201
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Sattar S, Haase KR, Milisen K, Campbell D, Kim SJ, Chalchal H, Kenis C. Oncology clinic nurses' attitudes and perceptions regarding implementation of routine fall assessment and fall risk screening: A survey study. Can Oncol Nurs J 2021; 31:367-375. [PMID: 34786454 PMCID: PMC8565430 DOI: 10.5737/23688076314367375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Falls in older adults with cancer are often under-recognized and under-reported. The objective of this study was to explore oncology clinic nurses' willingness and perceived barriers to implement routine falls assessment and falls screening in their practice. Nurses working in outpatient oncology clinics were invited to complete an online survey. Data were analyzed using descriptive statistics and sorted into thematic categories. The majority of respondents indicated willingness to routinely ask older patients about falls (85.7%) and screen for fall risks (73.5%). The main reasons for unwillingness included: belief that patients report falls on their own, lack of time, and lack of support staff. Findings from this study show many oncology nurses believe in the importance of routine fall assessment and screening and are willing to implement them routinely, although falls are not routinely asked about or assessed. Future work should explore strategies to address barriers nurses face given the implications of falls amongst this vulnerable population.
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Affiliation(s)
| | - Kristen R Haase
- School of Nursing, University of British Columbia, Vancouver, BC
| | - Koen Milisen
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium & Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Diane Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK
| | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Haji Chalchal
- College of Medicine, University of Saskatchewan; Saskatchewan Cancer Agency, Regina, SK
| | - Cindy Kenis
- University Hospitals Leuven, Leuven, Belgium
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202
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Relationship between Cataract Surgery and Mortality in Elderly Patients with Cataract: Nationwide Population-Based Cohort Study in South Korea. J Pers Med 2021; 11:jpm11111128. [PMID: 34834480 PMCID: PMC8625327 DOI: 10.3390/jpm11111128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to investigate the relationship between cataract surgery and all-cause and cause-specific mortality in Korean elderly patients with cataract using the Korean National Health Insurance Service-Senior cohort database. Elderly patients (≥60 years) diagnosed with cataract from 2002 through 2012 were included. The baseline characteristics included demographics and systemic and ocular comorbidities. Adjusted Cox regression models with time-varying covariates for cataract surgery were used to assess the relationship between cataract surgery and mortality. The study cohort included 241,062 patients, of whom 127,941 were in the cataract surgery group and 113,121 were in the cataract diagnosis group. The incidence of all-cause mortality was 3.62 deaths/100 person-years and 3.19 deaths/100 person-years in the cataract surgery and cataract diagnosis groups, respectively. Cataract surgery was associated with a decreased hazard of all-cause mortality after adjusting for demographics as well as systemic and ocular comorbidities (hazard ratio (HR), 0.93; p < 0.001). A protective association was noted between cataract surgery and mortality from vascular (HR, 0.92; p < 0.001) or neurologic (HR, 0.64; p < 0.001) causes. Patients with cataract who were 85 years of age and older, women, those who had lower income, and a Charlson comorbidity index score of 5 or more, or those without glaucoma revealed the largest reductions in mortality hazards resulting from cataract surgery.
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203
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Sattar S, Haase KR, Milisen K, Campbell D, Kim SJ, Chalchal H, Kenis C. Évaluation systématique des chutes et du risque de chutes : Sondage sur l’attitude et les perceptions des infirmières cliniques en oncologie. Can Oncol Nurs J 2021; 31:376-385. [PMID: 34786455 PMCID: PMC8565442 DOI: 10.5737/23688076314376385] [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: 12/18/2022] Open
Abstract
Chez les personnes âgées atteintes de cancer, les chutes sont un problème souvent sous-estimé et peu rapporté. La présente étude visait à explorer la volonté des infirmières cliniques en oncologie à évaluer et à dépister systématiquement les chutes dans leur pratique; l’étude examinait également les obstacles perçus à l’évaluation et au dépistage systématique. Les infirmières ont donc été invitées à remplir un sondage en ligne. Les données ont été analysées à l’aide de statistiques descriptives. La majorité des infirmières ayant répondu ont dit qu’elles accepteraient de poser systématiquement des questions sur les chutes (85,7 %) et de dépister les risques de chutes (73,5 %) chez les personnes âgées. Voici les principales raisons des réticences : conviction que les patients signalent les chutes d’euxmêmes, manque de temps, pénurie de personnel de soutien. Selon les résultats de l’étude, beaucoup d’infirmières en oncologie trouvent important d’évaluer et de dépister systématiquement les chutes, et sont d’accord pour l’intégrer à leur pratique bien que, d’habitude, les chutes ne fassent pas automatiquement l’objet de questions ou d’une évaluation. Étant donné les conséquences des chutes sur ces patients vulnérables, la recherche à venir devra explorer les stratégies permettant de surmonter les obstacles auxquels se butent les infirmières.
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Affiliation(s)
- Schroder Sattar
- Collège des sciences infirmières, Université de la Saskatchewan, Regina, SK
| | - Kristen R Haase
- École des sciences infirmières, Université de la Colombie-Britannique, Vancouver, BC
| | - Koen Milisen
- Département de gériatrie, Hôpital universitaire de Louvain, Louvain, Belgique, et Département de santé publique et de soins primaires, Centre universitaire de sciences infirmières et de pratique sagefemme, KU Leuven, Louvain, Belgique
| | - Diane Campbell
- Collège des sciences infirmières, Université de la Saskatchewan, Regina, SK
| | - Soo Jung Kim
- Service de gériatrie, Centre de cancérologie Memorial Sloan Kettering, New York, États-Unis
| | - Haji Chalchal
- Collège de médecine, Université de la Saskatchewan, Agence du cancer de la Saskatchewan, Regina, SK
| | - Cindy Kenis
- Hôpital universitaire de Louvain, Louvain, Belgique
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204
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Kitayuguchi J, Abe T, Okuyama K, Gomi T, Okada S, Shiwaku K, Mutoh Y. Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study. J Rural Med 2021; 16:214-221. [PMID: 34707730 PMCID: PMC8527625 DOI: 10.2185/jrm.2021-028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: Falls in older adults are a major public health issue, and it is
unclear whether the neighborhood environment is associated with falls among this group.
This cross-sectional study investigated whether hilly neighborhood environmental factors
were associated with fall status (falls or fear of falling) in rural Japanese older
adults. Materials and Methods: Data obtained from 965 participants aged 65 years and
older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status
was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of
falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental
factors, the mean elevation and land slope were assessed using a geographic information
system. The logistic regression model examined the odds ratios (OR) and 95% confidence
intervals (CIs) of fall status in quartiles for elevation and land slope, respectively,
and was adjusted for confounders. Results: Falls and fear of falling were observed in 16.8% and 43.2% of
participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI
1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74,
95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling
was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR
1.51, 95% CI 1.01–2.25 for Q4 vs. Q1). Conclusion: Our study found that elevation and land slope as hilly
neighborhood environment factors were positively associated with falls or fear of falling
among older adults living in rural Japan. Prospective observational studies that
investigate the effects of region-specific environmental factors on falls among older
adults should be conducted.
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Affiliation(s)
- Jun Kitayuguchi
- Physical Education and Medicine Research Center UNNAN, Japan
| | - Takafumi Abe
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Japan
| | - Kenta Okuyama
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Japan.,Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
| | | | - Shinpei Okada
- Physical Education and Medicine Research Foundation, Japan
| | | | - Yoshiteru Mutoh
- The Research Institute of Health Rehabilitation of Tokyo, Japan
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205
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Su YH, Chang YM, Kung CY, Sung CK, Foo WS, Wu MH, Chiou SJ. A study of correlations between metabolic syndrome factors and osteosarcopenic adiposity. BMC Endocr Disord 2021; 21:216. [PMID: 34711214 PMCID: PMC8555223 DOI: 10.1186/s12902-021-00880-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Aging reduces the quality and strength of bones and muscles and increases body fat, which can lead to the simultaneous occurrence of sarcopenia, osteopenia, and adiposity, a condition referred to as OsteoSarcopenic Adiposity (OSA). While previous studies have demonstrated that metabolic syndrome is associated with sarcopenia, osteopenia, and adiposity, the relationship between metabolic syndrome and OSA remains largely unknown. METHODS We analyzed data for a sample of middle-aged individuals from a Health Management Center database, which was collected in 2016-2018. There are 2991 cases of people over 50 years from a physical examination center in a hospital in Taiwan during 2016-2018. In addition to descriptive statistics, chi-squared test, analysis of variance, and multinomial logistic regression analysis were conducted to examine OSA risk and associated factors. RESULTS Based on multinomial logistic regression analysis, in different OSA severity level (1-3 more serious), those who are with metabolic syndrome has increased the 2.49-2.57 times risk of OSA (p < 0.001) in OSA = 2 and 3 groups while there is no significant difference in OSA =1 group. CONCLUSION The prevalence of OSA may impair the health and quality of life in the elderly group, especially those diagnosed with metabolic syndrome, increasing the risk of OSA. These results can help promote early diagnosis and treatment of OSA in clinical settings, particularly among aging individuals with abnormal physical function, the group with the highest OSA incidence.
