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Using Multivariate Statistics

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. Up to 30% may fall in a year. Although one in five falls may require medical attention, less than one in 10 results in a fracture.
This review looked at the healthcare literature to establish which fall prevention interventions are effective for older people living in the community, and included 159 randomised controlled trials with 79,193 participants.  
Group and home-based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures.
Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow-up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined.  
Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti-slip shoe device worn in icy conditions can also reduce falls.
Taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment.  
Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls.
Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure.
In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling.
The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

Interventions for preventing falls in older people living in the community

The Pharmacological Basis of Therapeutics A Textbook of Pharmacology, Toxicology and Therapeutics for Physicians and Medical Students. By Prof. Louis Goodman and Prof. Alfred Gilman. Pp. xiii + 1383. (New York: The Macmillan Company, 1941.) 50s. net.

The Pharmacological Basis of Therapeutics

/pdf/a-podiatry-intervention-to-reduce-falls-in-care-home-3zzo21ewl9.pdf

A podiatry intervention to reduce falls in care home residents is feasible and demonstrates benefits: results from PIRFECT, a feasibility randomised controlled trial

Developing a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases: A scoping review and report from the OMERACT 2022 foot and ankle special interest group session.

This chapter outlines commonly suggested environmental modification strategies, and reviews the literature evaluating falls prevention programmes that have involved environmental modification as an individual intervention or as part of multi-faceted programmes. It discusses potential barriers to home modification, issues related to hazard removal and design strategies for minimizing older people's risk of falling in public places. Approaches for addressing environmental risk factors within institutions are discussed in Chapter 15. Environmental modification strategies Table 8.1 in Chapter 8 presents a list of environmental falls risk factors that have been suggested in the literature. These posited risk factors are replicated in Table14.1 along with potential solutions. Environmental modification as an individual intervention Environmental modification is seen by many as an attractive falls prevention strategy. The homes of most older people have many environmental hazards and the majority of these are amenable to modification. Correction and/or removal of potential hazards is a one-off intervention that can be carried out relatively cheaply. Indeed, cost-effectiveness modelling has predicted that spending AUD$244 per person on a programme involving home assessment by an occupational therapist and subsequent modifications, would save $92 per person and $916 per fall prevented, over a ten year period. However, this study assumes that such a programme could prevent 25% of falls. Reductions of this magnitude have yet to be demonstrated in controlled studies. Early investigations indicated that home modification might be an effective falls prevention strategy for the general population of older people.

Falls in Older People: Modifying the environment to prevent falls

The 2011 Australasian Podiatry Council conference was held from April 26 to 29 in Melbourne, Victoria, Australia. This commentary provides a brief overview of the conference, including the speakers and topic areas covered, selected original research highlights, and award winning presentations.

/pdf/setting-the-pace-the-2011-australasian-podiatry-council-4bmwujdp2a.pdf

Hylton B. Menz

Papers

A podiatry intervention to reduce falls in care home residents is feasible and demonstrates benefits: results from PIRFECT, a feasibility randomised controlled trial

Developing a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases: A scoping review and report from the OMERACT 2022 foot and ankle special interest group session.

Falls in Older People: Modifying the environment to prevent falls

Setting the pace: the 2011 Australasian Podiatry Council conference.

Optimizing movement and preventing falls in Parkinson's disease : strategies for patients and caregivers