
due to weakness, use a lap tray. Any medical
equipment supplier can provide you with
one o f these, I f your loved one xteeds a
hospital bed, decide whether you will need

Source : ‘WHO Global Report On Falls Prevention In Older Age”

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bed rails to prevent falls out o f bed. If your
loved one uses an oxygen concentrator,
make sure it is plugged into it’s own power
outlet. D on’t allow anyone to smoke around

7,2 03 5 ,4 2oxygen.
Falls can’t always be prevented but ensuring
that the home is a safe place will make your
job o f caring for your loved one much easier
and provide you with added piece o f
mind. °
Fall Prevention Awareness Week
In 2008 ,The National Council On Aging
(NCOA) has sponsored a Fall Prevention
A w areness Day on Septem ber, with
participation o f the event from 11 states to
48 states and the District o f Columbia.35.The
9th annual FPAD was observed on Sept. 22,
2016. The theme o f the event was Ready,
Steady, Balance: Prevent Falls in 2016.35
Fall Related Financial Burden On Older
Adult And Their Families
Falls create a large cost burden for both the
public and private purse,’ regardless o f how
health and social care is funded. There are
not only direct costs o f treatment and care,
but also indirect costs o f lost productivity
from carers o f those who fell, and
opportunity costs associated with use o f
resources, which could otherwise have been
effectively used in another way.’1
Direct costs o f falls include health care
costs, and indirect costs include societal
productivity o f individuals or caregivers
(such as income loss)’. The total economic
burden o f falls may be significantly higher
if direct nonm edical, intangible, and
indirect costs o f falls are also included.
The costs related to medical management,
hospital stay, and rehabilitation o f fall-
related injuries are considerable. The
consequent morbidity and dependency for
daily activities may require assistance of
family members (informal caregivers) or
nursing aides (formal caregivers). Both
types o f assistance are associated with
considerable direct and indirect costs.1’4’1
Conclusion
Falls are an emerging public health problem
and a barrier to active ageing. Falls are
easily preventable. They represent an
attractive target to increase the quality o f
life. Thus, by eliminating or reducing
injuries from accidental falls amongst
elderly people, can improve their quality o f

1 ife and social well-being. 44

Reference:
1. S u b a i y a L. a n d B a n s o d D . W.

“Demographics of Population Ageing in
India:Trends and Diferentials” , BKPAI
Working Paper No. 1 , United Nations
Population Fund (UNFPA), New Delhi.
2011.

2. Health Topics- ageing [Internet], World
Health Organisation. 2016 [cited 25
N o v e m b e r 2016], A v ailab le from:
http://www.who.int/topics/ageing/eny

3. D’souza S A, Rajashekar B, D’souza HS.
“Fall in Indian Older adults: a barrier to
active aging”. Asian Journal of Gerontology
& Geriatrics. 2 0 14;9(l):33-40.

4. Help Age India. Annual report 2015
[I n te rn e t]. 2015. Ava i l a bl e fr om:
h t t p : / / w w w . h e l p a g e . o r g / w h o – w e –
are/annual-review-2015/

5. Krishnaswamy B and Usha G. “Falls In
Older People: National / Regional Review
India” [Internet], [cited 25 November
2 0 1 6 ] . A v a i l a b l e f r o m :
http://www.who.int/ageing/projects/SEAR
O

6. Patil SS, Suryanarayana S P, Dinesh R,
Shivraj N S, Murthy N S. Risk factors for
falls among elderly: A community-based
study. IntJ Health Allied Sci 2015 ;4 :135-40

7. ‘Who Global Report On Falls Prevention In
Older A ge’ [Internet], World Health
Organisation. 2007 [cited 18 November
2016],
Available from: http:// www. who. int /
ageing / publications / Falls_ prevention 7
M arch. pdf

8. Saiin R. Accidental Falls Amongst the
elderly: Health Impact and Effective
intervention Strategies.

9. Kumar A, Srivastava D, Verma A. ‘The
Problems Of Fall, Risk Factors And Their
Management Among Geriatric Population
In India’. Indian Journal of Community
Health. 2013 ;25(2).

10. Faisal W., Eastern Mediterranean Regional
Review, October 2016.

11. Preventing Falls: A Guide to Implementing
Ef f ect i ve Co mmu n i t y -B ased Fall
Prevention Programs [Internet], Centre for
disease prevention and control. 2015 [cited
22 November 2016], Available from:
h t t p s : / / w w w . c d c . g o v /
h o m e a n d r e c r e a t i o n a l s a f e t y / p d f /
falls/fallpreven tionguide-2015-a

12. Oliver D, Healy F. Falls risk prediction tools
for hospital inpatients: do they work? Nurs
Times. 2009; 105 (7): 18-21

13. Rubenstein L. ‘Falls in older people:

JK-Practitioner Vol.22, No (1-2) January – June 2017 17

http://www.who.int/topics/ageing/eny

http://www.helpage.org/who-we-are/annual-review-2015/

http://www.helpage.org/who-we-are/annual-review-2015/

http://www.who.int/ageing/projects/SEAR

review

epidemiology, risk factors and strategies for
prevention. ’ Age and ageing. 35(2):37-41.

14. NIH Senior Health: Falls and Older Adults –
Causes and Risk Factors [Internet],
N ihseniorhealth.gov. 2013 [cited 23
N ovem ber 2016]. A v ailab le from :
https://nihseniorhealth.gov/falls/causesand
riskfactors/Ol.html

15. Kruger J, Ham SA, Sanker S. Physical
inactivity during leisure time among older
a d u l t s — B e h a v io r a l R is k F a c t o r
Surveillance System, 2005. J Aging Phys
Act. 2008; 16:280-91

16. S e d e n t a r y l i f e s t y l e [ I n t e r n e t ] .
En.wikipedia.org. [cited 25 November
2 0 1 6 ] . A v a i l a b l e f r o m
https://en.wikipedia.org/wiki/Sedentary li
festyle

17. Aging & Socioeconomic Status [Internet].
http://w w w .apa.org. 2016 [cited 18
November 2016]. Available from: https://
www. apa. org/ pi/ ses/ resources /
publications/age.aspx

18. The health problems associated with poor
housing and home conditions, inadequate
water supplies and sanitation [Internet],
Flealth Knowledge, [cited 19 November
2 0 1 6 ] , A v a i l a b l e f r o m :
http://www.healthknowdedge.org.uk/public
– h e a lth -te x tb o o k /d is e a s e -c a u s a tio n –
d ia g n o s tic /2 f – e n v ir o n m e n t/h e a lth –
problems-poor-housing

19. Social Determinants of Health | Healthy
P e o p l e 2 0 2 0 [ I n t e r n e t ] .
Healthypeople.gov.[cited 12 November
2 0 1 6 ] , A v a i l a b l e f r o m :
https://www.healthypeople.gov/2020/topic
s-objectives/topic/social-determinants-ol-
health

20. Fall T.I.P.S.- Home [Internet]. Partners.org.
[cited 20 November 2016]. Available from:
http://www.partners.org/cird/FallsPreventi
on/

21. What are the main risk factors for falls
amongst older people and what are the most
effective interventions to prevent these
falls? [Internet]. World Health Organisation
Europe. [cited27November2016].
Available from: http:// www. euro. who. int /
_ data / assets / pdf _ file / 0018 / 74700 /
E82552

22. Perell K, Nelson A, Goldman R, Luther S,
Prieto-Lewis N, Rubenstein L. Fall Risk
A ssessm ent M easures: An A nalytic
Review. The Journals of Gerontology Series
A: Biological Sciences and Medical
Sciences. 2001 ;56(12):M761-M766.

23. Fall Risk Assessment and prevention in
long term care,medical mutualinsurance
company of maine. www. medicalmutual

.com
24. Dhargave P, Sendhilkumar R. Prevalence of

risk factors for falls among elderly people
living in long-term care homes. Journal of
Clinical Gerontology and Geriatrics.
2016;7(3 ):99-103.

25. Fall Risk assessm ent Tool (FRAT)
[Internet], Health.vie. 2000 [cited 23
N o v em b er 2016]. A v ailab le from:
https://www2.health.vic.gov.au/about/publ
ications/policiesandguidelines/falls-risk-
assessment-tool

26. Gu Y, Balcaen K, Ni Y, Arnpe J, Goftin J.
Review on prevention of falls in hospital
settings. Chinese Nursing Research.
2016;3(1 ):7-10.

27. Gallardo M, Asencio J, Sanchez J.
instruments for assessing the risk o f falls in
acute hospitalized patients: a systematic
review and meta-analysis. BMC Health
Services Research. 2013.

28. Lee A. Preventing Falls in the Geriatric
Population. The Permanente Journal.
2013;:37-39.

29. Morse Fall Scale [Internet], [cited 16
N ovem ber 2016], A v a ilab le from:
http://www.networkofcare.org/library/Mor
se%20Fall%20Scale

30. Falls and related injuries in residential
care:A fram ew ork and to o lk it for
prevention [Internet], [cited 21 November
2016]. Available from: http:// www.
in ju r y r e s e a r c h . b c .c a /d o c s / 3_
20110811 100931Residential%20Care%2
0Framework_Aug%2010_2011

31. Care Management and the Future of Health
Care [Internet], 2012 [cited 29 November
2 0 1 6 ] . A v a i l a b l e f r o m :
http://www.wipro.com/documents/resourc
e – c e n t e r / C a r e _
Management_and_the_Future_of_Health_
Care .

32. Frameworks of Integrated Care for the
Elderly: A Systematic Review [Internet],
[cited 29 November 2016]. Available from:
http://www.cpni.org/documents/49813 E
N

33. STEADI Initiative for Health Care
Providers | STEADI – Older Adult Fall
Prevention | CDC Injury Center [Internet],
Cdc.gov. [cited 21 November 2016].
A v a i l a b l e f r o m :
https://www.cdc.gov/steadi/

34. Health & Aging [Internet]. National
Institute on Aging, [cited 22 November
2 0 1 6 ] . A v a i l a b l e f r o m :
https://www.nia.nih.gov/health

35. Falls Prevention Programs [Internet].
NCOA. 2016 [cited 21 November 2016].
Available from: https:// www. ncoa. org/

18 JK-Practitioncr Vol.22, No ( I -2) January – June 2017

https://nihseniorhealth.gov/falls/causesand

https://en.wikipedia.org/wiki/Sedentary

http://www.apa.org

http://www.healthknowdedge.org.uk/public

https://www.healthypeople.gov/2020/topic

http://www.partners.org/cird/FallsPreventi

https://www2.health.vic.gov.au/about/publ

http://www.networkofcare.org/library/Mor

http://www.wipro.com/documents/resourc

http://www.cpni.org/documents/49813

https://www.cdc.gov/steadi/

https://www.nia.nih.gov/health

review

h e a lth y -a g in g /fa lls -p re vent io n /fa 11s-
prevention-programs-for-older-adults/

36. Falls & Otago Resources — cgec [Internet],
Med.unc.edu. [cited 14 November 2016],
A v a i l a b l e f r o m :
https://www.med.unc.edu/aging/cgec/exer
cise-program

37. Danielsen A, Olofsen H, Bremdal B.
Increasing fall risk awareness using
wearables: A fall risk awareness protocol.
Journal o f Biom edical Inform atics.
2016;63:184-194

38. S te p p in g On | W IHA [ I n te r n e t] .
Wihealthyaging.org. [cited 21 November
2 0 1 6 ] . A v a i l a b l e f r o m :
https://wihealthyaging.org/stepping-on

39. The Otago Exercise Program reduces falls
among older adults — News Room – UNO
H e a l t h C a r e [ I n t e r n e t ] .
N e w s .u n c h e a lth c a re .o rg . [c ite d 24
November 2016]. Available from: http://
n e w s , u n c h e a l t h c a r e .
o rg /n ew s/2 0 1 3 /sep tem b er/th e-o tag o –
exercise-program -reduces-falls-am ong-
older-adults

40. Voukelatos A, Cumming R, Lord S, Rissel
C. A Randomized, Controlled Trial of tai chi
for the Prevention of Falls: The Central
Sydney tai chi Trial. Journal of the
A m e r i c a n G e r i a t r i c s S o c i e t y .
2007;55(8): 1185-1191.

41. Choi J, Moon J, Song R. Effects of Sun-style
Tai Chi exercise on physical fitness and fall
prevention in fall-prone older adults.
J o u r n a l o f A d v a n c e d N u r s i n g .
2005;51 (2): 150-157.

42. Y.Angela Marrow,R.N,Fall Prevention
,Basic Very Well Home Safety For Care
Giver,Updated January 20,2016

43. Davis JC, Robertson MC, Asha MC, LIu-
Ambrose T, Khan KM, Marra CA.
International comparision of cost of falls in
older adults living in the community: a
systematic review. Osteoporos Int. 2010;
21:1295-305

44. Shamsi SKhan S. Fall Prevention Efforts in
G e r i a t r i c P o p u l a t i o n Fu l l Text .
2014; 1 (2/3): 1-10.

JK-Practitioner Vol.22, No (1-2) January – June 2017 19

https://www.med.unc.edu/aging/cgec/exer

https://wihealthyaging.org/stepping-on

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individual use.

