Background: Falls risk assessment tools are used in hospital inpatient settings to identify pa-tients at increased risk of falls (which may be related to muscle loss/sarcopenia) to guide and target interventions for falls prevention. In 2022, Western Health, Melbourne, Australia, intro-duced a new falls risk assessment tool, the Western Health St. Thomas’ Risk Assessment Tool (WH-STRATIFY), a modified version of The Northern Hospital’s risk tool (TNH-STRATIFY), which replaced the Peninsula Health Risk Screening Tool (PH-FRAT). Aims: To determine the predictive accuracy of three falls risk assessment tools (PH-FRAT, TNH-STRATIFY and WH-STRATIFY) on admission to Geriatric Evaluation Management (GEM) units. Method: A retrospective observational study was conducted on four GEM units. Data was col-lected on 54 consecutive patients who fell during admission and 62 randomly sampled patients who did not fall between December 2020 and June 2021. Participants were scored against three falls risk assessment tools. The event rate Youden (Youden IndexER) indices were calculated and compared using default and optimal cut points to determine which tool was most accurate for predicting falls. Results: Using default cut points to compare falls assessment tools, TNH-STRATIFY had the highest predictive accuracy (Youden IndexER = 0.20, 95% confidence interval CI = 0.07, 0.34). The PH-FRAT (Youden IndexER = 0.01 and 95% CI = -0.04, 0.05) and WH-STRATIFY (Youden IndexER = 0.00 and 95% CI = -0.04, 0.03) were statistically equivalent and not predictive of falls compared to TNH-STRATIFY. When calculated optimal cut points were applied, predictive accuracy im-proved for PH-FRAT (Cut point 17, Youden IndexER = 0.14 and 95% CI = 0.01, 0.29) and WH-STRATIFY (Cut point 7, Youden IndexER = 0.18 and 95% CI = 0.00, 0.35). Overall, all tools had low predictive accuracy for falls. Conclusion: TNH-STRATIFY had the highest predictive accuracy for falls. The predictive accu-racy of WH-STRATIFY improved and was significant when the calculated optimal cut point was applied. The optimal cut points of falls risk assessment tools should be determined and validated in different clinical settings to optimise local predictive accuracy, enabling targeted falls risk mitigation strategies and resource allocation.

As there is lack of understanding about the effect of transitioning between different flooring materials on the gait of older adults, this study investigated the effect of transitioning between a carpeted floor and a vinyl floor on the gait characteristics of older adults. Fourteen older (65 years old and over) and 14 younger (18 to 35 years old) adults walked on different transitional floors by measuring various gait parameters. While the older participants had greater toe clearance than their younger counterparts, the older participants had smaller toe clearance on a carpeted floor than on a vinyl floor, which would increase the probability of a trip-induced fall. Further, the study found the slower transitional acceleration of the whole body COM and the increased friction demand, especially during the toe-off phase, rather than heel contact phase, which will lead to a slip-induced fall on a vinyl floor shortly after transitioning from a carpeted floor to a vinyl floor. Although the increased likelihood of a slip or trip accident was found throughout the changes in gait parameters, the older participants did not perceive of slipping and tripping much. Therefore, older adults are recommended to be made aware of the danger of slipping and tripping while transitioning between different flooring materials.

Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate falls/fractures risk compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious falls risk. Methods: We conducted a retrospective cohort study including non-cancer fee-for-service Medicare beneficiaries initiating OPI and/or BZD in 2016-2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated time to first injurious fall within 3 months post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. Results: Among 622,588 beneficiaries (age≥65=84.6%, female=58.1%, White=82.7%; having injurious falls=0.45%), we identified 13 distinct OPI-BZD trajectories: Group(A):Very-low OPI-only (early discontinuation)(44.9% of the cohort); (B):Low OPI-only (rapid decline)(15.1%); (C):Very-low OPI-only (late discontinuation)(7.7%); (D):Low OPI-only (gradual decline)(4.0%); (E):Moderate OPI-only (rapid decline)(2.3%); (F):Very-low BZD-only (late discontinuation)(11.5%); (G):Low BZD-only (rapid decline)(4.5%); (H):Low BZD-only (stable) (3.1%); (I):Moderate BZD-only (gradual decline)(2.1%); (J):Very-low OPI (rapid decline)/Very-low BZD (late discontinuation)(2.9%); (K):Very-low OPI (rapid decline)/Very-low BZD (increasing)(0.9%); (L):Very-low OPI (stable)/Low BZD (stable)(0.6%); and (M):Low OPI (gradual decline)/Low BZD (gradual decline)(0.6%). Compared with Group(A), 6 trajectories had increased 3-month injurious fall risks: (C): HR, 95%CI=1.78, 1.58-2.01; (D): 2.24, 1.93-2.59; (E): 2.60, 2.18-3.09; (H): 2.02, 1.70-2.40; (L): 2.73, 1.98-3.76; and (M): 1.96, 1.32-2.91. Conclusions: Our findings suggest that 3-month injurious fall risk varied across OPI-BZD trajectories, highlighting the importance of considering both dose and duration when assessing fall risks of OPI-BZD use among older adults.

Falls are the third-leading cause of disabilities among the elderly population worldwide. In Pakistan, the prevalence is 44%; out of them, 8% develop injuries, placing them at high risk for hospitalization or even premature death. Interestingly, fall is multifactorial, and fall risk depends on individual characteristics (intrinsic factors) and environmental features (extrinsic factors), which can be different from context to context. Therefore, regular assessment of fall risk factors is required to develop a strategy for fall prevention. This study aimed to identify intrinsic risk factors for falls in Pakistani elders living in the communities, and provide evidence for preventive strategies of falls in elderlies. Data were collected from 140 Muslim elders from two residential areas of Peshawar, Khyber Pakhtunkhwa, from July 2022 to August 25, 2022, after taking permission from Zhengzhou University Ethical Review Board (ZUIRB #202254), and District Health Department Office (DHO #14207).Participants were informed and concern was taken before collect data. Data were collected using the Time Up and Go Test (TUGT), the Mini-Mental Status Examination, and interviews regarding the prayer practice. Factors associated with falls were; age, gender, education, cognitive status, TUGT level, incorrect prayer postures, poor vision, and history of falls with a significance of (P.<0.05). Poor cognition, low vision, poor walking speed, and prayers without body movements have good membership with falls risk prediction as (P<0.005) in Omnibus, Lemeshow score (0.77). Hence, our study provides a road map for future risk assessment for falls by adding the four mentioned risk factors as offered in the proposed model to facilitate taking timely action to prevent fall-related ailments in Pakistani elders.

When bone substitutes materials are used, the increased risk of infection due to the none-autogenic graft is often discussed. The treatment of large bone defects in geriatric patients, often with osteoporotic bone, often presents major challenges to surgery. Bone substitutes materials are available indefinitely without the risk of additional surgery in each patient. Can bone substitutes materials be used without hesitation in the geriatric patient?Eighty-three patients suffered traumatic fractures of the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with bone substitute material based on nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group without the void filling with a bone graft substitute (void defects, ED) was studied. All patients over the age of 64 years were retrospectively evaluated for complications and radiological outcomes. Results: 106 patients sustained traumatic fractures of the distal radius (68.9%), proximal humerus (5.7%), and proximal tibia (22.6%). No differences in infections were found when comparing the groups (p=1.0). retrospectively evaluated. The KEM group had a nonsignificantly lower rate of pseudarthrosis (p=0.09). A relative risk (RR) reduction of complications of 32.64% was observed when bone grafting material was used. The NNT for the prevention of complications was 5.99. When bone healing was assessed by radiological images, some follow-up studies showed significant differences in fracture bridging (p<0.001).Conclusions: In contrast to previous studies, bone substitutes materials can support the healing process in geriatric patients without relevant disadvantages. With an NNT of 6 regarding complications, many patients could benefit from bone graft augmentation. No increased infection rate was observed.