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Affiliation(s)
- Yu-Hsiang Su
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu-Ming Chang
- Department of Urology, West Garden Hospital, Taipei, Taiwan
| | - Chih-Ying Kung
- Department of Medical Research and Education, West Garden Hospital, Taipei, Taiwan
| | - Chiu-Kuei Sung
- Department of Nursing, West Garden Hospital, Taipei, Taiwan
| | - Wei-Shin Foo
- Department of Rehabilitation, West Garden Hospital, Taipei, Taiwan
| | - Mei-Hua Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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206
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Alipour V, Azami-Aghdash S, Rezapour A, Derakhshani N, Ghiasi A, Yusefzadeh N, Taghizade S, Amuzadeh S. Cost-Effectiveness of Multifactorial Interventions in Preventing Falls among Elderly Population: A Systematic Review. Bull Emerg Trauma 2021; 9:159-168. [PMID: 34692866 PMCID: PMC8525694 DOI: 10.30476/beat.2021.84375.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/25/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective: To review the cost-effectiveness of multifactorial interventions to prevent falls in elderly people. Methods: In this systematic review, the databases including PubMed via MEDLINE, Web of Science, Embase, Scopus, Cochrane Library and Google Scholar (from 1st January 2000 to 30th February) were used. All pre-reviewed articles related to cost-effectiveness analysis of multifactorial interventions to prevent falls in elderly were included in this paper and congresses abstracts were excluded. Descriptive statistics were used for quantitative data and content-analysis method to analyze qualitative data. Results: Out of the 456 articles, 19 were finally included in the study. Eighteen articles were conducted in High-Income Countries (HICs) and 16 were at the community level. Medical visits consultation and education were the most common interventions. Most studies were cost-effectiveness and using the Randomized Control Trial (RCT) methods. A fall of prevention costs ranged from $ 272 to $ 987. Incremental Cost-Effectiveness Ratio (ICER) interventions also ranged from the US $ 120,667 to the US $ 4280.9. Conclusion: The results show that despite the high effectiveness of multifactorial interventions to prevent elderly falls, the cost of the interventions are high and they are not very cost-effective. It would be better to design and implement multifactorial interventions with low cost and high effectiveness that are appropriate for each country.
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Affiliation(s)
- Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Derakhshani
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Akbar Ghiasi
- Health Administration HEB School of Business & Administration, University of the Incarnate Word, Texas, USA
| | - Neghar Yusefzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Taghizade
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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207
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Loureiro V, Gomes M, Loureiro N, Aibar-Almazán A, Hita-Contreras F. Multifactorial Programs for Healthy Older Adults to Reduce Falls and Improve Physical Performance: Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10842. [PMID: 34682586 PMCID: PMC8535839 DOI: 10.3390/ijerph182010842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 12/29/2022]
Abstract
The aim of this systematic review of randomized controlled trials (RCTs) was to investigate the effects of multifactorial programs on the rate of falls and physical performance in ≥60 years old adults. A systematic literature search was conducted in four databases (PubMed, Scopus, Web of Science and Cochrane Library). A total of 518 articles were identified in the initial search, and six RCTs were finally included. Articles written in English, Portuguese and Spanish and published from January 2009 to May 2020 were included in this study. The methodological quality of the included studies was evaluated by the PEDro scale. A total of 518 studies were identified in the initial search, six RCTs were finally included, and three reached a level 1 of evidence. The findings of this systematic review of RCTs suggest that a physical exercise program, especially exercise group activities, combined with health education or with fall risk home assessment, were the most effective multifactorial program in reducing the rate of falls, although the results were not conclusive in all the studies included. Significant beneficial effects were observed in physical performance, particularly when assessed as gait, mobility and balance, regardless of the components of multifactorial program or exercise. This inconsistency in the results, particularly regarding the rate of falls, together with the variability among the multifactorial programs, suggest that any conclusion must be drawn with caution.
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Affiliation(s)
- Vânia Loureiro
- Department of Arts, Humanities and Sports, School of Education, Polytechnic Institute of Beja, 7800-295 Beja, Portugal; (M.G.); (N.L.)
- ISAMB Research Centre, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
| | - Margarida Gomes
- Department of Arts, Humanities and Sports, School of Education, Polytechnic Institute of Beja, 7800-295 Beja, Portugal; (M.G.); (N.L.)
| | - Nuno Loureiro
- Department of Arts, Humanities and Sports, School of Education, Polytechnic Institute of Beja, 7800-295 Beja, Portugal; (M.G.); (N.L.)
- ISAMB Research Centre, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (A.A.-A.); (F.H.-C.)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (A.A.-A.); (F.H.-C.)
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208
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Cortés OL, Piñeros H, Aya PA, Sarmiento J, Arévalo I. Systematic review and meta-analysis of clinical trials: In-hospital use of sensors for prevention of falls. Medicine (Baltimore) 2021; 100:e27467. [PMID: 34731123 PMCID: PMC8519232 DOI: 10.1097/md.0000000000027467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 09/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Intra-hospital falls have become an important public health problem globally. The use of movement sensors with alarms has been studied as elements with predictive capacity for falls at hospital level. However, in spite of their use in some hospitals throughout the world, evidence is lacking about their effectiveness in reducing intra-hospital falls. Therefore, this study aims to develop a systematic review and meta-analysis of existing scientific literature exploring the impact of using sensors for fall prevention in hospitalized adults and the elderly population. METHODS We explored literature based on clinical trials in Spanish, English, and Portuguese, assessing the impact of devices used for hospital fall prevention in adult and elderly populations. The search included databases such as IEEE Xplore, the Cochrane Library, Scopus, PubMed, MEDLINE, and Science Direct databases. The critical appraisal was performed independently by two researchers. Methodological quality was assessed based on the ratings of individual biases. We performed the sum of the results, generating an estimation of the grouped effect (Relative Risk, 95% CI) for the outcome first fall for each patient. We assessed heterogeneity and publication bias. The study followed PRISMA guidelines. RESULTS Results were assessed in three randomized controlled clinical trials, including 29,691 patients. A total of 351 (3%) patients fell among 11,769 patients assigned to the intervention group, compared with 426 (2.4%) patients who fell among 17,922 patients assigned to the control group (general estimation RR 1.20, 95% CI 1.04, 1.37, P = .02, I2 = 0%; Moderate GRADE). CONCLUSION Our results show an increase of 19% in falls among elderly patients who are users of sensors located in their bed, bed-chair, or chair among their hospitalizations. Other types of sensors such as wearable sensors can be explored as coadjutants for fall prevention care in hospitals.
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Affiliation(s)
- Olga L. Cortés
- Department of Research and Department of Nursing. Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
| | - Hillary Piñeros
- Biomedical Engineering student, Faculty of Biomedical Engineering. Universidad del Rosario - Escuela Colombiana de Ingeniería Julio Garavito, Bogotá, Colombia
| | - Pedro Antonio Aya
- Biomedical Engineer, MSC. Faculty of Biomedical Engineering. Universidad del Rosario - Escuela Colombiana de Ingeniería Julio Garavito, Bogotá, Colombia
| | - Jefferson Sarmiento
- Electronic Engineer, Faculty of Biomedical Engineering. Universidad del Rosario - Escuela Colombiana de Ingeniería Julio Garavito, Bogotá, Colombia
| | - Indira Arévalo
- Nurse, Director of Nursing Department. Clínica Universidad de la Sabana, Chía, Cundinamarca, Colombia
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209
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Vestibular rehabilitation with mobile posturography as a "low-cost" alternative to vestibular rehabilitation with computerized dynamic posturography, in old people with imbalance: a randomized clinical trial. Aging Clin Exp Res 2021; 33:2807-2819. [PMID: 33677737 DOI: 10.1007/s40520-021-01813-2] [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: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vestibular rehabilitation (VR), specifically, VR with dynamic computerized posturography (CDP) has proven to be useful to improve balance and reduce the risk of falling in old patients. Its major handicap is probably its cost, which has hindered its generalisation. One solution to reduce this cost is performing VR with mobile posturography systems, which allow assessment of stability at the center of body mass in daily-life conditions. Also, rehabilitation with vibrotactile neurofeedback training could be used in dynamic tasks. OBJECTIVE To assess whether two different protocols of vestibular rehabilitation (using CDP and the Vertiguard system) show significant differences in the improvement of balance among older persons with imbalance METHODS: A clinical trial comparing VR with CDP exercises and VR with mobile posturography (Vertiguard) exercises, was designed. The participants were people over 65 years, with imbalance. The composite (average balance) in the sensory organization test (SOT) of the CDP was the main outcome measure; it was compared before and 3 weeks after VR, and between both intervention groups. RESULTS 40 patients were included in the study (19 in the CDP-VR group and 21 in the Vertiguard-VR group). Average balance was significantly improved in both intervention groups (51% pre-VR vs 60% post-VR, p = 0.002, CDP-VR group; 49% pre-VR vs 57% post-VR, p = 0.008, Vertiguard-VR group); no significant differences in this improvement were found comparing both groups (p = 0.580). DISCUSSION AND CONCLUSIONS VR using mobile posturography is useful to improve stability in old people with instability, showing similar improvement rates to those of VR using CDP. UNIQUE IDENTIFIER NCT03034655 www.clinicaltrials.gov Registered on 25 January 2017.