Use of Information Technology for Falls Detection
and Prevention in the Elderly

Oladele Ademola Atoyebi & Antony Stewart &
June Sampson

Published online: 25 September 2014
# Springer Science+Business Media New York 2014

Abstract This research aims to clarify the arguments in the body of knowledge on
IT use in fall prevention among the elderly, synthesize ideas to assist in the
delivery of healthcare to prevent falls in older people and further add to the
available body of knowledge. An extensive literature search was carried out and
the information retrieved from the literature was synthesised into paragraphs using
themes to structure the types of information technology used for falls prevention.
The different modalities of IT used in falls prevention at the different places of
care for each category were explored and inferences were drawn from the struc-
tured themes which summarized the major findings. The research found that there
is potential ground for a wider use of the forms of IT used in falls prevention in
the elderly in various settings and outlined the factors involved in this usage. With
further refinements in larger studies, many of these forms of IT would be better
explored and acceptance is likely guaranteed provided they are accessible and
affordable. The need for IT use in fall prevention in the elderly is unavoidable
with the trend in technology and the associated convenience. More work is needed to
further define the effects of IT in falls prevention using larger prospective studies that
will be more generalizable.

Keywords Information technology. Falls prevention . Elderly. Active ageing

Ageing Int (2015) 40:277–299
DOI 10.1007/s12126-014-9204-0

O. A. Atoyebi (*)
Department of Community Medicine, Federal Medical Centre, Ido-Ekiti, Nigeria
e-mail: delato_pet@yahoo.com

A. Stewart: J. Sampson
Faculty of Health Sciences, Staffordshire University, Staffordshire, UK

A. Stewart
e-mail: antony.stewart@staffs.ac.uk

J. Sampson
e-mail: j.c.sampson@staffs.ac.uk

Introduction

Information Technology (IT) has been put to several uses, creating speed, comfort and
efficiency in service delivery in its various applications. It has served several functions
all through its evolution and its use in healthcare is increasingly being linked to
advances in the field of medicine. This can be exemplified by the higher quality of
health care delivery in more technologically advanced countries when compared to the
developing world (Tomasi et al. 2004). Information technology includes any part of the
hardware or software used to store, retrieve, and manipulate information (Alexandrou
2011) and it has helped patients and healthcare workers to communicate faster and
monitor treatment processes with ease (ADHA 2003). Particularly important is the use
of various forms of IT in delivering healthcare to the aged. For many aged care service
providers, the use of information technology offers many benefits in terms of efficiency,
resident care and safety (ADHA 2008).

Falls are the leading cause of injury-related deaths in the ageing population
(Weber et al. 2008). Approximately 51 % of residents in long-term care facilities
fall at least once each year with ten percent to 25 % of these falls resulting in
serious injuries (Scott et al. 2003) while 30–40 % of community dwelling older
adults have been estimated to fall each year (Moyer 2012; Rao 2005). Also, an
analysis of research on preventing falls in older people showed that falls place a
financial burden on the individual and the community (ADHA 2004). It was
estimated that falls in those aged above 65 costs the NHS £4,600,000 each day
(Age UK 2010).

Significant gaps exist in research on effective falls prevention and few studies exist
that demonstrate the successful translation of evidence to practice (Scott et al. 2007).
Further research is justified to clarify the impact of IT strategies to optimise care for
people with tendencies to fall (Gillespie et al. 2009). There is a need to explore the
benefits of information technology in preventing falls in the elderly (Leitch et al. 2010),
and it is important to identify methods for improving uptake and ongoing participation
by older people in recommended fall prevention actions (ADHA 2004). Scott et al.
(2003) in their published review on best practices in falls prevention also recommended
further research on falls prevention interventions and their effect on different sub-
populations of seniors.

Potentially, IT strategies aimed at optimising care and preventing falls in the elderly
offer significant contribution to effectiveness of health services. While a prelimi-
nary search revealed that a review on the use of information technology for falls
prevention in the elderly has not been published, this study explored the different
ways information technology is being used and its benefits in falls prevention in
the elderly. This study is a contribution to understanding the benefits of IT use in
falls prevention in the elderly.

This review is theoretical in nature and is intended to adopt a textual approach to
elucidate contentious areas in the body of knowledge on the use of information
technology for fall prevention in the elderly and also provide new conceptual insights
into such knowledge. This research summarized and critically analyse current knowl-
edge generated by basic science as the foundation of future scientific and clinical
advancement because an understanding of the current state of knowledge is a prereq-
uisite for further studies. It also aimed to clarify and perform a critical analysis on the

278 Ageing Int (2015) 40:277–299

arguments in the body of knowledge on IT use in falls prevention among the elderly,
offer ideas to assist in the delivery of healthcare to prevent falls in older people and
further add to the available body of knowledge. This is because a sound theoretical base
is considered vital to the design of complex interventions and in explaining likely
mechanisms for success (Wilson and Petticrew 2008).

Methodology

Search Strategy

A number of databases were used in the search for relevant academic published articles
including BMJ, Oxford Journals, Sage journals, PubMed, Scopus, Embase, Cochrane,
Sumsearch, Uptodate, Web of Science, Medscape, MD Consult, Ovid MEDLINE,
Cinahl, African HealthLine, MagNet, Asian Journal of Social Sciences, Google scholar
and Web of Knowledge. Bibliographies cited within references, Internet Evidence
Based Medicine Resources and text book sources were also used. Searches for grey
literature on the topic area were conducted using Google. Articles for this review were
drawn from peer-reviewed journals, conference papers, consumer studies, health pro-
fessional studies, research by recognised independent institutions as well as systematic
and narrative reviews of the various related topics.

A broad range of databases were chosen because studies on this title might be
referenced in non-academic databases.

Search Terms

The terms used for search purposes were: elderly, health, internet, falls prevention, use
of information technology, online health information, e-health and aged care.

Exclusion/Inclusion Criteria

The literature review focused on research published from 2002 to November 2012.
This time interval was chosen because of the bulk of the published materials on the
topic and because studies earlier than 2002 would give references that may no longer be
relevant to the current technology. The study therefore excluded research works
published before 2002. Studies from any country, exploring the use of information
technology in preventing falls among the aged and dealing with the research question
were included. The studies included were only those that have been carried out on
patients aged 65 and above who are classified as ‘elderly’ by the World Health
Organization (WHO 2001, 2008). Papers that are not relevant to the topic or that are
duplicates of other articles were excluded. The search was also limited to studies
published in English because it is the commonest language used in international
conferences and seminars worldwide (Moher et al. 2003) and yielded adequate litera-
ture for this review. This language limit also reduced the complications, time and
resource consumption that may arise from interpretation of other languages and as well
reduced information that might be hard to compare (CRD 2009). A diagrammatical
illustration of the exclusion process is rendered in Fig. 1.

Ageing Int (2015) 40:277–299 279

Search Results

This search strategy yielded 337 articles and these were examined in order to assess
their suitability. In total, 88 articles met the criteria for this review after eliminating
duplicates.

Citations located by the search were sifted through and a first decision was made
based on titles and, where available, abstracts. These were assessed against the outlined
inclusion and exclusion criteria, and the research question. An article that did not meet
the inclusion criteria was rejected. Rejected articles that were clearly not relevant were
recorded as irrelevant studies while those that addressed the topic of interest but failed
on one or more inclusion criteria were noted as such. For studies that appeared to meet
the inclusion criteria, or in cases when a definite decision could not be made based on
the title and/or abstract alone, the full paper was obtained for a full assessment against
the inclusion criteria.

Narrative Synthesis

The information retrieved from the literature was synthesised into comprehensive
paragraphs using a narrative approach (Popay et al. 2006). Themes were used to
structure the types of information technology used for falls prevention and categorise
them under some likely places of falls of the elderly: falls at home, falls in a nursing

Total number of abstracts found

= 337 Excluded after first refinement= 192
• Published before 2002= 86
• Meant to promote specific IT product= 9
• In language other than English= 7
• Without enough details /Unable to

obtain further information required to make

and assessment= 85

• Duplicates of other articles= 5 .

Documents retrieved for more details

= 145

Documents found and added from list of references

of products of initial search= 16

Further search= 34

Excluded after second refinement=107

• (Without enough details /Unable to
obtain further information required to make

an assessment)

Total publications included in the review

= 88

Fig. 1 Diagram showing path of document selection

280 Ageing Int (2015) 40:277–299

home or hospital. These described the different modalities of IT use in falls prevention
at the different places of care.

The different methods and types of IT use in falls prevention for each category were
explored. The literature was interpreted along with the quality assessment of the papers.
This assessment was done with a narrative overview rating scale which was obtained
from the clinical update of Green et al. (2006).

Literature Review—Preventing Falls at Home

There are several IT methods and tools that have been tested or used in falls prevention
while maintaining the ability of the elderly to grow old at home (ageing in place) and
they are discussed in the following paragraphs.

The Telephone in Falls Prevention

The use of telephones as a form of IT in falls prevention has been explored in several
ways. A fall risk model constructed by Stalenhoef et al. (2002) using telephone calls for
follow-up helped to monitor risk prone elderly patients in their homes and information
about fall determinants were gathered. This model facilitated the prediction and
prevention of falls and is an easily accessible means of IT for use in preventing falls,
as telephones are available to most individuals and are easy to use. An evaluation
carried out by Dai et al. (2010) on the use of Android phones as a platform for detecting
falls also revealed a high level of fall detection performance. This result is similar to
that obtained from the Telecare program to improve care for falls at a Veterans Affairs
healthcare facility described by Miake-Lye et al. (2011). The Telecare program used a
nurse advice telephone line to identify patients’ risk factors for falls and to triage
patients to appropriate services. Although only 35 out of the 113 patients considered for
inclusion participated during the lifespan of the project, medical record review showed
that the system enhanced usual medical care with respect to home safety counselling
and helped veterans maintain a higher level of safety. A modification of this system had
been used in Thailand by Assantachai et al. (2002) who recruited 1,043 elderly subjects
living in the urban area around a hospital for a study with 585 of them allocated to the
study group and 458 subjects to the control group. A leaflet containing information on
important risk factors of falls within their community was enclosed with a follow-up
postcard in the study group only. All respondents received a postcard asking about
any falls which had occurred over the previous 2 months on six occasions and a
telephone call if the postcards were not returned to the team. The percentage of
elderly who kept in contact was 92.5, 90.6, 89.3, 89.2, 86.2 and 85.45 % for the
first to final follow-up respectively. After 1 year of longitudinal study, the overall
incidence of falls was 6.6 % in the study group and 10.1 % in the control group.
This modification is a cost-effective method of preventing falls as leaflets can be
easily supplied to patients and followed up with phone calls. Illiterate patients
however may find it difficult to read from leaflets and benefit from this programme.
This can be solved by having the leaflets translated to the local dialects of the
patients and the healthcare worker or literate relative of the patient may also read
and explain the contents of the leaflets.

Ageing Int (2015) 40:277–299 281

A difficulty that users of telephones for falls prevention may face is the fluctuation in
network signals that may arise especially in severe weather conditions and this may prove
to be a significant disadvantage in periods of need. Also, elderly residents of areas not
reached by telephone networks especially in rural communities of developing nations may
not be served by such technology. However, it is expected that telephones would be easy
to use and beneficial to the elderly provided that telecommunication companies and
service providers can maintain good network service to as many areas as possible.

Smart Home Technology and Wireless Sensor Network

It has been observed that many people prefer to grow old at home (Cheek et al. 2005).
Smart home technology facilities would aid ageing-in-place by assisting patients
with emergency assistance, fall prevention/detection, reminder systems, medication
administration and assistance for those with hearing, visual or cognitive impair-
ments. The benefits of this technology include continuous monitoring and improved
psychosocial effects to make ageing-in-place a reality.

A wireless sensor network (WSN) can be used in smart homes monitoring and it
consists of spatially distributed autonomous sensors to monitor physical or environ-
mental conditions, such as temperature, sound, pressure, etc. and to cooperatively pass
their data through the network to a main location (Surie et al. 2008). The WSN is built
of “nodes” connected to a sensor with each node typically having several parts: a radio
transceiver with an internal antenna or connection to an external antenna; a microcon-
troller; an electronic circuit for interfacing with the sensors; and an energy source,
usually a battery (Debnath et al. 2012) (Figs. 2 and 3).

Tyrer et al. (2006) explored the use of sensors to monitor the activities of the elderly
and prevent falls while they live in their homes by measuring motion, footfalls, sleep
and restlessness through sensors and sensing mats, all connected wirelessly to a
computer. This study focused on offering the elderly ‘ageing in place’ and allowing
them to have control over their privacy and treatment while providing substantive
improvement in quality of life. Measurements of motion, footfalls and sleep patterns
with the sensor network are a substitute for some monitoring functions of a caregiver
and would relieve the burden of patient care. Workload on caregivers and functional
decline of patients would be reduced as data collected are continually used to implement
interventional programmes. Also, the wireless models presented by Fernandez-Luque

Fig. 2 A simple wireless sensor network (VTT 2013)

282 Ageing Int (2015) 40:277–299

et al. (2010a, b) for detecting falls in the elderly were based on nodes that hopped radio
messages to a base station where they were passed to a personal computer. These
systems assist the user without the need to wear a device, a contrast to the modified
fall detection sensor device created by Eklund et al. (2005) which has to be placed on the
user’s hip like a waist belt. Although this device provides continuous and instantaneous
data corresponding to the changes in the user’s body and it facilitates the safety, security,
and continuous and accurate supervision of a constant care environment, the user must
remember to wear it. When the subject moves around at night-time, such as making a
trip from the bedroom to the toilet, it is unlikely that they would remember or even feel
an inclination to wear such a device. Ariani et al. (2010) investigated the potential
usefulness of an unobtrusive fall detection system, based on the use of passive infrared
sensors (PIRs) and pressure mats (PMs) that detected falls automatically by recognizing
unusual activity sequences in the home environment (Table 1).

