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Canever JB, de Souza Moreira B, Danielewicz AL, de Avelar NCP. Are multimorbidity patterns associated with fear of falling in community-dwelling older adults? BMC Geriatr 2022; 22:192. [PMID: 35272634 PMCID: PMC8915478 DOI: 10.1186/s12877-022-02889-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/02/2022] [Indexed: 01/09/2023] Open
Abstract
Background Multimorbidity is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in the same individual and can be grouped into different patterns based on the type of disease. These patterns are associated with poorer quality of life and premature death. It is believed that these patterns entail functional limitations, which may contribute to the fear of falling; however, this association remains unknown. Identifying this possible association is fundamental for developing individual and collective care approaches aimed at preventing the different patterns of chronic diseases in older adults in order to decrease the fear of falling. The objective of this study was to investigate the association between multimorbidity patterns and fear of falling in older adults. Methods This was a cross-sectional study including 308 older adults. The exposure variables were the presence of three multimorbidity patterns (cardiopulmonary, musculoskeletal, and vascular-metabolic) and pattern association assessed by self-report of two or more similar coexisting chronic diseases. The outcome was fear of falling assessed by the Brazilian version of Falls Efficacy Scale-International (cut-off point ≥ 23 points). Multivariable logistic regression was used to analyze the association between variables. Results Older adults with cardiopulmonary, musculoskeletal, vascular-metabolic patterns and pattern association had 3.49 (95%CI 1.13; 10.78), 2.03 (95%CI 1.13; 3.64), 2.14 (95%CI 1.20; 3.82), and 4.84 (95%CI 2.19; 10.68), respectively, greater chances of presenting fear of falling when compared to older adults without the patterns. Conclusions The presence of multimorbidity patterns is associated with higher chances of reporting fear of falling. It is emphasized that the introduction of public health programs aimed at preventing multimorbidity patterns is essential to reduce possible adverse health outcomes, including fear of falling and its negative consequences for older adult health.
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Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | | | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil.
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de Souza Moreira B, Cristina de Souza Andrade A, Xavier CC, Proietti FA, Braga LDS, Friche AADL, Teixeira Caiaffa W. Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:522-534. [PMID: 32568556 DOI: 10.1080/09603123.2020.1782354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.
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Affiliation(s)
- Bruno de Souza Moreira
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Luciana de Souza Braga
- Department of Preventive and Social Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amélia Augusta de Lima Friche
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Waleska Teixeira Caiaffa
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Effects of age and surface instability on the control of the center of mass. Hum Mov Sci 2022; 82:102930. [PMID: 35123153 DOI: 10.1016/j.humov.2022.102930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
During standing, posture can be controlled by accelerating the Center of Mass (CoM) through shifting the center of pressure (CoP) within the base of support by applying ankle moments ("CoP mechanism"), or through the "counter-rotation mechanism", i.e., changing the angular momentum of segments around the CoM to change the direction of the ground reaction force. Postural control develops over the lifespan; at both the beginning and the end of the lifespan adequate postural control appears more challenging. In this study, we aimed to assess mediolateral balance performance and the related use of the postural control mechanisms in children, older adults and younger adults when standing on different (unstable) surfaces. Sixteen pre-pubertal children (6-9y), 17 younger adults (18-24y) and eight older adults (65-80y) performed bipedal upright standing trials of 16 s on a rigid surface and on three balance boards that could freely move in the frontal plane, varying in height (15-19 cm) of the surface of the board above the point of contact with the floor. Full body kinematics (16 segments, 48 markers, using SIMI 3D-motion analysis system (GmbH) and DeepLabCut and Anipose) were retrieved. Performance related outcome measures, i.e., the number of trials with balance loss and the Root Mean Square (RMS) of the time series of the CoM acceleration, the contributions of the CoP mechanism and the counter-rotation mechanism to the CoM acceleration in the frontal plane and selected kinematic measures, i.e. the orientation of the board and the head and the Mean Power Frequency (MPF) of the balance board orientation and the CoM acceleration were determined. Balance loss only occurred when standing on the highest balance board, twice in one older adult once in one younger adult. In children and older adults, the RMS of the CoM accelerations were larger, corresponding to poorer balance performance. Across age groups and conditions, the contribution of the CoP mechanism to the total CoM acceleration was much larger than that of the counter-rotation mechanisms, ranging from 94% to 113% vs 23% to 38% (with totals higher than 100% indicating opposite effects of both mechanisms). Deviations in head orientation were small compared to deviations in balance board orientation. We suggest that the CoP mechanism is dominant, since the counter-rotation mechanism would conflict with stabilizing the orientation of the head in space.
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Nualyong T, Siriphorn A. Accuracy of the figure of 8 walk test with and without dual-task to predict falls in older adults. J Bodyw Mov Ther 2022; 30:69-75. [DOI: 10.1016/j.jbmt.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022]
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Spanò B, Lombardi MG, De Tollis M, Szczepanska MA, Ricci C, Manzo A, Giuli S, Polidori L, Griffini IA, Adriano F, Caltagirone C, Annicchiarico R. Effect of Dual-Task Motor-Cognitive Training in Preventing Falls in Vulnerable Elderly Cerebrovascular Patients: A Pilot Study. Brain Sci 2022; 12:168. [PMID: 35203932 PMCID: PMC8869774 DOI: 10.3390/brainsci12020168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
Falling is a frequent and major clinical problem among older adults, as well as in patients with chronic cerebrovascular diseases (CVD). At present, sequential (mixed) and simultaneously (dual-task) motor-cognitive trainings are the best approaches to affording patients more autonomy in their everyday motor independence while reducing fall risks and consequences. The objective of this study was to evaluate the efficacy of an advanced and innovative dual-task motor-cognitive rehabilitation program on fall risks in vulnerable older persons with chronic CVD. To this purpose, 26 consecutive older fallers with chronic CVD were recruited, and completed a mixed motor-cognitive or a dual-task motor-cognitive training program. Each patient also underwent two test evaluations to assess balance, gait, fear of falling, and walking performance at pre-and post-intervention. We found that our experimental motor-cognitive dual-task rehabilitation program could be an effective method to improve walking balance, gait, walking speed, and fear of falling, while reducing the risk of falls in older people with chronic CVD. Furthermore, results show that the simultaneous motor-cognitive training is more effective than the sequential motor-cognitive training. Therefore, our study brings innovative data, which can contribute positively to the management of this population.
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Affiliation(s)
- Barbara Spanò
- Technology and Training Methods for Disability Care Laboratory, Department of Clinical and Behavioral Neurology, Santa Lucia Foundation IRCCS, 00179 Rome, Italy; (M.G.L.); (M.D.T.); (M.A.S.); (C.R.); (A.M.); (S.G.); (L.P.); (I.A.G.); (F.A.); (C.C.); (R.A.)
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Qian XX, Chen Z, Fong DYT, Ho M, Chau PH. Post-hospital falls incidence and risk factors among older adults: a systematic review and meta-analysis. Age Ageing 2022; 51:6408804. [PMID: 34718373 DOI: 10.1093/ageing/afab209] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Post-hospital falls constitute a significant health concern for older adults who have been recently discharged from the hospital. OBJECTIVES To systematically summarise existing evidence on the incidence and risk factors for post-hospital falls among older adults. METHODS A systematic review and meta-analysis was conducted. Six electronic databases were searched to identify cohort studies investigating the incidence and risk factors for post-hospital falls in older adults. The incidence and risk factors for post-hospital falls were extracted. The meta-analysis was used to calculate pooled incidences and 95% confidence intervals (CI). The meta-regression and subgroup meta-analysis were conducted to explore sources of heterogeneity in incidence proportions across the eligible studies. A qualitative synthesis was performed for the post-hospital falls risk factors. RESULTS Eighteen studies from eight countries (n = 9,080,568) were included. The pooled incidence proportion of any and recurrent post-hospital falls was 14% (95% CI: 13%-15%) and 10% (95% CI: 5%-14%), respectively. Follow-up period, study quality, study country, setting, percentage of female subjects, percentage of subjects with previous falls and the primary data collection method for falls significantly contributed to the 64.8% of the heterogeneity in incidence proportions. Twenty-six risk factors for post-hospital falls were identified in the eligible studies, where biological factors were the most commonly identified factors. The highest risks were reported for previous falls, previous fractures, delirium and neurological diseases. CONCLUSION The findings of this study suggested future post-hospital falls prevention should prioritise the needs of older adults with the dominant risk factors. Further investigations into the period-specific incidence and socioeconomic and environmental risk factors for post-hospital falls are also required.
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Affiliation(s)
- Xing Xing Qian
- School of Nursing, The University of Hong Kong, Pok Lu Fam, Hong Kong
| | - Zi Chen
- School of Nursing, The University of Hong Kong, Pok Lu Fam, Hong Kong
| | - Daniel Y T Fong
- School of Nursing, The University of Hong Kong, Pok Lu Fam, Hong Kong
| | - Mandy Ho
- School of Nursing, The University of Hong Kong, Pok Lu Fam, Hong Kong
| | - Pui Hing Chau
- School of Nursing, The University of Hong Kong, Pok Lu Fam, Hong Kong
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Machado MF, Lima RS, Correia DM, Soares ÉDFM, Melo MTBD. Epidemiological and clinical profile and trend analysis of hospitalizations for fall-related injuries among older adults, Alagoas (Brazil), 2008–2019. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: To analyze the epidemiological and clinical profile and the time trend of hospitalizations for fall-related injuries among older people (aged 60 years or older) in Alagoas between 2008 and 2019. Methods: This is a time series study with data collected from the Hospital Information System of the Unified National Health System (SIHSUS) referring to hospitalizations for fall-related injuries among older adults in Alagoas between 2008 and 2019. Hospitalization and lethality rates, average annual percent change (AAPC), and annual percent change (APC) were calculated; time trends were analyzed using a Joinpoint Regression Model according to sex, skin color, age range, and causes. A 95% confidence interval (95%CI) was adopted. A p-value<0.01 was adopted for defining statistical significance. Results: In Alagoas, 14 817 cases of hospitalizations due to fall-related injuries were reported among older people in the analyzed period. The highest incidence rate was observed in 2016 (48.39/10 000 inhabitants). There were 517 deaths, and the mean lethality rate was 3.4%. A higher proportion of cases was seen in men (66.36%; n=9832), those aged 80 years or older(34.59%; n=5125), and with Brown skin (54.70%; n=8106). The incidence coefficient varied, showing an upward trend with time (APC: 4.1; 95%CI 0.2–8.2; p<0.01). Conclusion: During the analyzed period, the study showed a higher incidence in individuals aged 80 years or older, men, and found an upward trend in hospitalizations. We suggest the optimization of hospital care and promotion of fall prevention programs among older adults.
