Falls in older people in long-term care
1
Correspondence www.thelancet.com Vol 381 April 6, 2013 1179 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ further investigation as potential causes of falling. Although visual impairment is an established risk factor for falls, very few randomised controlled trials have been designed to examine the effectiveness of visual intervention for fall prevention; most interventions (eg, providing new glasses) seem to have no effect, 4 with the exception of first eye cataract surgery (which reduces risk of fall by 34%). 5 The lack of effect highlights the need for novel visual aids and treatment strategies specifically for fall prevention, instead of simply focusing on improving visual acuity. I declare that I have no conflicts of interest. Yingfeng Zheng [email protected] State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China 1 Robinovitch SN, Feldman F, Yang Y, et al. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet 2013; 381: 47–54. 2 Lamoureux EL, Chong E, Wang JJ, et al. Visual impairment, causes of vision loss, and falls: the Singapore Malay Eye Study. Invest Ophthalmol Vis Sci 2008; 49: 528–33. 3 Wang MY, Rousseau J, Boisjoly H, et al. Activity limitation due to a fear of falling in older adults with eye disease. Invest Ophthalmol Vis Sci 2012; 53: 7967–72. 4 Cumming RG, Ivers R, Clemson L, et al. Improving vision to prevent falls in frail older people: a randomized trial. J Am Geriatr Soc 2007; 55: 175–81. 5 Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol 2005; 89: 53–59. The world’s neglect of the Syrian humanitarian and medical crises My country (Syria) has been completely transformed in the past 2 years. What began as peaceful protests calling for freedom and reforms has turned into an all-out civil war without any indication of an end in the near future. The world, most notably the UN, stands by as hospitals and bakeries are being systematically shelled with heavy artillery weapons, resulting in the deaths of about 100–200 civilians daily. After losing control of some cities, the Assad regime has changed its strategy; its intention is now to starve the people of these cities. Everyday necessities such as heating oil, infant formula, drinking water, and medicines are severely lacking in most cities in Syria. During these many months of turmoil, Syrian civilians have become acutely aware that their risk of being killed increases by simply leaving their homes to buy bread at their local bakery. The shelling of bakeries in Aleppo and other cities is no accident—it is part of the Assad regime’s strategy to target civilians. Hundreds of civilians thus far have lost their lives inside and in front of bakeries while waiting to buy bread, an indispensable part of every meal in Syria. The bombardment of targets includes not only bakeries but also hospitals. For example, Dar al-Shifa Hospital in Aleppo, where injured demonstrators and rebels were being treated, was bombed, bringing about the deaths of dozens of victims. Amid the chaos, at least 3 million Syrians have become displaced inside and outside of Syria. The UN places the current death toll of Syrian civilians, troops, and rebels at more than 70 000. However, the real number of deaths could be higher because many of those killed might not have been registered. I myself have relatives (civilians) who were killed in Aleppo but whose deaths were not registered by either the rebels or the government. The Syrian people do not understand why the ongoing Syrian humanitarian and medical crises are being ignored by the world and why nothing is being done to protect civilians in Syria. What are the differences between genocide and that which is happening in Syria? How many Syrian civilians have to be killed before the world says enough is enough? How many massacres have to be carried out before the world takes a stand and intervenes? How much longer must Syria endure the shelling of bakeries and hospitals and the systematic killing of civilians? I declare that I have no conflicts of interest. Mohamed Al-Khaled [email protected] luebeck.de Department of Neurology, University of Lübeck, 23538 Lübeck,Germany Falls in older people in long-term care Stephen Robinovitch and colleagues (Jan 5, p 47) 1 provide video-based evidence of the common characteristics of, and reasons for, falls in older people. The leading causes of falling included incorrect weight shifting (41%), trip or stumble (21%), and hit or bump (11%). However, some of these falls might be due to visual impairment. This issue was not mentioned in the Article. Visual impairment is a commonly cited cause of falling in older people. Several cross-sectional and pro- spective population-based studies have identified the link between severe vision loss and falls. 2 Compared with normal-sighted people, those with visual impairment are twice as likely to fall and have recurrent falls and fractures, and can limit their activities owing to a fear of falling. 3 Patients with glaucoma are particularly susceptible to falling because of a visual field defect associated with poor postural stability and a greater likelihood of bump. 2 Given the high prevalence of visual impairment in elderly people, visual impairment and eye disease deserve Stephen Robinovitch and colleagues’ analysis through video film of falls in nursing homes adds enormously to our understanding of this common geriatric syndrome. 1 However, since a disorder of gait and balance was the most common precipitant of the falls, one important aspect not addressed in the paper was that of the presence of pre-existing gait disorders. Given that gait disorders are common in nursing-home residents and amenable to assessment and treatment, 2 further analysis of the existing videotapes and medical notes Corbis
Transcript of Falls in older people in long-term care
Correspondence
www.thelancet.com Vol 381 April 6, 2013 1179
Submissions should be made via our electronic submission system at http://ees.elsevier.com/thelancet/
further investigation as potential causes of falling.
