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Le Berre M, Apap D, Babcock J, Bray S, Gareau E, Chassé K, Lévesque N, Robbins SM. The Psychometric Properties of a Modified Sit-to-Stand Test With Use of the Upper Extremities in Institutionalized Older Adults. Percept Mot Skills 2016; 123:138-52. [DOI: 10.1177/0031512516653388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current sit-to-stand protocols do not permit use of upper extremities, limiting the protocols’ utility for institutionalized older adults with diminished physical function. The objective of this study was to modify a 30-s sit-to-stand protocol to allow for arm use and to examine test–retest reliability and convergent validity; 54 institutionalized older adult men (age = 91 ± 3 year) performed the 30-s sit-to-stand twice within a span of 3 to 7 days. Results suggest good test–retest reliability (intraclass correlation coefficient = .84) and convergent validity with the Timed Up and Go Test ( r = −.62). This modified 30-s sit-to-stand can be used to assess physical function performance in institutionalized older adults and will ensure that individuals with lower physical function capacity can complete the test, thus eliminating the floor effect demonstrated with other sit-to-stand protocols.
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Affiliation(s)
- Melanie Le Berre
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada; Solidage McGill University-Université de Montréal Research Group on Frailty & Aging, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - David Apap
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jade Babcock
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Sarah Bray
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Esther Gareau
- Rehabilitation Department, Ste. Anne’s Veterans Hospital, Montreal, QC, Canada
| | - Kathleen Chassé
- Rehabilitation Department, Ste. Anne’s Veterans Hospital, Montreal, QC, Canada
| | - Nicole Lévesque
- Rehabilitation Department, Ste. Anne’s Veterans Hospital, Montreal, QC, Canada
| | - Shawn M. Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, Montreal, QC, Canada
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Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study. Curr Gerontol Geriatr Res 2016; 2016:1520932. [PMID: 27247571 PMCID: PMC4877464 DOI: 10.1155/2016/1520932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction. Falls are frequent in older adults and may have serious consequences but awareness of fall-risk is often low. A questionnaire might raise awareness of fall-risk; therefore we set out to construct and test such a questionnaire. Methods. Fall-risk factors and their odds ratios were extracted from meta-analyses and a questionnaire was devised to cover these risk factors. A formula to estimate the probability of future falls was set up using the extracted odds ratios. The understandability of the questionnaire and discrimination and calibration of the prediction formula were tested in a cohort study with a six-month follow-up. Community-dwelling persons over 60 years were recruited by an e-mail snowball-sampling method. Results and Discussion. We included 134 persons. Response rates for the monthly fall-related follow-up varied between the months and ranged from low 38% to high 90%. The proportion of present risk factors was low. Twenty-five participants reported falls. Discrimination was moderate (AUC: 0.67, 95% CI 0.54 to 0.81). The understandability, with the exception of five questions, was good. The wording of the questions needs to be improved and measures to increase the monthly response rates are needed before test-retest reliability and final predictive value can be assessed.
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Reider N, Gaul C. Fall risk screening in the elderly: A comparison of the minimal chair height standing ability test and 5-repetition sit-to-stand test. Arch Gerontol Geriatr 2016; 65:133-9. [PMID: 27018571 DOI: 10.1016/j.archger.2016.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/23/2016] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Successfully identifying older adults with a high risk of falling can be complicated, time consuming and not feasible in daily medical practice. This study compared the effectiveness of the Minimal Chair Height Standing Ability Test (MCHSAT) and 5-repetition sit-to-stand tst (5R-STS) as fall risk-screening instruments for the elderly. METHODS 167 community-dwelling older adults (mean age=83.6±7.3years) were interviewed for demographics, fall history, cognition, and mobility status. MCHSAT performance was assessed using a chair whose seat height was modifiable by increments of 5cm, starting at 47cm and lowering after each successful attempt. 5R-STS performance was assessed by recording the time it took to rise and sit back down five consecutive times from a chair of 47cm high. Operating Receiving Characteristic (ROC) curves and Area under the Curve (AUC) were calculated for each test as well as for sub-groups of participants classified based on medical comorbidities (e.g. cardiac disease/stroke, lower limb arthritis). RESULTS The MCHSAT and 5R-STS were equally effective fall-risk screening instruments for the overall population (AUC (95% CI)=0.72 (0.63-0.82) and 0.73(0.64-0.81) respectively). The 5R-STS was more effective than the MCHSAT for participants suffering from lower limb arthritis (AUC (95% CI)=0.81(0.70-0.92) and 0.71(0.58-0.85) respectively) while the opposite was true for participants with a history of cardiac disease or stroke (AUC (95% CI)=0.59 (0.44-0.80) and 0.65 (0.47-0.84) respectively). CONCLUSION Due to their simplicity and quick administration time, the MCHSAT and 5R-STS are equally suitable for implementation in clinical settings.
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Affiliation(s)
- Nadia Reider
- University of Victoria, Schoolof Exercise Science, Physical & Health Education, Canada.
| | - Catherine Gaul
- University of Victoria, Schoolof Exercise Science, Physical & Health Education, Canada.