Fig. 3 A multi-hop network (SensLAB 2013)

Table 1 Sensitivity, specificity and accuracy of a sensor based algorithm (Ariani et al. 2010)

Sensitivity (the ability of the system to detect actual falls when they occur) 100 %

Specificity (ability of the system to detect a ‘no fall’ situation when the subject has not fallen) 66.67 %

Accuracy 90.91 %

The system reduced the ‘long-lie’ scenario (inability to get up from the floor after a fall, followed by lying on
the floor for 60 min, or more) after a fall

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The specificity of this system is relatively low and false positives could be high such
that falls alarm are triggered when falls have not occurred. This could be improved by
using algorithms with higher differentiating capacities. Since patients do not need to
wear any device, it would help prevent falls in frail geriatrics patients and those
suffering from dementia. However, the cost and availability of WSNs are major
concerns of this technology (Cheek et al. 2005). It would be useful for further research
studies to be carried out on WSNs to explore cheaper components so as to make
feasible its applicability in low income households. Sensors can be improved to cost
less and weigh less with batteries lasting longer. It is important to consider the cost and
sustainability when selecting WSN for use as long as reasonable quality and function
are not compromised.

Artificially Intelligent Camera-Based System

A method to detect falls with a multiple camera system without any wearable device
was proposed by Auvinet et al. (2008). The system used image analysis to localise
people and reconstruct their 3D shape and position while cameras shared a large
common field of view and detected fall positions. Experimental results obtained with
14 different fall scenarios and 14 normal daily activities showed a 100 % fall detection
efficiency. Similarly, Wang et al. (2010) conducted experiments using inexpensive
webcams for extracting body sway parameters from a three-dimensional reconstruction.
Subjects stood and swayed in the anterior–posterior direction and then in the lateral
directions with two different frequencies. On computer software, the images taken from
the cameras are used to construct a three-dimensional representation of the markers,
noting the position of the subject. The development of this technology provides potential
capability of measuring body sway in daily living environment for elderly people, and
can be used as part of a balance, stability and fall risk assessment tool. Swaying can be
captured and assessed for fall risks in elderly patients for whom interventions can be
designed to prevent falls. A Camera based systems is particularly important for an
elderly person who has suffered a fall because such may lie on the ground for a long
period of time before proper healthcare would arrive, a major risk factor, particularly for
the elderly living alone. The system is automatically activated and reliable for prompt
detection of falls, injury limitation and prevention of possible subsequent falls.

Digital Video Disc (DVD) and Game-Based Measures

Technology created for informative entertainment and recreation like the DVD and game
consoles can be utilised as a tool in falls prevention. Yamada et al. (2011a) carried out a
randomized control trial to evaluate the effectiveness of a DVD-based dual-task (DT)
stepping exercise to improve the DT walking capability in elderly people. Dual tasking
(DT), or engaging in two activities at the same time, is common in daily living. With
advancing age, the addition of walking to activities of daily living involving DTcan create
difficulties that lead to complex multi-task situations, thus increasing the risk of falling. If
DT is improved, it helps the subject to concentrate and have greater control on his
surroundings thus reducing the incidence of falls (Silsupadol et al. 2006) (Table 2).

In another study, Yamada et al. (2011b) carried out a game-based assessment with
the purpose of examining whether the Wii Fit program can be used for fall risk

284 Ageing Int (2015) 40:277–299

assessment in healthy, community-dwelling older adults. The 45 elderly women who
were included in the trial were aged 65 years or older and community-dwelling. A
peripheral Wii Balance Board is available with the Nintendo Wii video game console. It
is a wireless device that can be powered for up to 60 h with four AA batteries and
communicates via Bluetooth with the Wii console. It has four pressure sensors situated
at each corner from which enough information is available to obtain calibrated readings
on changes in user’s standing posture. The Wii Fit program requires the distribution of
attention to a motor task and the monitor (cognitive task). Thus, it is assumed that the
Wii Fit program includes a constituent of DT.

Websites

The internet is a vital tool for delivering health promotion and prevention strategies.
Internet-based health prevention aims not only to reach a wider population more
efficiently, but also to sustain effective communication between patients and the
healthcare professionals that take care of them. In addition, the Internet gives unlimited
possibilities for finding health information and offers access to knowledge and em-
powerment (Alpay et al. 2004). The internet is also a system that the elderly can use
themselves if they have access to simplified information, websites and technology. A
survey of 500 elderly people (65 and above) living in Lisbon, Portugal revealed 72 %
owned a mobile phone, 13 % used computers, and ten percent used the Internet. The
same survey revealed the elderly were willing to learn how to use computers and the
internet if properly guided. Programmes can be targeted at training the aged on how to
use computers and health care providers can put information on the web which can be
read and utilised.

Websites have been developed to target the elderly population for effective preven-
tion of falls. For example, the NHS has websites that can be accessed by older persons
for information on healthcare (Brzezinski 2009) and the Dutch ‘SeniorGezond’ website
is also focused on the elderly population in the domain of fall prevention (Alpay et al.
2007a). Nyman and Yardley (2009) accessed the usability and acceptability of a
website that provides older people with tailored advice to help motivate them to
undertake physical activities that prevent falls. Views on the website from interviews

Table 2 DVD-based DT exercise trial (Yamada et al. 2011a)

DT group Control group

Prescribed activity 20 min of group training twice a week using an exercise
DVD that included a 15-min basic exercise and a 5-min
DT exercise

Nil exercise programme

(Dual task involved verbal task and quick stepping)

Duration 24 weeks 24 weeks

Clusters 4 4

Sample size (n) 48 45

The median relative adherence to the study was 87.5 % in the DVD group and the outcome measurements,
including the DT walking capability among participants in the DVD group were significantly improved
(p<0.05)

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with 16 older people and 26 sheltered housing wardens were analysed thematically.
The website was well received with only one usability difficulty with the action plan
calendar. The older people selected balance training activities out of interest or enjoy-
ment, and the wardens were motivated to promote the website to their residents. Studies
like this would help website developers to improve on areas of need. According to
Tinetti (2003), it is important to consider putting several aspects of falls prevention into
broadcast/website with well integrated message of healthcare teaching for elderly
citizens taking medications that can make them more susceptible to falls. The doctors
prescribing these drugs and the patients using them need to be informed about the risks
of falls associated with them as well as the precautions to follow to avoid falls.

A disadvantage in relying on the internet for falls prevention was investigated by
Whitehead et al. (2012) who stated that “websites have fallen short of their potential to
provide accessible, evidence-based information on the risks of falls and their preven-
tion” despite noting that increasing numbers of older people are accessing the internet
for health-related information. Forty-two websites were identified using popular search
engines and were assessed using evidence-based guidelines and codes of conduct on
coverage of falls-related information, credibility and senior friendliness. Overall, scores
were poor for coverage of falls information and credibility, although they were higher
for senior friendliness. Few of the websites had been recently updated and none
provided individually-tailored advice.

Another disadvantage in solely relying on the website in falls prevention unlike
other forms technology described is that it is dependent on the patient being able to
access it. Elderly citizens that are not computer literate or have some limitations in
using a computer may not be able to utilise it. Even seniors who are computer literate
may find navigation difficult on a website. They may also have problems in evaluating
health information, assessing good quality information and understanding the informa-
tion retrieved (Alpay et al. 2007b) Generally though, it still remains advantageous and
could positively complement other forms of information technology in falls prevention
especially as many patients are more involved and take an active role in deciding about
and planning their care (Evans et al. 2003). There is an increased awareness amongst
the elderly population that although they may have health problems, they can take
action to live healthy. As the ageing population is rising and health costs become more
expensive, health professionals and policy makers are often stimulating this attitude and
the need for more prevention and self-management. Appropriate information organised
in a meaningful way should be made available to the elderly. Websites intended for falls
prevention should be made simple, easy to access and preferably equipped with a
navigation guide for the elderly population. The information given should be two-way
with the healthcare giver supplying information on falls prevention and also getting
information on website usability from the users.

In-Patient Settings—Hospitals and Nursing Homes

In-patient falls are relatively common and are widely recognized as causing significant
patient morbidity and increased costs of care (Bates et al. 2003). Risk of falls increases
markedly with age (Dykes et al. 2010) and hospitalization further increases risk of the
unfamiliar environment, illnesses, and treatments. Various ideas are being offered that

286 Ageing Int (2015) 40:277–299

would provide the appropriate level of care in nursing homes and hospital settings in a
more efficient manner by taking advantage of current technologies.

Cameras

Cameras can be used to monitor elderly in-patients so as to prevent falls. Oggier et al.
(2003) developed a toolbox for the automatic monitoring of elderly residents in a
nursing home (or in the natural home environment) that monitors patients’ activity
patterns and the changes associated with such patterns rather than monitoring vital
signs or other biomedical parameters. The information on activity is derived from
visual information using image processing algorithms while the visual information is
acquired using 3D camera technology. The system is highly accurate and can monitor
patients and detect various falls positions. By incorporating this technology into the
unobtrusive fall detection system (WSN) described by Ariani et al. (2010), the
specificity of that system could be improved since the cameras are meant to record
whatever is in their view and the likelihood of misinterpreting a standing position
for a fall is low. Using cameras in a falls detection system has an added advantage
of automatically monitoring people without the need for victims to initiate a call for help.
Studies based on a similar principle of automation have been carried out by Belshaw
et al. (2011) who used a frame that classifies positions of the subject into fall and no-fall
positions and sends signals to the computer if the fall position is detected. The patient
does not need to remember to wear a device because the system is an automatic
emergency response type which has a wide field of view that can capture activities in
a single large room, is able to operate effectively under moderate lighting changes and is
able to handle multiple active movements as well as fall postures on the floor. The
technology could be improved and explored for a wider scope of use in falls prevention
in older person’s nursing homes.

Accelerometers and Sensors

Sensor-based IT devices are also useful in the nursing home environment for
preventing falls in the elderly. A device capable of automatically detecting a fall with
loss of consciousness (FLoC) and activate an alarm by means of an accelerometer
sensor was designed and tested by Quagliarella et al. (2008). Of all the 400 trials
performed by 20 participants (10 young and 10 elderly adults), all FLoC cases were
correctly detected using this method thereby supporting its usefulness in preventing
falls. The algorithm used relied on the recognition of the effects of three events
characterizing a FLoC: impact of the body against the ground, lying down and
immobility. Likewise, other studies have shown the applicability of accelerometry to
detect persons with a high fall risk. Marschollek et al. (2008) provided a simple
unsupervised method to assess the fall risk of elderly persons as measured by reference
clinical fall risk assessment scores. Parameters computed by analysis on accelerometer
data recorded in a clinical setting were used, and they were evaluated using simple
logistic regression (statistical process for estimating the relationships among variables
which helps one understand how the typical value of the dependent variable changes
when any one of the independent variables is varied) with reference to three clinical
reference scores. The overall prediction accuracy of the models ranged from 65.5 to

Ageing Int (2015) 40:277–299 287

89.1 %, with sensitivity and specificity between 78.5–99 % and 15.4–60.4 %, respec-
tively. These results showed that a simple method can be used to detect persons with a
high fall risk with a fair to good predictive accuracy when tested against common
clinical reference scores. The specificity is low and the number of false positive results
would be high. Further modifications and studies are indicated to improve the
specificity of falls detection using this device. Such modifications have been done on
other technologies for falls prevention. Brown (2005) developed and conducted a
research on a rectangular sensor board which was designed to monitor continuous
acceleration on a sensor device placed on the waist while the values registered by this
device is used to monitor falls in the elderly. The idea was a modification on the wrist
version of the sensor device which was dropped and tried on other body parts because
of the unpredictability of a user’s motor response in the case of a fall and inaccuracy of
a wrist sensor’s falls detection capabilities as the arm continuously moves (Eklund et al.
2005). The waist was then concluded as the most stable position to monitor movement
using the sensor board after several tests were conducted with it in various positions
such as the chest, the neck, and the waist. Marschollek et al. (2011) also conducted a
study with 119 geriatric inpatients wearing an accelerometer on the waist and results
obtained suggest that accelerometer data may be used to predict falls in an unsupervised
setting and the parameters used for prediction are measurable with an unobtrusive
sensor device during normal activities of daily living. Such reliable automated fall
detection can increase confidence in people with fear of falling, promote active safe
living for older adults, and reduce complications from falls.

