User:Melanievandyke/sandbox

My Developmental Psychology class is working to add updated information and high quality review citations to 2 pages: Falls in Older Adults and Fall Prevention.

== Falls in Older Adults (Place edits below this section): 1. Specific placement of addition (Name of Section heading, if it's a new section, and the sentence before and after the addition) 2. APA reference to source 3. Addition ==

1.   The placement of my article will be under causes specifically under “Intrinsic factors”

2.    Saftari, L. N., & Kwon, O. S. (2018). Ageing vision and falls: A review. Journal of Physiological Anthropology, 37(1), 11. https://doi-org.stlcopisa.stlcop.edu/10.1186/s40101-018-0170-1

3.   As aging occurs, visual function begins to deteriorate which will increase the risk of falls. Visual acuity is related to the vestibule, the part of your ear that helps control balance. If visual acuity becomes weakened and unbalanced then it is more likely to cause falls. With age, the flexibility of the lens decreases causing the eye to struggle focusing on near and far objects. Also, the Melbourne Edge Test, which assesses contrast sensitivity showed that low contrast sensitivity in the elderly has led to falls due to the lack of being able to detect objects in a visually difficult environment. Contrast sensitivity (differentiating between different luminance levels in a static image) can even become more difficult with certain lightings, such as in a dark area or a room with flashing lights. Depth perception (the ability to perceive distance between something and ourselves) can be measured through a stereo acuity test. The weakness in stereo acuity was also associated with an increase in hip fractures, which is a common injury caused by falls. As an individual’s age increases, the ciliary muscle relaxes which in turn causes the change in diameter. This results in the viewing of objects at various distances to sometimes be inaccurate. The Salisbury Eye Evaluation, a study that tested visual performance of 2520 older adults aged 65 to 84 years old, found that many self-reported falls had to do with the lack of effective vision.

1.) My information will be located in Falls in Older Adults. It belongs in the section labeled “Causes” underneath the subheading labeled “Intrinsic Factors.”

2.) APA Citation containing DOI link

Remelli, F., Vitali, A., Zurlo, A., & Volpato, S. (2019). Vitamin D Deficiency and Sarcopenia in

Older Persons. Nutrients, 11(12), 2861. https://doi-org.stlcopisa.stlcop.edu/10.3390/nu11122861

3.) Vitamin D plays an essential role in maintaining the functionality of skeletal muscles, which are the muscles that move our bones and allow for bodily locomotion. With age, vitamin D production is reduced. This can pose a risk to older adults because a lack of vitamin D can cause skeletal muscles to weaken. When elderly people become vitamin D deficient, the likely result is a condition called Sarcopenia. Sarcopenia is generally only present in older persons, and it can negatively impact gait in those affected. If one loses the ability to walk with ease, they are bound to experience balance issues or a fall, which could cause injuries. The presence of Sarcopenia in an elderly person’s life can cause their quality of life to decrease, which can be depressing, embarrassing, and frustrating for the individual. However, to decrease the probability of losing muscle mass and strength in skeletal muscle, older adults could consider taking vitamin D as a supplement. A decline in older persons with Sarcopenia could minimize the likelihood of falls occurring in this age group.

