Objective: to summarise and critically evaluate evidence on the effect of bedrails on falls and injury

Design: systematic literature review using the principles of QuoRoM guidance.

Setting and Subjects: adult healthcare settings

Review Methods: using the keyword, bedrail, and synonyms, databases were searched from 1980 to June 2007 for direct injury from bedrails or where falls, injury from falls, or any other effects were related to bedrail use.

Results: 472 papers were located; 24 met the criteria. Three bedrail reduction studies identified significant increases in falls or multiple falls, and one found that despite a significant decrease in falls in the discontinue-bedrails group, this group remained significantly more likely to fall than the continue-bedrails group; one case-control study found patients who had their bedrails raised significantly less likely to fall; one retrospective survey identified a significantly lower rate of injury and head injury in falls with bedrails up. Twelve papers described direct injury from bedrails.

Discussion: it is difficult to perform conventional clinical trials of an intervention already embedded in practice, and all included studies had methodological limitations. However, this review concludes that serious direct injury from bedrails is usually related to use of outmoded designs and incorrect assembly rather than being inherent, and bedrails do not appear to increase the risk of falls or injury from falls.

Methods: consecutive new female patients aged 65 years and older recruited from outpatient UI clinics in Quebec received a behavioural management protocol for UI. At 3-month follow-up, patients and physicians were independently asked for their global impression of change in UI status. Patients completed 3-day voiding diaries and a UI-specific quality-of-life index before and after treatment.

Results: 108 patients (mean age 73 ± 5 years, range 65-86 years) with stress, urge and mixed UI participated. There was concordance between patients' and physicians' ratings of change in 57% of cases. Among the remaining cases, patients were 1.6 times as likely to report significant improvements compared to physicians. Patients' ratings correlated more strongly with improvements in UI episodes in the voiding diary (r = 0.4, P = 0.002 versus r = 0.3, P = 0.004 for physicians) and on the quality-of-life index (r = –0.5, P < 0.0001 versus r = –0.4, P < 0.0001 for physicians).

Conclusion: physicians underestimate clinically meaningful changes in UI in older women following behavioural interventions.

Objective: the aim of this study was to measure functional performance and aerobic reserve in older adults during the serial performance of daily tasks.

Subjects: twenty-nine (n = 29) men and women (n = 23females) 70–92 years of age participated in this study.

Methods: performance based physical function was assessed using the Continuous-Scale Physical Functional Performance test (CS-PFP). A Cosmed K4b^2TM portable metabolic system was used to measure VO_2PEAK and oxygen uptake during the serial performance of a battery of daily tasks (VO_2PFP). Aerobic reserve was calculated as the difference between VO_2PEAK and VO_2PFP.

Results: the correlation coefficient between aerobic reserve and functional performance was r = 0.50(P = 0.006). Participants utilized 32.2 ± 8.1%, 42.7 ± 10.8%, and 50.3 ± 12.3% of VO_2PEAK for the low, moderate, and high workloads of the CS-PFP, respectively.

Conclusions: light housework and carrying groceries require 40 to 50% of peak oxygen consumption. This information can be used by clinicians and health professionals working with older adults as a guide to how much aerobic fitness is needed to perform ADLs and maintain independence. These can then be used as guides for assessment and for setting training goals in older adults.

Methods: DCM (version 8) was conducted in three elderly care general hospital wards and in two community hospitals. Summary statistics were calculated from the DCM data to assess feasibility and adequacy of the DCM coding system.

Results: fifty-eight participants were mapped for 84 observation hours/414 patient hours (4,968 5-min time frames). There was a relatively high proportion (942/2,376; 40% time frames) of missing data in the community hospitals due to time patients spent away from the area under observation. All 3,624 of the time frames with patient-observed data could be coded utilising the existing Behaviour Category and Mood/Engagement Value coding frameworks.

Discussion: the results from this preliminary study are promising and indicate that DCM is potentially feasible in elderly care general hospital wards, without the need for major modification.

Design: retrospective analysis of the oldest old from a population-based cohort study.

Setting: population-based study in England and Wales: two rural and three urban sites.