As many of the falls detection systems use accelerometers attached to the torso, Sim
et al. (2011) went further to place accelerometers on shoes to detect falls in the elderly.
The shoes were preferred to make the device easy to carry as it was perceived that the
elderly would feel uncomfortable when banding a sensor on the chest every day. Also,
Noury (2002) had previously given a proposition of a fall sensor principle integrated in
a garment. Various positions for the sensor have been favoured by different researchers
with reasonable and scientific explanations. Regardless of the sensor site, the system
should be designed with convenience, effectiveness and affordability in mind.

Electronic Walkway

An electronic walkway system was designed to measure gait parameters to predict
short-term fall risk in nursing home residents with dementia in a prospective cohort
study conducted by Sterke et al. (2012). Measurements were collected every 3 months
over a 15 month period from 57 ambulatory nursing home residents with moderate to
severe dementia, with each measurement being a baseline for the subsequent measure-
ment. The predictive validity of the walkway system, the GAIT Rite® walkway system
(a portable computer based electronic roll-up walkway with an overall dimension of
823×90×0.6 cm connected to a personal computer with application software for calcu-
lation of temporal and spatial parameters of gait) was expressed in terms of sensitivity and
specificity while logistic regression analysis was conducted to examine the association
between these parameters and falls occurrence within each 3 months for which measure-
ments were collected. The best predictive values were a velocity of 68 m/s (with a
sensitivity of 82 % and a specificity of 52 %) and a mean stride length of 85 cm (with a
sensitivity of 86 % and a specificity of 52 %). It was found that gait parameters as

288 Ageing Int (2015) 40:277–299

measured with the electronic walkway system can be used for the prediction of short-
term fall risk in nursing home residents with moderate to severe dementia. This
would in turn help prevent falls among such residents. However, the sample size of
57 ambulatory patients used in the research by Sterke et al. (2012) was relatively
small and studies with larger sample sizes will help to increase the precision of their
findings and as well increase the applicability of seemingly positive findings to a
larger population.

Bed-Exit Alarm System

Bed alarm systems are built to detect a person making attempt to get out of bed thereby
making it easy for the caregiver to monitor them closely and prevent unguided move-
ments that could lead to falls. Major identified requirements for an optimized bed-exit
alarm system were usability, wide range usage, low costs, hygiene factors, integration into
nursing beds and nurse call systems and an adequate alarm/false alarm ratio with early
alarm trigger functionality (Yuki 2002). On the basis of the criteria mentioned above,
Hilbe et al. (2010) developed an integrated bed-exit alarm system and collected data
regarding preliminary sensitivity and specificity for alarm set-off. Both the preliminary
sensitivity (96.0 %) and the specificity (95.5 %) of the trigger level indicate a satisfactory
alarm/false alarm ratio. In general, it was observed that bed-exit alarm systems with
extended features could play a major role in ambient assisted living technologies.
However, besides the theoretical evaluation, it is necessary to perform more tests and to
gather more data about the effect of bed alarm system on fall rates and resulting injuries.
This system may also need to be adequately evaluated for applicability to the restless, light
weighted individuals, uncooperative patients, incontinent and confused patients. Other
new technologies make use of adjustable sensor pads fixed with an alarm system that
connects to the nurse call system to alert staff when at-risk patients attempt to exit the bed
unaided. The sensor pads and alarm systems that have been used in pilot studies were
fixed to beds or chairs in patients’ rooms (Poe et al. 2005). This may however be abused
as the staff may feel that when patients were placed on beds or chairs with activated fall
alarms, the periodic checks that they would ordinarily need to carry out in lying-in wards
may not be necessary. This may create a problem for patients who require these checks for
their safety. Such patients as are comatose, completely paralyzed, or completely
immobilized need basic safety interventions and it is important to define situations in
which the use of alarm systems and sensor pads would still require close monitoring and
frequent periodic checks. Overall, alarm systems that notifies the caregiver when a patient
attempts to leave the bed or chair are better preventive measures than those that alerts
when the patient has fallen. This is not to say that the latter has no place in the care of
elderly patients. For example, Li et al. (2010) developed an acoustic fall detection system,
FADE, which automatically detects a fall and reports it to the caregiver, thereby giving the
patient a chance to be urgently attended to. Alerting the caregiver after a fall may help
limit injuries and their impacts.

Fall Prevention Software

Software can integrate existing communication patterns into a health information
technology application for falls prevention. Dykes et al. (2010) designed a falls

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prevention toolkit (FPTK) software which produced bed posters composed of brief text
with an accompanying icon, patient education handouts, and plans of care, all com-
municating patient-specific alerts to key stakeholders. Cluster randomized study was
conducted from January 1, 2009 through June 30, 2009, comparing patient fall rates in
four urban US hospitals (Table 3).

These results supported earlier findings by Browne et al. (2004) on using informa-
tion technology to redesign a fall prevention program for adult in-patients using a
computerized information system for which the tool (ADAPT Fall Tool) provided an
accurate assessment of the fall risk of each patient. Indicators embedded into routine
assessment documentation for each patient and tailored interventions for specific
patient risks helped to significantly reduce fall risks. Furthermore, fall risk information
gathered can easily be integrated into the geriatric patient care plan.

Data Mining

Data mining is the process of finding correlations or patterns among dozens of fields in
large relational databases that includes data preparation, selection, cleansing, incorpo-
rating prior knowledge on data sets and interpreting accurate solutions from the
observed results (Frand 2009). The process entails analyzing data from different
perspectives and summarizing it into useful information. A widely used technique in
data mining is the knowledge discovery in database (KDD) process (Fig. 4) which
generates models that can predict the likelihood of falls among the elderly who reside in
long-term care facilities.

Volrathongchia et al. (2005) incorporated a data mining technique termed
Likelihood Basis Pursuit into the KDD process, applied it to a dataset and were able
to correctly identify which of the variables in this data set were associated with falls .
Falls can be predicted and mitigated using this model.

Factors Affecting Use of Information Technology for Falls Prevention
in the Elderly

Advances in information communications technology and related computational power
are providing a wide array of systems and related services to support the health, safety

Table 3 Result from use of fall prevention tool kit (Dykes et al. 2010)

Parameters Intervention (falls prevention programme
using FPTK)

Control (usual care)

Number of hospital units 4 4

Number of patients 5,160 5,104

Number of falls (p=0.02) 67 87

Site adjusted fall rates (95 %
confidence interval)

3.15 per 1,000 patient-days (2.54–3.90) 4.18 per 1,000 patient-days
(3.45–5.06)

The software was found to be particularly effective with patients aged 65 years or older (adjusted rate
difference, 2.08 [95 % CI, 0.61–3.56] per 1,000 patient-days; P=0.003)

290 Ageing Int (2015) 40:277–299

and independence of older adults. While these technologies offer significant bene-
fits to older people and their families, they are also transforming older adults into
lead adopters of a new lifestyle of being monitored, managed, and, at times,
motivated, to maintain their health and wellness. Healthy ageing advocates have
expressed support for technological advancements along with a variety of factors
that included usability, reliability, trust, privacy, stigma, accessibility and affordability
(Coughlin et al. 2007) (Table 4).

The design of a falls prevention systems and the position or site of the device
influenced the patient’s choice of one. Gövercin et al. (2010) conducted focus group
discussions with older adults and their relatives to guide the development of assistive
devices for fall detection and prevention in the home and to include these requirements
in a user-centred development process. A semi-structured interview format based on an
interview guide was used to conduct three focus group discussions with 22 participants.
The average age was 75 years in the first group, 68 years in the second group and
50 years in the third group (relatives). Participants widely considered a fall prediction
system to be as important as a fall detection system. Although the ambient, unobtrusive
character of the optical sensor system was appreciated, wearable inertial sensors were

Fig. 4 Knowledge discovery in database (Techopedia 2013)

Table 4 Comparison of the trial results of some IT methods used in falls prevention

Sensitivity (%) Specificity (%) Proportion of falls
detected (%)

Smart home technology 100 66.67

Artificially intelligent camera based system Not available Not available 100

Accelerators and sensors Not available Not available 100

Electronic walkway 86 52

Bed exit alarm 96 95.5

Ageing Int (2015) 40:277–299 291

preferred because of their wide range of use, which provides higher levels of security.
Security and mobility were two major reasons for people at risk of falling to buy a
wearable and/or optical fall prediction and fall detection device. The participants also
preferred design specifications that include a wearable, non-stigmatising sensor at the
user’s wrist, with an emergency option in case of falling. The study helped to sample
the opinion of the potential user of IT devices and would solve the problem that may
arise with user acceptance (one of the major problems in the development of informa-
tion and communication technologies for older adults).

Highly educated people were more in favour of a programme via Internet compared
with their lower educated counterparts. However, when diverse formats of effective
programmes are made available, uptake and adherence may be increased (Debnath
et al. 2012). Nyman and Yardley (2009) noted that while a minority of older people use
the Internet, some older people underestimated how much activity was enough to
improve balance, and others perceived themselves as too old for the activities. Also,
some verbal persuasion or physical cueing may be necessary in as many as 80.7 % of
older persons before participating in IT based studies aimed at falls prevention Sterke
et al. (2012). However, according to Whitehead et al. (2012), increasing numbers of
older people are accessing the internet for health-related information, including infor-
mation on falls risk and prevention and evaluated English-language websites offering
falls-related advice to members of the public. It has been deduced that older persons’
attitude to technology is healthy and they will try helpful approaches to protect
themselves from falling. Studies aimed at determining the attitudes, concerns and
impressions of the elderly and health care staff to IT use in health care yielded results
that showed the elderly support the use of IT for falls prevention (Tyrer et al. 2006). IT
reduces the workload on caregivers, fostering communication between residents and
family, and giving the elderly independence.

Awareness of the general population about IT available for falls prevention and the
effectiveness of an IT system will also aid its acceptability by potential users (Skelton
et al. 2004). A multifaceted program that utilized multiple personalized interventions
was more effective in reducing the falls rate of frail (those with complex medical and
psychosocial problems) nursing home residents (Theodos 2003). This kind of pro-
gramme will more easily be accepted by such residents and their families because of its
scientifically proven effectiveness.

Also, methods used in keeping health records may indirectly assist in ensuring
complete data on falls in the elderly are kept for proper decision making. For example,
e-coding of causes of death on fall death rates in the elderly helps to adequately identify
all fall related death rates, thereby accounting for actual fall mortality burden in the
elderly. Each unit increase in the median number of cause of death codes was
associated with a 10 % increase in the number of falls (Maresh et al. 2012). This can
assist policy makers as well as caregivers to direct fall prevention strategies appropri-
ately against specific fall risks.

The cost of falls detection and falls prevention technology is a very important
determinant of access to such. In communities where the government is absolutely
responsible for the healthcare of seniors, direct costs are not really borne by the
patients. The important task would be to convince decision makers to subscribe to
IT for falls prevention in the elderly. They will also need to employ well trained
personnel for proper application of the gadgets and tools. However, where payment

292 Ageing Int (2015) 40:277–299

for healthcare is mainly out-of-pocket, it is only those that can afford them that will
benefit from such technology.

Conclusion and Future Work

Introduction

In a general perspective of IT use, this research set out to add to understanding its
applications to falls prevention in its several forms alongside a concern about the
relevance and appropriateness of such uses. The study also examined the factors that
influenced the acceptance and use of IT in falls prevention and the effectiveness of the
different devices and methods.

Overview of the Research

Fall events constitute an important factor in terms of mortality, morbidity and costs in
the ageing population and these events have a high incidence especially in the elderly.
Falls in the elderly remain a leading cause of deaths due to injury and a major cost to
the health system despite being often preventable. The research aimed at clarifying the
claims and arguments in the body of knowledge on IT use in preventing falls among the
elderly, synthesizing ideas to assist in the delivery of healthcare to prevent falls in older
people using IT and further adding to the available body of knowledge as a basis for the
design of complex interventions and in explaining likely mechanisms for success.
Several IT methods aimed at optimising care and preventing falls in the elderly offer
significant contributions to effectiveness of health services. These methods and IT
equipments like cameras, telephones, sensors and software are essential in falls pre-
vention while maintaining the ability of the elderly to grow old at home.

Limitations and Difficulties

The initial hindrance that was encountered with the research was as a result of difficulty
to access the full text versions of certain important and needed abstracts. Those not
available through Athens were accessed through research gate and by contacting
authors personally. Authors contacted in all cases responded and shared full versions
of their papers. Restriction of the search to electronic database might have led to
publication bias as this approach is unlikely to identify studies that have not been
published in peer review journals, studies that have been published in non-electronic
journals or grey literature. The effect of this was reduced as much as possible by
accessing the National Technical Information Service (NTIS), the Health Management
Information Consortium (HMIC), the conference of papers Index and some non-
electronic journals. Although a systematic review would be preferable, a narrative
approach was used so as to fully interpret collected evidence and also because studies
on IT use in fall prevention in older persons might be too diverse to combine in a meta-
analysis (CRD 2009). Since meta-analysis was not carried out, the evidence based
precision that is associated with combining the data and results of several studies might
have been avoided. Nevertheless, the review led to an interesting and potentially useful

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focus on the capacity of researchers to carry out larger prospective studies on the use of
IT for falls prevention among older persons. This review also demonstrates the
relevance of a narrative approach in pooling literature for knowledge base and basis
for policy making. A narrative review is an essential part of a knowledge management
system which helps to pull many pieces of information together into a readable format
and summarise primary research findings which would be laborious to pick and read
from several published articles (Cipriani and Geddes 2003).