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Schettino L, Pereira R, Coqueiro RS, Fernandes MH. Stratifying Risk of Falls in Community-Dwelling Elderly Adults Through a Simple Tool. HUMAN MOVEMENT 2016. [DOI: 10.1515/humo-2016-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractPurpose. Falls are among the main disabling events for elderly adults and the identification of old people prone to falls enables the development of preventive and rehabilitative strategies. This study aimed to develop a simple tool, based on easily obtained variables (anthropometric measurements, motor performance tests and sociodemographic characteristics), to early identify community-dwelling old people prone to falls. Methods. The population-based household study was conducted among 316 elders (≥ 60 years old) of both sexes, living in the urban area of Lafaiete Coutinho in Brazil. History of falls in the previous 12 months (dependent variable), sociodemographic characteristics, anthropometric measurements and motor performance tests results (explanatory variables) were recorded, and a multivariate logistic regression was applied to identify the association between the explanatory variables and the history of falls. Fall probability for each elderly adult was calculated from the logistic regression parameters, and the predictive power of the final model and the cutoff for higher propensity to fall were evaluated on the basis of the receiver operating characteristic curve. Results. The prevalence of falls was 25.8% and the final model was influenced by the variables of sex (female) and poor performance in the balance test. The estimated probability model predicted approximately 66.5% (95% CI, 61-72%) of the falls. The sensitivity and specificity were 58 and 70%, respectively. Conclusions. We conclude that there is a high prevalence of falls among the studied elderly individuals, and the proposed method allowed to construct a simple tool for screening old adults prone to fall.
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Kabeshova A, Launay CP, Gromov VA, Fantino B, Levinoff EJ, Allali G, Beauchet O. Falling in the elderly: Do statistical models matter for performance criteria of fall prediction? Results from two large population-based studies. Eur J Intern Med 2016; 27:48-56. [PMID: 26686927 DOI: 10.1016/j.ejim.2015.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/17/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare performance criteria (i.e., sensitivity, specificity, positive predictive value, negative predictive value, area under receiver operating characteristic curve and accuracy) of linear and non-linear statistical models for fall risk in older community-dwellers. METHODS Participants were recruited in two large population-based studies, "Prévention des Chutes, Réseau 4" (PCR4, n=1760, cross-sectional design, retrospective collection of falls) and "Prévention des Chutes Personnes Agées" (PCPA, n=1765, cohort design, prospective collection of falls). Six linear statistical models (i.e., logistic regression, discriminant analysis, Bayes network algorithm, decision tree, random forest, boosted trees), three non-linear statistical models corresponding to artificial neural networks (multilayer perceptron, genetic algorithm and neuroevolution of augmenting topologies [NEAT]) and the adaptive neuro fuzzy interference system (ANFIS) were used. Falls ≥1 characterizing fallers and falls ≥2 characterizing recurrent fallers were used as outcomes. Data of studies were analyzed separately and together. RESULTS NEAT and ANFIS had better performance criteria compared to other models. The highest performance criteria were reported with NEAT when using PCR4 database and falls ≥1, and with both NEAT and ANFIS when pooling data together and using falls ≥2. However, sensitivity and specificity were unbalanced. Sensitivity was higher than specificity when identifying fallers, whereas the converse was found when predicting recurrent fallers. CONCLUSIONS Our results showed that NEAT and ANFIS were non-linear statistical models with the best performance criteria for the prediction of falls but their sensitivity and specificity were unbalanced, underscoring that models should be used respectively for the screening of fallers and the diagnosis of recurrent fallers.
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Affiliation(s)
- Anastasiia Kabeshova
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France; Computational Mathematics and Mathematical Cybernetics Department, Faculty of Applied Mathematics, OlesHonchar Dnepropetrovsk National University, Dnepropetrovsk, Ukraine
| | - Cyrille P Launay
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France
| | - Vasilii A Gromov
- Computational Mathematics and Mathematical Cybernetics Department, Faculty of Applied Mathematics, OlesHonchar Dnepropetrovsk National University, Dnepropetrovsk, Ukraine
| | - Bruno Fantino
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France
| | - Elise J Levinoff
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - Gilles Allali
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA; Department of Neurology, Geneva University Hospital and University of Geneva, Switzerland
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada; Holder of Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada; Centre of Excellence on Aging and Chronic Diseases of McGill Integrated University Health Network, QC, Canada.