When bone substitutes materials are used, the increased risk of infection due to the none-autogenic graft is often discussed. The treatment of large bone defects in geriatric patients, often with osteoporotic bone, often presents major challenges to surgery. Bone substitutes materials are available indefinitely without the risk of additional surgery in each patient. Can bone substitutes materials be used without hesitation in the geriatric patient? Eighty-three patients suffered traumatic fractures of the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with bone substitute material based on nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group without the void filling with a bone graft substitute (void defects, ED) was studied. All patients over the age of 64 years were retrospectively evaluated for complications and radiological outcomes. Results: 106 patients sustained traumatic fractures of the distal radius (68.9%), proximal humerus (5.7%), and proximal tibia (22.6%). No differences in infections were found when comparing the groups (p=1.0). retrospectively evaluated. The KEM group had a nonsignificantly lower rate of pseudarthrosis (p=0.09). A relative risk (RR) reduction of complications of 32.64% was observed when bone grafting material was used. The NNT for the prevention of complications was 5.99. When bone healing was assessed by radiological images, some follow-up studies showed significant differences in fracture bridging (p<0.001). Conclusions: In contrast to previous studies, bone substitutes materials can support the healing process in geriatric patients without relevant disadvantages. With an NNT of 6 regarding complications, many patients could benefit from bone graft augmentation. No increased infection rate was observed.

Postural instability (PI) in Parkinson’s disease (PD) exposes patients to increased risk of falls (RF). Although dopaminergic therapy and deep brain stimulation (DBS) improve motor performance in advanced PD patients, their effects on PI and RF are not clear. PI and RF were assessed by a stabilometric platform in 6 advanced PD patients. Patients were evaluated on and off dopaminergic medication and four DBS conditions: bilateral-DBS, DBS of the more- or less-affected side and DBS-off. Dopaminergic medication alone worsened PI and RF, DBS alone worsened RF, and no medication/DBS combination produced an improvement in postural control with respect to the OFF-medication/DBS-off condition. When ON-medication, PI and RF significantly improved after turning the DBS on, regardless of medication condition. Among DBS conditions, bilateral-DBS provided the maximal improvement of PI and RF when ON medication, and minimal worsening of PI and RF when OFF medication, whereas patients performed worse when in most-affected side DBS condition. These results can help in developing the best therapeutic strategy for postural disorders in patients with advanced PD.

This study aimed to characterize the risk of falling in low, moderate and high risk participants from two different geographical locations using a portable force-plate. A sample of 390 older adults from South and North America were matched for age, sex, height and weight. All participants performed a standardized balance assessment using a force plate. Participants were classified in low, moderate and high risk of falling. No differences were observed between South and North American men, nor comparing North American men and women. South American women showed the significantly shorter center of pressure path length compared to other groups. The majority of the sample was categorized as having low risk of falling (male: 65.69 % and female: 61.87 %), with no differences between men and women. Also, no differences were found between North vs. South Americans, nor for falls risk levels when male and female groups were compared separately. In conclusion, South American women had better balance compatible with the status of the 50-59 years’ normative age-range. The prevalence of low falls risk was ~ 61-65 % and the prevalence of moderate to high risk was ~ 16-19 %. The frequency of fall risk did not differ significantly between North and South Americans, nor between males and females.