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Warrington DJ, Shortis EJ, Whittaker PJ. Are wearable devices effective for preventing and detecting falls: an umbrella review (a review of systematic reviews). BMC Public Health 2021; 21:2091. [PMID: 34775947 PMCID: PMC8591794 DOI: 10.1186/s12889-021-12169-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background Falls are a common and serious health issue facing the global population, causing an estimated 646,000 deaths per year globally. Wearable devices typically combine accelerometers, gyroscopes and even barometers; using the data collected and inputting this into an algorithm that decides whether a fall has occurred. The purpose of this umbrella review was to provide a comprehensive overview of the systematic reviews on the effectiveness of wearable electronic devices for falls detection in adults. Methods MEDLINE, Embase, Cochrane Database of Systematic Reviews (CDSR), and CINAHL, were searched from their inceptions until April 2019 for systematic reviews that assessed the accuracy of wearable technology in the detection of falls. Results Seven systematic reviews were included in this review. Due to heterogeneity between the included systematic reviews in their methods and their reporting of results, a meta-analysis could not be performed. Most devices tested used accelerometers, often in combination with gyroscopes. Three systematic reviews reported an average sensitivity of 93.1% or greater and an average specificity of 86.4% or greater for the detection of falls. Placing sensors on the trunk, foot or leg appears to provide the highest accuracy for falls detection, with multiple sensors increasing the accuracy, specificity, and sensitivity of these devices. Conclusions This review demonstrated that wearable device technology offers a low-cost and accurate way to effectively detect falls and summon for help. There are significant differences in the effectiveness of these devices depending on the type of device and its placement. Further high-quality research is needed to confirm the accuracy of these devices in frail older people in real-world settings.
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Affiliation(s)
- Daniel Joseph Warrington
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Room 2.545, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
| | - Elizabeth Jane Shortis
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Room 2.545, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Paula Jane Whittaker
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Room 2.545, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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Nørgaard JE, Jorgensen MG, Ryg J, Andreasen J, Danielsen MB, Steiner DK, Andersen S. Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis. Age Ageing 2021; 50:1914-1924. [PMID: 34120163 DOI: 10.1093/ageing/afab105] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE falls among older adults are common and can have devastating consequences. A novel task-specific exercise modality, gait adaptability training (GAT), has shown promising preventive effects. This systematic review and meta-analysis synthesise the evidence regarding GATs effect on falls and fall-related fractures in community-dwelling older adults. METHODS electronic databases (PubMed, EMBASE, CINAHL, CENTRAL) were systematically searched from inception to 18 June 2020. Additional sources include searches of trial registrations, manual screening of reference lists and requests to experts. We included randomised controlled trials (RCTs) evaluating the effect of GAT on falls with at least 6-month follow-up among community-dwelling people aged 60+ years. Two reviewers independently screened studies against eligibility criteria, extracted relevant information and appraised studies for bias. Random-effects meta-analytic models were employed to pool effect estimates. RESULTS eleven studies with 1,131 participants were included. A meta-analysis in which an outlier study was excluded showed that GAT reduces fall rates by 42% (incidence rate ratio 0.58, 95% confidence interval [CI] 0.39-0.81, I2 = 0.00%; moderate certainty; seven RCTs). Moreover, proportion with fall-related fractures and proportion of fallers was reduced by 81% (risk ratio [RR] 0.19, 95% CI 0.06-0.56, I2 = 0.00%; very low certainty; two RCTs) and 43% (RR 0.57, 95% CI 0.4-to 0.8, I2 = 47.08%; low certainty; 11 RCTs), respectively. CONCLUSIONS our results show that GAT significantly reduces the number of falls and prevents fall-related fractures in older community dwellers. GAT is a promising and feasible exercise modality; however, studies of high quality should be conducted to support a robust conclusion. PROTOCOL REGISTRATION PROSPERO; CRD42020191051.
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Affiliation(s)
- Jens Eg Nørgaard
- Department of Geriatric Medicine, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
| | | | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, DK-5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Jane Andreasen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, DK-9000 Aalborg, Denmark
| | - Mathias Brix Danielsen
- Department of Geriatric Medicine, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
| | | | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
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Pereira C, Veiga G, Almeida G, Matias AR, Cruz-Ferreira A, Mendes F, Bravo J. Key factor cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults: the role of physical fitness, body composition, physical activity, health condition, and environmental hazards. BMC Public Health 2021; 21:977. [PMID: 34758785 PMCID: PMC8582090 DOI: 10.1186/s12889-021-10947-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background Fall risk assessment and determination of older adults’ individual risk profiles are crucial elements in fall prevention. As such, it is essential to establish cutoffs and reference values for high and low risk according to key risk factor outcomes. This study main objective was to determine the key physical fitness, body composition, physical activity, health condition and environmental hazard risk outcome cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults. Methods Five-hundred community-dwelling Portuguese older adults (72.2 ± 5.4 years) were assessed for falls, physical fitness, body composition, physical (in) activity, number of health conditions and environmental hazards, and sociodemographic characteristics. Results The established key outcomes and respective cutoffs and reference values used for fall risk stratification were multidimensional balance (low risk: score > 33, moderate risk: score 32–33, high risk: score 30–31, and very high: score < 30); lean body mass (low risk: > 44 kg, moderate risk: 42–44 kg, high risk: 39–41 kg, and very high: < 39 kg); fat body mass (low risk: < 37%, moderate risk: 37–38%, high risk: 39–42%, and very high: > 42%); total physical activity (low risk: > 2800 Met-min/wk., moderate risk: 2300–2800 Met-min/wk., high risk: 1900–2300 Met-min/wk., and very high: < 1900 Met-min/wk); rest period weekdays (low risk: < 4 h/day, moderate risk: 4–4.4 h/day, high risk: 4.5–5 h/day, and very high: > 5 h/day); health conditions (low risk: n < 3, moderate risk: n = 3, high risk: n = 4–5, and very high: n > 5); and environmental hazards (low risk: n < 5, moderate risk: n = 5, high risk: n = 6–8, and very high: n > 8). Conclusions Assessment of community-dwelling older adults’ fall risk should focus on the above outcomes to establish individual older adults’ fall risk profiles. Moreover, the design of fall prevention interventions should manage a person’s identified risks and take into account the determined cutoffs and respective interval values for fall risk stratification.
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Affiliation(s)
- Catarina Pereira
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal. .,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.
| | - Guida Veiga
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal
| | - Gabriela Almeida
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal
| | - Ana Rita Matias
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal
| | - Ana Cruz-Ferreira
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal
| | - Felismina Mendes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.,Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Largo do Sr. da Pobreza 2B, Évora, Portugal
| | - Jorge Bravo
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal
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SARC-F and the Risk of Falling in Middle-Aged and Older Community-Dwelling Postmenopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111570. [PMID: 34770084 PMCID: PMC8583486 DOI: 10.3390/ijerph182111570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The objective of the present study was to determine the ability of the SARC-F questionnaire to identify individuals at risk of falling among middle-aged and older community-dwelling postmenopausal women. (2) Methods: An analytical cross-sectional study was conducted on 157 women (70.80 ± 8.37 years). The SARC-F questionnaire was used to screen for risk of sarcopenia. Fear of falling and balance confidence, as measured by the Falls Efficacy Scale-International (FES-I) and the Activities-Specific balance Scale-16 items (ABC-16) respectively, were used to assess risk of falling. Anxiety and depression (Hospital Anxiety and Depression Scale), fatigue (Fatigue Severity Scale), body mass index, waist-to-hip ratio, and sleep duration were also determined. (3) Results: Logistic regression showed that higher risk of falling as assessed by FES-I was associated with higher SARC-F scores (OR = 1.656), anxiety levels (OR = 1.147), and age (OR = 1.060), while increased SARC-F scores (OR = 1.612), fatigue (OR = 1.044), and shorter sleep duration (OR = 0.75) were related to ABC-16 scores. In addition, a SARC-F cutoff of 1.50 (83.33% sensitivity and 59.13% specificity) and 3.50 (44.44% sensitivity and 89.26% specificity) were shown to be able to discriminate participants at risk of falling according to the FES-I and the ABC-16, respectively. (4) Conclusions: our results show that SARC-F is an independent predictor of the risk of falling among middle-aged and older community-dwelling postmenopausal women.
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Dallaire M, Gagnon G, Fortin É, Nepton J, Severn AF, Côté S, Smaili SM, Gonçalves de Oliveira Araújo HA, de Oliveira MR, Ngomo S, Bouchard J, da Silva RA. The Impact of Parkinson's Disease on Postural Control in Older People and How Sex can Mediate These Results: A Systematic Review. Geriatrics (Basel) 2021; 6:105. [PMID: 34842716 PMCID: PMC8628755 DOI: 10.3390/geriatrics6040105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Parkinson's disease is most prevalent among elderly people, 65 years and over, and leads to an alteration in motor control associated with postural instability. Current evidence shows that postural control decreases with the aging process. In addition, postural control is more altered in healthy aged men than in women. Until today, few studies have evaluated the combined impact of Parkinson's disease and sex on postural control. This review has allowed to evaluate the impact of Parkinson's disease and sex on postural control measurements in elderly people. METHODOLOGY Studies have been selected from two main databases: PubMed and EBSCO using the keywords "Parkinson", "postural control OR balance" and "sex". Articles related to the evaluation of postural control, including men and women with Parkinson's aged over 65 years old, regardless of stage, were included (n = 179). Articles were excluded if not written in French or English or not presenting original content. RESULTS Ten (10) studies out of 179 that fulfilled inclusion and exclusion criteria were reported in the final analysis, which cumulates a total of 944 individuals with Parkinson's (410 women). In general, results show greater postural instability among people with Parkinson's compared to healthy subjects, and this according to different objective measurements using stabilographic parameters from force platforms. Only two studies out of ten evaluated postural control while briefly considering distinctions between sex, but without showing a significant difference between men and women with Parkinson's. Parkinson's severity, length of time of Parkinson's disease and cognitive state of the person are the three variables with a negative impact on postural control. CONCLUSION Older people with Parkinson's disease have greater postural instability. Sex does not seem to influence the postural control of elderly people with Parkinson's, although more studies are necessary.