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Zimba Kalula S, Ferreira M, Swingler G, Badri M, Aihie Sayer A. Prevalence of Falls in an Urban Community-Dwelling Older Population of Cape Town, South Africa. J Nutr Health Aging 2015; 19:1024-31. [PMID: 26624215 DOI: 10.1007/s12603-015-0664-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Falls are a major cause of disability and mortality in older adults. Studies on falls in this population have mainly been conducted in high income countries, and scant attention has been given to the problem in low and middle income countries, including South Africa. The aim of the study was to establish a rate for falls in older adults in South Africa. DESIGN A cross-sectional survey with a 12-month follow-up survey. SETTING Three purposively selected suburbs of Cape Town: Plumstead, Wynberg Central and Gugulethu. PARTICIPANTS Eight hundred and thirty seven randomly sampled ambulant community-dwelling subjects aged ≥ 65 years grouped according to ethnicity in three sub-samples: black Africans, coloureds (people of mixed ancestry) and whites. MEASUREMENTS Data were collected on socio-demographic and health characteristics, and history of falls using a structured questionnaire and a protocol for physical assessments and measurements. RESULTS Of the total baseline (n=837) and follow-up (n=632) survey participants, 76.5% and 77.2 % were females with a mean (S.D) age of 74 years (6.4) and 75 years (6.2), respectively. Rates of 26.4% and 21.9% for falls and of 11% and 6.3% for recurrent falls, respectively, were calculated at baseline and follow-up. Fall rates differed by ethnic sub-sample at baseline: whites 42 %, coloureds 34.4% and black Africans 6.4 % (p=0.0005). Rates of 236, 406 and 354 falls per 1000 person years were calculated for men, women and both genders, respectively. Recurrent falls were more common in women than in men. CONCLUSION Falls are a significant problem in older adults in South Africa. Effective management of falls and falls prevention strategies for older people in South Africa, need to be developed and implemented.
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Affiliation(s)
- S Zimba Kalula
- S. Zimba Kalula, University of Cape Town, Institute of Ageing in Africa, L51, Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, Western Cape 7925, South Africa,
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Avila MAGD, Pereira GJC, Bocchi SCM. Family participation to elderly rehabilitation with femoral fracture. Rev Bras Enferm 2015. [DOI: 10.1590/0034-7167.2015680517i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACTObjective:verify if the mode of care adopted by caregivers favored functional independence recovery by elderly with and without the presence of nervous system disease and mental and behavioral disorders; and, if disease interfered with their functional independence.Method:transversal study, with 12-month follow-up of 89 Brazilian elders (≥ 60 years) after proximal femoral surgery, and their family caregiver.Results:the Functional Independence Measure scores decreased by 0.7 points per year of life, and in the case of presenting nervous system disease and mental and behavioral disorders, this loss amounted to 20.5 points.Conclusion:The incentive to ambulate increased by 18.8 for self-care, 12.8 for self-care, and 11.5 for leisure activities on the Functional Independence Measure. Encouraging movement and ambulation, self-care and leisure activities, especially with those elderly with nervous system diseases and mental and behavioral disorders, is recommended.
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Melillo P, Orrico A, Attanasio M, Rossi S, Pecchia L, Chirico F, Testa F, Simonelli F. A pilot study for development of a novel tool for clinical decision making to identify fallers among ophthalmic patients. BMC Med Inform Decis Mak 2015; 15 Suppl 3:S6. [PMID: 26391731 PMCID: PMC4705496 DOI: 10.1186/1472-6947-15-s3-s6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Falls in the elderly is a major problem. Although falls have a multifactorial etiology, a commonly cited cause of falls in older people is poor vision. This study proposes a method to discriminate fallers and non-fallers among ophthalmic patients, based on data-mining algorithms applied to health and socio-demographic information. Methods A group of 150 subjects aged 55 years and older, recruited at the Eye Clinic of the Second University of Naples, underwent a baseline ophthalmic examination and a standardized questionnaire, including lifestyles, general health, social engagement and eyesight problems. A subject who reported at least one fall within one year was considered as faller, otherwise as non-faller. Different tree-based data-mining algorithms (i.e., C4.5, Adaboost and Random Forest) were used to develop automatic classifiers and their performances were evaluated by assessing the receiver-operator characteristics curve estimated with the 10-fold-crossvalidation approach. Results The best predictive model, based on Random Forest, enabled to identify fallers with a sensitivity and specificity rate of 72.6% and 77.9%, respectively. The most informative variables were: intraocular pressure, best corrected visual acuity and the answers to the total difficulty score of the Activities of Daily Vision Scale (a questionnaire for the measurement of visual disability). Conclusions The current study confirmed that some ophthalmic features (i.e. cataract surgery, lower intraocular pressure values) could be associated with a lower fall risk among visually impaired subjects. Finally, automatic analysis of a combination of visual function parameters (either self-evaluated either by ophthalmological tests) and other health information, by data-mining algorithms, could be a feasible tool for identifying fallers among ophthalmic patients.
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Jodaitis L, Vaillant F, Snacken M, Boland B, Spinewine A, Dalleur O, Gilles C, Petrovic M, Pepersack T. Orthostatic hypotension and associated conditions in geriatric inpatients. Acta Clin Belg 2015; 70:251-8. [PMID: 26135806 DOI: 10.1179/2295333715y.0000000006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Screening of orthostatic hypotension (OH) was performed in 285 patients aged 75 years. Current drugs, reasons for admission, geriatric syndromes, and confounding medical conditions were collected. Patients with OH (n = 116, 41%) as compared to those without OH (n = 169) more frequently (P < 0.01) presented falls in the last 6 months (62 vs. 40%, P < 0.001), a fall as the reason for the current admission (49 vs. 26%, P < 0.001), feeling of fainting (20 vs. 6%, P = 0.002), syncope (29 vs. 4%, P < 0.001) or functional decline (71 vs. 47%, P = 0.012). No difference was observed between the two groups in terms of age (85 ± 5 vs. 84 ± 4 years), gender (59 vs. 50% female), common geriatric conditions (e.g. malnutrition 46 vs. 58%, dementia 22 vs. 26%), comorbidity or confounding conditions (dehydration 28 vs. 30%, sepsis 2 vs. 6%). No difference was detected in the use of drugs with psychotropic cardiovascular or diuretic effect, or in their associations. Orthostatic hypotension is frequent upon hospital admission and should be screened, particularly in geriatric fallers. This absence of relation between OH and drugs use suggests that non-pharmacological interventions should be first attempted in older inpatients with OH before deciding to reduce or withdraw useful drugs.