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210
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Rogers C. Audiologists should not fail with falls: A call to commit to prevention of falls in older adults. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e5. [PMID: 34636596 PMCID: PMC8517736 DOI: 10.4102/sajcd.v68i1.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022] Open
Abstract
Globally, falls are a serious economic and public health concern. While all age groups are impacted by falls, the threats to morbidity and mortality are most severe in older adults. Recent literature has linked hearing loss, and related issues such as an increase in sedentary behaviour, to a greater risk of falls. Therefore, this opinion article aims to raise audiologists’ awareness of falls in ageing patients or clients, and calls for change in terms of having these rehabilitation professionals embrace identification and management of fall risk.
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Affiliation(s)
- Christine Rogers
- Department of Health and Rehabilitation Sciences, Division of Communication Sciences and Disorders, Faculty of Health Sciences, University of Cape Town, Cape Town.
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211
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Meekes WM, Korevaar JC, Leemrijse CJ, van de Goor IA. Practical and validated tool to assess falls risk in the primary care setting: a systematic review. BMJ Open 2021; 11:e045431. [PMID: 34588228 PMCID: PMC8483054 DOI: 10.1136/bmjopen-2020-045431] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 08/18/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Although several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently. DESIGN A systematic review based on prospective studies. METHODS An extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included. RESULTS Six falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%-83.3%, specificity:28.4%-96.6%). CONCLUSIONS Given that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history. TRIAL REGISTRAION NUMBER The Netherlands Trial Register, NL7917; Pre-results.
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Affiliation(s)
- Wytske Ma Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | - Ien Am van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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212
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Kwon J, Lee Y, Young T, Squires H, Harris J. Qualitative research to inform economic modelling: a case study in older people's views on implementing the NICE falls prevention guideline. BMC Health Serv Res 2021; 21:1020. [PMID: 34583685 PMCID: PMC8479997 DOI: 10.1186/s12913-021-07056-1] [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: 06/05/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background High prevalence of falls among older persons makes falls prevention a public health priority. Yet community-based falls prevention face complexity in implementation and any commissioning strategy should be subject to economic evaluation to ensure cost-effective use of healthcare resources. The study aims to capture the views of older people on implementing the National Institute for Health and Care Excellence (NICE) guideline on community-based falls prevention and explore how the qualitative data can be used to inform commissioning strategies and conceptual modelling of falls prevention economic evaluation in the local area of Sheffield. Methods Focus group and interview participants (n = 27) were recruited from Sheffield, England, and comprised falls prevention service users and eligible non-users of varying falls risks. Topics concerned key components of the NICE-recommended falls prevention pathway, including falls risk screening, multifactorial risk assessment and treatment uptake and adherence. Views on other topics concerning falls prevention were also invited. Framework analysis was applied for data analysis, involving data familiarisation, identifying themes, indexing, charting and mapping and interpretation. The qualitative data were mapped to three frameworks: (1) facilitators and barriers to implementing the NICE-recommended pathway and contextual factors; (2) intervention-related causal mechanisms for formulating commissioning strategies spanning context, priority setting, need, supply and demand; and (3) methodological and evaluative challenges for public health economic modelling. Results Two cross-component factors were identified: health motives of older persons; and professional competence. Participants highlighted the need for intersectoral approaches and prioritising the vulnerable groups. The local commissioning strategy should consider the socioeconomic, linguistic, geographical, legal and cultural contexts, priority setting challenges, supply-side mechanisms spanning provider, organisation, funding and policy (including intersectoral) and health and non-health demand motives. Methodological and evaluative challenges identified included: incorporating non-health outcomes and societal intervention costs; considering dynamic complexity; considering social determinants of health; and conducting equity analyses. Conclusions Holistic qualitative research can inform how commissioned falls prevention pathways can be feasible and effective. Qualitative data can inform commissioning strategies and conceptual modelling for economic evaluations of falls prevention and other geriatric interventions. This would improve the structural validity of quantitative models used to inform geriatric public health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07056-1.
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Affiliation(s)
- Joseph Kwon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA.
| | - Yujin Lee
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, England, CV4 7AL
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
| | - Hazel Squires
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
| | - Janet Harris
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
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Swanson VA, Chan V, Cruz-Coble B, Alcantara CM, Scott D, Jones M, Zondervan DK, Khan N, Ichimura J, Reinkensmeyer DJ. A Pilot Study of a Sensor Enhanced Activity Management System for Promoting Home Rehabilitation Exercise Performed during the COVID-19 Pandemic: Therapist Experience, Reimbursement, and Recommendations for Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10186. [PMID: 34639494 PMCID: PMC8508164 DOI: 10.3390/ijerph181910186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
Adherence to home exercise programs (HEPs) during physical rehabilitation is usually unmonitored and is thought to be low from self-reports. This article describes exploratory implementation of a Sensor Enhanced Activity Management (SEAM) system that combines HEP management software with a movement sensor for monitoring and motivating HEP adherence. The article also presents results from attempting to gain reimbursement for home use of the system with therapist oversight using Remote Physiologic Monitoring (RPM) codes. Four therapists used the system in their regular practice during the first six months of the COVID-19 pandemic. Therapists filled out surveys, kept notes, and participated in interviews. Billing and reimbursement data were obtained from the treatment facility. Exercise data from the SEAM system were used to understand HEP adherence. Patients were active for a mean of 40% (26% SD) of prescribed days and completed a mean of 25% (25% SD) of prescribed exercises. The therapists billed 23 RPM codes (USD 2353), and payers reimbursed eight of those instances (USD 649.21). The therapists reported that remote monitoring and the use of a physical movement sensor was motivating to their patients and increased adherence. Sustained technical support for therapists will likely improve implementation of new remote monitoring and treatment systems. RPM codes may enable reimbursement for review and program management activities, but, despite COVID-19 CMS waivers, organizations may have more success if these services are billed under supervision of a physician.
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Affiliation(s)
- Veronica A. Swanson
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
| | - Vicky Chan
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Betsaida Cruz-Coble
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Celeste M. Alcantara
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Douglas Scott
- Division of Rehabilitative Services, University of California, Irvine, CA 92868, USA;
| | - Mike Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA;
| | | | | | - Jan Ichimura
- Department of Physical Therapy, Acute Rehabilitation Unit, University of California, Irvine, CA 92868, USA;
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
- Department of Anatomy and Neurobiology, UC Irvine School of Medicine, University of California, Irvine, CA 92697, USA
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214
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Arkkukangas M. App-based strength and balance self-test in older adults: an exploratory study from a user perspective. BMC Res Notes 2021; 14:379. [PMID: 34565455 PMCID: PMC8474945 DOI: 10.1186/s13104-021-05792-5] [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: 04/03/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Falls are a common problem, especially in the older population. The number of older adults aged over 65 years is increasing globally, leading to a major challenge in providing effective fall prevention interventions to older adults requiring such interventions. This study aimed to explore the usability of an app-based strength and balance self-tests in a small sample of four older adults. This study is a side product of another project. Results The results from this study indicated that self-test of strength and balance by using a smartphone application is a challenge for older adults. Basic test measures, such as start and stop and counts of sit-to-stand, were difficult to self-administer. However, from a user perspective, the possibility of independently performing these measures was considered important and needed to be further developed and evaluated in future studies.