Potential Application of Learning from this Study

Certain Information Technologies are still untested in a larger population but have the
potential in reducing risks of falling. The cost of applying some of these technologies
for falls prevention seems to be high but cannot be compared to the huge cost of
treatment for injuries resulting from falls. IT initiatives need to be further explored and
managed with a focus on equally effective and cheaper alternatives that can be
implemented in low resource environments. This study suggests that this issue should
be a concern for all stakeholders including healthcare providers, governments and IT
firms without leaving out elderly citizens.

For healthcare organisations and their IT departments, there is a need to understand
flexible IT use without limiting the freedom and comfort of geriatric patients.
Healthcare workers need to be orientated on the feasibility and simplicity of these
technologies in preventing falls. For the elderly, there is need to sensitize them on the
applicability and simplicity of using IT in preventing falls. For IT firms and companies
the successes and limitations identified in this study should act as a pointer to areas
requiring further research.

Applications and Recommendation

Many of the researches described were carried out on small sample populations
(sample size was 20–119 for most) while only two had sample sizes of above 1,000
(n=1,043 and 10,264) in community based studies. There is a need to explore the
feasibility of applying the technologies to larger prospective studies. It would be
useful to build on the findings of this research by testing them in larger populations
and in healthcare settings. Generally, it is expected that telephone-based systems
would be cheaper and easy to use and beneficial to the elderly provided that
telecommunication companies and service providers can maintain good network
service to as many areas as possible.

Eliciting the views of IT departments of healthcare institutions, research institutes
and other stakeholders in IT firms would serve to strengthen the findings. Research that
compares cost-effectiveness and safety practices in relation to IT initiatives for falls
prevention would potentially highlight approaches that are easily acceptable by most.
Research into the relative benefits of different approaches to planning and implemen-
tation of falls prevention programmes for the elderly in home and institutional settings
could give rise to practical tools and guidance for IT developers, users and managers of
such processes.

Research that helps to articulate changes and challenges in assumptions, structures
and roles, and identifies useful strategies to support implementation and use of IT in

294 Ageing Int (2015) 40:277–299

elderly falls prevention will make a contribution to the effective deployment of recent
advances in information communication technology.

Conclusion and Future Work

From the discussions in this review, there is evidence that the need for IT use in falls
prevention in the elderly is unavoidable with the trend in technology development and
the convenience IT brings with the added advantage of preventing fall episodes and
their associated costs. More work is needed to get the true picture of the effect of IT in
falls prevention using larger prospective studies. Besides, this review has not made a
classification for falls in the elderly occurring in shopping malls, places of worship and
on streets. There are many places where falls can occur but the home, nursing homes
and healthcare facilities are regular places where the aged stay or visit. The potential
adaptation of successful IT use in these regular places to other sites where falls could
occur can be studied. The wearable sensors, camera based systems and the ubiquitous
monitoring systems or their modifications could be used in any of these places. The
feasibility of incorporating falls prevention strategies using IT into primary health care
should also be explored. Further studies, using larger sample sizes and appropriate
technology should be considered. The need to provide affordable, safe and effective
service to elderly patients through best practice will be the ultimate drive for the general
use of various cost-effective IT forms in falls prevention.

Conflict of Interest Atoyebi Oladele Ademola, Stewart Antony and Sampson June declare that they have
no conflict of interest.

Informed Consent As there is no person or personal data appearing in the paper, there is no one from whom
a permission should be obtained in order to publish personal data.

Ethical Treatment of Experimental Subjects (Animal and Human) No animal or human studies were
carried out by the authors for this article.

References

Age UK. (2010). Falls in the over 65s cost NHS £4.6 million a day. Available from: www.ageuk.org.uk/latest-
news/archive/cost-of-falls/. Accessed 30 May 2013.

Alexandrou, M. (2011). Definition of Information Technology. Infolific: tech (Online). Available from:
http://www.infolific.com/technology/definitions/computer-dictionary/information-technology/. Accessed
03 Jan 2013.

Alpay, L. L., Toussaint, P. J., Ezendam, N. P. M., Rövekamp, T., Graafmans, G., & Westendorp, R. (2004). Easing
Internet access of health information for the elderly users. Health Informatics Journal, 10(3), 185–194.

Alpay, L. L., Toussaint, P., Ezendam, N., Rövekamp, T., Westendorp, R., Verhoef, J., & Zwetsloot-Schonk, B.
(2007a). The Dutch Website ‘SeniorGezond’: An illustration of a road map for the informed patient.
Managed Care (online), 2. Available from: http://www.fmc.ch/uploads/tx_userzsarchiv/MC2-2007_
alpay_-with_numbers . Accessed 03 Jan 2013.

Alpay, L. L., Overberg, R. I., & Zwetsloot-Schonk, J. H. M. (2007b). Empowering citizens in assessing health
related websites: a driving force for healthcare governance. International Journal of Healthcare
Technology and Management (IJHTM), Special issue: “Governing ICT in healthcare and governing
healthcare with ICT”, 8(1/2), 141–160.

Ageing Int (2015) 40:277–299 295

http://www.ageuk.org.uk/latest-news/archive/cost-of-falls/

http://www.ageuk.org.uk/latest-news/archive/cost-of-falls/

Definition of Information Technology

http://www.fmc.ch/uploads/tx_userzsarchiv/MC2-2007_alpay_-with_numbers

http://www.fmc.ch/uploads/tx_userzsarchiv/MC2-2007_alpay_-with_numbers

Ariani, A., Redmond, S. J., Chang, D., & Lovell, N. H. (2010). Software simulation of unobtrusive falls
detection at night-time using passive infrared and pressure mat sensors. Conference Proceedings of the
IEEE Engineering in Medicine and Biology Society, 2010, 2115–2118.

Assantachai, P., Chatthanawaree, W., Thamlikitkul, V., Praditsuwan, R., & Pisalsarakij, D. (2002). Strategy to
prevent falls in the Thai elderly: a controlled study integrated health research program for the Thai elderly.
Journal of the Medical Association of Thailand, 85(2), 215–222.

Australian Department of Health and Ageing. (2003). Clinical IT in Aged Care. Available from: http://www.
health.gov.au/internet/main/publishing.nsf/Content/14ED56407A4946FFCA256F1E0012E27B/$File/
clinitintrep . Accessed 22 Aug 2012.

Australian Department of Health and Ageing. (2004). An analysis of research on preventing falls and falls
injury in older people: Community, residential care and hospital settings. Available from: http://www.
health.gov.au/internet/main/publishing.nsf/Content/5F45FC4A37A71E0BCA256F19000403C7/$File/
falls_community . Accessed 07 Oct 2012.

Australian Department of Health and Ageing. (2008). Information Technology for Aged Care Providers—A
Step-by-Step Guide. Available from: http://www.health.gov.au/internet/publications/publishing.nsf/Content/
CA25774C001857CACA2574AC00183992/$File/ITAC%20Guide . Accessed 24 Sept 2012.

Auvinet, E., Reveret, L., St-Arnaud, A., Rousseau, J., & Meunier, J. (2008). Fall detection using multiple cameras.
Conference Proceedings of the IEEE Engineering in Medicine and Biology Society, 2008, 2554–2557.

Bates, D. W., Evans, R. S., Murff, H., Stetson, P. D., Pizziferri, L., & Hripcsak, G. (2003). Detecting adverse
events using information technology. Journal of the American Medical Informatics Association, 10,
115–128.

Belshaw, M., Taati, B., Snoek, J., & Mihailidis, A. (2011). Towards a single sensor passive solution for
automated fall detection. Conference Proceedings of the IEEE Engineering in Medicine and Biology
Society, 2011, 1773–1776.

Brown, G. (2005). An Accelerometer Based Fall Detector: Development, Experimentation, and Analysis,
EECS (online). Available from: citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.128.6988&rep=
rep1&type=pdf. Accessed 13 Jan 2013.

Browne, J. A., Covington, B. G., & Davila, Y. (2004). Using information technology to assist in redesign of a
fall prevention program. Journal of Nursing Care Quality, 19(3), 218–225.

Brzezinski N. (2009). Does a universal health care system cause a decrease in quality of care?: A comparison
of American and British quality in primary care. The Internet Journal of Academic Physician Assistants
(online), 6(2). Available from: http://www.ispub.com/journal/the-internet-journal-of-academic-physician-
assistants/volume-6-number-2/does-a-universal-health-care-system-cause-a-decrease-in-quality-of-care-a-
comparison-of-american-and-british-quality-in-primary-care.html. Accessed 23 Sept 2012.

Centre for Reviews and Dissemination. (2009). Systematic reviews: CRD’s guidance for undertaking reviews
in healthcare. York: YPS. Available from: http://www.york.ac.uk/inst/crd/pdf/Systematic_Reviews .
Accessed 03 Oct 2012.

Cheek, P., Nikpour, L., & Nowlin, H. D. (2005). Aging well with smart technology. Nursing Administration
Quarterly, 29(4), 329–338.

Cipriani A., & Geddes, J. (2003). Comparison of systematic and narrative reviews: the example of the atypical
antipsychotics. Epidemiologia e Psichiatria Sociale, 12(3). Available from: http://www.psychiatry.univr.
it/page_eps/docs/2003_3_cipriani . Accessed 09 Oct 2012.

Coughlin, J. F., D’Ambrosio, L. A., Reimer, B., & Pratt, M. R. (2007). Older adult perceptions of smart home
technologies: implications for research, policy & market innovations in healthcare. Conference
Proceedings of the IEEE Engineering in Medicine and Biology Society, 2007, 1810–1815.

Dai, J., Bai, X., Yang, Z., Shen, Z., & Xuan, D. (2010). Mobile phone-based pervasive fall detection. Personal
and Ubiquitous Computing Archive, 14(7), 633–643.

Debnath, A., Singaravelu, P., & Verma, S. (2012). Efficient spatial privacy preserving scheme for sensor
network. Central European Journal of Engineering, 3(1), 1–10.

Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R., Zuyov,
L., & Middleton, B. (2010). Fall prevention in acute care hospitals. JAMA, 304(17), 1912–1918.
Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107709/. Accessed 10 Jan 2013.

Eklund, J. M., Hansen, T. R., Sprinkle, J., & Sastry, S. S. (2005). Information technology for assisted living at
home: Building a wireless infrastructure for assisted living. In 27th Annual International Conference of
the IEEE Engineering in Medicine and Biology Society (EMBS). Innovation from Biomolecules to
Biosystems, September 2005, pp. 3931–3934. (Online).

Evans, S., Tritter, J., Barley, V., Daykin, N., Mcneill, J., Palmer, N., Rimmer, J., Sanidas, M., & Turton, P.
(2003). User involvement in UK cancer services: bridging the policy gap. European Journal of Cancer
Care (Engl), 12(4), 331–338.

296 Ageing Int (2015) 40:277–299

http://www.health.gov.au/internet/main/publishing.nsf/Content/14ED56407A4946FFCA256F1E0012E27B/File/clinitintrep

http://www.health.gov.au/internet/main/publishing.nsf/Content/14ED56407A4946FFCA256F1E0012E27B/File/clinitintrep

http://www.health.gov.au/internet/main/publishing.nsf/Content/14ED56407A4946FFCA256F1E0012E27B/File/clinitintrep

http://www.health.gov.au/internet/main/publishing.nsf/Content/5F45FC4A37A71E0BCA256F19000403C7/File/falls_community

http://www.health.gov.au/internet/main/publishing.nsf/Content/5F45FC4A37A71E0BCA256F19000403C7/File/falls_community

http://www.health.gov.au/internet/main/publishing.nsf/Content/5F45FC4A37A71E0BCA256F19000403C7/File/falls_community

http://www.health.gov.au/internet/publications/publishing.nsf/Content/CA25774C001857CACA2574AC00183992/File/ITAC%20Guide

http://www.health.gov.au/internet/publications/publishing.nsf/Content/CA25774C001857CACA2574AC00183992/File/ITAC%20Guide

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.128.6988&rep=rep1&type=pdf

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.128.6988&rep=rep1&type=pdf

http://www.ispub.com/journal/the-internet-journal-of-academic-physician-assistants/volume-6-number-2/does-a-universal-health-care-system-cause-a-decrease-in-quality-of-care-a-comparison-of-american-and-british-quality-in-primary-care.html

http://www.ispub.com/journal/the-internet-journal-of-academic-physician-assistants/volume-6-number-2/does-a-universal-health-care-system-cause-a-decrease-in-quality-of-care-a-comparison-of-american-and-british-quality-in-primary-care.html

http://www.ispub.com/journal/the-internet-journal-of-academic-physician-assistants/volume-6-number-2/does-a-universal-health-care-system-cause-a-decrease-in-quality-of-care-a-comparison-of-american-and-british-quality-in-primary-care.html

http://www.york.ac.uk/inst/crd/pdf/Systematic_Reviews

http://www.psychiatry.univr.it/page_eps/docs/2003_3_cipriani

http://www.psychiatry.univr.it/page_eps/docs/2003_3_cipriani

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107709/

Fernandez-Luque, F. J., Zapata, J., Ruiz, R., & Iborra, E. (2010a). A wireless sensor network for assisted
living at home of elderly people. Yumpu, Lecture Notes in Computer Science, 5602, 65–74. Available
from: http://www.yumpu.com/en/document/view/6518245/lecture-notes-in-computer-science-5602/84.
Accessed 06 June 2013.