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Oliveira CC, Lee AL, McGinley J, Thompson M, Irving LB, Anderson GP, Clark RA, Clarke S, Denehy L. Falls by individuals with chronic obstructive pulmonary disease: A preliminary 12-month prospective cohort study. Respirology 2015. [DOI: 10.1111/resp.12600] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Cristino C. Oliveira
- Department of Physiotherapy; School of Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - Annemarie L. Lee
- Department of Physiotherapy; School of Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - Jennifer McGinley
- Department of Physiotherapy; School of Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - Michelle Thompson
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Louis B. Irving
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Lung Health Research Centre; The University of Melbourne; Melbourne Victoria Australia
| | - Gary P. Anderson
- Lung Health Research Centre; The University of Melbourne; Melbourne Victoria Australia
| | - Ross A. Clark
- School of Exercise Science; Australian Catholic University; Melbourne Victoria Australia
| | - Sandy Clarke
- Statistical Consulting Centre; The University of Melbourne; Melbourne Victoria Australia
| | - Linda Denehy
- Department of Physiotherapy; School of Health Sciences; The University of Melbourne; Melbourne Victoria Australia
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Jalali MM, Gerami H, Heidarzadeh A, Soleimani R. Balance performance in older adults and its relationship with falling. Aging Clin Exp Res 2015; 27:287-96. [PMID: 25286899 DOI: 10.1007/s40520-014-0273-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 10/01/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population. METHODS A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: young-old (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests. RESULTS The fall rate (>2 in the last year) was 27.0 %. The cut-off point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cut-off point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test. CONCLUSIONS This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.
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Affiliation(s)
- Mir Mohammad Jalali
- Department of Otolaryngology, Otolaryngology Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, 41396-38459, Rasht, Iran,
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Prediction of future falls in a community dwelling older adult population using instrumented balance and gait analysis. Z Gerontol Geriatr 2015; 49:232-6. [PMID: 25862429 DOI: 10.1007/s00391-015-0885-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/08/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The role of instrumented balance and gait assessment when screening for prospective fallers is currently a topic of controversial discussion. OBJECTIVES This study analyzed the association between variables derived from static posturography, instrumented gait analysis and clinical assessments with the occurrence of prospective falls in a sample of community dwelling older people. METHODS In this study 84 older people were analyzed. Based on a prospective occurrence of falls, participants were categorized into fallers and non-fallers. Variables derived from clinical assessments, static posturography and instrumented gait analysis were evaluated with respect to the association with the occurrence of prospective falls using a forward stepwise, binary, logistic regression procedure. RESULTS Fallers displayed a significantly shorter single support time during walking while counting backwards, increased mediolateral to anteroposterior sway amplitude ratio, increased fast mediolateral oscillations and a larger coefficient (Coeff) of sway direction during various static posturography tests. Previous falls were insignificantly associated with the occurrence of prospective falls. CONCLUSION Variables derived from posturography and instrumented gait analysis showed significant associations with the occurrence of prospective falls in a sample of community dwelling older adults.
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Artificial Neural Network and Falls in Community-Dwellers: A New Approach to Identify the Risk of Recurrent Falling? J Am Med Dir Assoc 2015; 16:277-81. [DOI: 10.1016/j.jamda.2014.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 09/15/2014] [Accepted: 09/22/2014] [Indexed: 11/23/2022]
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König N, Taylor WR, Armbrecht G, Dietzel R, Singh NB. Identification of functional parameters for the classification of older female fallers and prediction of 'first-time' fallers. J R Soc Interface 2015; 11:20140353. [PMID: 24898021 PMCID: PMC4208368 DOI: 10.1098/rsif.2014.0353] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Falls remain a challenge for ageing societies. Strong evidence indicates that a previous fall is the strongest single screening indicator for a subsequent fall and the need for assessing fall risk without accounting for fall history is therefore imperative. Testing in three functional domains (using a total 92 measures) were completed in 84 older women (60-85 years of age), including muscular control, standing balance, and mean and variability of gait. Participants were retrospectively classified as fallers (n = 38) or non-fallers (n = 42) and additionally in a prospective manner to identify first-time fallers (FTFs) (n = 6) within a 12-month follow-up period. Principal component analysis revealed that seven components derived from the 92 functional measures are sufficient to depict the spectrum of functional performance. Inclusion of only three components, related to mean and temporal variability of walking, allowed classification of fallers and non-fallers with a sensitivity and specificity of 74% and 76%, respectively. Furthermore, the results indicate that FTFs show a tendency towards the performance of fallers, even before their first fall occurs. This study suggests that temporal variability and mean spatial parameters of gait are the only functional components among the 92 measures tested that differentiate fallers from non-fallers, and could therefore show efficacy in clinical screening programmes for assessing risk of first-time falling.