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Affiliation(s)
- Mathieu Dallaire
- Masters of Biomedical Science Program at l’Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (M.D.); (S.N.)
- Laboratoire de Recherche BioNR, Centre Intersectoriel en Santé Durable, Département des Sciences de la Santé, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada;
| | - Guillaume Gagnon
- Physical Therapy McGill Program in Extension at the Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (G.G.); (É.F.)
| | - Émilie Fortin
- Physical Therapy McGill Program in Extension at the Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (G.G.); (É.F.)
| | - Josée Nepton
- Centre Intégré de Santé et Services Sociaux du Saguenay—Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics services–La Baie Hospital, Saguenay, QC G7H 7K9, Canada; (J.N.); (A.-F.S.); (S.C.)
| | - Anne-France Severn
- Centre Intégré de Santé et Services Sociaux du Saguenay—Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics services–La Baie Hospital, Saguenay, QC G7H 7K9, Canada; (J.N.); (A.-F.S.); (S.C.)
| | - Sharlène Côté
- Centre Intégré de Santé et Services Sociaux du Saguenay—Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics services–La Baie Hospital, Saguenay, QC G7H 7K9, Canada; (J.N.); (A.-F.S.); (S.C.)
| | - Suhaila Mahmoud Smaili
- Doctoral Program in Rehabilitation Sciences, UEL/UNOPAR, Londrina 86041-120, Brazil; (S.M.S.S.); (H.A.G.d.O.A.)
| | | | - Márcio Rogério de Oliveira
- Doctoral and Masters Program in Physical Exercise on Health Promotion, Universidade Pitagoras UNOPAR, Londrina 86041-120, Brazil;
| | - Suzy Ngomo
- Masters of Biomedical Science Program at l’Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (M.D.); (S.N.)
- Laboratoire de Recherche BioNR, Centre Intersectoriel en Santé Durable, Département des Sciences de la Santé, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada;
- Physical Therapy McGill Program in Extension at the Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (G.G.); (É.F.)
| | - Julie Bouchard
- Laboratoire de Recherche BioNR, Centre Intersectoriel en Santé Durable, Département des Sciences de la Santé, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada;
| | - Rubens A. da Silva
- Masters of Biomedical Science Program at l’Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (M.D.); (S.N.)
- Laboratoire de Recherche BioNR, Centre Intersectoriel en Santé Durable, Département des Sciences de la Santé, Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada;
- Physical Therapy McGill Program in Extension at the Université du Québec à Chicoutimi (UQAC), Saguenay, QC G7H 2B1, Canada; (G.G.); (É.F.)
- Centre Intégré de Santé et Services Sociaux du Saguenay—Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics services–La Baie Hospital, Saguenay, QC G7H 7K9, Canada; (J.N.); (A.-F.S.); (S.C.)
- Doctoral Program in Rehabilitation Sciences, UEL/UNOPAR, Londrina 86041-120, Brazil; (S.M.S.S.); (H.A.G.d.O.A.)
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Zuin M, Brombo G, Capatti E, Romagnoli T, Zuliani G. Orthostatic hypotension and vitamin D deficiency in older adults: systematic review and meta-analysis. Aging Clin Exp Res 2021; 34:951-958. [PMID: 34628636 DOI: 10.1007/s40520-021-01994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Over the latest years different studies have investigated the possible relationship between D deficiency and occurrence of orthostatic hypotension (OH), often reaching controversial results. We perform an update meta-analysis providing an update overview on the association between hypovitaminosis D and orthostatic hypotension (OH) in older adults. METHODS Data extraction was independently performed by two authors and based upon predefined criteria. The meta-analysis was performed using a random-effects model. Statistical heterogeneity between groups was measured using the Higgins I2 statistic. RESULTS Eight investigations enrolling 16.326 patients (mean age 75.5 years) met the inclusion criteria and were considered for the analysis. Patients with vitamin D deficiency were more likely to have OH compared to those without (OR: 1.36, 95% CI 1.14-1.63, p = 0.0001, I2 = 43.6%). A further sub-analysis, based on three studies, estimating the risk of OH in patients with hypovitaminosis D receiving antihypertensive treatment, did not reach the statistical significance (OR: 1.40, 95% CI 0.61-3.18, p = 0.418, I2 = 53.3%). Meta-regression performed using age (p = 0.12), BMI (p = 0.73) and gender (p = 0.62) as moderators did not reveal any statistical significance in influencing OH. Conversely, physical activity, Vitamin D supplementation and use of radioimmunoassay for the measurement of vitamin D serum levels showed a significant inverse relationship towards the risk of OH (Coeff.-0.09, p = 0.002, Coeff. - 0.12, p < 0.001 and Coeff. - 0.08, p = 0.03, respectively) among patients with hypovitaminosis D. A direct correlation between the administration of antihypertensive treatment and the risk of OH in older patients with low vitamin D level was observed (Coeff. 0.05, p < 0.001). CONCLUSIONS Hypovitaminosis D is significantly associated with OH in older adults and directly influence by the administration of antihypertensive drugs. Conversely, physical activity, vitamin D supplementation and use of radioimmunoassay as analytic method inversely correlated with the risk of OH in older patients.
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Martin P, Keppler AM, Alberton P, Neuerburg C, Drey M, Böcker W, Kammerlander C, Saller MM. Self-Assessment of Mobility of People over 65 Years of Age. MEDICINA-LITHUANIA 2021; 57:medicina57090980. [PMID: 34577903 PMCID: PMC8469271 DOI: 10.3390/medicina57090980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/23/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under- or overestimate themselves in many aspects. Since this can have serious consequences in their treatment and care, the aim of this study was to identify differences in the self and external assessment of mobility of persons over 65 years of age. MATERIALS AND METHODS 222 participants over 65 years of age and one external, closely-related relative or professional caregiver were interviewed by a unique study assistant using a standardized questionnaire. Participants were divided into people living in nursing homes and independent people living at home, where either the caregivers or the relatives provided the external assessment of mobility, respectively. The questionnaire included demographics, cognitive abilities (Mini Mental Status Test); fall risk (Hendrich 2 Fall Risk Model); as well as the Parker Mobility Score, Barthel Index, and EQ-5D-5L to measure mobility, activities of daily life and quality of life. In each case, the participant and the external person were asked for their assessment to the participants' mobility situation. Statistical significance of the difference between self and external assessment was calculated with a Wilcoxon rank-sum test and assumed with a p-value of ≤ 0.05. RESULTS Self-assessment indicated a significantly higher value, when compared to an external assessment for the Parker Mobility Score for females in nursing homes (p ≤ 0.01), as well as for the Barthel Index for females (p ≤ 0.01) and males (p ≤ 0.01) in nursing homes. The EQ-5D-5L received a significantly higher self-assessment value for females (p ≤ 0.01) and males (p ≤ 0.01) living at home and females (p ≤ 0.01) and males (p ≤ 0.05) in nursing homes. CONCLUSIONS Persons over 65 years of age tend to overestimate their level of mobility, quality of life and activities of daily life. Especially for people living in nursing homes, these scoring systems should be treated with caution due to the differences between the verbal statements. It is important to properly assess the mobility situation of elderly patients to ensure correct medical treatment and prevention of falls.
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Affiliation(s)
- Pascal Martin
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Alexander Martin Keppler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Paolo Alberton
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Michael Drey
- Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, 80336 Munich, Germany;
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Christian Kammerlander
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
- Traumahospital Styria, Graz & Kalwang, Austria
| | - Maximilian Michael Saller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
- Correspondence:
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Khalatbari-Soltani S, Stanaway F, Sherrington C, Blyth FM, Naganathan V, Handelsman DJ, Seibel MJ, Waite LM, Le Couteur DG, Cumming RG. The Prospective Association Between Socioeconomic Status and Falls Among Community-Dwelling Older Men. J Gerontol A Biol Sci Med Sci 2021; 76:1821-1828. [PMID: 33537735 DOI: 10.1093/gerona/glab038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) has been suggested as a risk factor for falls but the few prospective studies to test this have had mixed results. We evaluated the prospective association between SES and falls in the Concord Health and Ageing in Men Project (CHAMP). METHODS CHAMP is a population-based prospective cohort study of men aged ≥70 years in Sydney, Australia. Incident falls were ascertained by triannual telephone calls for up to 4 years. SES was assessed with 4 indicators (education, occupation, source of income, home ownership) and cumulative SES score. We tested for interaction between SES indicators and country of birth and conducted stratified analyses. RESULTS We evaluated 1624 men (mean age: 77.3 ± 5.4 years). During a mean ± SD follow-up of 42.6 ± 8.7 months, 766 (47%) participants reported ≥1 incident falls. In nonstratified analyses, there were no associations between SES indicators and falls. In stratified analyses, falls rates were higher among Australian-born men with less formal education (incidence rate ratio [IRR] 1.66, 95% confidence interval [CI] 1.16-2.37, compared with those with more education) and those with low occupational position (1.45; 1.09-1.93). However, among men born in non-main English-speaking countries the rate of falls was lower among those with low educational level and no associations were evident for occupational position. CONCLUSIONS Lower educational level and occupational position predicted a higher falls rate in Australian-born men; the opposite relationship was evident for educational level among migrants born in non-main English-speaking countries. Further studies should test these relationships in different populations and settings and evaluate targeted interventions.