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Affiliation(s)
- Marina Arkkukangas
- Research and Development in Sörmland, Region Sörmland, Eskilstuna, Sweden. .,School of Health and Social Studies, Department of Medicine, Sport and Fitness Science, Dalarna University, Falun, Sweden. .,Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
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215
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Ko S, Jun C, Nam J. Effects of vitamin D supplementation on the functional outcome in patients with osteoporotic vertebral compression fracture and vitamin D deficiency. J Orthop Surg Res 2021; 16:571. [PMID: 34560907 PMCID: PMC8464138 DOI: 10.1186/s13018-021-02717-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In osteoporotic vertebral compression fractures, supplementation using vitamin D preparations and maintenance of blood vitamin D level within the normal range are necessary for proper fracture union, enhancement of muscle strength, and maintenance of body balance. The purpose of this study is to investigate the effects of vitamin D supplementation on blood vitamin D level, pain relief, union time, and functional outcome in patients with osteoporotic vertebral compression fracture and vitamin D deficiency. METHODS One hundred thirty patients who were deficient in blood vitamin D level and had osteoporotic vertebral compression fracture were divided into supplementation group and non-supplementation group. Initially, 3 months, 6 months, and 12 months after the injury, radiographs were taken to assess fracture union, and questionnaires were evaluated to evaluate the functional outcome and quality of life. RESULTS The mean age of the 130 patients (36 males and 94 females) was 74.75 ± 7.25 years. There were no statistically significant differences in initial severity of low back pain, functional outcome, and quality of life between the insufficient group and the deficient group (all p values were > 0.05). There was no significant time-by-group interaction between the supplementation group and the non-supplementation group (p = 0.194). In terms of SF-36 physical component score, there was no significant time-by-group interaction between the supplementation group and the non-supplementation group (p = 0.934). CONCLUSIONS Fracture union was achieved in all patients regardless of serum vitamin D level, and there were significant improvements in severity of low back pain, functional outcome, and quality of life over 12 months in patients with osteoporotic vertebral compression fracture. Short-term vitamin D supplementation of patients with osteoporotic vertebral compression fracture and deficiency of vitamin D did not result in significant differences in fracture union status, functional outcome, and quality of life between the supplementation groups and the non-supplementation groups of patients.
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Affiliation(s)
- Sangbong Ko
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University, Daegu Catholic University Hospital, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Korea.
| | - ChungMu Jun
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University, Daegu Catholic University Hospital, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Korea
| | - Junho Nam
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University, Daegu Catholic University Hospital, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Korea
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216
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Forth KE, Layne CS, Madansingh SI. Self-Monitoring of Balance Performance can Reduce the Rate of Falls Among Older Adults. Front Sports Act Living 2021; 3:680269. [PMID: 34632375 PMCID: PMC8498210 DOI: 10.3389/fspor.2021.680269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: 29% of older adults fall annually, resulting in the leading cause of accidental death. Fall prevention programs typically include exercise training and self-monitoring of physical activity has a positive effect on the self-efficacy and self-regulation of exercise behaviors. We assessed if self-monitoring of fall risk, without an intervention, impacts fall rates. Methods: Fifty-three older adults had open access to a balance measuring platform which allowed them to self-monitor their postural stability and fall risk using a simple 1-min standing balance test. 12-month retrospective fall history was collected and a monthly/bimonthly fall log captured prospective falls. Participants had access to self-monitoring for up to 2.2 years. Fall history and fall incidence rate ratios and their confidence intervals were compared between the periods of time with and without access to self-monitoring. Results: A 54% reduction in the number of people who fell and a 74% reduction in the number of falls was observed when participants were able to self-monitor their postural stability and fall risk, after normalizing for participation length. Further, 42.9% of individuals identified as having high fall risk at baseline shifted to a lower risk category at a median 34 days and voluntarily measured themselves for a longer period of time. Discussion: We attribute this reduction in falls to changes in health behaviors achieved through empowerment from improved self-efficacy and self-regulation. Providing older adults with the ability to self-monitor their postural stability and intuit their risk of falling appears to have modified their health behaviors to successfully reduce fall rates.
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Affiliation(s)
| | - Charles S. Layne
- Department of Health and Human Performance, University of Houston, Houston, TX, United States
- Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, United States
- Center for Neuro-Engineering and Cognitive Science, University of Houston, Houston, TX, United States
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217
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Outcomes and longitudinal trend of traumatic cataract wound dehiscence in patients with blunt ocular injury. Sci Rep 2021; 11:18191. [PMID: 34521923 PMCID: PMC8440533 DOI: 10.1038/s41598-021-97723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/30/2021] [Indexed: 11/08/2022] Open
Abstract
Longitudinal trends on traumatic cataract wound dehiscence are scant. In this study, we present the characteristics of traumatic cataract wound dehiscence using 15 years of longitudinal trend in one of the largest medical centers in Taiwan for a period when cataract surgeries were gradually shifting from extracapsular cataract extraction (ECCE) to phacoemulsification. All patients with a prior cataract surgery who suffered from blunt open globe trauma between 2001 and 2015 at a tertiary referral center in Taiwan were included. The number of cases per year; type of prior cataract surgery; visual acuity (VA); mechanism and place of injury were analyzed. The risk factors associated with final VA were investigated in patients followed up for ≥ 1 month. Seventy-six eyes of 75 patients were included and all of them were traumatic cataract wound dehiscence with a prior ECCE (65 eyes) or phacoemulsification. The most common mechanism and place of injury was fall and at home in both cataract surgical types. The mean log of the minimal angle resolution (logMAR) of final VA was 2.15 ± 0.88 (ECCE) and 1.61 ± 0.83 (phacoemulsification) (P = .026). The most significant risk factors associated with worse final VA were retinal detachment at the initial visit and low ocular trauma score (both P < .001). Long-term visual outcome of phacoemulsification wound dehiscence was better than that of ECCE wound after a blunt trauma.
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218
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Jansen CP, Nerz C, Labudek S, Gottschalk S, Kramer-Gmeiner F, Klenk J, Dams J, König HH, Clemson L, Becker C, Schwenk M. Lifestyle-integrated functional exercise to prevent falls and promote physical activity: Results from the LiFE-is-LiFE randomized non-inferiority trial. Int J Behav Nutr Phys Act 2021; 18:115. [PMID: 34479573 PMCID: PMC8414469 DOI: 10.1186/s12966-021-01190-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The 'Lifestyle-integrated Functional Exercise' (LiFE) program successfully reduced risk of falling via improvements in balance and strength, additionally increasing physical activity (PA) in older adults. Generally being delivered in an individual one-to-one format, downsides of LiFE are considerable human resources and costs which hamper large scale implementability. To address this, a group format (gLiFE) was developed and analyzed for its non-inferiority compared to LiFE in reducing activity-adjusted fall incidence and intervention costs. In addition, PA and further secondary outcomes were evaluated. METHODS Older adults (70 + years) at risk of falling were included in this multi-center, single-blinded, randomized non-inferiority trial. Balance and strength activities and means to enhance PA were delivered in seven intervention sessions, either in a group (gLiFE) or individually at the participant's home (LiFE), followed by two "booster" phone calls. Negative binomial regression was used to analyze non-inferiority of gLiFE compared to LiFE at 6-month follow-up; interventions costs were compared descriptively; secondary outcomes were analyzed using generalized linear models. Analyses were carried out per protocol and intention-to-treat. RESULTS Three hundred nine persons were randomized into gLiFE (n = 153) and LiFE (n = 156). Non-inferiority of the incidence rate ratio of gLiFE was inconclusive after 6 months according to per protocol (mean = 1.27; 95% CI: 0.80; 2.03) and intention-to-treat analysis (mean = 1.18; 95% CI: 0.75; 1.84). Intervention costs were lower for gLiFE compared to LiFE (-€121 under study conditions; -€212€ under "real world" assumption). Falls were reduced between baseline and follow-up in both groups (gLiFE: -37%; LiFE: -55%); increases in PA were significantly higher in gLiFE (+ 880 steps; 95% CI 252; 1,509). Differences in other secondary outcomes were insignificant. CONCLUSIONS Although non-inferiority of gLiFE was inconclusive, gLiFE constitutes a less costly alternative to LiFE and it comes with a significantly larger enhancement of daily PA. The fact that no significant differences were found in any secondary outcome underlines that gLiFE addresses functional outcomes to a comparable degree as LiFE. Advantages of both formats should be evaluated in the light of individual needs and preferences before recommending either format. TRIAL REGISTRATION The study was preregistered under clinicaltrials.gov (identifier: NCT03462654 ) on March 12th 2018.