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 * 1) Falls in Older Adults, under subheading Screening
 * 2) Ambrose, A. F., Cruz, L., & Paul, G. (2015). Falls and fractures: A systematic approach  to screening and prevention. Maturitas, 82(1), 85-93. https://doi-org.stlcopisa.stlcop.edu/10.1016/j.maturitas.2015.06.035
 * 3) Physical examinations are important for assessing falls in older adults. They help reduce falls and more importantly, they help reduce the risk of fractures from falling.  a)       Vision: Vision should be tested with elderly adults that have fallen more than two times. The treatment in vision impairments have results in the reduction in the risk of falls. A successful study resulted in a decrease of fall rates when single lenses were put in place of multifocal glasses.  b)      Mental health and cognitive capacity: A cohort study found a link between falls and depression in older adults that live in a community dwelling setting. A brief assessment can include asking “Have you been bothered lately by feeling down, depressed, or hopeless?” and “Have you been bothered lately by little interest or pleasure in doing things?” If this assessment becomes positive, then a full evaluation should be performed. The fear of falling is also a risk factor for falls and this can be assessed by using the Activities-Specific Balance Confidence Scale (ABC Scale). This is a 16-item scale that allows physicians to see how confident adults are with their balance while performing daily activities. As for cognitive capacity assessment, the Mini Mental Status Exam is a screening assessment that can see if the patient has cognitive impairment that put them at great risk for falling. c)       Balance tests: Four balance tests to assess elderly adults include Tinetti Mobility Test (TMT), Berg Balance Scale, 30 Second Chair Test, and the Four Stage Balance Test (FSBT). The Tinetti Mobility Test is used to assess static, dynamic, reactive, and anticipatory balance. It is useful for community-dwelling older adults. The Berg Balance Scale determines a patient’s score by their ability to complete 14 mobility tasks. The Four Stage Balance Test and the 30 Second Chair Test are both recommended by the CDC. FSBT has the patient stand in 4 positions, which gets harder with each position. If the patient can not stand longer than 10 seconds for the third position, then they have a greater risk of falling. The 30 Second Chair Test consists of measuring the number of times a patient can stand up from a seated position within 30 seconds. If the patient ends up not making above the average for their age, then they are at risk for falling. Gait evaluation: Stride-to-stride measures for gait timing have identified fall risks in laboratory settings, studying the movement of elderly adults during daily tasks, which include sensitive insoles, 3-D imaging, and inertial sensors. Although this technology is good for identifying the risk of falling, it requires testing outside of the laboratory.

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1. New subheading: Upcoming Fall Prevention Technology

2. Sun, R., & Sosnoff, J. J. (2018). Novel sensing technology in fall risk assessment in older adults: A systematic review. BMC Geriatrics, 18(14), 1-10. https://doi.org/10.1186/s12877-018-0706-6

3. Balance and sensor devices, such as the Wii balance board and pressure sensing insoles, are being researched on to better predict and better prepare for future falls.[1] These devices detect the movements of an individual to evaluate the chance of the individual falling in the future. In fact, the accuracy with predicting future falls was greater than 50% with only a few devices falling short.

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 * 1) My addition to Wikipedia will be placed in Falls in Older Adults under the section titled ‘Epidemiology’
 * 2) Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017;318(17):1687–1699. doi:10.1001/jama.2017.15006
 * 3) Although risks associated with falls in older adults increase with age, interventions can help reduce them. According to a systematic review and meta-analysis of adults aged 65 years or older, 4 interventions were associated with reducing falls in older adults:  1.      Exercise (specifically balance-enhancing exercise)  2.      Exercise combined with vision treatment  3.      Exercise combined with vision and environmental assessment and treatment  4.      Clinic-level improvement strategies, multifactorial treatment, calcium supplementation, and vitamin D supplementation combined  These results are supported by research, however the choice of a particular intervention is based on the patient and/or caregiver’s preference.

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== Fall Prevention (Place edits below this section): 1. Specific placement of addition (Name of Section heading, if it's a new section, and the sentence before and after the addition) 2. APA reference to source 3. Addition == 1.     In Falls Prevention under Strategies and Interventions section, make a new sub-heading called Exercise starting with their sentence “Exercise as a single intervention has been shown to prevent falls in community dwelling older adults” and replace “A systematic review suggests that having an exercise regimen that includes challenging balance workouts for three or more hours per week results in a lesser chance of falling.” with my addition.

2. Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J., & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine, 51(24), 1750–1758. https://doi-org.stlcopisa.stlcop.edu/10.1136/bjsports-2016-096547

3.     Programs that include physical exercises can prevent falls in older adults. Those programs include balance, strength, and flexibility exercises. Studies have shown that balance exercises are the most effective types of exercises in reducing the risk of falls in older adults, especially when older individuals are consistently active. Exercise programs include 3 types of balance exercises:

1.      Reducing the base of support – Exercises that focus on standing and maintaining balance. The main goal is to improve an individual’s stability (e.g., standing still while feet are close together, one leg stands, etc.)

2.     Moving the center of gravity and controlling body position while standing – Exercises that focus on maintaining balance during movement. (e.g., transferring body weight from one leg to another, step-ups on a higher surface, etc.)

3.     Standing without using the arms for support (e.g., balancing on an unstable surface while using one or no hands)

Being active and consistent with an exercise routine/schedule can reduce the number of falls in older adults. Balance exercises are most effective when combined with more than 3 hours per week of regular exercise. A meta-analysis with approximately 19 000 participants showed that older adults who combined balance exercises with more than 3 hours of regular exercise had positive results, reducing falls by 21%.