Infants’ avoidance of drop-offs has been described as an affordance learning that is not transferable between different locomotor postures. In addition, there is evidence that infants perceive and act similarly around real and water cliffs. This cross-sectional study investigated the effects of specific locomotor experiences on infants’ avoidance behaviour using the Real Cliff / Water Cliff paradigm. The experiments included 102 infants, 58 crawling, but pre-walking, infants (M_age= 11.57 months, SD = 1.65) with crawling experience ranging between 0.03 and 7.4 months (M = 2.16, SD = 1.71) and 44 walking infants (M_age = 14.82 months, SD = 1.99), with walking experience ranging between 0.13 and 5.2 months (M = 1.86, SD = 1.28). The association between crawling experience and crawlers’ avoidance of the real and water cliffs was confirmed. Importantly, crawling and total self-produced locomotor experience, and not walking experience, were associated with walkers’ avoidance behaviour on both cliffs. These results suggest that some degree of perceptual learning acquired through crawling experience was developmentally transferred to the walking posture. A longer duration of crawling experience facilitates a more rapid recalibration to the new walking capability. In addition, there was no difference in infants’ avoidance of falling on the real and the water cliff. However, infants explored the water cliff more than the real cliff, revealing more enticement to examine bodies of water than for drop-offs.

The results of this study offer a potential to gain a better understanding of the mechanisms underlying the falls in the elderly. The results were recorded for a group of 27 women in a control group (CON) and 16 women in an experimental group (EXP), aged 60-70. Participants took part in the six-weeks Elderly Recreation Movement Program (ERMP) with the difference, that the EXP group practiced twice as often as the CON group. The measurement of variations in the index called limits of stability (LOS) was performed by application of Kistler force plate and the coactivation index (CI) was registered by means of sEMG. The results demonstrate the existence of statistically significant differences in terms of the principal outcome of the exercise time in the measurements of LOS (F (1.42) = 10.0, p = 0.003), and CI (F (1.42) = 10.5, p = 0.002). The effect of the program was associated with an increase the level of the maximum LOS, and a decrease of the CI level, especially in the experimental group. Hence, the implementation of an innovative ERMP exercise program results in the improvement of the physical capabilities of senior subjects and a reduction of the risk of falls.

Tripping is the largest cause of falls and low swing foot ground clearance during the mid-swing phase, particularly at the critical gait event known as Minimum Foot Clearance (MFC) is the major risk factor for tripping-related falls. Intervention strategies to increase MFC height can be effective if applied in real-time based on feed-forward prediction. The current study investigated the capability of machine learning models to classify the MFC into various categories using toe-off kinematics data. Specifically, three MFC sub-categories (less than 1.5cm, between 1.5-2.0cm and higher than 2.0cm) were predicted applying machine learning approaches. A total of 18,490 swing phase gait cycles’ data were extracted from six healthy young adults, each walking for 5-minutes at a constant speed of 4km/h on a motorised treadmill. Both K-Nearest Neighbour (KNN) and Random-Forest were utilised for prediction based on the data from toe-off for five consecutive frames (0.025s duration). Foot kinematics data were obtained from inertial measurement unit attached to the mid-foot, recording tri-axial linear accelerations and angular velocities of the local coordinate. KNN and Random-Forest achieved 84% and 86% accuracy, respectively, in classifying MFC into the three sub-categories with run time of 0.39 seconds and 13.98 seconds respectively. The KNN-based model was found to be more effective if incorporated into an active exoskeleton as the intelligent system to control MFC based on the preceding gait event, toe-off due to its quicker computation time. The machine learning based prediction model shows promise for the prediction of critical MFC data indicating higher tripping risk.

As is known, the construction industry has one of the highest occupational accidents incidence rates among all economic sectors. Currently, Building Information Modeling (BIM) appears as a tool that addresses occupational safety issues throughout the construction life cycle projects, avoiding hazards and risks and, consequently, increasing safety. This work investigates BIM methodology and related technologies application for building safety planning in construction and demonstrates the potential of this technology for the integrated implementation of safety measures during the design phase and the construction site management. The first step consisted of a literature review on the application of BIM in safety in the design and planning phases. Following, to show the potentialities of construction simulation, a case study based on BIM 4D to prevent falls from height was developed. With BIM 4D, it is possible to follow the construction process over time, giving the construction safety technicians’, designers, supervisors and managers the capability to analyse, in each phase, the potential risks and which safety measures should be implemented. BIM can effectively integrate safety measures from the design phase to the construction and use phase and do integrated safety planning within construction planning, leading to reliable safety management throughout the construction process.