Methods: two types of analyses were conducted: (i) a descriptive analysis of those individuals who were aged 90 years or more, and 100 years or more, and (ii) a survival analysis of those who reached their 90th, 95th, or 100th birthday during the study. Median survival time was calculated by the Kaplan–Meier method. Effects of socio-demographic characteristics on survival were evaluated using the Cox proportional-hazards regression model.

Results: in total, 958 individuals aged 90 years or more, and 24 individuals aged 100 years or more, had been interviewed at least once during the study. Twenty-seven per cent were living in residential or nursing homes. Women aged 90 years or more were more likely to be living in residential and nursing homes, be widowed, have any disability or have lower MMSE scores. The centenarians were mostly cognitively and functionally impaired. The median survival times for those reaching their 90th (n = 2,336), 95th (n = 638), or 100th birthday (n = 92) during the study were 3.7 years (95% CI: 3.5–4.0), 2.3 (2.1–2.6) and 2.1 (1.7–2.6) years for women, and 2.9 (95% CI: 2.6– 3.1), 2.0 (1.2–3.1) and 2.2 (0.5–2.3) for men, respectively. Those living in residential and nursing homes had a shorter survival when aged 90 years, with similar non-significant effects for those aged 95 and 100 years. After the age of 100 years, the high mortality rate and small sample size limited the ability to detect any differences between the different groups.

Conclusion: even at the very oldest ages, the majority live in non-institutionalised settings. Among the oldest old, women were frailer than men. Being male and living in residential nursing homes shortened survival in those aged 90 years or more.

Methods: prospective cohort study with a 2-year follow-up.

Setting: the English Longitudinal Study of Ageing (ELSA), a national probability sample of non-institutionalised older people.

Participants: 4,148 participants aged 60 years and over.

Measurements: exposure was a census-based index of neighbourhood deprivation [the Index of Multiple Deprivation (IMD)]; outcomes were measured and self-reported incident mobility difficulties.

Results: neighbourhood deprivation had a statistically significant effect on physical function following adjustment for individual socio-economic factors, health behaviours and health status. Compared to those living in the least deprived 20% of neighbourhoods, those in the most deprived neighbourhoods had a risk ratio (RR) of incident self-reported mobility difficulties of 1.75 (95% CI 1.14–2.70) and RR of incident-impaired gait speed of 1.63 (95% CI 1.01–2.62). In adjusted models, 4.0 per 100 (95% CI 3.0–5.4) older adults in neighbourhoods in the least deprived 20% had incident mobility difficulties over a 2-year period, whereas 13.6 per 100 (95% CI 10.5–17.4) older adults had incident mobility difficulties in neighbourhoods in the most deprived 20%.

Conclusions: older people living in deprived neighbourhoods are significantly more likely to experience incident mobility difficulties than those in less-deprived neighbourhoods. The mechanisms underlying this relationship are unclear and research to identify mechanisms and appropriate interventions is needed.

Objective: to evaluate the risk of early unplanned readmission, and to identify predictors in inpatients aged 75 and over, admitted to medical wards through emergency departments.

Design: prospective multi-centre study.

Setting: nine French hospitals.

Subjects: one thousand three hundred and six medical inpatients, aged 75 and older admitted through emergency departments (SAFES cohort).

Methods: using logistic regressions, factors associated with early unplanned re-hospitalisation (defined as first unplanned readmission in the thirty days after discharge) were identified using data from the first week of hospital index stay obtained by comprehensive geriatric assessment.

Results: data from a thousand out of 1,306 inpatients were analysed. Early unplanned readmission occurred in 14.2% of inpatients and was not related with sociodemographic characteristics, comorbidity burden or cognitive impairment. Pressure sores (OR = 2.05, 95% CI = 1.0–3.9), poor overall condition (OR = 2.01, 95% CI = 1.3–3.0), recent loss of ability for self-feeding (OR = 1.9, 95% CI = 1.2–2.9), prior hospitalisation during the last 3 months (OR = 1.6, 95% CI = 1.1–2.5) were found to be risk factors, while sight disorders appeared as negatively associated (OR = 0.5, 95% CI = 0.3–-0.8).

