Richard W. Sattin

The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques

OBJECTIVEnTo determine if short-term exercise reduces falls and fall-related injuries in the elderly.nnnDESIGNnA preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years.nnnSETTINGnTwo nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home.nnnPARTICIPANTSnNumbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling.nnnINTERVENTIONSnExercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements.nnnMAIN OUTCOME MEASURESnTime to each fall (fall-related injury) by self-report and/or medical records.nnnRESULTSnUsing the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome.nnnCONCLUSIONSnTreatments including exercise for elderly adults reduce the risk of falls.

Intense Tai Chi Exercise Training and Fall Occurrences in Older, Transitionally Frail Adults: A Randomized, Controlled Trial

Objectives: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty.

Associations of Demographic, Functional, and Behavioral Characteristics with Activity‐Related Fear of Falling Among Older Adults Transitioning to Frailty

OBJECTIVES: To determine, in a cohort of older individuals transitioning to frailty (defined by Speechley and Tinetti, 1991) who have previously fallen, whether there are significant associations between demographic, functional, and behavioral characteristics and activity‐related fear of falling, using both the Falls Efficacy Scale (FES) and the Activities‐Specific Balance Confidence Scale (ABC).

Reduction in fear of falling through intense Tai Chi exercise training in older, transitionally frail adults

Objectives: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty.

Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.

BACKGROUNDnA decade after promulgation of treatment guidelines by the Brain Trauma Foundation (BTF), few studies exist that examine the application of these guidelines for severe traumatic brain injury (TBI) patients. These studies have reported both cost savings and reduced mortality.nnnMATERIALSnWe projected the results of previous studies of BTF guideline adoption to estimate the impact of widespread adoption across the United States. We used surveillance systems and national surveys to estimate the number of severely injured TBI patients and compared the lifetime costs of BTF adoption to the current state of treatment.nnnRESULTSnAfter examining the health outcomes and costs, we estimated that a substantial savings in annual medical costs (

Home Environmental Hazards and the Risk of Fall Injury Events Among Community‐Dwelling Older Persons

262 million), annual rehabilitation costs (

Leading Causes of Unintentional and Intentional Injury Mortality: United States, 2000–2009

43 million) and lifetime societal costs (

A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness.

3.84 billion) would be achieved if treatment guidelines were used more routinely. Implementation costs were estimated to be

Chronic Medical Conditions and Risk of Fall Injury Events at Home in Older Adults

61 million. The net savings were primarily because of better health outcomes and a decreased burden on lifetime social support systems. We also estimate that mortality would be reduced by 3,607 lives if the guidelines were followed.nnnCONCLUSIONSnWidespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

Physical activity, functional limitations, and the risk of fall-related fractures in community-dwelling elderly

OBJECTIVE: To determine if home environmental hazards increase the risk of fall injury events among community‐dwelling older persons.