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Affiliation(s)
- N König
- Institute for Biomechanics, ETH, Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH, Zürich, Switzerland
| | - G Armbrecht
- Centre for Muscle and Bone Research, Charité-Universitätsmedizin, Berlin, Germany
| | - R Dietzel
- Centre for Muscle and Bone Research, Charité-Universitätsmedizin, Berlin, Germany
| | - N B Singh
- Institute for Biomechanics, ETH, Zürich, Switzerland
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Carpenter CR, Avidan MS, Wildes T, Stark S, Fowler SA, Lo AX. Predicting geriatric falls following an episode of emergency department care: a systematic review. Acad Emerg Med 2014; 21:1069-82. [PMID: 25293956 DOI: 10.1111/acem.12488] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/19/2014] [Accepted: 06/21/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. OBJECTIVES This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor's accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. METHODS A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the projected benefits or harms of fall prevention interventions in the ED. RESULTS A total of 608 unique and potentially relevant studies were identified, but only three met our inclusion criteria. Two studies that included 660 patients assessed 29 risk factors and two risk stratification instruments for falls in geriatric patients in the 6 months following an ED evaluation, while one study of 107 patients assessed the risk of falls in the preceding 12 months. A self-report of depression was associated with the highest positive likelihood ratio (LR) of 6.55 (95% confidence interval [CI] = 1.41 to 30.48). Six fall predictors were identified in more than one study (past falls, living alone, use of walking aid, depression, cognitive deficit, and more than six medications) and meta-analysis was performed for these risk factors. One screening instrument was sufficiently accurate to identify a subset of geriatric ED patients at low risk for falls with a negative LR of 0.11 (95% CI = 0.06 to 0.20). The test threshold was 6.6% and the treatment threshold was 27.5%. CONCLUSIONS This study demonstrates the paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults. The screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk.
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Affiliation(s)
| | | | - Tanya Wildes
- The Department of Medicine Division of Medical Oncology; St. Louis MO
| | - Susan Stark
- The Department of Occupational Therapy; St. Louis MO
- The Department of Neurology; St. Louis MO
| | - Susan A. Fowler
- Washington University in St. Louis School of Medicine; St. Louis MO
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Hirase T, Inokuchi S, Matsusaka N, Nakahara K, Okita M. A Modified Fall Risk Assessment Tool That Is Specific to Physical Function Predicts Falls in Community-Dwelling Elderly People. J Geriatr Phys Ther 2014; 37:159-65. [DOI: 10.1519/jpt.0b013e3182abe7cb] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Liang CK, Chou MY, Peng LN, Liao MC, Chu CL, Lin YT, Chen LK. Gait speed and risk assessment for falls among men aged 80 years and older: A prospective cohort study in Taiwan. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Reider NC, Naylor PJ, Gaul C. Sensitivity and specificity of the minimal chair height standing ability test: a simple and affordable fall-risk screening instrument. J Geriatr Phys Ther 2014; 38:90-5. [PMID: 25089365 DOI: 10.1519/jpt.0000000000000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Fall-risk screening instruments have been underutilized in clinical settings because of their lengthy administration time, need of cumbersome equipment, and lack of validation. The primary objective of this study was to assess the validity (sensitivity and specificity) of the Minimal Chair Height Standing Ability Test (MCHSAT). The secondary objective was to develop guidelines to provide physical therapists with best-practice recommendations that can easily be implemented in clinical practice. METHODS A retrospective cohort study design was used in which falling history, major medical conditions, cognitive status (Mini-Mental State Examination), and level of independence (Independent Activities of Daily Living) were obtained for 167 community-dwelling older adults (mean age = 83.6 ± 7.3 years), residents of British Columbia, Canada. Participants MCHSAT performance was assessed using a chair whose seat height was modifiable by increments of 5 cm, starting at 47 cm and lowering after each successful attempt. Sensitivity and specificity of the MCHSAT at each chair height were calculated and plotted as a receiver operating characteristic curve. A model to identify participants with history of falls was developed using a forward logistic regression (Wald). RESULTS Mean MCHSAT performance (cm) was significantly better for participants without history of falls (30.3 cm, 95% CI: 28.1-32.5 cm) than for those with history of falls (37.7 cm, 95% CI: 35.5-40.0 cm) and was the single risk factor associated with fall status (β= 1.087, P < .001). The optimal MCHSAT performance for identifying participants with history of falls was 34 cm (AUC = 0.72, 95% CI: 0.63-0.82). At this threshold, sensitivity and specificity values were 75% and 62%, respectively. DISCUSSION Using 34 cm as the optimal performance, the MCHSAT correctly identified 75% of participants with history of falls and 62% of participants without history of falls. This provides evidence that the MCHSAT is a valid screening tool for use with an older Canadian population. CONCLUSION As a simple and inexpensive testing instrument, the MCHSAT has potential to enhance the care of our elderly population, improve an understanding of patients' fall-risk status, and substantially reduce fall-related costs to the health care system.