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 * 1) My addition would go in the “Strategies and Interventions” section. I would want my addition to be the first thing in the section, as it would transition nicely with the other strategies that the author listed.

2. Phelan, E. A., & Ritchey, K. (2018). Fall prevention in community-dwelling older adults. Annals of Internal Medicine, 169(11), ITC81-ITC96. http://doi.org/10.7326/aitc201812040

3. Multifactorial preventative methods are shown to be much more effective at preventing falls in elderly adults, supported by a review including 41,596 subjects in 54 trials. Individual methods include exercise, facing fears of falling, regular consultations, medication reviews, and vitamin supplements. With a combination of these methods, an older adult can have significantly less falls than if they just implement one method of prevention. Research studies show that these individual methods are successful in reducing the number of falls. Yet, when these methods are used synchronously, there is a significant decrease in the number of falls.

One of the ways to prevent future falls is to have a medication review, as certain medications can compromise the balance of an elderly who struggles with frequent falls. A meta-analysis with 22 research studies and 79,081 subjects concluded that there are certain medications that increased the risk of falls such as antidepressants and neuroleptics. A doctor would suggest either switching medications or removing the medication entirely to prevent future falls.

Another way to prevent future falls is to exercise more frequently. Exercise, specifically focusing on balance and strength, is the method that is proven to be the most beneficial intervention method, according to the same trial mentioned above. Doctors suggest combining exercise with vision assessment or home modifications to further reduce the potential for falls.

Fear of falling increases the chances of falling in the future. The reason behind this is because when elderly is afraid of falling, they avoid as much physical activity as possible. The disuse of muscles results in detrimental changes in posture and balance, which increases the chance of falling. A way to prevent this is to understand that a fear of falling only increases the chance of falling. The fear can be reduced by therapy, self-assurances, and frequent movement. Once the elderly take steps to recover from their fear, they will have less falls.

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 * 1) I would put this information under the section of Environmental modification. Since the use of a wheelchair would part of a home environment and could potentially cause many hazards if not taken precautions. I would specifically put this information between the subsections of Lighting and Eyeglasses selection and usage.

2. Sutton D, McCormack S. (2019). Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jul 19. https://www.ncbi.nlm.nih.gov/books/NBK546784

3. Patients in a wheelchair and their caregivers may benefit from assessment and training on the proper transfer method and basic functioning of a wheelchair from a trained professional. Some of the safety precautions would include that the wheelchair is in a good working condition and should be in the appropriate height for the patient. Wheelchairs that are too short or tall compared to the patient’s height would make it challenging for the patient to appropriately adjust to it. Patients need to communicate well with someone in order to understand all the pros and cons of a wheelchair. Especially if they are going to be on their own, they need to know the proper methods of how they can move themselves around in specific environments, including problems with slippery floors and lighting during the day and nighttime. Overall, patients need to be as cautious as they can, in order for them to prevent any difficulties in a wheelchair and to prevent falls.

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 * 1) I would like my addition in the Fall Prevention article under the “Occupational and physical therapy” heading and then under the subheading “Older adults” in the second paragraph.

2. Elliot, S., & Leland, N.E. (2018). Occupational Therapy Fall Prevention Interventions for Community-Dwelling Older Adults: A Systematic Review. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 72(4), 1-11. https://doi.org/10.5014/ajot.2018.030494

3. Different approaches to occupational therapy fall-prevention interventions were found to be effective, and the group-based multicomponent intervention was most effective. These approaches included single-component interventions, group-based multicomponent interventions, multifactorial interventions that are uniquely tailored, and population-based interventions. Single-component interventions focused on areas such as balance, exercise, guided imagery, or relaxation. Occupational Therapists assessed the home and functional abilities as well as educated patients on fall risks. Group-based interventions included both exercise and education. These strategies focused on strength, balance, functional tasks, gait speed, and even included training with fall techniques and obstacle courses to improve Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Education included footwear risks, assistive devices, and home risks, fall recovery, and medication management. Multifactorial interventions that were uniquely tailored included assessing fall risk for each individual, developing goals, training, and group activities. The population-based intervention focused on group-based exercises such as eight 2-hour group sessions that focused on decreasing fear, building balance confidence, and increasing activity levels, as well as cognitive-behavioral interventions and safe behavior programs. The group-based multicomponent intervention was the most effective--it had the strongest evidence showing an increase in balance confidence, reduction in fall rate, increased gait speed, and a decrease in ADL and IADL impairments.