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Affiliation(s)
- Saman Khalatbari-Soltani
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia.,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Australia
| | - Fiona Stanaway
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
| | - Cathie Sherrington
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Australia
| | - Fiona M Blyth
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia.,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, Australia
| | - Markus J Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital, Australia
| | - Louise M Waite
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - David G Le Couteur
- ANZAC Research Institute, University of Sydney and Concord Hospital, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, New South Wales, Australia
| | - Robert G Cumming
- The University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia.,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Australia
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Mehta J, Knowles K, Wilson E. Prevalence of Falls in Patients Presenting to an Ophthalmic Outpatients Department- A Surveillance Study. Br Ir Orthopt J 2021; 17:134-141. [PMID: 34466777 PMCID: PMC8378087 DOI: 10.22599/bioj.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Approximately 1 in 3 adults aged 65 and over experience a fall each year. Poor vision is an identified risk factor. The aim of this cross-sectional public health surveillance audit was to determine the prevalence of falls experienced in the previous 12 months by adult patients presenting to an ophthalmology department. Methods: A short questionnaire was given to consecutive patients attending an ophthalmology department at two trusts in the North West to determine whether they had experienced a fall in the previous 12 months, whether they had suffered a fracture, their eye condition and the type of glasses worn. Results: Data was collected for 585 patients (mean age: 69 years, SD: 13.8). Falls in the previous 12 months were reported by 96 (16.4%) patients, and a significant proportion of these were aged 60 years and over (82%, p < 0.0001, one-sample binomial test). Half of the respondents were unaware of their eye health condition for which they were attending the department. Glaucoma was the most prevalent condition in those who had experienced a fall (43%). A significant proportion of the individuals who reported a fall wore single-vision glasses (43%, p < 0.0001, one-sample chi-square test). Conclusion: In an ophthalmology outpatient department, the proportion of older adults who experienced a fall in the previous 12 months was lower than the reported prevalence in the general population. There is a need for health literacy to educate patients about their eye condition, the potential effects on their visual function and, consequently, managing falls risk.
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Affiliation(s)
| | | | - Erin Wilson
- Wirral University Teaching Hospital NHS Foundation Trust, GB
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Lapierre N, Um Din N, Igout M, Chevrier J, Belmin J. Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study. JMIR Res Protoc 2021; 10:e24665. [PMID: 34435968 PMCID: PMC8430847 DOI: 10.2196/24665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/16/2020] [Accepted: 03/05/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. OBJECTIVE This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. METHODS This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. RESULTS The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I-Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. CONCLUSIONS The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. TRIAL REGISTRATION ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/24665.
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Affiliation(s)
- Nolwenn Lapierre
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France.,Centre de Recherches Interdisciplinaires, Université Paris Descartes, Paris, France
| | - Nathavy Um Din
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France
| | - Manuella Igout
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France
| | - Joël Chevrier
- Centre de Recherches Interdisciplinaires, Université Paris Descartes, Paris, France
| | - Joël Belmin
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, Ivry-Sur-Seine, France.,Faculté de Médecine Sorbonne, Sorbonne Université, Paris, France
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A secondary analysis of a randomised controlled trial to investigate the effect of Tai Chi on the instrumented timed up and go test in people with mild to moderate dementia. Aging Clin Exp Res 2021; 33:2175-2181. [PMID: 33141417 PMCID: PMC8302509 DOI: 10.1007/s40520-020-01741-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023]
Abstract
Background Previous research has identified that Tai Chi is effective for reducing risk of falls and improving timed up and go scores. However, our previous research identified no-significant difference in time to complete the timed up and go test following a Tai Chi intervention in people with dementia. Aim To conduct a secondary analysis to extend our understanding of the effect of Tai Chi on the instrumented Timed Up and Go test. Methods This is a secondary analysis of a randomised controlled trial set in the community. People with dementia, recruited from NHS databases, memory clinics, local charities and self-referral across the south of England, received either 20 weeks of Tai Chi plus normal care or normal care. Outcomes were assessed using the instrumented Timed Up and Go test, completed at baseline and after 6 months. Results From 83 people with dementia volunteering for the study, 67 complete datasets were available for analysis. Within-group pairwise comparison across time revealed no-significant gains for any of the instrumented Timed Up and Go variables, and no-significant difference for between-group pairwise comparisons. Discussion This suggests that Tai Chi had no effect on the instrumented Timed Up and Go in people with dementia. This lack of effect may be due to the lack of specificity of the training stimulus to the outcome measure. Conclusion Tai Chi had no effect on any instrumented Timed Up and Go variables, suggesting Tai Chi may not be best placed to enhance the sub-elements of the instrumented Timed Up and Go to reduce fall risk among community-dwelling people with dementia. Clinical trial registration number: NCT02864056.
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Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study. Ear Hear 2021; 43:487-494. [PMID: 34334680 DOI: 10.1097/aud.0000000000001111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in vision, vestibular, somatosensation, age-related orthopedic changes, and polypharmacy). Hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association between self-reported hearing status and falls or falls-related injury. We hypothesized that hearing aid use would reduce the impact of hearing loss on the odds of falling and falls-related injury. If hearing aid users have reduced odds of falling compared with nonhearing aid users, then that would have an important implications for falls prevention healthcare. DESIGN Data were drawn from the 2004-2016 surveys of the Health and Retirement Study (HRS). A generalized estimating equation approach was used to fit logistic regression models to determine whether or not hearing aid use modifies the odds of falling and falls injury associated with self-reported hearing status. RESULTS A total of 17,923 individuals were grouped based on a self-reported history of falls. Self-reported hearing status was significantly associated with odds of falling and with falls-related injury when controlling for demographic factors and important health characteristics. Hearing aid use was included as an interaction in the fully-adjusted models and the results showed that there was no difference in the association between hearing aid users and nonusers for either falls or falls-related injury. CONCLUSIONS The results of the present study show that when examining self-reported hearing status in a longitudinal sample, hearing aid use does not impact the association between self-reported hearing status and the odds of falls or falls-related injury.
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Post-Drive Standing Balance of Vehicle Passengers Using Wearable Sensors: The Effect of On-Road Driving and Task Performance. SENSORS 2021; 21:s21154997. [PMID: 34372234 PMCID: PMC8347861 DOI: 10.3390/s21154997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/03/2022]
Abstract
Postural sway has been demonstrated to increase following exposure to different types of motion. However, limited prior studies have investigated the relationship between exposure to normative on-road driving conditions and standing balance following the exposure. The purpose of this on-road study was to quantify the effect of vehicle motion and task performance on passengers’ post-drive standing balance performance. In this study, trunk-based kinematic data were captured while participants performed a series of balance exercises before and after an on-road driving session in real-time traffic. Postural sway for all balance exercises increased following the driving session. Performing a series of ecologically relevant visual-based tasks led to increases in most post-drive balance metrics such as sway position and velocity. However, the post-drive changes following the driving session with a task were not significantly different compared to changes observed following the driving session without a task. The post-drive standing balance performance changes observed in this study may increase vulnerable users’ risk of falling. Wearable sensors offer an opportunity to monitor postural sway following in-vehicle exposures.
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Guyon M, Chea C, Laroche D, Fournel I, Baudet A, Toupet M, Bozorg Grayeli A. Measuring threshold and latency of motion perception on a swinging bed. PLoS One 2021; 16:e0252914. [PMID: 34242212 PMCID: PMC8270192 DOI: 10.1371/journal.pone.0252914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Our objective was to develop and to evaluate a system to measure latency and threshold of pendular motion perception based on a swinging bed. MATERIALS AND METHODS This prospective study included 30 healthy adults (age: 32 ± 12 years). All subjects were tested twice with a 10 min. interval. A second trial was conducted 2 to 15 days after. A rehabilitation swinging bed was connected to an electronic device emitting a beep at the beginning of each oscillation phase with an adjustable time lag. Subjects were blindfolded and auditory cues other than the beep were minimized. The acceleration threshold was measured by letting the bed oscillate freely until a natural break and asking the patient when he did not perceive any motion. The perception latency was determined by asking the patient to indicate whether the beep and the peak of each oscillation were synchronous. The time lag between sound and peak of the head position was swept from -750 to +750 ms by 50 ms increments. RESULTS The mean acceleration threshold was 9.2±4.60 cm/s2. The range width of the synchronous perception interval was estimated as 535±190 ms. The point of subjective synchronicity defined as the center of this interval was -195±106 ms (n = 30). The test-retest evaluation in the same trial showed an acceptable reproducibility for the acceleration threshold and good to excellent for all parameters related to sound-movement latency. CONCLUSION Swinging bed combined to sound stimulation can provide reproducible information on movement perception in a simple and non-invasive manner with highly reproducible results.
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Affiliation(s)
- Maxime Guyon
- Otolaryngology Department, Dijon University Hospital, Dijon, France
| | - Cyrielle Chea
- Otolaryngology Department, Dijon University Hospital, Dijon, France
| | - Davy Laroche
- INSERM CIC 1432, Plateforme d’Investigation Technologique, Dijon University Hospital, Dijon, France
- INSERM UMR1093, Cognition, Action et Plasticité Sensorimotrice, Université de Bourgogne Franche Comté, Dijon, France
| | - Isabelle Fournel
- INSERM CIC 1432, Module Epidémiologie Clinique/Essais Cliniques, Dijon, France
| | - Audrey Baudet
- INSERM CIC 1432, Plateforme d’Investigation Technologique, Dijon University Hospital, Dijon, France
| | - Michel Toupet
- Otolaryngology Department, Dijon University Hospital, Dijon, France
- Centre d’Explorations Fonctionnelles Otoneurologiques, Paris, France
| | - Alexis Bozorg Grayeli
- Otolaryngology Department, Dijon University Hospital, Dijon, France
- CNRS UMR 6306, Le2i Research Laboratory, Dijon, France
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72
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Williams JM, Nyman SR. Age Moderates Differences in Performance on the Instrumented Timed Up and Go Test Between People With Dementia and Their Informal Caregivers. J Geriatr Phys Ther 2021; 44:E150-E157. [PMID: 32175993 PMCID: PMC7611094 DOI: 10.1519/jpt.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers. METHODS Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed. RESULTS People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity. CONCLUSIONS Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.