Fernandez-Luque, F. J., Zapata, J., & Ruiz, R. (2010b). A system for ubiquitous fall monitoring at home via a
wireless sensor network. Conference Proceedings of the IEEE Engineering in Medicine and Biology
Society, 2010, 2246–2249.

Frand, J. (2009). Data Mining: What is Data Mining? Available from: http://www.anderson.ucla.edu/faculty/
jason.frand/teacher/technologies/palace/datamining.htm. Accessed 07 Sept 2013.

Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Lamb, S. E., Gates, S., Cumming, R. G., & Rowe, B. H.
(2009). Interventions for preventing falls in older people living in the community (Review). The Cochrane
Library. Available from: http://www.mnfallsprevention.org/downloads/Review-Interventions-for-preventing-
falls . Accessed 07 Oct 2012.

Gövercin, M., Költzsch, Y., Meis, M., Wegel, S., Gietzelt, M., Spehr, J., Winkelbach, S., Marschollek, M., &
Steinhagen-Thiessen, E. (2010). Defining the user requirements for wearable and optical fall prediction
and fall detection devices for home use. Informatics for Health & Social Care, 35(3–4), 177–187.

Green, B. N., Johnson, C. D., & Adams, A. (2006). Writing narrative literature reviews for peer-reviewed
journals: secrets of the trade. Journal of Chiropractic Medicine (online), 5(3), 101–117. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647067/pdf/main . Accessed 08 Oct 2012.

Hilbe, J., Schulc, E., Linder, B., & Them, C. (2010). Development and alarm threshold evaluation of a side rail
integrated sensor technology for the prevention of falls. International Journal of Medical Informatics,
79(3), 173–180.

Leitch, K. K., Schnarr, K., Pino, L. J., & Snowdon, A. (2010). Leveraging information technologies to
transform and sustain British Columbia’s health care sector. Available from http://sites.ivey.ca/
healthinnovation/files/2010/10/BC-White-Paper-Final . Accessed 30 Sept 2012.

Li, Y., Zeng, Z., Popescu, M., & Ho, K. C. (2010). Acoustic fall detection using a circular microphone array.
Conference Proceedings of the IEEE Engineering in Medicine and Biology Society, 2010, 2242–2245.

Maresh, J., Guse, C., Layde, P. (2012). National trends and coding patterns in fall-related mortality among the
elderly in the United States. Journal of Public Health Policy, 33(2), 202–214.

Marschollek, M., Rehwald, A., Wolf, K., Gietzelt, M., Nemitz, G., Meyer Zu Schwabedissen, H., & Haux, R.
(2008). Assessing elderly persons’ fall risk using spectral analysis on accelerometric data—a clinical
evaluation study. Conference Proceedings of the IEEE Engineering in Medicine and Biology Society,
2008, 3682–3685.

Marschollek, M., Rehwald, A., Wolf, K., Gietzelt, M., Nemitz, G., Schwabedissen, H., & Schulze, M. (2011).
Sensors vs. experts—a performance comparison of sensor-based fall risk assessment vs. conventional
assessment in a sample of geriatric patients. BMC Medical Informatics and Decision Making, 11, 48.

Miake-Lye, I. M., Amulis, A., Saliba, D., Shekelle, P. G., Volkman, L. K., & Ganz, D. A. (2011). Formative
evaluation of the telecare fall prevention project for older veterans. BMC Health Services Research,
11, 119.

Moher, D., Pham, B., Lawson, M. L., & Klassen, T. P. (2003). The inclusion of reports of randomised
trials published in languages other than English in systematic reviews. Health Technology Assessment,
7(41), 1–90.

Moyer, V. A. (2012). Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task
Force recommendation statement. Annals of Internal Medicine, 157(3), 197–204.

Noury, N. (2002). A smart sensor for the remote follow up of activity and fall detection of the
elderly. Microtechnologies in Medicine & Biology 2nd Annual International IEEE-EMB Special, 2002,
314–317.

Nyman, S. R., & Yardley, L. (2009). Usability and acceptability of a website that provides tailored advice on
falls prevention activities for older people. Health Informatics Journal, 15(1), 27–39.

Oggier, T., Lehmann, M., Kaufmann, R., Schweizer, M., Richter, M., Metzler, P., Lang, G., Lustenberger, F.,
& Blac, N. (2003). An all-solid-state optical range camera for 3d real-time imaging with sub-centimeter
depth resolution. In SPIE Proceedings, pp. 5249–65, St. Etienne.

Poe, S. S., Cvach, M. M., Gartrell, D. G., Radzik, B. R., & Joy, T. L. (2005). An evidence-based approach to
fall risk assessment, prevention, and management—lessons learned. Journal of Nursing Care Quality,
20(2), 107–116.

Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., Britten, N., Roen, K., & Duffyet, S.
(2006). Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Available from:
http://www.lancaster.ac.uk/shm/research/nssr/research/dissemination/publications/NS_Synthesis_
Guidance_v1 . Accessed 15 Jan 2013.

Ageing Int (2015) 40:277–299 297

http://www.yumpu.com/en/document/view/6518245/lecture-notes-in-computer-science-5602/84

http://www.anderson.ucla.edu/faculty/jason.frand/teacher/technologies/palace/datamining.htm

http://www.anderson.ucla.edu/faculty/jason.frand/teacher/technologies/palace/datamining.htm

http://www.mnfallsprevention.org/downloads/Review-Interventions-for-preventing-falls

http://www.mnfallsprevention.org/downloads/Review-Interventions-for-preventing-falls

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647067/pdf/main

http://sites.ivey.ca/healthinnovation/files/2010/10/BC-White-Paper-Final

http://sites.ivey.ca/healthinnovation/files/2010/10/BC-White-Paper-Final

http://www.lancaster.ac.uk/shm/research/nssr/research/dissemination/publications/NS_Synthesis_Guidance_v1

http://www.lancaster.ac.uk/shm/research/nssr/research/dissemination/publications/NS_Synthesis_Guidance_v1

Quagliarella, L., Sasanelli, N., & Belgiovine, G. (2008). An interactive fall and loss of consciousness detector
system. Gait & Posture, 28(4), 699–702.

Rao, S. S. (2005). Prevention of falls in older patients. American Family Physician, 72(1), 81–88.
Scott, V. J., Donaldson, M., & Gallagher, E. M. (2003). A review of the literature on best practices in falls

prevention for residents of long-term care facilities. Long Term Care Falls Review (online). Available
from: http://www.coag.uvic.ca/resources/publications/reports/A_review_of_literature_best%20practices_
falls%20 . Accessed 03 Oct 2012.

Scott, V. J., Donaldson, M., & Gallagher, E. M. (2007). Falls prevention: policy, research and practice. World
Health Organization Report: Prevention of Falls in Older Age (online). Available from: http://www.who.
int/ageing/projects/5.Intervention,%20policies%20and%20sustainability%20of%20falls%20prevention.
pdf. Accessed 03 Oct 2012.

SensLAB. (2013). Multi-hop network (online). Available from: http://www.senslab.info/. Accessed 13
June 2013.

Silsupadol, P., Siu, K. C., Shumway-Cook, A., & Woollacott, M. H. (2006). Training of balance under single-
and dual- task conditions in older adults with balance impairment. Physical Therapy, 86, 269–281.

Sim, S. Y., Jeon, H. S., Chung, G. S., Kim, S. K., Kwon, S. J., Lee, W. K., & Park, K. S. (2011). Fall detection
algorithm for the elderly using acceleration sensors on the shoes. Conference Proceedings of the IEEE
Engineering in Medicine and Biology Society, 2011, 4935–4938.

Skelton, D. A., Becker, C., Lamb, S. E., Close, J. C. T., Zijlstra, W., Yardley, L., & Todd, C. J. (2004).
Prevention of falls network Europe: a thematic network aimed at introducing good practice in effective
falls prevention across Europe. European Journal of Ageing, 1(1), 89–94.

Stalenhoef, P. A., Diederiks, J. P., Knottnerus, J. A., Kester, A. D., & Crebolder, H. F. (2002). A risk model for
the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. Journal of
Clinical Epidemiology, 55(11), 1088–1094.

Sterke, C. S., van Beeck, E. F., Looman, C. W., Kressig, R. W., & van der Cammen, T. J. (2012). An electronic
walkway can predict short-term fall risk in nursing home residents with dementia. Gait & Posture, 36(1),
95–101.

Surie, D., Laguionie, O., & Pederson, T. (2008). Wireless sensor networking of everyday objects in a smart
home environment. In Proceedings of the 4th International Conference on Intelligent Sensors, Sensor
Networks and Information Processing, Sydney, Australia, pp. 189–194.

Techopedia. (2013). Knowledge Discovery in Databases (KDD) [online] Available from: http://www.
techopedia.com/definition/25827/knowledge-discovery-in-databases-kdd. Accessed 11 June 2013.

Theodos, P. (2003). Fall prevention in frail elderly nursing home residents: a challenge to case management:
part I. Lippincott’s Case Management, 8(6), 246–251.

Tinetti, M. E. (2003). Preventing falls in elderly persons. New England Journal of Medicine, 348, 1.
Tomasi, E., Facchini, A. L., & Maia, M. S. (2004). Health information technology in primary health care in

developing countries: a literature review. Bulletin of the World Health Organization, 82, 867–874.
Available from: http://www.who.int/bulletin/volumes/82/11/en/867 . Accessed 05 Oct 2012.

Tyrer, H. W., Alwan, M., Demiris, G., He, Z., Keller, J., Skubic, M., & Rantz, M. (2006). Technology for
successful aging. Conference Proceedings of the IEEE Engineering in Medicine and Biology Society,
2011, 3290–3293.

Volrathongchia, K., Brennan, P. F., & Ferris, M. C. (2005). Predicting the likelihood of falls among the elderly
using likelihood basis pursuit technique. AMIA Annual Symposium Proceedings, 2005, 764–768.

VTT. (2013). VTT’s wireless sensor networks and embedded devices (online). Available from: http://www.vtt.
fi/research/technology/wireless_sensor_networks_and_embedded_devices.jsp?lang=en. Accessed 12
June 2013.

Wang, F., Skubic, M., Abbott, C., & Keller, J. M. (2010). Body sway measurement for fall risk assessment
using inexpensive webcams. Conference Proceedings of the IEEE Engineering in Medicine and Biology
Society, 2010, 2225–2229.

Weber, V., White, A., & McIlvried, R. (2008). An electronic medical record (EMR)-based intervention to
reduce polypharmacy and falls in an ambulatory rural elderly population. Journal of General Internal
Medicine (online), 23(4), 399–404. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2359523/. Accessed 03 Oct 2012.

Whitehead, S. H., Nyman, S. R., Broaders, F., Skelton, D. A., & Todd, C. J. (2012). The quality of English-
language websites offering falls-prevention advice to older members of the public and their families.
Health Informatics Journal, 18(1), 50–65.

Wilson, P., & Petticrew, M. (2008). Why promote the findings of single research studies? BMJ (online),
336(7646):722. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276286/. Accessed 02
Oct 2012.

298 Ageing Int (2015) 40:277–299

http://www.coag.uvic.ca/resources/publications/reports/A_review_of_literature_best%20practices_falls%20

http://www.coag.uvic.ca/resources/publications/reports/A_review_of_literature_best%20practices_falls%20

http://www.who.int/ageing/projects/5.Intervention,%20policies%20and%20sustainability%20of%20falls%20prevention

http://www.who.int/ageing/projects/5.Intervention,%20policies%20and%20sustainability%20of%20falls%20prevention

http://www.who.int/ageing/projects/5.Intervention,%20policies%20and%20sustainability%20of%20falls%20prevention

http://www.senslab.info/

http://www.techopedia.com/definition/25827/knowledge-discovery-in-databases-kdd

http://www.techopedia.com/definition/25827/knowledge-discovery-in-databases-kdd

http://www.who.int/bulletin/volumes/82/11/en/867

http://www.vtt.fi/research/technology/wireless_sensor_networks_and_embedded_devices.jsp?lang=en

http://www.vtt.fi/research/technology/wireless_sensor_networks_and_embedded_devices.jsp?lang=en

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359523/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359523/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276286/

World Health Organization. (2001) Men, Ageing and Health. WHO Bulletin (Online) Available from: http://
whqlibdoc.who.int/hq/2001/who_nmh_nph_01.2 . Accessed 10 Oct 2012.

World Health Organization. (2008). Global Health and Ageing. WHO Publication (Online) Available from:
http://www.who.int/ageing/publications/global_health . Accessed 10 Oct 2012.

Yamada, M., Aoyama, T., Hikita, Y., Takamura, M., Tanaka, Y., Kajiwara, Y., Nagai, K., Uemura, K., Mori, S.,
& Tanaka, B. (2011a). Effects of a DVD-based seated dual-task stepping exercise on the fall risk factors
among community-dwelling elderly adults. Telemedicine Journal and e-Health, 17(10), 768–772.