Conclusions: markers of frailty (poor overall condition, pressure sores, prior hospitalisation) or severe disability (for self-feeding) were the most important predictors of early readmission among elderly medical inpatients. Early identification could facilitate preventive strategies in risk group.

Method: design—population-based cross-sectional study; setting—local community in Southeast Region of Singapore; subjects—Chinese older adults aged 55 and above (N = 2, 550); measurements—serum albumin, haemoglobin, BMI and Mini-Mental State Examination (MMSE).

Results: in multivariable analyses controlling for gender, age, education and vascular risk factors, low albumin in the bottom quintile (OR 2.04; 95% CI 1.22–3.41) and low haemoglobin in the bottom quintile (OR 1.56; 95% CI 1.00–2.47) and low BMI with chronic comorbidity (OR 1.73; 95%CI 1.02–2.95) were independently associated with poor cognitive performance (MMSE ≤ 23). Among cognitively intact respondents (MMSE ≥ 24), albumin concentration showed a significant inverse linear relationship with MMSE scores (P for trend =0.002).

Conclusion: low albumin, low haemoglobin and low BMI (in the presence of chronic comorbidity) are independently associated with poor cognitive performance in community-living older adults.

Objective: the objective of this study was to examine the comparative ability and clinical utility of eight mobility tests for predicting multiple falls in older community-dwelling people.

Methods: design—prospective cohort study; subjects –362 subjects aged 74–98 years; measurements—the sit-to-stand test with one and five repetitions, the pick-up-weight test, the half-turn test, the alternate-step test (AST), the six-metre-walk test (SMWT) and stair ascent and descent tasks. Falls were monitored for 1 year with fall calendars.

Results: in the 12-month follow-up period, 80 subjects (22.1%) suffered two or more falls. Multiple fallers performed significantly worse than non-multiple fallers in the sit-to-stand test with five repetitions (STS-5), the AST, the half-turn test, the SMWT and the stair-descent test. When dichotomised using cut-off points from receiver-operated characteristics (ROC) curve analyses, these tests demonstrated reasonable sensitivity and specificity in identifying multiple fallers. A principal components analysis identified only one factor underlying the mobility tests. Poor performances in two mobility tests, however, increased the risk of multiple falls more than poor performance in one test alone (ORs = 3.66, 95% CI = 1.44, 9.27 and 1.61, 95% CI = 0.62, 4.16 respectively).

Conclusions: the mobility tests appear to be measuring a similar ‘mobility’ construct. Based on feasibility and predictive validity, the AST, STS-5 and SMWTs were the best tests.

Design: cohort study, 6-month prospective follow-up for falls.

Participants: 183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women.

Methods: the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as ’high’ or ’low’; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR⁺ to rule in and LR^– to rule out a high fall risk).

Results: 53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR⁺ between 0.9 and 2.6 and LR^– between 0.1 and 1.0. The GLORF showed an LR⁺ of 2.8 and an LR^– of 0.6 and fall history showed an LR⁺ of 2.4 and an LR^– of 0.6.

Conclusions: in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.

Objective: to quantify the prevalence of PA in older asthmatics and to explore the potential psychosocial determinants of PA in this population.

Study Design and Setting: cross-sectional data available from the Canadian Community Health Survey (CCHS), cycle 2.1, were used. There was a total of 1,772 older asthmatics in the sample.

Results: there were significant differences in the prevalence of PA between older asthmatic females compared to middle-aged asthmatic females (² = 23.65, P < 0.0001) and older asthmatics compared to older non-asthmatics (² = 38.1, P < 0.0001). Logistic regression revealed a significant association between PA and perceived health in older asthmatic males (OR = 5.39, CI = 1.36–21.33) and females (OR = 4.81, CI = 1.41–16.38). Being a member of a volunteer organisation was also significantly associated with PA in older asthmatic females (OR = 1.59, CI = 1.11–2.30).

Conclusion: older asthmatics were less active than their non-asthmatic peers. Perceived health was an important predictor of PA in both older asthmatic males and females. Exercise interventions in this population should make an effort to improve self-perceived health.