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Affiliation(s)
- Nadia C Reider
- School of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
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Falls in the elderly were predicted opportunistically using a decision tree and systematically using a database-driven screening tool. J Clin Epidemiol 2014; 67:877-86. [DOI: 10.1016/j.jclinepi.2014.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 03/01/2014] [Accepted: 03/11/2014] [Indexed: 11/18/2022]
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Seichi A, Hoshino Y, Doi T, Akai M, Tobimatsu Y, Kita K, Iwaya T. Determination of the optimal cutoff time to use when screening elderly people for locomotive syndrome using the one-leg standing test (with eyes open). J Orthop Sci 2014; 19:620-6. [PMID: 24842007 DOI: 10.1007/s00776-014-0581-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/25/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish the cutoff time for the one-leg standing (OLS) test (with eyes open) to use when screening elderly people for locomotive syndrome. METHODS Patients visiting orthopedic clinics and healthy volunteers, all ≥65 years old, were recruited. Participants were asked to complete the 25-question Geriatric Locomotive Function Scale (GLFS-25) and then underwent the OLS test. Using the previously determined GLFS-25 cutoff value, participants were divided into two groups: the locomotive and the non-locomotive syndrome groups (GLFS-25 scores of ≥16 and <16, respectively). Conventional receiver operating characteristic curve (ROC) analysis was used to calculate the optimal cutoff time for the OLS. RESULTS Data from 880 individuals (261 men, 619 women; mean age (SD), 77 (6) years; range 65-96 years) were analyzed; 497 were in the locomotive syndrome group and 383 were in the non-locomotive syndrome group. A significant difference was seen between each group mean for individual average (IA) OLS times (IA-OLS: the average of the OLS times obtained for both legs of an individual). According to ROC analysis without age adjustment, when the IA-OLS time was ~9 s, the sum of the sensitivity and specificity of the test was highest. However, because of a statistically significant difference in IA-OLS time among the three age groups (aged ≤70, aged >70 and ≤75, and aged >75), we determined the optimal cutoff value for IA-OLS time for each of the three age groups using ROC analysis. According to additional ROC analysis, the optimal cutoff for IA-OLS time was 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons for locomotive syndrome. CONCLUSIONS We propose using a GLFS-25 score of 16 and/or a cutoff for the IA-OLS time of 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons to determine who should receive medical intervention or undergoing training programs.
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Affiliation(s)
- Atsushi Seichi
- Department of Orthopedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan,
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71
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Batista WO, Alves EDD, Porto F, Pereira FD, Santana RF, Gurgel JL. Influence of the length of institutionalization on older adults' postural balance and risk of falls: a transversal study. Rev Lat Am Enfermagem 2014; 22:645-53. [PMID: 25296149 PMCID: PMC4292658 DOI: 10.1590/0104-1169.3515.2463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 05/20/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE to ascertain the influence of the length of institutionalization on older adults' balance and risk of falls. METHOD to evaluate the risk of falls, the Berg Balance Scale and the Timed Get Up and Go test were used; and for measuring postural balance, static stabilometry was used, with acquisition of the elliptical area of 95% and mean velocities on the x and y axes of center of pressure displacement. Parametric and nonparametric measures of association and comparison (α<0.05) were used. RESULTS there was no significant correlation between the length of institutionalization and the tests for evaluation of risk of falling, neither was there difference between groups and within subgroups, stratified by length of institutionalization and age. In the stabilometric measurements, there was a negative correlation between the parameters analyzed and the length of institutionalization, and difference between groups and within subgroups. CONCLUSION this study's results point to the difficulty of undertaking postural control tasks, showing a leveling below the clinical tests' reference scores. In the stabilometric behavior, one should note the reduction of the parameters as the length of institutionalization increases, contradicting the assumptions. This study's results offer support for the development of a multi-professional model for intervention with the postural control and balance of older adults living in homes for the aged.
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Affiliation(s)
- Wagner Oliveira Batista
- Doctoral student, Escola de Enfermagem Aurora de Afonso Costa,
Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Edmundo de Drummond Alves
- PhD, Associate Professor, Instituto de Educação Física, Universidade
Federal Fluminense, Niterói, RJ, Brazil
| | - Flávia Porto
- PhD, Professor, Universidade do Estado do Rio de Janeiro, Rio de
Janeiro, RJ, Brazil
| | | | - Rosimere Ferreira Santana
- PhD, Adjunct Professor, Escola de Enfermagem, Centro de Ciências
Médicas, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Jonas Lírio Gurgel
- PhD, Adjunct Professor, Instituto de Educação Física, Universidade
Federal Fluminense, Niterói, RJ, Brazil
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Vennu V, Bindawas SM. Relationship between falls, knee osteoarthritis, and health-related quality of life: data from the Osteoarthritis Initiative study. Clin Interv Aging 2014; 9:793-800. [PMID: 24855348 PMCID: PMC4020882 DOI: 10.2147/cia.s62207] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the relationship between self-reported falls, doctor-diagnosed knee osteoarthritis (OA), and health-related quality of life (HRQoL). We hypothesized that falls and knee OA would be associated with poor HRQoL on both disease-specific and generic measures. METHODS This cross-sectional study used data from the publicly available Osteoarthritis Initiative data sets. A total of 4,484 subjects aged 45-79 years at baseline were divided into three subpopulations: those who had neither a history of falling nor doctor-diagnosed knee OA; those who had either a self-reported history of falling or doctor-diagnosed knee OA; and those who had both a self-reported history of falling and doctor-diagnosed knee OA. HRQoL was assessed using both disease-specific and generic measures. Multiple regression analyses were used to examine the relationship between self-reported falls, doctor-diagnosed knee OA, and HRQoL assessed using the Knee Injury and Osteoarthritis Outcome Score-Quality of Life (KOOS-QoL) subscale and two Short Form-12 (SF-12) summary scales. The models were adjusted for participant sociodemographic, lifestyle, and clinical characteristics. RESULTS Falls and knee OA were significantly associated with lower scores on the KOOS-QoL (β= -34.4, standard error 2.27, P≤0.0001) and on the physical component scale of the SF-12 (β= -9.44, standard error 0.90, P<0.0001). No significant relationship was found with the mental component scale score when adjusted for sociodemographic, lifestyle, and clinical characteristics. CONCLUSION When compared with those having neither a self-reported history of falling nor doctor-diagnosed knee OA and those with a self-reported history of falling or doctor-diagnosed knee OA, persons with both conditions (falls and knee OA) had significantly lower KOOS-QoL and physical component scale scores after adjusting for sociodemographic, lifestyle, and clinical characteristics. Future research should assess potential mediating factors in an effort to improve HRQoL in persons with knee OA who are at high risk of falling.