Although visual impairment is an established risk factor for falls, very few randomised controlled trials have been designed to examine the eff ectiveness of visual intervention for fall prevention; most inter ventions (eg, providing new glasses) seem to have no eff ect,4 with the exception of fi rst eye cataract surgery (which reduces risk of fall by 34%).5 The lack of eff ect highlights the need for novel visual aids and treatment strategies specifi cally for fall prevention, instead of simply focusing on improving visual acuity.I declare that I have no confl icts of interest.
Yingfeng [email protected]
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
1 Robinovitch SN, Feldman F, Yang Y, et al. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet 2013; 381: 47–54.
2 Lamoureux EL, Chong E, Wang JJ, et al. Visual impairment, causes of vision loss, and falls: the Singapore Malay Eye Study. Invest Ophthalmol Vis Sci 2008; 49: 528–33.
3 Wang MY, Rousseau J, Boisjoly H, et al. Activity limitation due to a fear of falling in older adults with eye disease. Invest Ophthalmol Vis Sci 2012; 53: 7967–72.
4 Cumming RG, Ivers R, Clemson L, et al. Improving vision to prevent falls in frail older people: a randomized trial. J Am Geriatr Soc 2007; 55: 175–81.
5 Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following fi rst eye cataract surgery: a randomised controlled trial. Br J Ophthalmol 2005; 89: 53–59.
The world’s neglect of the Syrian humanitarian and medical crises
My country (Syria) has been completely transformed in the past 2 years. What began as peaceful protests calling for freedom and reforms has turned into an all-out civil war without any indication of an end in the near future. The world, most notably the UN, stands by as hospitals and bakeries are being systematically shelled with heavy artillery weapons, resulting in the deaths of about 100–200 civilians daily.
After losing control of some cities, the Assad regime has changed its strategy; its intention is now to starve the people of these cities. Everyday ne cessities such as heating oil, infant formula, drinking water, and medicines are severely lacking in most cities in Syria. During these many months of turmoil, Syrian civilians have become acutely aware that their risk of being killed increases by simply leaving their homes to buy bread at their local bakery. The shelling of bakeries in Aleppo and other cities is no accident—it is part of the Assad regime’s strategy to target civilians. Hundreds of civilians thus far have lost their lives inside and in front of bakeries while waiting to buy bread, an indispensable part of every meal in Syria.
The bombardment of targets includes not only bakeries but also hospitals. For example, Dar al-Shifa Hospital in Aleppo, where injured demonstrators and rebels were being treated, was bombed, bringing about the deaths of dozens of victims.
Amid the chaos, at least 3 million Syrians have become displaced inside and outside of Syria. The UN places the current death toll of Syrian civilians, troops, and rebels at more than 70 000. However, the real number of deaths could be higher because many of those killed might not have been registered. I myself have relatives (civilians) who were killed in Aleppo but whose deaths were not registered by either the rebels or the government.
The Syrian people do not understand why the ongoing Syrian humanitarian and medical crises are being ignored by the world and why nothing is being done to protect civilians in Syria.
What are the diff erences between genocide and that which is happening in Syria? How many Syrian civilians have to be killed before the world says enough is enough? How many massacres have to be carried out before the world takes a stand and intervenes? How much longer must Syria endure the shelling of bakeries and hospitals and the systematic killing of civilians?I declare that I have no confl icts of interest.
Mohamed [email protected]
Department of Neurology, University of Lübeck, 23538 Lübeck,Germany
Falls in older people in long-term careStephen Robinovitch and colleagues (Jan 5, p 47)1 provide video-based evidence of the common character istics of, and reasons for, falls in older people. The leading causes of falling included incorrect weight shifting (41%), trip or stumble (21%), and hit or bump (11%). However, some of these falls might be due to visual impairment. This issue was not mentioned in the Article.
Visual impairment is a commonly cited cause of falling in older people. Several cross-sectional and pro-spective population-based studies have identifi ed the link between severe vision loss and falls.2 Compared with normal-sighted people, those with visual impairment are twice as likely to fall and have recurrent falls and fractures, and can limit their activities owing to a fear of falling.3 Patients with glaucoma are particularly susceptible to falling because of a visual fi eld defect associated with poor postural stability and a greater likelihood of bump.2 Given the high prevalence of visual impairment in elderly people, visual impairment and eye disease deserve
Stephen Robinovitch and colleagues’ analysis through video fi lm of falls in nursing homes adds enormously to our understanding of this common geriatric syndrome.1 However, since a disorder of gait and balance was the most common precipitant of the falls, one important aspect not addressed in the paper was that of the presence of pre-existing gait disorders.
Given that gait disorders are common in nursing-home residents and amenable to assessment and treatment,2 further analysis of the existing videotapes and medical notes
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