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Abstract
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We have read the article by Goldstein et al.1 with great interest. We appreciate the effort involved in this study to evaluate the falls after hospital discharge among older adults with previous myocardial infarction. Older adults may be less likely to report their falls depending on the frequency or severity. Although this study covered an important topic, we have some comments about it.
First, the causes of fall are multifactorial and include extrinsic (environment-related), intrinsic (person-related), and behavioral (activity-related) factors. The authors focused on the intrinsic and activity-related factors. However, there was no information regarding environmental fall-related factors in this study. During the 6-month follow-up, the interviewers could have asked participants about the causes of the fall and safety hazards, one of the most modifiable risk factors.
Second, gait instability is a relatively consistent risk factor for falls. Most screening programs to identify those at risk for falls involve the assessment of gait and balance. The authors stated that mobility was evaluated using the timed up-and-go (TUG) test. However, we would expect that the patients' balance be assessed during hospitalization, even with a single question or observation. The timed TUG test has limited ability to predict falls in older adults and does not specifically measure balance.2 In addition, physical inactivity during hospitalization may increase and exacerbate the risk of disability and falls.3 Physical exercises may significantly reduce fall rate and risk in healthy older adults and may mitigate fall risk during hospitalization.4 Did the participants perform muscle strengthening and balance-providing exercises during hospitalization? What was the exercise status after discharge? We believe that addressing these issues would be beneficial.
Third, the authors evaluated many factors related to falls...
Language: en |