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Affiliation(s)
- Carl-Philipp Jansen
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
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Ming Y, Zecevic AA, Hunter SW, Miao W, Tirona RG. Medication Review in Preventing Older Adults' Fall-Related Injury: a Systematic Review & Meta-Analysis. Can Geriatr J 2021; 24:237-250. [PMID: 34484506 PMCID: PMC8390322 DOI: 10.5770/cgj.24.478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Medication review is essential in managing adverse drug reactions and improving drug safety in older adults. This systematic review evaluated medication review's role as a single intervention or combined with other interventions in preventing fall-related injuries in older adults. METHODS Electronic databases search was conducted in PubMed, EMBASE, Scopus, and CINAHL. Two reviewers screened titles and abstracts, reviewed full texts, and performed data extraction and risk of bias assessment. Meta-analyses were conducted on studies with similar participants, interventions, outcomes or settings. RESULTS Fourteen randomized, controlled studies were included. The pooled results indicated that medication review as a stand-alone intervention was effective in preventing fall-related injuries in community-dwelling older adults (Risk Difference [RD] = -0.06, 95% CI: [-0.11, -0.00], I2 = 61%, p = .04). Medication review also had a positive impact on decreasing the risk of fall-related fractures (RD = -0.02, 95% CI: [-0.04, -0.01], I2 = 0%, p = .01). DISCUSSION This systematic review and meta-analysis has demonstrated that medication review is effective in preventing fall-related injuries in general, and fractures specifically, in community-dwelling older adults. Future investigations focusing on the process of performing medication review will further inform fall-related injury prevention for older adults.
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Affiliation(s)
- Yu Ming
- Health and Rehabilitation Sciences, School of Health Studies, Western University, London, ON
| | | | | | - Wenxin Miao
- School of Information and Media Studies, Western University, London, ON
| | - Rommel G. Tirona
- School of Physiology and Pharmacology, Western University, London, ON
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey AB, Lovell-Smith C, Gallanders J, Cooney J, Williams NH. Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.
Objectives
To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.
Data sources
Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.
Design
Realist evidence synthesis and co-design for primary care service innovation.
Setting
Primary care in Wales and England.
Participants
Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.
Methods
The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.
Results
Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.
Limitations
Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.
Conclusions
We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.
Future work
A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.
Study registration
This study is registered as PROSPERO CRD42018103027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - Jennifer Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Bartosch P, Malmgren L, Kristensson J, McGuigan FE, Akesson KE. In community-dwelling women frailty is associated with imminent risk of osteoporotic fractures. Osteoporos Int 2021; 32:1735-1744. [PMID: 33661308 PMCID: PMC8387253 DOI: 10.1007/s00198-021-05886-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED Frailty reflects an accelerated health decline. Frailty is a consequence of fracture and contributes to fracture. Greater frailty was associated with higher fracture risk. Frail women were at immediate risk (within 24 months) of a hip or major fracture. Fracture prevention could be improved by considering frailty status. INTRODUCTION Frailty encompasses the functional decline in multiple systems, particularly the musculoskeletal system. Frailty can be a consequence of and contribute to fracture, leading to a cycle of further fractures and greater frailty. This study investigates this association, specifically time frames for risk, associated fracture types, and how grade of frailty affects risk. METHODS The study is performed in the OPRA cohort of 1044, 75-year-old women. A frailty index was created at baseline and 5 and 10 years. Women were categorized as frail or nonfrail and in quartiles (Q1 least frail; Q4 most frail). Fracture risk was assessed over short (1 and 2 years) and long terms (5 and 10 years). Fracture risk was defined for any fracture, major osteoporotic fractures (MOFs), and hip and vertebral fracture, using models including bone mineral density (BMD) and death as a competing risk. RESULTS For women aged 75, frailty was associated with higher risk of fracture within 2 years (Hip SHRadj. 3.16 (1.34-7.47)) and MOF (2 years SHRadj. 1.88 (1.12-3.16)). The increased risk continued for up to 5 years (Hip SHRadj. 2.02 (1.07-3.82)); (MOF SHRadj. 1.43 (0.99-2.05)). Grade of frailty was associated with increased 10-year probability of fracture (p = 0.03). Frailty predicted fracture independently of BMD. For women aged 80, frailty was similarly associated with fracture. CONCLUSION Frail elderly women are at immediate risk of fracture, regardless of bone density and continue to be at risk over subsequent years compared to identically aged nonfrail women. Incorporating regular frailty assessment into fracture management could improve identification of women at high fracture risk.
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Affiliation(s)
- P Bartosch
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - L Malmgren
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
- Department of Geriatrics, Skåne University Hospital, Malmö, Sweden
| | - J Kristensson
- Department of Health Sciences, Proactive an integrated care research unit, Faculty of Medicine, Lund University, 22100, Lund, Sweden
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - F E McGuigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - K E Akesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28, Malmö, Sweden.
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden.
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223
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Tsekoura M, Stasi S, Gliatis J, Sakellari V. Methodology of a home-based motor control exercise and ergonomic intervention programme for community-dwelling older people: The McHeELP study. J Frailty Sarcopenia Falls 2021; 6:153-162. [PMID: 34557615 PMCID: PMC8419848 DOI: 10.22540/jfsf-06-153] [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] [Accepted: 02/15/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of this research (Motor control Home ergonomics Elderlies' Prevention of falls; McHeELP study) was to develop a novel intervention combining motor control home-based exercises and a home ergonomic safety-improvement strategy in order to reduce falls in frail ambulatory older adults. A randomized controlled trial of a novel intervention is proposed including motor control exercises and home ergonomic assessment and modification in older adults who have at least one fall experience. Participants are randomized to control or intervention group in a 1:1 ratio. Participants will be assessed three times: at baseline, at 3rd month (end of intervention period) and again at 6th month (follow-up measurement). The primary outcome is of the effect on functional mobility using the Timed Up and Go test. Secondary outcomes include assessments of functionality, fear of falling and quality of life. This will be the first study to develop an exercise intervention approach that combines home-based motor control exercise intervention with home assessment and modification. This study is expected to explore a low-cost, easy-to-popularize, and effective exercise intervention approach for improving functional mobility and prevent falls among older adults.
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Affiliation(s)
- Maria Tsekoura
- Department of Physical Therapy, Faculty of Health and Care Sciences, University of West Attica (UniWA), Egaleo, Attica, Greece
- Department of Physical Therapy, School of Health Rehabilitation Sciences, University of Patras, Aigio, Greece
| | - Sophia Stasi
- Department of Physical Therapy, Faculty of Health and Care Sciences, University of West Attica (UniWA), Egaleo, Attica, Greece
| | - John Gliatis
- Department of Medicine, School of Health Sciences, University of Patras, Rio, Patra, Greece
| | - Vasiliki Sakellari
- Department of Physical Therapy, Faculty of Health and Care Sciences, University of West Attica (UniWA), Egaleo, Attica, Greece
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Performance and Characteristics of Wearable Sensor Systems Discriminating and Classifying Older Adults According to Fall Risk: A Systematic Review. SENSORS 2021; 21:s21175863. [PMID: 34502755 PMCID: PMC8434325 DOI: 10.3390/s21175863] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/30/2022]
Abstract
Sensor-based fall risk assessment (SFRA) utilizes wearable sensors for monitoring individuals’ motions in fall risk assessment tasks. Previous SFRA reviews recommend methodological improvements to better support the use of SFRA in clinical practice. This systematic review aimed to investigate the existing evidence of SFRA (discriminative capability, classification performance) and methodological factors (study design, samples, sensor features, and model validation) contributing to the risk of bias. The review was conducted according to recommended guidelines and 33 of 389 screened records were eligible for inclusion. Evidence of SFRA was identified: several sensor features and three classification models differed significantly between groups with different fall risk (mostly fallers/non-fallers). Moreover, classification performance corresponding the AUCs of at least 0.74 and/or accuracies of at least 84% were obtained from sensor features in six studies and from classification models in seven studies. Specificity was at least as high as sensitivity among studies reporting both values. Insufficient use of prospective design, small sample size, low in-sample inclusion of participants with elevated fall risk, high amounts and low degree of consensus in used features, and limited use of recommended model validation methods were identified in the included studies. Hence, future SFRA research should further reduce risk of bias by continuously improving methodology.
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225
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Tang EHM, Bedford LE, Yu EYT, Tse ETY, Dong W, Wu T, Cheung BMY, Wong CKH, Lam CLK. Unintentional Injury Burden in Hong Kong: Results from a Representative Population-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8826. [PMID: 34444574 PMCID: PMC8392553 DOI: 10.3390/ijerph18168826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
Abstract
Unintentional injuries are major causes of mortality and morbidity. Although generally perceived as accidents, it is possible to identify those at higher risk and implement appropriate prevention measures. This study aims to investigate the common causes of unintentional injuries and their associated risk factors among a large representative sample. Data of 12,022 individuals who completed the Hong Kong Population Health Survey 2014/15 were extracted. The primary outcome was the prevalence of having unintentional injury(-ies) in the previous 12 months that was severe enough to limit daily activities. Multivariable logistic regression analyses were conducted to identify associations between injuries and sociodemographic, clinical and lifestyle factors. 14.5% of respondents reported episode(s) of unintentional injury in the past 12 months in the population level. The main causes of top three most severe unintentional injuries were sprains (24.0%), falls (19.9%) and being hit/struck (19.6%). 13.2% injury episodes were work-related among the most severe episode. Factors independently associated with significantly higher risks of injury included currently employed, homemaker or student, born in Hong Kong (as compared with immigrants), doctor-diagnosed chronic conditions, harmful alcohol consumption, insufficient sleep, and disturbed sleep. To summarize, unintentional injuries are highly prevalent and associated with harmful drinking, insufficient sleep, and disturbed sleep, which are potential modifiable risk factors for prevention.