Yamada, M., Aoyama, T., Nakamura, M., Tanaka, B., Nagai, K., Tatematsu, N., Uemura, K., Nakamura, T.,
Tsuboyama, T., & Ichihashi, N. (2011b). The reliability and preliminary validity of game-based fall risk
assessment in community-dwelling older adults. Geriatric Nursing, 32(3), 188–194.

Yuki, Y. (2002). Alarm system optimization for increasing operations productivity. ISA Transactions, 41(3),
383–387.

Oladele Ademola Atoyebi, MPH is a senior resident at the Department of Community Medicine, Federal
Medical Centre, Ido-Ekiti. He received his masters degree from Staffordshire University in England. His
research area is healthy and active ageing, physical activity and substance abuse prevention.

Antony Stewart, Professor in Public Health is a consultant, researcher, chair of the Staffordshire and
Shropshire Public Health Institute and the award leader of MPH (Health Informatics) at Staffordshire
University in England. He has strong links with the Faculty of Public Health, the Royal Society for Public
Health and West Midlands Public Health Training Scheme. He is an experienced NHS Consultant in Public
Health, having senior level responsibility for many public health areas including cervical and breast cancer
screening, sexual health, eye services, maternity and perinatal mortality, health needs assessment and Research
& Development. He has published many research papers, as well as textbooks on clinical audit, medical
statistics and epidemiology. His textbook “Basic Statistics and Epidemiology” won first prize in the 2011
BMA Medical Book Awards, Basis of Medicine category.

June Sampson, Senior Lecturer (Public Health) is a researcher and award Leader for MSc. Physical
Activity and Public Health at Staffordshire University in England. She leads modules on both the undergrad-
uate and postgraduate degrees and has been involved with a number of research projects relating to physical
activity and health for special population groups. She is a member of the Royal Society for Public Health. Her
current research interest lies in the effect of different physical environments on physical activity participation,
and associated benefits, for the general population of adults.

Ageing Int (2015) 40:277–299 299

http://whqlibdoc.who.int/hq/2001/who_nmh_nph_01.2

http://whqlibdoc.who.int/hq/2001/who_nmh_nph_01.2

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• Use of Information Technology for Falls Detection and Prevention in the Elderly

Abstract
Introduction
Methodology
Search Strategy
Search Terms
Exclusion/Inclusion Criteria
Search Results
Narrative Synthesis
Literature Review—Preventing Falls at Home
The Telephone in Falls Prevention
Smart Home Technology and Wireless Sensor Network
Artificially Intelligent Camera-Based System
Digital Video Disc (DVD) and Game-Based Measures
Websites
In-Patient Settings—Hospitals and Nursing Homes
Cameras
Accelerometers and Sensors
Electronic Walkway
Bed-Exit Alarm System
Fall Prevention Software
Data Mining
Factors Affecting Use of Information Technology for Falls Prevention in the Elderly
Conclusion and Future Work
Introduction
Overview of the Research
Limitations and Difficulties
Potential Application of Learning from this Study
Applications and Recommendation
Conclusion and Future Work
References

RESEARCH

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Prevenção de quedas em idosos domiciliados: promoção do envelhecimento ativo

Prevention of falls in the elderly in the home: promoting active ageing

Prevención de caídas en los ancianos domiciliados: promoción del envejecimiento activo

Maria Laurência Parreirinha Gemito
1
, Maria de Fátima Sousa Batinas

2
, Felismina Rosa Parreira

Mendes
3
, Silvana Sidney Costa Santos

4
, Manuel José Lopes

5

Objective: To determine the frequency of falls and identify risk factors in the homes of the elderly under the
Home Care Service of a village in Alentejo (Portugal). Method: Exploratory, descriptive study. The target group
were elderly persons under the Home Care Service (23). The questionnaire consists of open and closed
questions, and was based on the Jefferson Area Board for Aging Safety in the Home Assessment; Instrument to
Assess the Risk of Falls and Adaptations to Prevent Falls at Home. Results: Of the 23 seniors, 13 were men; the
mean age was 85; 10 widowers; 11 live alone; 12 cannot read or write; 17 have experienced falls, loss of balance
being the main cause. They report changes in vision (21), hearing (14) and rheumatic diseases (14); hypertension
(19); they use 4 or more drugs on a daily basis (16). Conclusion: The physiological changes associated with
ageing may increase the risk of falls. Due to the consequences, it is a priority field in community intervention.
Descriptors: Aged, Accidental falls, Risk factors, Nursing.

Objetivo: Conhecer a frequência de quedas e identificar fatores de risco no domicílio dos idosos do Serviço de
Apoio Domiciliário de uma vila alentejana (Portugal). Método: Estudo exploratório, descritivo. O grupo alvo
foram os idosos do Serviço de Apoio Domiciliário (23). O questionário é composto de perguntas abertas e
fechadas, teve subjacente a Avaliação da Segurança em Casa de Jefferson Area Board for Aging; Instrumento
para Avaliar o Risco de Quedas e Adaptações no Domicílio para Prevenir Quedas. Resultados: Dos 23 idosos, 13
são homens; idade média de 85 anos; 10 viúvos; 11 vivem sozinhos; 12 não sabem ler nem escrever; 17 sofreram
quedas, o desequilíbrio foi a causa principal. Referem alterações na visão (21), audição (14), doenças reumáticas
(14); hipertensão (19); usam 4 ou mais medicamentos diariamente (16). Conclusão: As mudanças fisiológicas
decorrentes do envelhecimento podem aumentar o risco de quedas. Pelas consequências é um campo prioritário
da intervenção comunitária. Descritores: Idoso, Acidentes por quedas, Fatores de risco, Enfermagem.

Objetivo: Conocer la frecuencia de caídas e identificar los factores de riesgo en los domicilios de ancianos del
Servicio de Asistencia Domiciliaria en el Alentejo (Portugal). Método: Estudio descriptivo, exploratorio. El grupo
objetivo fueron los usuarios mayores del Servicio de Asistencia Domiciliaria (23). El cuestionario consta de
preguntas abiertas y cerradas, tenían la seguridad subyacente Inicio de Evaluación de la Junta Jefferson Área
para el Envejecimiento; Instrumento para Evaluar el Riesgo de Caídas y adaptaciones para evitar caídas en el
hogar. Resultados: De los 23 ancianos, 13 eran hombres, con una edad media 85, 10 viudos, 11 viven solos, 12
no saben leer ni escribir, 17 han sufrido caídas, el desequilibrio fue la causa principal. Refieren cambios en la
visión (21), escuchar (14), enfermedades reumáticas (14), hipertensión (19), con cuatro o más medicamentos
diarios (16). Conclusión: Los cambios fisiológicos relacionados con el envejecimiento pueden aumentar el riesgo
de caídas. Las consecuencias es un ámbito prioritario de intervención comunitaria. Descriptores: Anciano,
Accidentes por caídas, Factores de riesgo, enfermería.

1
PhD in Sociology. Assistant Professor at the S. João de Deus School of Nursing of the University of Évora,

Portugal. Researcher at the Centre for Research in Health Sciences and Technologies of Évora, Portugal.
mlpg@uevora.pt.

2
Nurse at the Espírito Santo Hospital of Évora EPE, Portugal. Master’s Degree in Community

Nursing and Health Education, m.fatimabatinas@gmail.com.
3
PhD in Sociology. Coordinating Professor of the S.

João de Deus School of Nursing of the University of Évora, Portugal. Researcher at the Centre for Research and
Studies in Sociology of the Lisbon University Institute (CIES/ISCTE-IUL), Portugal. fm@uevora.pt.

4
Nurse. PhD in

Nursing. Associate Professor I at the School of Nursing of the Federal University of Rio Grande (FURG). Leader of
the Study and Research Group in Gerontology and Geriatrics, Nursing/Health Education, GEP-GERON.
silvanasidney@terra.com.br.

5
PhD in Nursing Sciences. Director of the São João de Deus School of Nursing of the

University of Évora, Portugal. Director of the Centre for Research in Health Sciences and Technologies of Évora,
Portugal. mjl@uevora.pt.

ABSTRACT

RESUMO

RESUMEN

mailto:mlpg@uevora.pt

mailto:m.fatimabatinas@gmail.com

mailto:fm@uevora.pt

mailto:silvanasidney@terra.com.br

mailto:mjl@uevora.pt

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T

he increase in the elderly population due to low birth rates and increased life

expectancy, among other factors, has contributed to the ageing of the population. Due to

the inherent consequences, the phenomenon of demographic ageing has been a matter of

great concern.

Ageing can cause diseases in itself, which increase the demand for health services

and the diversity of levels of care.
1
The importance of focusing on disease prevention and

health promotion should be stressed, in order to contribute to active ageing, preserving

functional capacity, independence and autonomy for the longest time possible.

In Portugal, the National Programme for the Health of Older Persons in 2006
2

intended to contribute to the generalisation and practice of the concept of active ageing in

people over 65 years of age, so as to achieve gains in years of life with independence.

According to the WHO
3
, the policy framework for active ageing includes three pillars:

health, social participation and security, the latter being closely linked to issues of

protection, housing and social environment.

Security is a right of all human beings, with particular relevance to those who are

most vulnerable. Effective security is essential to achieve active and successful ageing.

Security plays an important role in the process of active ageing in relation to falls and

architectural barriers. Falls are the leading cause of accidents among the elderly. Sensory

changes, sight and/or hearing problems, changes in balance and musculoskeletal diseases,

such as osteoporosis, are related to the increase in the number of falls.
4

Five situations are classified as risk factors for the occurrence of falls: if the person

has fallen at least once in the last year, the intake of four or more drugs per day, the

presence of Parkinson’s disease or if the person has suffered a stroke, if the person has

balance problems and is unable to get up from a chair without using the support of at least

one arm.
5
Other identified risk factors are: living alone; taking drugs (especially

psychotropic drugs); the presence of chronic diseases; reduced mobility; cognitive

impairment and dementia; reduced visual acuity; the use of canes and walking frames;

slippery or uneven floors and degraded surfaces.
6

In addition to the physical consequences, psychologically, falls also have other

negative consequences, giving rise to the so-called post-fall syndrome, which causes

feelings of insecurity and anxiety about the possibility of a further fall. Falls also have

economic consequences, increasing the costs of health and social support.
7

Given the relevance of this problem, the following research question was

formulated: What are the risk factors of falls in the homes of elderly individuals registered

under the Home Care Service in a village in the Alentejo Region (Portugal)?

The following objectives were defined:

INTRODUCTION

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METHOD

– To determine the frequency of falls in the homes of elderly individuals registered under

the Home Care Service of a village in Alentejo (Portugal);

– To identify the risk factors for falls in the home of these elderly individuals.

This is a study of an exploratory, descriptive and cross-sectional nature that takes a

quantitative approach. The target group of the study were all elderly individuals registered

under the Home Care Service of a village in the Alentejo Region (Portugal), totalling 23

persons. In order to recruit the population it was necessary to identify the elderly

individuals registered under the Home Care Service, through the cooperation of its Managers

after they had given formal authorisation.

For the evaluation of risk factors for falls in the home, a questionnaire was chosen as

the instrument to collect data, consisting of open and closed questions applied after the

completion of the pre-test on a sample population with characteristics identical to those of

the study. It was created based on the literature, the Jefferson Area Board for Aging Safety

in the Home Assessment;
8
Instrument to Assess the Risk of Falls

9
and Adaptations to Prevent

Falls at Home.
4

The questionnaire consists of four parts. Part 1 aimed to undertake a

sociodemographic characterisation of the elderly individuals, part 2 featured the current

state of health, part 3 identified the existence of changes in the mobility of the elderly

individuals; the purpose of part 4 was to evaluate the safety conditions of housing in terms

of the prevention of falls in the elderly.

All ethical principles inherent to conducting the study were followed, in accordance

with the Declaration of Helsinki on Ethics in Research Involving Humans. The purpose of the

study, respecting the right to self-determination, the signing of the informed consent form,

the right to anonymity and confidentiality, as well as fair and equitable treatment before,

during and after participation in the study, were explained to the participating elderly

individuals. They were also informed that they could leave the study at any time without

suffering any negative consequences.

The data were processed by computer using the statistical program Statistical

Package for Social Sciences (SPSS). In order to systematise and enhance the information

provided by the data, descriptive statistical techniques were used.

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RESULTS AND DISCUSSION

It was found that these elderly individuals were aged between 75 and 90, with a

mean of 85. Regarding gender, 13 of the elderly individuals were male, and 10 female.

Regarding marital status, 12 were married, 10 were widowed and 1 single.

Regarding education, 12 elderly individuals could not read or write, 10 received

education up to the 4th year. One elderly individual can read and write, but did not attend

school. Of the 23 elderly individuals, 17 were rural workers, who are now retired. Eleven

elderly individuals live alone, 10 live with their spouse and 2 live with their spouse and

child/children.

Risk factors for falls in the home were identified, which will be described below.

Regarding medication, 16 use four or more drugs per day, 19 taking anti-hypertensive drugs,

3 take diuretic drugs, 2 take drugs to aid gastrointestinal motility.