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Affiliation(s)
- Jonathan M Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, England
| | - Samuel R Nyman
- Department of Psychology and Ageing and Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, England
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73
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Abstract
Presbyopia is an age-related condition that affects approximately 1.8 billion people worldwide. Strategies to correct presbyopia include both nonsurgical and surgical approaches. Although eye care providers assume that multifocal spectacles and monovision have lower risks than surgical interventions, there is evidence to suggest that the use of these nonsurgical approaches in the older population increases the risk for trips and falls. Each year, fall-related injuries and deaths are reported in a substantial portion of the population, both globally and in the United States. Previous studies have shown a link between visual acuity, contrast sensitivity, stereoacuity, and visual field impairments and falls. More recent mechanistic and epidemiological studies have shown that multifocal spectacles and monovision can increase the risk for falls as well. Although evidence on the financial burden of falls related to multifocal spectacles or monovision is limited, total direct medical costs related to falls associated with multifocal spectacles are estimated to be approximately $11 billion annually in the United States. Therefore, it is important that eye care providers consider the risk for falls associated with multifocal spectacles and monovision when making decisions on the best strategy for correcting presbyopia in older adults. [J Refract Surg. 2021;37(6 Suppl):S12-S16.].
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74
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Riska KM, Peskoe SB, Gordee A, Kuchibhatla M, Smith SL. Preliminary Evidence on the Impact of Hearing Aid Use on Falls Risk in Individuals With Self-Reported Hearing Loss. Am J Audiol 2021; 30:376-384. [PMID: 34033509 DOI: 10.1044/2021_aja-20-00179] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Falls are considered a significant public health issue, and hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association. We hypothesized that routine hearing aid use would reduce the impact of hearing loss on the odds of falling. If hearing aid users have reduced odds of falling, then that would have an important impact on falls prevention health care. Method Data from 8,091 individuals 40 years of age and older who completed National Health and Nutrition Examination Survey (NHANES) cycles 1999-2004 were used. NHANES comprises a series of cross-sectional studies, each of which is representative of the total civilian noninstitutionalized population of children and adults in the United States, enabling unbiased national estimates of health that can be independently reproduced. Self-reported hearing, hearing aid status, falls history, and comorbidities were extracted and analyzed using regression modeling. Results The 8,091 individuals were grouped based on a self-reported history of falls in the last year. Self-reported hearing loss was significantly associated with odds of falling. Categorizing individuals based on routine hearing aid use was included as an interaction term in the fully adjusted models and was not significant, suggesting no difference in falls based on hearing aid status. Conclusions The unique results of the current study show that when examining self-reported hearing in a nationally representative sample, hearing aid use does not appear to mitigate or modify the association between self-reported hearing and falls. Future research designs are highlighted to address limitations identified using NHANES data for this research and focus on the use of experimental designs to further understand the association between hearing loss and falls, including whether hearing loss may be a modifiable risk factor for falls. Supplemental Material https://doi.org/10.23641/asha.14642784.
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Affiliation(s)
- Kristal M. Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Durham, NC
| | - Sarah B. Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Alex Gordee
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Sherri L. Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
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Adam CE, Fitzpatrick AL, Leary CS, Hajat A, Phelan EA, Park C, Semmens EO. The Association between Gait Speed and Falls in Community Dwelling Older Adults with and without Mild Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073712. [PMID: 33918186 PMCID: PMC8038190 DOI: 10.3390/ijerph18073712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Falls are common in older adults and result in injuries, loss of independence, and death. Slow gait is associated with falls in older adults, but few studies have assessed the association between gait speed and falls among those with mild cognitive impairment (MCI). (2) Methods: The association between gait speed and falls was assessed in 2705 older adults with and without MCI participating in the Ginkgo Evaluation of Memory Study. Gait speed was measured via a 15-foot walk test and fall history through self-report. We used data collected at the 12-month (2001–2003) and 18-month visits (2002–2004). (3) Results: Participant average age was 78.5 years (sd = 3.2); 45% were female, and 14% had MCI at baseline. The average gait speed was 0.93 m/s (sd = 0.20). Sixteen percent (n = 433) and 18% (n = 498) reported at least one fall at the 12-month and 18-month visits, respectively. Faster gait speed was associated with decreased risk of falling (RR: 0.95, 95% CI: 0.91, 0.99) for every 10 cm/s increase in gait speed adjusted for age, gender, study arm, site, and MCI status. (4) Conclusions: The relationship between gait speed and risk of falling did not vary by MCI status (interaction p-value = 0.78).
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Affiliation(s)
- Claire E. Adam
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Skaggs Building Room 177, Missoula, MT 59812, USA; (C.S.L.); (E.O.S.)
- Correspondence:
| | - Annette L. Fitzpatrick
- Department of Family Medicine, University of Washington, Box #356390, Seattle, WA 98195-6390, USA;
- Department of Epidemiology, School of Public Health, University of Washington, UW Box #351619, Seattle, WA 98195, USA; (A.H.); (C.P.)
- Department of Global Health, University of Washington, UW Box #351620, Seattle, WA 98195-7965, USA
| | - Cindy S. Leary
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Skaggs Building Room 177, Missoula, MT 59812, USA; (C.S.L.); (E.O.S.)
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, UW Box #351619, Seattle, WA 98195, USA; (A.H.); (C.P.)
| | - Elizabeth A. Phelan
- Division of Gerontology and Geriatric Medicine, Harborview Medical Center, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499, USA;
| | - Christina Park
- Department of Epidemiology, School of Public Health, University of Washington, UW Box #351619, Seattle, WA 98195, USA; (A.H.); (C.P.)
| | - Erin O. Semmens
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Skaggs Building Room 177, Missoula, MT 59812, USA; (C.S.L.); (E.O.S.)
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Chen B, Liu P, Xiao F, Liu Z, Wang Y. Review of the Upright Balance Assessment Based on the Force Plate. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052696. [PMID: 33800119 PMCID: PMC7967421 DOI: 10.3390/ijerph18052696] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
Quantitative assessment is crucial for the evaluation of human postural balance. The force plate system is the key quantitative balance assessment method. The purpose of this study is to review the important concepts in balance assessment and analyze the experimental conditions, parameter variables, and application scope based on force plate technology. As there is a wide range of balance assessment tests and a variety of commercial force plate systems to choose from, there is room for further improvement of the test details and evaluation variables of the balance assessment. The recommendations presented in this article are the foundation and key part of the postural balance assessment; these recommendations focus on the type of force plate, the subject's foot posture, and the choice of assessment variables, which further enriches the content of posturography. In order to promote a more reasonable balance assessment method based on force plates, further methodological research and a stronger consensus are still needed.
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77
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Chen B, Shin S. Bibliometric Analysis on Research Trend of Accidental Falls in Older Adults by Using Citespace-Focused on Web of Science Core Collection (2010-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041663. [PMID: 33572483 PMCID: PMC7916410 DOI: 10.3390/ijerph18041663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
The present study aimed to identify the trends in research on accidental falls in older adults over the last decade. The MeSH (Medical Subject Headings) and entry terms were applied in the Web of Science Core Collection. Relevant studies in English within articles or reviews on falls in older adults were included from 2010 to 2020. Moreover, CiteSpace 5.6.R5 (64-bit) was adopted for analysis with scientific measurements and visualization. Cooper Cyrus, Stephen R Lord, Minoru Yamada, Catherine Sherrington, and others have critically impacted the study of falls in older adults. Osteoporosis, dementia, sarcopenia, hypertension, osteosarcopenia, traumatic brain injury, frailty, depression, and fear of falling would be significantly correlated with falls in older adults. Multiple types of exercise can provide effective improvements in executive cognitive performance, gait performance, quality of life, and can also lower the rates of falls and fall-related fractures. Fall detection, hospitalization, classification, symptom, gender, and cost are the current research focus and development direction in research on falls in older adults. The prevention of falls in older adults is one of the most important public health issues in today’s aging society. Although lots of effects and research advancements had been taken, fall prevention still is uncharted territory for too many older adults. Service improvements can exploit the mentioned findings to formulate policies, and design and implement exercise programs for fall prevention.
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Affiliation(s)
- Boyuan Chen
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou 450001, China;
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea
| | - Sohee Shin
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea
- Correspondence:
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Ziebart C, Bobos P, Furtado R, MacDermid JC, Bryant D, Szekeres M, Suh N. The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis. Arch Rehabil Res Clin Transl 2021; 2:100065. [PMID: 33543091 PMCID: PMC7853376 DOI: 10.1016/j.arrct.2020.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the efficacy of fall hazards identification programs when compared to no intervention or other fall prevention programs on number of falls, falls incidence, and identifying fall hazards in community-dwelling adults. Data Sources CINAHL, PubMed, EMBASE, Scopus, and PsychINFO were used to identify articles. Study Selection Studies were selected to compare fall hazards identification programs to a control group. Studies were eligible if they were randomized controlled trials and enrolled adults older than 50 years with the incidence rate of falls as an outcome. Data Extraction Study or authors, year, sample characteristics, intervention or comparison groups, number of falls, and number of hazards identified in the intervention and control groups, and follow-up were extracted. The risk of bias assessment was performed using the Cochrane Risk of Bias tool. Quality was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach per outcome. Data Synthesis A total of 8 studies (N=8) and 5177 participants were included. There was a high risk of bias across the studies mostly due to improper blinding of personnel of the outcome assessor. Pooled estimate effects from 5 studies assessing the incidence rate of falls from 3019 individuals indicated no difference between fall hazards identification programs and control (incidence rate ratio=0.98; 95% confidence interval, 0.87-1.10). Conclusions The current study suggests that there may be a benefit for fall hazards programs in reducing incident falls. However, because of a moderate GRADE rating, more large-scale studies with a higher number of falls events and more consistent control groups are required to determine the true effect.