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Affiliation(s)
- Vishal Vennu
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Milos V, Bondesson Å, Magnusson M, Jakobsson U, Westerlund T, Midlöv P. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatr 2014; 14:40. [PMID: 24674152 PMCID: PMC3986685 DOI: 10.1186/1471-2318-14-40] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation with falls in a sample of 369 community-dwelling and nursing home patients aged ≥75 years and who were using a multi-dose drug dispensing system. METHODS Data were collected from the patients' electronic medication lists. Retrospective data on reported falls during the previous three months and severe falls during the previous 12 months were collected. Primary outcome measures were incidence of falls as well as numbers of FRIDs and ODs in fallers and non-fallers. RESULTS The studied sample had a high incidence of both reported falls (29%) and severe falls (17%). Patients were dispensed a mean of 2.2 (SD 1.5) FRIDs and 2.0 (SD 1.6) ODs. Fallers used on average more FRIDs. Severe falls were more common in nursing homes patients. More women than men experienced severe falls. There were positive associations between number of FRIDs and the total number of drugs (p < 0.01), severe falls (p < 0.01) and female sex (p = 0.03). There were also associations between number of ODs and both total number of drugs (p < 0.01) and being community dwelling (p = 0.02). No association was found between number of ODs and severe falls. Antidepressants and anxiolytics were the most frequently dispensed FRIDs. CONCLUSIONS Fallers had a higher number of FRIDs. Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.
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Affiliation(s)
- Veronica Milos
- Center for Primary Health Care Research, Institution of Clinical Sciences, Lund University, Lund, Sweden.
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Lee J, Geller AI, Strasser DC. Analytical review: focus on fall screening assessments. PM R 2014; 5:609-21. [PMID: 23880047 DOI: 10.1016/j.pmrj.2013.04.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 03/30/2013] [Accepted: 04/02/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Falls and their associated injuries profoundly impact health outcomes, functional independence, and health care expenses, particularly for the ever-increasing elderly population. This systematic search and review assessed the current evidence for the role of fall screening assessments. OBJECTIVE To review the current evidence for fall risk screening assessments in community-dwelling (outpatient), inpatient medical and surgical wards, inpatient rehabilitation centers, and postrehabilitation outpatient settings. DATA SOURCES MEDLINE and Embase (January 1980 to December 2012). STUDY SELECTION Prospective validation studies of acute medical or surgical inpatients, acute rehabilitation inpatients, outpatients who completed acute inpatient rehabilitation, or community-dwelling elderly. DATA EXTRACTION Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristics with area under the curve. RESULTS We summarized key findings from 6 literature reviews. We then identified 31 articles: 12 studies in community setting, 13 in the acute medical inpatient or surgical inpatient setting, and 6 studies in the rehabilitation setting. Twenty-two studies not previously reviewed were included, and 9 studies previously reviewed were considered relevant and were included to allow comparison with data from the studies not previously reviewed. CONCLUSION We recommend consideration of 7 assessment tools to be used in conjunction with overall clinical evaluation to assess falls risk: the Timed Up and Go Test with a cutoff of >12.34 seconds and Functional Gait Assessment among community-dwelling elderly; St Thomas Risk Assessment Tool in medical inpatients <65 years old and surgical inpatients; Hendrich fall risk model II in medical inpatients; 10-Minute Walk Test in patients in poststroke rehabilitation; and Berg Balance Scale or the Step Test in patients in poststroke rehabilitation who had fallen during their inpatient stay.