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Affiliation(s)
- Eric Ho Man Tang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Weinan Dong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Tingting Wu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Bernard Man Yung Cheung
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China;
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
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Möller U O, Fänge A M, J K, D S, F F, Hansson E E. Modern technology against falls - A description of the MoTFall project. Health Informatics J 2021; 27:14604582211011514. [PMID: 34006139 DOI: 10.1177/14604582211011514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To meet future challenges from an older and physically less active population innovative solutions are needed. Modern Technology against Falls (MoTFall) aims to prevent falls, increase physical activity and improve self-rated health among older people by means of an information and communication technology based system. The project has developed technology-based solutions, focusing on person-centred care. A participatory research design was applied in the development of a mobile application, a wearable inertial movement measurement unit (IMMU), called the Snubblometer ('snubbla' is 'stumble' in Swedish) and a web-based education programme for health care professionals. The mobile application includes a fall risk index, exercises and information related to falls prevention. By linking the app to the IMMU, person-centred interventions can be developed and implemented in various health care settings and with different target populations. The IMMU has shown good validity and reliability for measuring postural sway and high sensitivity and specificity for measuring a near fall. The education programme is directed at non-graduate health care professionals in nursing homes and home care. The technical solutions have potential for use in research and in clinical practice.
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Affiliation(s)
| | | | | | - Smedberg D
- Lund University, Skåne University Hospital, Sweden
| | - Falkvall F
- Research Institutes of Sweden (RISE), Security and Transport/Measurement Technology, Sweden
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227
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Aladul MI, Patel B, Chapman SR. Impact of the introduction of falls risk assessment toolkit on falls prevention and psychotropic medicines' utilisation in Walsall: an interrupted time series analysis. BMJ Open 2021; 11:e039649. [PMID: 34373286 PMCID: PMC8354286 DOI: 10.1136/bmjopen-2020-039649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine the impact of the introduction of a falls risk assessment toolkit (FRAT) in a UK medical centre on the number and cost of non-elective admissions for falls and psychotropic medication utilisation. DESIGN Interrupted time series analysis quantifying the number and cost of non-elective admissions for falls and primary care use data for Rushall Medical Centre before and after the implementation of FRAT at July 2017. SETTING Data on the monthly number and cost of non-elective admissions for falls and number of referrals and assessment to the falls service were provided by Walsall Clinical Commissioning Group. Primary care prescribing cost and volume data for Rushall Medical Centre was derived from the Openprescribing.net website for prescriptions dispensed between April 2015 and November 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The number and cost of non-elective admissions for falls and number of referrals and assessment to the falls service, and the volume of utilisation of psychotropic medicines. RESULTS Following the implementation of FRAT at Rushall Medical Centre in July 2017, the number of non-elective admissions for falls decreased at a rate of 0.414 admissions per month (p<0.033, 95% CI -0.796 to -0.032). The utilisation of psychotropic medications (alimemazine, citalopram, escitalopram, fluoxetine, mirtazapine, olanzapine and risperidone) decreased. The expenditure on psychotropic medications prescribed/used at Rushall Medical Centre decreased by at least £986 per month (p<0.001, 95% CI -2067 to -986). CONCLUSIONS The implementation of FRAT at Rushall Medical Centre was associated with a reduction in the number of non-elective admissions for falls. Assessment of these patients together with deprescribing of psychotropic medications resulted in a reduction in the number of non-elective admissions for falls and associated costs.
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Affiliation(s)
- Mohammed Ibrahim Aladul
- Pharmacy College, Department of Clinical Pharmacy, University of Mosul, Mosul, Iraq
- Pharmacy College, Ninevah University, Mosul, Iraq
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228
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Chiu HL, Yeh TT, Lo YT, Liang PJ, Lee SC. The effects of the Otago Exercise Programme on actual and perceived balance in older adults: A meta-analysis. PLoS One 2021; 16:e0255780. [PMID: 34358276 PMCID: PMC8345836 DOI: 10.1371/journal.pone.0255780] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 07/24/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Falls are serious issues in older populations. Balance problems are a major cause of falls and may lead to fear of falling and decreased balance confidence. The Otago Exercise Programme (OEP) is an effective fall prevention program that benefits balance function and fear of falling. The primary aim of the meta-analysis was to investigate the effectiveness of the OEP intervention on actual balance performance (i.e., static, dynamic, proactive or reactive balance) and perceived balance ability (i.e., balance confidence or fear of falling) for older adults; the secondary aim was to examine which OEP protocol most improves balance in older adults. Methods A systematic electronic review search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to identify randomized controlled trials (RCTs) investigating the effects of the OEP on actual balance performance and perceived balance ability in healthy older adults, and examining which OEP training protocol and intervention format most improves balance. Results A total of 12 RCTs were included in the analyses. The OEP exerted significant effects on static balance (Hedges’s g = 0.388; 95% confidence interval [CI] = 0.131 to 0.645), dynamic balance (g = -0.228; 95% CI = -0.352 to -0.1.4), proactive balance (g = 0.239; 95% CI = 0.061 to 0.416) and perceived balance (g = -0.184; 95% CI = -0.320 to -0.048) in older adults. Subgroup analysis indicated that the group format for the OEP was more effective for improving static (p = 0.008), dynamic (p = 0.004) and perceived balance (p = 0.004) than was the individual format. Sessions of >30 minutes were more effective in improving static (p = 0.007) and perceived balance (p = 0.014) than were sessions of ≤30 minutes. However, the effects of the OEP on balance were unrelated to the types of control group, training frequency and training period. Discussion The OEP is helpful for improving actual balance including static, dynamic, and proactive balance; enhancing confidence in balance control; and reducing fear of falling in older adults. In particular, administrating the OEP in a group setting in >30-minute sessions may be the most appropriate and effective exercise protocol for improving balance.
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Affiliation(s)
- Huei-Ling Chiu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Ting-Ting Yeh
- Master Degree Program in Healthcare Industry, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Ting Lo
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Jung Liang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shu-Chun Lee
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Stark S, Keglovits M, Somerville E, Hu YL, Barker A, Sykora D, Yan Y. Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2122044. [PMID: 34463746 PMCID: PMC8408671 DOI: 10.1001/jamanetworkopen.2021.22044] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults. OBJECTIVE To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021. INTERVENTIONS The intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral. MAIN OUTCOMES AND MEASURES The primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life. RESULTS A total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02392013.