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Affiliation(s)
- Christina Ziebart
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Rochelle Furtado
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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79
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Lin YC, Chang YH. Poor Appetite and Eating Difficulties Can Predict the Long-Term Risk of Falling: A Longitudinal Study in Middle-Aged and Older Adults. J Appl Gerontol 2020; 40:1465-1474. [PMID: 33267709 DOI: 10.1177/0733464820976439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study investigates whether self-reported nutritional status affects falling among middle-aged and older adults. METHOD We used 8-year follow-up data from the Taiwan Longitudinal Study on Aging. At baseline, respondents' appetite, changes in amount of food intake, and eating difficulties were assessed in a questionnaire-based survey in addition to anthropometric measurements (body mass index, mid-arm circumferences, and involuntary body weight loss). Their associations with falls in the follow-up were examined using multivariable log-binomial regression. RESULTS The study included 2,519 respondents aged 50 years and older. Poor appetite (prevalence ratio [PR] = 1.25, 95% confidence interval [CI] = [1.07, 1.46]) and eating difficulties (PR = 1.16, 95% CI = [1.02, 1.32]) significantly predicted falling 8 years later with adjustments for sociodemographics, health behaviors, comorbidities, and anthropometric measures by taking into account probabilities of follow-up. CONCLUSION Poor appetite and eating difficulties can predict falling in the long-term independent of anthropometric measurements among middle-aged and older adults.
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Affiliation(s)
- Yu-Chun Lin
- China Medical University Hospital, Taichung City, Taiwan
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80
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Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review. J Am Med Dir Assoc 2020; 21:1852-1861.e8. [DOI: 10.1016/j.jamda.2020.05.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/19/2023]
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81
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Bustamante-Troncoso C, Herrera-López LM, Sánchez H, Pérez JC, Márquez-Doren F, Leiva S. [Effect of a multidimensional intervention for prevention of falls in the eldery]. Aten Primaria 2020; 52:722-730. [PMID: 31740074 PMCID: PMC8054286 DOI: 10.1016/j.aprim.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/30/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN Randomised clinical trial. SETTING Family health centre, primary care. PARTICIPANTS Independent elderly people living in the community. INTERVENTION For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n=77), and those assigned to the control group (CG, n=77) received usual care in the family health centre. MAIN MEASUREMENTS Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P<.001 and CG: P<.001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r=0.25) and shoes (r=0.24), as well as an increase in the perception of risk of falls associated with walking (r=0.21) and the presence of objects or furniture (r=0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P=.004). CONCLUSIONS The multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.
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Affiliation(s)
| | | | - Hugo Sánchez
- Servicio de Salud Metropolitano Sur, Santiago de Chile, Chile
| | - J Carola Pérez
- Facultad de Psicología, Universidad del Desarrollo, Santiago de Chile, Chile
| | | | - Sara Leiva
- Centro de Salud Familiar Félix de Amesti, Departamento de Salud Municipalidad de Macul, Santiago de Chile, Chile
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82
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Ma Y, Li X, Pan Y, Zhao R, Wang X, Jiang X, Li S. Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study. Eur J Neurol 2020; 28:381-388. [PMID: 33030300 DOI: 10.1111/ene.14572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Falling is considered an important public health problem among older people. A recent cross-sectional study suggested that cognitive frailty (CF) is associated with falls. We aimed to explore whether CF is a risk factor for falls in a population-based longitudinal study. METHODS Using data from the Rugao Longevity and Aging Study, physical frailty was assessed according to the modified Fried's phenotype, and the 20% of participants with the lowest scores on the Revised Hasegawa Dementia Scale were defined as having cognitive impairment (CoI). Cognitive frailty (CF) was defined as the coexistence of physical frailty and CoI, but excluded severe CoI (revised Hasegawa Dementia Scale score ≤ 10). The outcome of number of falls in the previous 12 months was measured using a questionnaire. RESULTS At baseline, the prevalence of CF was 2.6% and the prevalence of two or more falls was 6.7%. Cross-sectional analysis found that two or more falls was associated with physical frailty without CoI (odds ratio [OR] 6.79, 95% confidence interval [CI] 3.17-14.56), pre-frailty with CoI (OR 4.54, 95% CI 2.44-8.44) and CF (OR 3.51, 95% CI 1.18-10.44). Slow gait with CoI was associated with two or more falls (OR 2.21, 95% CI 1.08-4.53). At 3-year follow-up, the prevalence of two or more falls was 10.6%. Logistic regression analysis showed that, compared with the robust and non-CoI elderly groups, the CF elderly group had a higher risk of two or more falls (OR 3.41, 95% CI 1.11-10.50). CONCLUSIONS Cognitive frailty was associated with two or more falls at baseline and might be a risk factor for two or more falls after 3 years. Early screening of CF might be beneficial in the prevention of falls.
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Affiliation(s)
- Y Ma
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Y Pan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - R Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai, China
| | - X Jiang
- Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | - S Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Relationship Between Balance Status and Risk of Falling Among Elderly Patients in Northern Turkey. TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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de Azeredo Passos VM, Champs APS, Teixeira R, Lima-Costa MFF, Kirkwood R, Veras R, Nascimento BR, Nogales AM, Schmidt MI, Duncan BB, Cousin E, Naghavi M, Souza FM. The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017. Popul Health Metr 2020; 18:14. [PMID: 32993668 PMCID: PMC7524597 DOI: 10.1186/s12963-020-00206-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brazil is the world's fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. METHODS The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. RESULTS LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. CONCLUSIONS The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.
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Affiliation(s)
- Valéria Maria de Azeredo Passos
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil. .,, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | | | - Renato Teixeira
- Postgraduate Program on Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Renata Kirkwood
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renato Veras
- Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce Bartholow Duncan
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ewerton Cousin
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Washington, USA
| | - Fatima Marinho Souza
- Postgraduate Program on Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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85
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Scoping Review of Clinical Practice Guidelines for Fall Risk Screening and Assessment in Older Adults across the Care Continuum. Can J Aging 2020; 40:206-223. [PMID: 32985402 DOI: 10.1017/s0714980820000112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.
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86
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Lu Z, Lam FMH, Leung JCS, Kwok TCY. The U-Shaped Relationship Between Levels of Bouted Activity and Fall Incidence in Community-Dwelling Older Adults: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 75:e145-e151. [PMID: 32115656 PMCID: PMC7518560 DOI: 10.1093/gerona/glaa058] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It remains uncertain whether the association between physical activity (PA) and falls is U-shaped, and few studies have explored the potential mediation of PA accumulation pattern. METHODS We measured PA in 671 community-dwelling older adults (82.7 ± 3.8 years) using wrist-worn accelerometer for 7 days. PA was further classified to bouted PA (≥10 minutes bout length) and sporadic PA (<10 minutes bout length) for subanalysis. Fall incidence in the following 12-month was recorded through tri-monthly telephone interviews. Classification and Regression Tree analysis was used to identify two optimal cutoff values of each PA measurement to predict falls. Participants were then divided into "inactive," "moderately active," and "highly active" groups accordingly. Negative binomial regression models were used to estimate the association between the PA measures and fall incidence. RESULTS Six hundred and thirty-nine participants completed 12-month follow-up. Ninety-three (14.6%) experienced a total of 118 falls. Inactive and highly active older adults had higher falls per person month relative to the moderately active group (inactive: incidence rate ratios [IRR] = 2.372, 95% confidence interval [CI] = 1.317-4.271; highly active: IRR = 2.731, 95% CI = 1.196-6.232). Subanalyses found similar significant finding with bouted PA (p < .001) but not sporadic PA (p ≥ .221). The association between bouted PA and falls remained significant even after adjusting fall incidence for bouted activity time (inactive: IRR = 3.636, 95% CI = 2.238-5.907; highly active: IRR = 1.823, 95% CI = 1.072-3.1). Further adjustments for fall-related risk factors did not meaningfully change the results. CONCLUSION A U-shaped relationship was identified between bouted but not sporadic PA and fall incidence. There is an approximately twofold increase in fall rate in highly active older adults even after adjusting for activity time.
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Affiliation(s)
- Zhihui Lu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Freddy M H Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
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88
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Mackenzie L, Beavis AM, Tan ACW, Clemson L. Systematic Review and Meta-Analysis of Intervention Studies with General Practitioner Involvement Focused on Falls Prevention for Community-Dwelling Older People. J Aging Health 2020; 32:1562-1578. [PMID: 32912102 DOI: 10.1177/0898264320945168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: Falls are a significant health problem for the ageing population. This review aimed to identify effective falls prevention interventions with involvement of general practitioners (GPs). Methods: Systematic review of randomised controlled trials conducted from 1999-2019, with meta-analysis. Searches located 2736 articles. A quality assessment was conducted of all included studies. Results: 21 randomised controlled trials met the inclusion criteria and 19 studies could be included in a meta-analysis. Overall, studies were not effective for reducing multiple falls (Relative Risk (RR) 1.16, 95% CI .97-1.39 and p = .10) or reducing one or more falls (RR .91, 95% CI: .82-1.01 and p = .08), but were effective for reducing injurious falls (RR .76, 95% CI: .66-.87 and p = .001). Discussion: Studies involving the GP in an active role and aligned with the primary care context were effective. The fidelity of interventions was limited by independent GP decisions and older participants being required to initiate the intervention.
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Affiliation(s)
- Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, 4334The University of Sydney, Australia
| | - Ann-Marie Beavis
- Discipline of Occupational Therapy, School of Health Sciences, 4334The University of Sydney, Australia
| | - Amy C W Tan
- Ageing Work and Health Research Unit, School of Health Sciences, 4334The University of Sydney, Australia
| | - Lindy Clemson
- Ageing Work and Health Research Unit, School of Health Sciences, 4334The University of Sydney, Australia
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Mielenz TJ, Kannoth S, Jia H, Pullyblank K, Sorensen J, Estabrooks P, Stevens JA, Strogatz D. Evaluating a Two-Level vs. Three-Level Fall Risk Screening Algorithm for Predicting Falls Among Older Adults. Front Public Health 2020; 8:373. [PMID: 32903603 PMCID: PMC7438745 DOI: 10.3389/fpubh.2020.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Falls account for the highest proportion of preventable injury among older adults. Thus, the United States' Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm to screen for fall risk. We referred to our STEADI algorithm adaptation as “Quick-STEADI” and compared the predictive abilities of the three-level (low, moderate, and high risk) and two-level (at-risk and not at-risk) Quick-STEADI algorithms. We additionally assessed the qualitative implementation of the Quick-STEADI algorithm in clinical settings. Research Design and Methods: We followed a prospective cohort (N = 200) of adults (65+ years) in the Bassett Healthcare Network (Cooperstown, NY) for 6 months in 2019. We conducted a generalized linear mixed model, adjusting for sociodemographic variables, to determine how baseline fall risk predicted subsequent daily falls. We plotted receiver operating characteristic (ROC) curves and measured the area under the curve (AUC) to determine the predictive ability of the Quick-STEADI algorithm. We identified a participant sample (N = 8) to gauge the experience of the screening process and a screener sample (N = 3) to evaluate the screening implementation. Results: For the three-level Quick-STEADI algorithm, participants at low and moderate risk for falls had a reduced likelihood of daily falls compared to those at high risk (−1.09, p = 0.04; −0.99, p = 0.04). For the two-level Quick-STEADI algorithm, participants not at risk for falls were not associated with a reduced likelihood of daily falls compared to those at risk (−0.89, p = 0.13). The discriminatory ability of the three-level and two-level Quick-STEADI algorithm demonstrated similar predictability of daily falls, based on AUC (0.653; 0.6570). Furthermore, participants and screeners found the Quick-STEADI algorithm to be efficient and viable. Discussion and Implications: The Quick-STEADI is a suitable, alternative fall risk screening algorithm. Qualitative assessments of the Quick-STEADI algorithm demonstrated feasibility in integrating a falls screening program in a clinical setting. Future research should address the validation and the implementation of the Quick-STEADI algorithm in community health settings to determine if falls screening and prevention can be streamlined in these settings. This may increase engagement in fall prevention programs and decrease overall fall risk among older adults.
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Affiliation(s)
- Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Kristin Pullyblank
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, NY, United States
| | - Julie Sorensen
- The Northeast Center for Occupational Health and Safety in Agriculture, Forestry, and Fishing, Cooperstown, NY, United States
| | - Paul Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Judy A Stevens
- University of North Carolina Injury Prevention Research Center (UNC IPRC), Carrboro, NC, United States
| | - David Strogatz
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, NY, United States
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90
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Handelzalts S, Alexander NB, Mastruserio N, Nyquist LV, Strasburg DM, Ojeda LV. Detection of Real-World Trips in At-Fall Risk Community Dwelling Older Adults Using Wearable Sensors. Front Med (Lausanne) 2020; 7:514. [PMID: 32984385 PMCID: PMC7492551 DOI: 10.3389/fmed.2020.00514] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Near-falls such as a trip, slip, stumble, or misstep involve a loss of balance (LOB) that does not result in a fall, occur more frequently than actual falls, and are associated with an increased fall risk. To date, studies have largely involved detection of simulated laboratory LOBs using wearable devices in young adults. Data on the detection of and kinematics of naturally occurring LOBs in people at high risk of falling are lacking. This may provide a new way to identify older adults at high risk for falls. We aimed to explore key body kinematics underlying real-world trips in at-fall risk community dwelling older adults wearing inertial measurement units (IMU). Methods: Five community-dwelling older adults with a history of falls who reported trips during the study period participated. They wore a voice recorder and 4 IMUs mounted on feet, lower back and wrist for two consecutive weeks to provide a record of the context and timing of LOB events. Sensor data prior to time-stamped voice recording of a trip were processed in order to visually identify unusual foot trajectories and lower back and arm orientations. Then, data of feet, lower back and wrist position and orientation were combined to create a three-dimensional animation representing the estimated body motion during the noted time segments in order to corroborate the occurrence of a trip. Events reported as a trip by the participant and identified as a trip by a researcher, blinded to voice recordings description, were included in the final analysis. Results: A total of 18 trips obtained from five participants were analyzed. Twelve trips occurred at home, three outside and for three the location was not reported. Trips were identified in the sensor data by observing (1) additional peaks to the typical foot velocity signal during swing phase; (2) increased velocity of the contralateral foot and (3) sharp changes in lower back pitch angles. Conclusions: Our approach demonstrates the feasibility of identifying and studying the mechanisms and context underlying trip-related LOBs in at-fall risk older adults during real world activities.
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Affiliation(s)
- Shirley Handelzalts
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Physical Therapy, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
| | - Neil B Alexander
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,VA Ann Arbor Health Care System Geriatrics Research Education and Clinical Center, Ann Arbor, MI, United States
| | - Nicholas Mastruserio
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Linda V Nyquist
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Debra M Strasburg
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lauro V Ojeda
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
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91
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Mattle M, Chocano-Bedoya PO, Fischbacher M, Meyer U, Abderhalden LA, Lang W, Mansky R, Kressig RW, Steurer J, Orav EJ, Bischoff-Ferrari HA. Association of Dance-Based Mind-Motor Activities With Falls and Physical Function Among Healthy Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2017688. [PMID: 32975570 PMCID: PMC7519422 DOI: 10.1001/jamanetworkopen.2020.17688] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Falls increase morbidity and mortality in adults 65 years and older. The role of dance-based mind-motor activities in preventing falls among healthy older adults is not well established. OBJECTIVE To assess the effectiveness of dance-based mind-motor activities in preventing falls. DATA SOURCES Systematic search included the PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsychINFO, Abstracts in Social Gerontology, AgeLine, AMED, and Scopus databases from database inception to February 18, 2018, using the Medical Subject Headings aged 65 and older, accidental falls, and dancing. STUDY SELECTION This systematic review and meta-analysis included 29 randomized clinical trials that evaluated a dance-based mind-motor activity in healthy older adults with regard to fall risk, fall rate, or well-established measures of physical function in the domains of balance, mobility, and strength. The included studies targeted participants without comorbidities associated with higher fall risk. Dance-based mind-motor activities were defined as coordinated upright mind-motor movements that emphasize dynamic balance, structured through music or an inner rhythm (eg, breathing) and distinctive instructions or choreography, and that involve social interaction. DATA EXTRACTION AND SYNTHESIS Standardized independent screening, data extraction, and bias assessment were performed. Data were pooled using random-effects models. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. MAIN OUTCOMES AND MEASURES Primary outcomes were risk of falling and rate of falls. For the secondary end points of physical function (balance, mobility, and strength), standardized mean differences (SMDs) were estimated and pooled (Hedges g). RESULTS In this systematic review and meta-analysis of 29 randomized clinical trials, dance-based mind-motor activities were significantly associated with reduced (37%) risk of falling (risk ratio, 0.63; 95% CI, 0.49-0.80; 8 trials, 1579 participants) and a significantly reduced (31%) rate of falls (incidence rate ratio, 0.69; 95% CI, 0.53-0.89; 7 trials, 2012 participants). In addition, dance-based mind-motor activities were significantly associated with improved physical function in the domains of balance (standardized mean difference [SMD], 0.62; 95% CI, 0.33-0.90; 15 trials, 1476 participants), mobility (SMD, -0.56; 95% CI, -0.81 to -0.31; 13 trials, 1379 participants), and lower body strength (SMD, 0.57; 95% CI, 0.23-0.91; 13 trials, 1613 participants) but not upper body strength (SMD, 0.18; 95% CI, -0.03 to 0.38; 4 trials, 414 participants). CONCLUSION AND RELEVANCE Among healthy older adults, dance-based mind-motor activities were associated with decreased risk of falling and rate of falls and improved balance, mobility, and lower body strength. This type of activity may be useful in preventing falls in this population.
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Affiliation(s)
- Michèle Mattle
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Patricia O. Chocano-Bedoya
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Melanie Fischbacher
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Ursina Meyer
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Lauren A. Abderhalden
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Wei Lang
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Richard Mansky
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Johann Steurer
- Horten Centre, University of Zurich, Zurich, Switzerland
| | - E. John Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Heike A. Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
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Tai Chi for the Prevention of Falls Among Older Adults: A Critical Analysis of the Evidence. J Aging Phys Act 2020; 29:343-352. [PMID: 32839351 DOI: 10.1123/japa.2020-0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/28/2020] [Accepted: 06/28/2020] [Indexed: 11/18/2022]
Abstract
Despite interest as to the benefits of Tai Chi, there remains a controversy over its effectiveness as an exercise intervention for preventing falls among older adults. This review synthesizes the evidence base with a focus on meta-analyses and randomized controlled trials with community-dwelling older adults. It provides a critical lens on the evidence and quality of the trials. High-quality evidence suggests that Tai Chi is an effective intervention for preventing falls in community settings; however, there is unclear evidence for long-term care facilities and an absence of evidence for hospital settings. When compared directly with other exercise interventions, Tai Chi may offer a superior strategy for reducing falls through its benefits on cognitive functioning. Using data from the current Cochrane review, a new synthesis is presented suggesting that 71-81% of community-dwelling older adults are adherent to class-based Tai Chi interventions. The practical opportunities and challenges for practitioners are discussed.
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93
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Arendts G, Leyte N, Dumas S, Ahamed S, Khokulan V, Wahbi O, Lomman A, Hughes D, Clayden V, Mandal B. Efficiency gains from a standardised approach to older people presenting to the emergency department after a fall. AUST HEALTH REV 2020; 44:576-581. [PMID: 32600521 DOI: 10.1071/ah19187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/27/2019] [Indexed: 11/23/2022]
Abstract
Objective Falls are a major cause of hospital-related costs in people aged ≥65 years. Despite this, falls are often seen as trivial and given low priority in an emergency department (ED), especially in the absence of overt major injury. ED systems that care for falls patients are often inefficient. The aims of this study were to: (1) design and implement a standardised and systematic approach to patients presenting to an ED after a fall; and (2) achieve hospital efficiency gains, such as reduced hospital length of stay, through implementation of this approach. Methods A prospective study was conducted with pre- and postintervention measurement of outcomes. The key features of the intervention were direct admission to an ED short stay unit, standardised assessment of cognition, medications, mobility and discharge risk, and access in the ED to a geriatric consultation service for complex patients. Results In the 12 months of the intervention, 1435 male and female patients aged ≥65 years were enrolled in the study. At the end of 12 months, these patients had significantly higher ED discharge (66% vs 46%; P<0.001) and, if admitted, shorter median hospital stays (6 vs 2 days; P<0.001) compared with the baseline pre-intervention phase. Analysis 1 year later revealed that these outcomes were sustained or further improved. Conclusion A systematic approach to falls in older patients attending the ED is feasible and beneficial. Decreased hospital stay and improved rates of effective discharge from ED back to the community are achievable and sustainable. What is known about the topic? Falls are common, serious and costly. Not identifying and managing falls risk factors is a common feature of ED practice. As a result, admission rates to hospital for patients who fall are high. What does this paper add? In this large study we have shown that a systematic approach to falls assessment is feasible, sustainable and results in higher discharge rates from the ED. What are the implications for practitioners? EDs are the gateway to a hospital bed. It is possible to redesign ED flow and bring front-loaded multidisciplinary geriatric care into an ED short stay environment, to the benefit of patients and health systems.