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Affiliation(s)
- Jacob Lee
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
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Lee S, Shin S. Effectiveness of virtual reality using video gaming technology in elderly adults with diabetes mellitus. Diabetes Technol Ther 2013; 15:489-96. [PMID: 23560480 DOI: 10.1089/dia.2013.0050] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diabetes in elderly adults is associated with an increased risk of fall. The aim of study was to determine whether a virtual reality exercise (VRE) program would improve balance, strength, gait, and falls efficacy in elderly adults with diabetes. SUBJECTS AND METHODS Fifty-five subjects with diabetes mellitus over 65 years of age were randomly assigned to a VRE group (VREG) (n=27) and a control group (CG) (n=28). The VREG received the VRE program and diabetes education, whereas the CG received only the diabetes education. The VRE program used video gaming (PlayStation(®) 2; Sony, Tokyo, Japan) and was conducted for 50 min twice a week for 10 weeks. Balance, muscle strength, gait, and falls efficacy were measured at baseline and after intervention. Measurements were taken using a clinical tests (the one-leg-standing test, the Berg Balance Scale, the functional reach test, the timed up-and-go test, and the sit-to-stand test), and gait analysis. A self-administered questionnaire was used to measure falls efficacy. RESULTS After training, the VREG showed significantly improved balance, decreased sit-to-stand times, and increased gait speed, cadence, and falls efficacy. CONCLUSIONS The VRE program was to maximize the effects of exercise by triggering players was to be fully immersed into the games and enhanced major influential factors on the falls of subject. This study suggests VRE programs are feasible and effective for reduced the risk of falls in elderly adults with type 2 diabetes.
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Affiliation(s)
- Sunwoo Lee
- Department of Nursing, Sahmyook Health University College, Seoul, Republic of Korea
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Rodrigues J, Ciosak SI. [Elderly victims of trauma: analysis of the risk factors]. Rev Esc Enferm USP 2013; 46:1400-5. [PMID: 23380784 DOI: 10.1590/s0080-62342012000600017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/04/2012] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to identify the risk factors for trauma among the elderly, using a quantitative, cross-sectional approach, as well as logistical regression analysis. This study was performed at the emergency rooms of two hospitals in Curitiba. Interviews were performed with 261 elderly individuals, 56.7% of whom were women, and 43.3% men. Their ages ranged between 60 and 103 years, with most being younger than 70 years (44.8%). The most frequent trauma mechanisms were: falls (75.9%), being run over (9.6%), direct trauma (5.4%) and motor vehicle accident (3.8%). The multivariate analysis permitted the authors to affirm that the female gender, the presence of a caregiver, the utilization of continuous-use medication, and the presence of hearing impairment significantly increased the risk of trauma due to falls. Individuals having vision problems (without the use of glasses) and aged individuals with a monthly income of less than three minimum salaries tend to have a higher risk of suffering trauma due to falls. If the factors that greatly influence trauma among the elderly are evaluated during nursing appointments, it is possible to promote health interventions that favor their prevention.
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Bayesian networks: a new method for the modeling of bibliographic knowledge. Med Biol Eng Comput 2013; 51:657-64. [DOI: 10.1007/s11517-013-1035-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 01/06/2013] [Indexed: 11/25/2022]
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Lee WK, Kong KA, Park H. Effect of preexisting musculoskeletal diseases on the 1-year incidence of fall-related injuries. J Prev Med Public Health 2012; 45:283-90. [PMID: 23091653 PMCID: PMC3469810 DOI: 10.3961/jpmph.2012.45.5.283] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 03/14/2012] [Indexed: 11/09/2022] Open
Abstract
Objectives People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. Methods We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. Results The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). Conclusions One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.
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Affiliation(s)
- Won Kyung Lee
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Menant JC, St George RJ, Fitzpatrick RC, Lord SR. Perception of the postural vertical and falls in older people. Gerontology 2012; 58:497-503. [PMID: 22759640 DOI: 10.1159/000339295] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 05/07/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on the relationship between vestibular function and falls in older people is sparse. The perception of the postural vertical (PPV) provides an indicator measure of vestibular (otolith) function in the absence of visual input and diminished somatosensory feedback. OBJECTIVE This study examined whether impaired PPV is associated with falls in this group. METHODS One hundred and ninety-five people aged 70 plus years stood blindfolded on a motorised platform that could be tilted in the roll plane and attempted to adjust it so that their bodies were aligned to the vertical. Somatosensory feedback was minimised as the base and vertical support surfaces on the tilting platform were covered in thick soft foam rubber. PPV error from true vertical and PPV variability (°) were calculated. Participants also underwent an assessment of distal tactile sensitivity and the physiological profile assessment (PPA); fallers were defined as those who had one or more falls during a prospective 12-month follow-up period. RESULTS Eighty-eight participants (45%) reported falling in the follow-up year. Increased PPV error and variability were correlated with increased lateral sway in a condition of absent visual input and reduced foot somatosensory feedback (eyes closed/foam; r range = 0.16-0.20, p < 0.05) and with composite PPA fall risk scores (r range = 0.22-0.26, p < 0.05). PPV variability was a significant and independent predictor of falls after adjusting for the composite PPA scores, age and gender [adjusted RR = 1.42 (1.01-1.98)]. CONCLUSIONS Older people with increased PPV variability are at increased risk of falls. These findings indicate that assessment of PPV may augment fall risk assessments in older people.
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Affiliation(s)
- Jasmine C Menant
- Neuroscience Research Australia, University of New South Wales, Sydney, N.S.W., Australia
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