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Affiliation(s)
- Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Yi-Ling Hu
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Abigail Barker
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Dave Sykora
- St Louis Area Agency on Aging, St Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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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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231
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Taylor ME, Todd C, O'Rourke S, Clemson LM, Close JC, Lord SR, Lung T, Berlowitz DJ, Blennerhassett J, Chow J, Dayhew J, Hawley-Hague H, Hodge W, Howard K, Johnson P, Lasrado R, McInerney G, Merlene M, Miles L, Said CM, White L, Wilson N, Zask A, Delbaere K. Implementation of the StandingTall programme to prevent falls in older people: a process evaluation protocol. BMJ Open 2021; 11:e048395. [PMID: 34312204 PMCID: PMC8314746 DOI: 10.1136/bmjopen-2020-048395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION One in three people aged 65 years and over fall each year. The health, economic and personal impact of falls will grow substantially in the coming years due to population ageing. Developing and implementing cost-effective strategies to prevent falls and mobility problems among older people is therefore an urgent public health challenge. StandingTall is a low-cost, unsupervised, home-based balance exercise programme delivered through a computer or tablet. StandingTall has a simple user-interface that incorporates physical and behavioural elements designed to promote compliance. A large randomised controlled trial in 503 community-dwelling older people has shown that StandingTall is safe, has high adherence rates and is effective in improving balance and reducing falls. The current project targets a major need for older people and will address the final steps needed to scale this innovative technology for widespread use by older people across Australia and internationally. METHODS AND ANALYSIS This project will endeavour to recruit 300 participants across three sites in Australia and 100 participants in the UK. The aim of the study is to evaluate the implementation of StandingTall into the community and health service settings in Australia and the UK. The nested process evaluation will use both quantitative and qualitative methods to explore uptake and acceptability of the StandingTall programme and associated resources. The primary outcome is participant adherence to the StandingTall programme over 6 months. ETHICS AND DISSEMINATION Ethical approval has been obtained from the South East Sydney Local Health District Human Research Ethics Committee (HREC reference 18/288) in Australia and the North West- Greater Manchester South Research Ethics Committee (IRAS ID: 268954) in the UK. Dissemination will be via publications, conferences, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers. TRIAL REGISTRATION NUMBER ACTRN12619001329156.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research, Applied Research Collaboration Greater Manchester, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Sandra O'Rourke
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Lindy M Clemson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Excellence for Population Ageing Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline Ct Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Lung
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Berlowitz
- Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jessica Chow
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Julia Dayhew
- Health Promotion, Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Helen Hawley-Hague
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Wendy Hodge
- ARTD Consultants, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Pamela Johnson
- Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
| | - Reena Lasrado
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Garth McInerney
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | | | - Lillian Miles
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Catherine M Said
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
- Physiotherapy, Western Health, St Albans, Victoria, Australia
- Australian Institute of Musculoskeletal Science, St Albans, Victoria, Australia
| | - Leanne White
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | | | - Avigdor Zask
- Health Promotion, Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Bourrelier J, Fautrelle L, Haratyk E, Manckoundia P, Mérienne F, Mourey F, Kubicki A. Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial. Geriatrics (Basel) 2021; 6:geriatrics6030072. [PMID: 34449605 PMCID: PMC8395892 DOI: 10.3390/geriatrics6030072] [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: 05/18/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. METHODS Frail older adults (n = 37) were included in this study who were randomized and divided into a VR exercises group (VR group) or a control group using the Nintendo Wii system (CTRL group). Finally, 22 patients were included in the data treatment. APA were studied through muscular activation timings measured with electromyographic activities. The functional reach test, the gait speed, and the time up and go were also evaluated before and after a 3-week training phase. RESULTS AND DISCUSSION As the main results, the training phase with VR improved the APA and the functional reach test score along the antero-posterior axis. Together, these results highlight the ability of a VR training phase to induce neuromuscular adaptations during the APA period in frail older adults. Then, it underlines the effective transfer from learning carried out during the VR training movements to control balance abilities in a more daily life context.
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Affiliation(s)
- Julien Bourrelier
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
| | - Lilian Fautrelle
- Laboratoire ToNIC, Toulouse NeuroImaging Center, UMR1214, Inserm, UPS, 31000 Toulouse, France;
- Equipe de Recherche Interdisciplinaire en Activités Physiques, Institut National Universitaire Champollion, STAPS, Campus de Rodez, 12000 Rodez, France
| | - Etienne Haratyk
- UFR Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Bourgogne Franche-Comté, 21000 Dijon, France;
| | - Patrick Manckoundia
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
- Centre Hospitalier Universitaire, Pôle Personnes Âgées, 21000 Dijon, France
| | - Frédéric Mérienne
- LE2I FRE 2005, Arts et Métiers, CNRS, UBFC, HeSam, 71100 Chalon-sur-Saône, France;
| | - France Mourey
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
- UFR Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Bourgogne Franche-Comté, 21000 Dijon, France;
| | - Alexandre Kubicki
- Laboratoire INSERM U1093 CAPS, Université de Bourgogne Franche-Comté, 21078 Dijon, France; (J.B.); (P.M.); (F.M.)
- IFMS NFC, Hôpital Nord Franche-Comté, 25200 Montbéliard, France
- Correspondence: ; Tel.: +33-643887789
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Kamran F, Harrold K, Zwier J, Carender W, Bao T, Sienko KH, Wiens J. Automatically evaluating balance using machine learning and data from a single inertial measurement unit. J Neuroeng Rehabil 2021; 18:114. [PMID: 34256799 PMCID: PMC8278701 DOI: 10.1186/s12984-021-00894-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recently, machine learning techniques have been applied to data collected from inertial measurement units to automatically assess balance, but rely on hand-engineered features. We explore the utility of machine learning to automatically extract important features from inertial measurement unit data for balance assessment. Findings Ten participants with balance concerns performed multiple balance exercises in a laboratory setting while wearing an inertial measurement unit on their lower back. Physical therapists watched video recordings of participants performing the exercises and rated balance on a 5-point scale. We trained machine learning models using different representations of the unprocessed inertial measurement unit data to estimate physical therapist ratings. On a held-out test set, we compared these learned models to one another, to participants’ self-assessments of balance, and to models trained using hand-engineered features. Utilizing the unprocessed kinematic data from the inertial measurement unit provided significant improvements over both self-assessments and models using hand-engineered features (AUROC of 0.806 vs. 0.768, 0.665). Conclusions Unprocessed data from an inertial measurement unit used as input to a machine learning model produced accurate estimates of balance performance. The ability to learn from unprocessed data presents a potentially generalizable approach for assessing balance without the need for labor-intensive feature engineering, while maintaining comparable model performance.
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Affiliation(s)
- Fahad Kamran
- Computer Science and Engineering, University of Michigan, Ann Arbor, USA.
| | - Kathryn Harrold
- Mechanical Engineering, University of Michigan, Ann Arbor, USA
| | - Jonathan Zwier
- Mechanical Engineering, University of Michigan, Ann Arbor, USA
| | - Wendy Carender
- Department of Otolaryngology, Michigan Medicine, Ann Arbor, USA
| | - Tian Bao
- Mechanical Engineering, University of Michigan, Ann Arbor, USA
| | | | - Jenna Wiens
- Computer Science and Engineering, University of Michigan, Ann Arbor, USA
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234
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Greene BR, McManus K, Ader LGM, Caulfield B. Unsupervised Assessment of Balance and Falls Risk Using a Smartphone and Machine Learning. SENSORS 2021; 21:s21144770. [PMID: 34300509 PMCID: PMC8309936 DOI: 10.3390/s21144770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/02/2022]
Abstract
Assessment of health and physical function using smartphones (mHealth) has enormous potential due to the ubiquity of smartphones and their potential to provide low cost, scalable access to care as well as frequent, objective measurements, outside of clinical environments. Validation of the algorithms and outcome measures used by mHealth apps is of paramount importance, as poorly validated apps have been found to be harmful to patients. Falls are a complex, common and costly problem in the older adult population. Deficits in balance and postural control are strongly associated with falls risk. Assessment of balance and falls risk using a validated smartphone app may lessen the need for clinical assessments which can be expensive, requiring non-portable equipment and specialist expertise. This study reports results for the real-world deployment of a smartphone app for self-directed, unsupervised assessment of balance and falls risk. The app relies on a previously validated algorithm for assessment of balance and falls risk; the outcome measures employed were trained prior to deployment on an independent data set. Results for a sample of 594 smartphone assessments from 147 unique phones show a strong association between self-reported falls history and the falls risk and balance impairment scores produced by the app, suggesting they may be clinically useful outcome measures. In addition, analysis of the quantitative balance features produced seems to suggest that unsupervised, self-directed assessment of balance in the home is feasible.
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Affiliation(s)
- Barry R. Greene
- Kinesis Health Technologies, D04 V2N9 Dublin, Ireland;
- Correspondence:
| | - Killian McManus
- Kinesis Health Technologies, D04 V2N9 Dublin, Ireland;
- Insight Centre, University College Dublin, D04 N2E5 Dublin, Ireland;
| | - Lilian Genaro Motti Ader
- Department Computer Science and Information Systems, University of Limerick, V94 XT66 Limerick, Ireland;
| | - Brian Caulfield
- Insight Centre, University College Dublin, D04 N2E5 Dublin, Ireland;
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Impact of Fall Risk and Direct Oral Anticoagulant Treatment on Quality-Adjusted Life-Years in Older Adults with Atrial Fibrillation: A Markov Decision Analysis. Drugs Aging 2021; 38:713-723. [PMID: 34235644 DOI: 10.1007/s40266-021-00870-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE The decision to initiate anticoagulation in older adults with atrial fibrillation is complicated by the benefit of ischemic stroke prevention vs the risk of falls resulting in major bleeds. The objective of this study was to assess the impact of different treatments including direct oral anticoagulants on quality-adjusted life-years (QALYs) in patients aged 75 years and older with atrial fibrillation in the context of falls. METHODS A Markov decision process was constructed for older patients with atrial fibrillation taking no anti-thrombotic, aspirin, warfarin, rivaroxaban, and apixaban. Input probabilities for clinical events were estimated from the available literature. One-way and two-way sensitivity analyses were performed by measuring the impact of varying input probabilities of clinical events on QALY outcomes. RESULTS The base-case scenario estimated that older adults treated with no anti-thrombotic, aspirin, warfarin, rivaroxaban, and apixaban had QALYs of 8.03, 8.69, 10.38, 11.02, and 11.56, respectively. The sensitivity analysis estimated that an older adult would need to fall over 45 (rivaroxaban) and 458 (apixaban) times per year for the QALY of a direct oral anticoagulant to be lower than that of aspirin. CONCLUSIONS Older adults with atrial fibrillation benefit from stroke protection of anticoagulants, especially direct oral anticoagulants, even if they are at high risk of falls. Clinicians should not consider fall risk as a deciding factor for withholding anticoagulation in this population of patients.