In terms of current health problems, it was found that 21 of the elderly individuals

had sight problems, 19 hypertension, 14 rheumatic disease, 14 hearing problems, 6

osteoporosis, 5 were obese, 2 had diabetes and 1 reported having venous insufficiency in

the lower limbs.

Of the 23 elderly individuals, 14 indicated having difficulty walking, stating they

need to use walking aids, a walking stick (11) and crutches (3). It was observed that 12 of

the elderly individuals needed to support at least one arm in order to get up and 16

reported having balance problems.

Regarding falls, it was observed that 17 of the elderly individuals have already

suffered falls. Of these, 7 have fallen once, 4 have fallen twice, 3 have fallen four times

and 3 reported having fallen five or more times. Of the 17 who have suffered falls, 6

reported that they fell less than one month ago, 5 between one and six months ago, 1 six

months to a year ago and 5 more than a year ago. The place where there was the highest

incidence of falls was the backyard (13), followed by the stairs (1), the bedroom (3), the

bathroom (3), the kitchen (2), the living room (2) and the corridor (1). The causes of these

falls were dizziness (8), loss of balance (9) and trips (4). A total of 5 elderly individuals

required hospitalisation due to fractured vertebrae (1), fracture of the scapulohumeral joint

(1), pains in the joints (1), fracture of the neck of the femur (1) and muscle pain in the

dorsal region (1).

After on-site observation at the elderly individuals’ homes, the rooms described

below were found. In the bathroom, all the elderly individuals have good lighting, 17 have a

rubber mat in the shower and a non-slip mat next to the shower, 19 have a towel rack and a

support for hygiene products, 10 have a fixed seat, 8 have a non-slip floor, 6 have an

emergency light, 4 have safety bars in the shower and 3 have grab bars next to the toilet.

In the bedroom, there no loose electrical wires, 21 of the elderly individuals can

support their feet on the floor when sitting on the bed and 19 have furniture fixed to the

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floor. They all have access to light switches without getting up from bed, 19 have carpets

that are not fixed to the floor and 4 have an emergency light.

In the kitchen, for 18 of the elderly individuals the cabinets are not high, 9 have a

non-slip floor and 2 have carpets that are not fixed to the floor. All have good lighting. One

person has loose wires on the floor and 5 have an emergency light.

In the living room, 12 of the elderly individuals have chairs with supporting arms, 11

report that the seats of the couches are soft and depressible, and all have lateral supports.

All are well lit, none has loose wires in this room of the house and 7 have an emergency

light. All have fixed furnishings.

Only 9 homes have stairs/steps. Of those homes that have stairs/steps, 6 have

handrails, all have good lighting, no carpet on the first and last step and 6 of the elderly

individuals report having difficulty walking up/down those stairs.

Ageing healthily, with autonomy and independence, makes us think about ageing

throughout life, based on measures to prevent disease and promote health. Aspects such as

promoting healthy lifestyles are important, such as physical exercise, healthy eating, safety

factors, and these should be included in projects promoting active ageing. Thus, the

collaboration of the entire community is required, as it is a collective, and not just an

individual, issue.

The natural process of ageing may, in some way, contribute to a loss/reduction in

functional capacity as a result of the deterioration of the physiological system. The decline

in functional abilities, especially physical abilities, includes a reduction in muscle strength

and a loss of balance, and these are identified as important risk factors for falls in the

elderly
(10)

. Safety may involve some environmental changes, such as changes in architecture

and also modification of certain behaviours.
4

The elderly is the most worrying group in terms of falls. They are identified as the

most frequent cause of mortality due to accidents after the age of 75.
11-12

Falls occur more frequently in the elderly, in part caused by the changes inherent to

the ageing process, such as degenerative osteoarticular diseases and decreased auditory and

visual capabilities.

Other factors are also considered: depression, associated with social isolation and

unsafe conditions in the home (loose rugs, inappropriate furniture, bathtubs without mats

and without supports, staircases without handrails, objects placed at height and difficult to

access, among others). Changes in gait, decreased muscle strength, joint stiffness, changes

in balance due to decreased postural sensitivity are some of the changes due to ageing that

may contribute to falls in the elderly.
12

Living alone is also one of the risk factors for falls in the home.
6
A study in

conducted in Barcelona showed that elderly individuals who are separated or divorced are

highly likely to suffer falls. Mutual care, between partners, may explain the reduced rate of

falls among those living with a partner.
13

The use of drugs has been the subject of several studies as a risk factor for falls. In

one study where the role played by psychiatric drugs, heart drugs and analgesics in the risk

of falls among the elderly was investigated, it was concluded that benzodiazepines,

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CONCLUSION

neuroleptics sedatives/hypnotics, antidepressants, diuretics in general, antiarrhythmic

drugs and digoxin were associated with a higher risk of falls in people aged over 60.
14

A study conducted for the purpose of determining whether there is an association

between the use of psychoactive drugs in elderly individuals over 65 and the occurrence of

falls showed that there were problems with the use of drugs among this group. Anxiolytics,

antidepressants, anticonvulsants and anti-hypertensive drugs proved unsuitable for this

population group, and were associated with falls.
15

Falls are also responsible for 90% of hospital admissions, and fracture of the neck of

the femur is the most common injury.
9
The origin of the fall may be related to intrinsic

factors (arising from the physiological changes of ageing, disease and the effects of drugs)

and extrinsic factors (social and environmental circumstances) that provide constant

challenges to the elderly. A study of 50 elderly individuals showed that 28% of them died

from the direct consequences of a fall (including fractures and neurological damage).
16-17

The prevention of falls in the home is a fundamental pillar for safe and active ageing.

Performing day-to-day tasks safely may require some architectural changes and/or

adaptations of which nurses should be aware, thus focusing on home visits and work in and

with the community.

The survey allowed a diagnosis of the state of health of the elderly individuals

registered under the Home Care Service in a village in Alentejo Region (Portugal) to be

prepared in light of the risk of falls in the home, thus allowing the development and

implementation of projects in the community to identify and eliminate risk factors for falls.

For this, the entire community must be involved in a collective project for the achievement

of an active old age, lived with autonomy and independence and based on health promotion

and disease prevention activities.

Taking into account the literature that deals with issues of preventing falls among

the elderly in the home, the results achieved and the objectives initially established

highlight the isolation in which the elderly live, a high number of whom reported having

current health problems, particularly sight problems, hypertension, rheumatic disease,

hearing problems and osteoporosis.

The functional limitations that many elderly individuals face are associated with

these problems (the need to support at least one arm to stand up and balance problems),

and these result in difficulties in walking, which leads to frequent use of walking aids. In

addition to the individual conditions, the housing context also represents a risk to the

integrity of the elderly. Thus, the safety conditions of the home emerged as an additional

risk factor, mainly due to a lack of grab bars in the bathroom, the use of carpets that are

not fixed, floors that are not non-slip and the use of sofas with soft, depressible seats.

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REFERENCES

Resulting from the functional limitations and the unfavourable physical environments

of the home, it was found that the majority have suffered falls, and these occurred mainly

in the backyard. The causes of the falls were primarily dizziness, a loss of balance and trips.

After the fall, some elderly individuals required hospitalisation as a result of fractures.

These data reveal that all the nursing work directed towards the prevention of falls

in the elderly must address both the individual and the physical context surrounding the

elderly individual. Thus, just as important as promoting an appropriate level of functionality

through actions aimed at promoting the health of the elderly and active ageing, work

centred on the context of the home, which effectively reduces the risk of falling, is

essential.

Ageing brings with it physiological changes, resulting sometimes in situations of

dependency, with the inherent social, health and family-related costs. It is therefore

important to promote active ageing, based on quality primary care that will enable them to

remain independent and autonomous for as long as possible.

1. Torres M, Marques E. Envelhecimento activo: um olhar multidimensional sobre a
promoção da saúde. Estudo de caso em Viana do Castelo. In: VI congresso português de
sociologia; Universidade Nova, Lisboa, Portugal. 2008. Número de série: 233. p. 1-12.
[citado 2010 dezembro 18]. Disponível em: http://www.aps.pt/vicongresso/pdfs/233

2. Ministério da Saúde, Direcção Geral de Saúde. Circular Normativa Nº 13/DGCG de
02/07/04: Programa Nacional para a Saúde das Pessoas Idosas. Lisboa; 2006. [citado 2010
novembro 10]. Disponível em: http://www.portaldasaude.pt/NR/rdonlyres/1C6DFF0E-9E74-
4DED-94A9-F7EA0B3760AA/0/i006346

3. Organização Mundial de Saúde. Envelhecimento activo: uma política de saúde. Brasília:
Organização Pan-Americana da Saúde; 2005. [citado 2011 junho 12]. Disponível em:
http://bvsms.saude.gov.br/bvs/publicacoes/envelhecimento_ativo

4. Duarte N, Barbosa C. Sinta-se seguro. In Ribeiro O, Paúl C, coordenadores. Manual de
envelhecimento activo. Lisboa: Lidel; 2011. p. 171-99.

5. The Swedish National Institute of Public Health. Injury Prevention. In Healthy ageing: a
challenge for Europe; 2007. p. 105-11. [citado 2011 junho 7]. Disponível em:
http://www.fhi.se/PageFiles/4173/Healthy_ageing

6. Ministério da Saúde, Direcção Geral da Saúde). Prevenção dos acidentes domésticos com
pessoas idosas. Lisboa; s.d. [citado 2011 junho 6]. Disponível em:
www.dgs.pt/upload/membro.id/ficheiros/i010166

7. Gama ZAS, Gómez-Conesa A. Factores de riesgo de caídas en ancianos: revisión
sistemática. Rev. Saúde Pública [internet]. 2008 [citado 2012 janeiro 10]; 42 (5): 946-56.
Disponível em: http://www.scielo.br/pdf/rsp/v42n5/6793

8. Stanhope M, Lancaster J. Enfermagem de Saúde Pública – Cuidados de Saúde na
Comunidade Centrados na População. 7.ª ed. Lisboa: Lusodidacta; 2011.

ISSN 2175-5361 DOI: 10.9789/2175-5361.2014.v6i5.131-138
Gemito MLP, Batinas MFS, Mendes FRP, et al. Prevention of falls in…

J. res.: fundam. care. online 2015. 2014. dez. 6(supl.):131-138 138

9. Potter P. Fundamentos de enfermagem: conceitos e procedimentos. 5ª ed. Loures:
Lusociência; 2006.

10. Novo A, Mendes E, Preto L. Risco de quedas em idosos – Influência da capacidade
funcional, força muscular e composição corporal. In: Congresso Internacional de
Enfermagem de Reabilitação. Lisboa, Portugal. 2011. [citado 2012 janeiro 12]. Disponível
em: http://bibliotecadigital.ipb.pt/handle/10198/6434

11. Rabiais S, Nunes B, Contreiras T. ADELIA 2005: Acidentes domésticos e de lazer:
informação adequada. 2006 [citado 2011 maio 23]. Disponível em:
http://webgate.ec.europa.eu/idb/documents/PT_proj_adelia_relat-final-2005_onsa

12. USF Marginal. Quedas no idoso. 2008 [citado 2012 março 15]. Disponível em:
http://www.usfmarginal.com/?p=61

13. Siqueira FV, Facchini LA, Piccini RX, Tomasi E, Thumé E, Silveira DS, et al. Prevalência
de quedas em idosos e factores associados. Rev. Saúde Pública [Internet]. 2007 [citado
2012 janeiro 10]; 41 (5): 749-56. Disponível em:
http://www.scielo.br/pdf/rsp/v41n5/6188

14. Coutinho ESF, Silva SD. Uso de medicamentos como factor de risco para fractura grave
decorrente de queda em idosos. Cad. Saúde Pública [Internet]. 2002 [citado 2012 janeiro
10]; 18 (5): 1359-66. Disponível em: http://www.scielosp.org/pdf/csp/v18n5/11009

15. Chaimowicz F, Ferreira TJXM, Miguel DFA. Use of psychoactive drugs and related falls
among older people living in a community in Brazil. Rev. Saúde Pública [Internet]. 2000
[citado 2012 janeiro 10]; 34(6): 631-5. Disponível em:
http://www.scielo.br/pdf/rsp/v34n6/3578

16. Fabrício SCC, Rodrigues RAP, Júnior MLC. Causas e consequências de quedas de idosos
atendidos em hospital público. Rev. Saúde Pública [Internet]. 2004 [citado 2012 janeiro 13];
38(1): 93-9. Disponível em: http://www.scielo.br/pdf/rsp/v38n1/18457

17. Menezes RL, Bachion MM. Estudo da presença de riscos intrínsecos para quedas, em
idosos institucionalizados. Ciênc. saúde coletiva [Internet]. 2008 [citado 2012 janeiro 30];
13 (4): 1209-18. Disponível em: http://www.scielo.br/pdf/csc/v13n4/17

Received on: 01/08/2014
Required for review: No
Approved on: 01/12/2014

Published on: 20/12/2014

Contact of the corresponding author:

Maria Laurência Parreirinha Gemito
Évora – Portugal

Email: mlpg@uevora.pt

http://www.scielo.br/pdf/csc/v13n4/17

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