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Affiliation(s)
- Glenn Arendts
- Emergency Medicine, University of Western Australia, Level 2R Block, QEII Medical Centre, Nedlands, WA 6009, Australia; and Department of Emergency Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ; ; and Corresponding author.
| | - Naomi Leyte
- Department of Emergency Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
| | - Sandra Dumas
- Department of Emergency Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
| | - Shabana Ahamed
- Department of Geriatric Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
| | - Vethanjaly Khokulan
- Department of Geriatric Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
| | - Ouday Wahbi
- Department of Emergency Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
| | - Andrea Lomman
- Department of Health, Western Australia. Level 1, B Block, 189 Royal Street, East Perth, WA 6004, Australia.
| | - David Hughes
- Department of Geriatric Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
| | - Vanessa Clayden
- Department of Emergency Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
| | - Bhaskar Mandal
- Department of Geriatric Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. ; ; ;
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Holloway-Kew KL, Baker TR, Sajjad MA, Kotowicz MA, Livingston PM, Khasraw M, Hakkennes S, Dunning TL, Brumby S, Page RS, Sutherland A, Venkatesh S, Brennan-Olsen SL, Williams LJ, Pasco JA. WITHDRAWN: The epidemiology of emergency presentations for falls across Western Victoria, Australia. Australas Emerg Care 2020:S2588-994X(20)30055-5. [PMID: 32605904 DOI: 10.1016/j.auec.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.auec.2019.08.003. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
| | | | | | - Mark A Kotowicz
- Deakin University, Geelong, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia
| | | | | | | | | | - Susan Brumby
- Deakin University, Geelong, Australia; National Centre for Farmer Health, Western District Health Service, Hamilton, Australia
| | - Richard S Page
- Deakin University, Geelong, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia; Barwon Centre for Orthopaedic Research and Education, Barwon Health and St John of God Hospital Geelong, Australia
| | - Alasdair Sutherland
- Deakin University, Geelong, Australia; South West Healthcare, Warrnambool, Australia
| | | | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia
| | | | - Julie A Pasco
- Deakin University, Geelong, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia
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Abstract
As the silver tsunami hits the world, older patients with hip fractures are expected to increase to 6.3 million by the year 2050, of which the majority will occur in Asia. The estimated global cost of hip fractures in the year 2050 is estimated to reach U.S. $130 billion. Hence, in addition to implementation of prevention strategies, it is important to develop an optimal model of care for older patients with hip fracture to minimize the huge medical and socioeconomic burden, especially in rapidly aging nations. This review summarizes the complications of hip fractures, importance of comprehensive geriatric assessment, and multidisciplinary rehabilitation, as well as predictors of rehabilitation outcome in older patients with hip fracture.
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96
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Morin SN, Djekic-Ivankovic M, Funnell L, Giangregorio L, Rodrigues IB, Ridout R, Feldman S, Kim S, McDonald-Blumer H, Kline G, Ward WE, Santesso N, Leslie WD. Patient engagement in clinical guidelines development: input from > 1000 members of the Canadian Osteoporosis Patient Network. Osteoporos Int 2020; 31:867-874. [PMID: 31838552 PMCID: PMC7170816 DOI: 10.1007/s00198-019-05248-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
Patient engagement in clinical guidelines development is essential. The results of a self-administered online survey identified themes important to people living with osteoporosis and will inform the development of Osteoporosis Canada clinical guidelines recommendations. INTRODUCTION Patient engagement is essential in the development of high-quality and relevant guidelines for osteoporosis management. Osteoporosis Canada (OC) is updating its national clinical practice guidelines in collaboration with people living with osteoporosis in the process. METHODS Using electronic mail, we contacted 6937 members of the Canadian Osteoporosis Patient Network (COPN) to provide input on the selection of relevant content, outcomes, and research questions via a self-administered online survey. Close-ended questions were analyzed using descriptive statistics, and conventional content analysis was conducted for open-ended questions. RESULTS A total of 1108 individuals completed the survey (97% women, 86% stated they lived with osteoporosis). Most participants considered it critical to have recommendations on physical activity and exercise (74%), fall prevention (69%), nutrition (68%), and initial bone mineral density testing (67%). In addition to preventing fractures, over 75% of respondents stated that consideration of preserving quality of life and ability to perform daily activities, preventing admission to long-term care and fracture-related death, and avoiding serious harms from medications were essential outcomes to consider in evaluating the evidence. In terms of selection of research questions, seven themes emerged from the content analysis including pharmacotherapy, screening and monitoring, diet and supplements, education, exercise, alternative therapies, and pain management. CONCLUSIONS Patients emphasized that autonomy, mobility, and quality of life are highly valued outcomes and must be integral to practice guideline development. As expected, guidance on pharmacotherapy, screening and monitoring, and fracture prevention were priorities identified to be included in osteoporosis management guidelines.
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Affiliation(s)
- S N Morin
- McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
| | - M Djekic-Ivankovic
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - L Funnell
- Osteoporosis Canada, Toronto, Canada
| | - L Giangregorio
- University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - I B Rodrigues
- University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - R Ridout
- University of Toronto, Toronto, Canada
| | - S Feldman
- University of Toronto, Toronto, Canada
| | - S Kim
- University of Toronto, Toronto, Canada
| | | | - G Kline
- University of Calgary, Calgary, Canada
| | - W E Ward
- Brock University, St. Catharines, Canada
| | | | - W D Leslie
- University of Manitoba, Winnipeg, Canada
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97
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Boolani A, Ryan J, Vo T, Wong B, Banerjee NK, Banerjee S, Fulk G, Smith ML, Martin R. Do Changes in Mental Energy and Fatigue Impact Functional Assessments Associated with Fall Risks? An Exploratory Study Using Machine Learning. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2020. [DOI: 10.1080/02703181.2020.1748788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Ali Boolani
- Department of Physical Therapy, Clarkson University, Potsdam, New York, USA
| | - Jenna Ryan
- Department of Computer Science, Clarkson University, Potsdam, New York, USA
| | - Trang Vo
- Department of Physician Assistant, Clarkson University, Potsdam, New York, USA
| | - Brandon Wong
- Department of Physician Assistant, Clarkson University, Potsdam, New York, USA
| | | | - Sean Banerjee
- Department of Computer Science, Clarkson University, Potsdam, New York, USA
| | - George Fulk
- Department of Physical Therapy, Clarkson University, Potsdam, New York, USA
- Department of Physical Therapy, State University of New York (SUNY) Upstate Medical Center, Syracuse, New York, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, USA
| | - Rebecca Martin
- Department of Physical Therapy, Clarkson University, Potsdam, New York, USA
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98
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Relevance of emergency head CT scan for fall in the elderly person. J Neuroradiol 2020; 47:54-58. [DOI: 10.1016/j.neurad.2019.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
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99
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Ambrens M, Tiedemann A, Delbaere K, Alley S, Vandelanotte C. The effect of eHealth-based falls prevention programmes on balance in people aged 65 years and over living in the community: protocol for a systematic review of randomised controlled trials. BMJ Open 2020; 10:e031200. [PMID: 31948985 PMCID: PMC7044832 DOI: 10.1136/bmjopen-2019-031200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/27/2019] [Accepted: 12/06/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Between 20% and 28% of community-dwelling older people experience a fall each year. Falls can result in significant personal and socioeconomic costs, and are the leading cause of admission to hospital for an older person in Australia. Exercise interventions that target balance are the most effective for preventing falls in community-dwellers; however, greater accessibility of effective programmes is needed. As technology has become more accessible, its use as a tool for supporting and promoting health and well-being of individuals has been explored. Little is known about the effectiveness of eHealth technologies to deliver fall prevention interventions. This protocol describes a systematic review with meta-analysis that aims to evaluate the effect of eHealth fall prevention interventions compared with usual care control on balance in people aged 65 years and older living in the community. METHODS AND ANALYSIS We will perform a systematic search of the following electronic databases: MEDLINE, CINAHL Complete, Embase and PsychINFO and citation search of Scopus, Web of Science, PubMed Central, Cochrane Database Central and PEDro for randomised controlled trials that use an eHealth technology to deliver a fall prevention intervention to community-dwellers aged ≥65 years, that are published in English, and include a balance outcome (primary outcome). The screening and selection of articles for review will be undertaken by two independent reviewers. The PEDro scale and Grading of Recommendations, Assessment, Development and Evaluations will be used to assess study quality. The results will be synthesised descriptively, and if sufficient data are available and the studies are not overly heterogeneous, a meta-analysis will be conducted using the random effects model. ETHICS AND DISSEMINATION As this will be a systematic review, without involvement of human participants, there will be no requirement for ethical approval. The results of this systematic review will be disseminated through peer-reviewed publications, conference presentations and dissemination to policymakers and consumers to maximise health impact. PROSPERO REGISTRATION NUMBER CRD42018115098.
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Affiliation(s)
- Meghan Ambrens
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, University of New South Wales, Randwick, New South Wales, Australia
| | - Stephanie Alley
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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100
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Luta X, Bagnoud C, Lambiris M, Decollogny A, Eggli Y, Le Pogam MA, Marques-Vidal P, Marti J. Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data. BMJ Open 2020; 10:e031156. [PMID: 31911512 PMCID: PMC6955498 DOI: 10.1136/bmjopen-2019-031156] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE This study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs. DESIGN Retrospective analysis of claims data. SETTING The study was conducted in nine cantons in Switzerland. PARTICIPANTS Older adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures. RESULTS Overall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65-69: 15.9%; 70-74: 18.4%; 75-80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35).Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (β=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21). CONCLUSIONS The proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.
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Affiliation(s)
- Xhyljeta Luta
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Mark Lambiris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Anne Decollogny
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yves Eggli
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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