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Gusdal AK, Johansson-Pajala RM, Arkkukangas M, Ekholm A, Zander V. Preventing Falls and Malnutrition among Older Adults in Municipal Residential Care in Sweden: A Registry Study. SAGE Open Nurs 2021; 7:23779608211026161. [PMID: 34286078 PMCID: PMC8267024 DOI: 10.1177/23779608211026161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/28/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions. Objectives The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk. Methods A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included. Results Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff’s least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations. Conclusions This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, which requires educational training for care staff and supportive leadership.
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Affiliation(s)
- Annelie K Gusdal
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | | | | | - Anna Ekholm
- Research and Development in Sörmland, Eskilstuna, Sweden
| | - Viktoria Zander
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
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Gait Flexibility among Older Persons Significantly More Impaired in Fallers Than Non-Fallers-A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137074. [PMID: 34281011 PMCID: PMC8297078 DOI: 10.3390/ijerph18137074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/12/2023]
Abstract
Gait disorders are a relevant factor for falls and possible to measure with wearable devices. If a wearable sensor can detect differences in gait parameters between fallers and non-fallers has not yet been studied. The aim of this study was to measure and compare gait parameters, vestibular function, and balance performance between fallers and non-fallers among a group of older persons. Participants were senior members (n = 101) of a Swedish non-profit gymnastic association. Gait parameters were obtained using an inertial measurement unit (IMU) that the participants wore on the leg while walking an obstacle course and on an even surface. Vestibular function was assessed by the Head-shake test, the Head impulse test, and the Dix-Hallpike maneuver. Balance was assessed by the Timed Up and Go, the Timed Up and Go manual, and the Timed Up and Go cognitive tests. Falls during the 12-month follow-up period were monitored using fall diaries. Forty-two persons (41%) had fallen during the 12-month follow-up. Fallers had more limited ability to vary their gait (gait flexibility) than non-fallers (p < 0.001). No other differences between fallers and non-fallers were found. The use of gait flexibility, captured by an IMU, seems better for identifying future fallers among healthy older persons than Timed Up and Go or Timed Up and Go combined with a cognitive or manual task.
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Mild cognitive impairment, dementia and risk of mortality in essential tremor: A longitudinal prospective study of elders. J Neurol Sci 2021; 428:117563. [PMID: 34274879 DOI: 10.1016/j.jns.2021.117563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is evidence that the risk of mortality is increased in patients with essential tremor (ET), however, there are few longitudinal, prospective data on the predictors of mortality in ET. There is also evidence that ET is associated with cognitive impairment; yet, it is unknown whether this is associated with elevated risk of mortality. METHODS In a longitudinal, prospective study of 194 elders with ET, an extensive neuropsychological test battery was performed at three time points: baseline, 18 months, and 36 months, and cognitive diagnoses (normal, mild cognitive impairment [MCI], and dementia) were assigned during consensus conferences. We used Cox proportional hazards models to estimate hazard ratios (HR) for death. RESULTS The mean baseline age was 79.1 ± 9.7 years. During follow-up, 52 (26.8%) died. In initial univariate models, a variety of baseline factors were associated with increased risk of mortality, including demographic variables (i.e., older age), cognitive variables and gait and balance variables. In the final multivariate Cox model, baseline dementia (HR = 2.66, p = 0.006), older baseline age (HR = 1.18, p < 0.001), and more reported falls at baseline (HR = 1.10, p < 0.001) were independently associated with increased risk of mortality. Amnestic MCI was marginally associated with increased risk of mortality (HR = 1.93, p = 0.08) in primary analyses and significantly (p < 0.05) in several sensitivity analyses. CONCLUSIONS In this longitudinal, prospective study, baseline dementia resulted in a 2- to 3-times increase in risk of mortality in ET, further highlighting the clinical significance of cognitive impairment, specifically dementia, in this population.
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Cockayne S, Pighills A, Adamson J, Fairhurst C, Crossland S, Drummond A, Hewitt CE, Rodgers S, Ronaldson SJ, McCaffery J, Whiteside K, Scantlebury A, Robinson-Smith L, Cochrane A, Lamb SE, Boyes S, Gilbody S, Relton C, Torgerson DJ. Home environmental assessments and modification delivered by occupational therapists to reduce falls in people aged 65 years and over: the OTIS RCT. Health Technol Assess 2021; 25:1-118. [PMID: 34254934 PMCID: PMC8287374 DOI: 10.3310/hta25460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Falls and fall-related fractures are highly prevalent among older people and are a major contributor to morbidity and costs to individuals and society. Only one small pilot trial has evaluated the effectiveness of a home hazard assessment and environmental modification in the UK. This trial reported a reduction in falls as a secondary outcome, and no economic evaluation was undertaken. Therefore, the results need to be confirmed and a cost-effectiveness analysis needs to be undertaken. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a home hazard assessment and environmental modification delivered by occupational therapists for preventing falls among community-dwelling people aged ≥ 65 years who are at risk of falling, relative to usual care. DESIGN This was a pragmatic, multicentre, modified cohort randomised controlled trial with an economic evaluation and a qualitative study. SETTING Eight NHS trusts in primary and secondary care in England. PARTICIPANTS In total, 1331 participants were randomised (intervention group, n = 430; usual-care group, n = 901) via a secure, remote service. Blinding was not possible. INTERVENTIONS All participants received a falls prevention leaflet and routine care from their general practitioner. The intervention group were additionally offered one home environmental assessment and modifications recommended or provided to identify and manage personal fall-related hazards, delivered by an occupational therapist. MAIN OUTCOME MEASURES The primary outcome was the number of falls per participant during the 12 months from randomisation. The secondary outcomes were the proportion of fallers and multiple fallers, time to fall, fear of falling, fracture rate, health-related quality of life and cost-effectiveness. RESULTS The primary analysis included all 1331 randomised participants and indicated weak evidence of a difference in fall rate between the two groups, with an increase in the intervention group relative to usual care (adjusted incidence rate ratio 1.17, 95% confidence interval 0.99 to 1.38; p = 0.07). A similar proportion of participants in the intervention group (57.0%) and the usual-care group (56.2%) reported at least one fall over 12 months. There were no differences in any of the secondary outcomes. The base-case cost-effectiveness analysis from an NHS and Personal Social Services perspective found that, on average per participant, the intervention was associated with additional costs (£18.78, 95% confidence interval £16.33 to £21.24), but was less effective (mean quality-adjusted life-year loss -0.0042, 95% confidence interval -0.0041 to -0.0043). Sensitivity analyses demonstrated uncertainty in these findings. No serious, related adverse events were reported. The intervention was largely delivered as intended, but recommendations were followed to a varying degree. LIMITATIONS Outcome data were self-reported by participants, which may have led to inaccuracies in the reported falls data. CONCLUSIONS We found no evidence that an occupational therapist-delivered home assessment and modification reduced falls in this population of community-dwelling participants aged ≥ 65 years deemed at risk of falling. The intervention was more expensive and less effective than usual care, and therefore it does not provide a cost-effective alternative to usual care. FUTURE WORK An evaluation of falls prevention advice in a higher-risk population, perhaps those previously hospitalised for a fall, or given by other professional staff could be justified. TRIAL REGISTRATION Current Controlled Trials ISRCTN22202133. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Queensland Health, Mackay Base Hospital, Mackay, QLD, Australia
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Catherine E Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah J Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jennifer McCaffery
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Katie Whiteside
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Lyn Robinson-Smith
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah E Lamb
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sophie Boyes
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Simon Gilbody
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Clare Relton
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Alghamdi M, Vallis LA, Leat SJ. The association between visual attention and body movement-controlled video games, balance and mobility in older adults. BMC Geriatr 2021; 21:405. [PMID: 34193074 PMCID: PMC8247204 DOI: 10.1186/s12877-021-02358-9] [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: 11/30/2020] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Body movement-controlled video games involving physical motion and visual attention may have the potential to train both abilities simultaneously. Our purpose was to determine the associations between performance in these games and visual attention, balance and mobility in a group of older adults. The long-term goal is to identify the optimal type of interactive games with regards to training potential. Methods Fifty healthy adults aged 65+ years participated in this cross-sectional study. Visual attention was measured with static and dynamic versions of a useful field of view (UFV) and a multiple object tracking (MOT) test. Balance was measured with a force plate in bi-pedal quiet stance test (QST) and one-legged stance (OLST). