Clemens Becker

Bio: Clemens Becker is an academic researcher from Robert Bosch Hospital. The author has contributed to research in topics: Poison control & Fall prevention. The author has an hindex of 49, co-authored 269 publications receiving 10737 citations. Previous affiliations of Clemens Becker include Folkwang University of the Arts & Heidelberg University.

Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus

Abstract: The prevention of injury associated with falls in older people is a public health target in many countries around the world. Although there is good evidence that interventions such as multifactorial fall prevention and individually prescribed exercise are effective in reducing falls, the effect on serious injury rates is unclear. Historically, trials have not been adequately powered to detect injury endpoints, and variations in case definition across trials have hindered meta-analysis. It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in populations who are at a higher risk of injury. Further research is required to determine whether fall-prevention interventions can reduce serious injuries. Prevention of Falls Network Europe (ProFaNE) is a collaborative project to reduce the burden of fall injury in older people through excellence in research and promotion of best practice (www.profane.eu.org). The European Commission funds the network, which links clinicians, members of the public, and researchers worldwide. The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity, including clinical trials, comparative research, and prospective meta-analysis. Work is being undertaken in a 4-year program. As a first step, the development of a common set of outcome definitions and measures for future trials or meta-analysis was considered.

Cost of falls in old age: a systematic review

Abstract: The purpose of this study was to review the evidence of the economic burden of falls in old age. This review showed that falls are a relevant economic burden. Efforts should be directed to fall-prevention programmes. Falls are a common mechanism of injury and a leading cause of costs of injury in the elderly. The purpose of this study was to review for the first time the evidence of the economic burden caused by falls in old age. A systematic review was conducted in the databases of PubMed, of the Centre for Reviews and Dissemination and in the Cochrane Database of Systematic Reviews until June 2009. Studies were assessed for inclusion, classified and synthesised. Costs per inhabitant, the share of fall-related costs in total health care expenditures and in gross domestic products (GDP) were calculated. If appropriate, cost data were inflated to the year 2006 and converted to US Dollar (USD PPP). A total of 32 studies were included. National fall-related costs of prevalence-based studies were between 0.85% and 1.5% of the total health care expenditures, 0.07% to 0.20% of the GDP and ranged from 113 to 547 USD PPP per inhabitant. Direct costs occurred especially in higher age groups, in females, in hospitals and long-term care facilities and for fractures. Mean costs per fall victim, per fall and per fall-related hospitalisation ranged from 2,044 to 25,955; 1,059 to 10,913 and 5,654 to 42,840 USD PPP and depended on fall severity. A more detailed comparison is restricted by the limited number of studies. Falls are a relevant economic burden to society. Efforts should be directed to economic evaluations of fall-prevention programmes aiming at reducing fall-related fractures, which contribute substantially to fall-related costs.

Measuring the psychological outcomes of falling: a systematic review.

Abstract: The objectives were to identify fall-related psychological outcome measures and to undertake a systematic quality assessment of their key measurement properties. A Cochrane review of fall-prevention interventions in older adults was used to identify fall-related psychological measurements. PubMed, CINAHL, and PsycINFO were systematically searched to identify instruments not used in trials and papers reporting the methodological quality of relevant measures. Reference lists of articles were searched for additional literature, and researchers were contacted. Two reviewers undertook quality extraction relating to content, population, reliability, validity, responsiveness, practicality, and feasibility. Twenty-five relevant papers were identified. Twenty-three measures met the inclusion criteria: six single-item questions, Falls Efficacy Scale (FES), revised FES, modified FES, FES-UK, Activities-specific Balance and Confidence Scale (ABC), ABC-UK, Confidence in maintaining Balance Scale, Mobility Efficacy Scale, adapted FES, amended FES, Survey of Activities and Fear of Falling in the Elderly (SAFFE), University of Illinois at Chicago Fear of Falling Measure, Concern about Falling Scale, Falls Handicap Inventory, modified SAFFE, Consequences of Falling Scale, and Concern about the Consequences of Falling Scale. There is limited evidence about the measurement properties of single-item measures. Several multiitem measures obtained acceptable reliability and validity, but there is less evidence regarding responsiveness, practicality, and feasibility. Researchers should select measures based on the constructs they intend to study. Further research is needed to establish and compare the instruments' measurement properties.

Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials

Abstract: OBJECTIVE: to review systematically the range of case definitions and methods used to measure falls in randomised controlled trials. Design/methods: a Cochrane review of fall prevention interventions was used to identify fall definitions in published trials. Secondary searches of various databases were used to identify additional methodological or theoretical papers. Two independent reviewers undertook data extraction, with adjudication by a third reviewer in cases of disagreement. Settings: community-dwelling and institutionalised older persons. RESULTS: 90 publications met the predefined inclusion criteria. Of these, 44 provided no definition of the term fall. In the remainder, there were substantial variations in the definition and methods of measuring falls. Reporting periods ranged from 1 week to 4 years with only 41% using prospective data collection methods. CONCLUSION: the standard of reporting falls in published trials is poor and significantly impedes comparison between studies. The review has been used to inform an international consensus exercise to make recommendations for a core set of outcome measures for fall prevention trials.

Evaluation of accelerometer-based fall detection algorithms on real-world falls.

Abstract: Despite extensive preventive efforts, falls continue to be a major source of morbidity and mortality among elders Real-time detection of falls and their urgent communication to a telecare center may enable rapid medical assistance, thus increasing the sense of security of the elderly and reducing some of the negative consequences of falls Many different approaches have been explored to automatically detect a fall using inertial sensors Although previously published algorithms report high sensitivity (SE) and high specificity (SP), they have usually been tested on simulated falls performed by healthy volunteers We recently collected acceleration data during a number of real-world falls among a patient population with a high-fall-risk as part of the SensAction-AAL European project The aim of the present study is to bechmark the performance of thirteen published fall-detection algorithms when they are applied to the database of 29 real-world fall To the best of our knowledge, this is the first systematic comparison of fall detection algorithms tested on real-world falls We found that the SP average of the thirteen algorithms, was (mean +/- std) 830%+/- 303% (maximum value = 98%) The SE was considerably lower (SE = 570%+/- 273%, maximum value = 828%), much lower than the values obtained on simulated falls The number of false alarms generated by the algorithms during 1-day monitoring of there representative fallers ranged from 3 to 85 The factors that affect the performance of the published algorithms, when they are applied to the real-world falls, are also discussed These findings indicate the importance of testing fall-detection algorithms in real-life conditions in order to produce more effective automated alarm systems with higher acceptance Further, the present results support the idea that a large, shared real-world fall database could, potentially, provide an enhanced understanding of the fall process and the information needed to design and evaluate a high-performance fall detector

In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982.

Abstract: Introduction 1. Woman's Place in Man's Life Cycle 2. Images of Relationship 3. Concepts of Self and Morality 4. Crisis and Transition 5. Women's Rights and Women's Judgment 6. Visions of Maturity References Index of Study Participants General Index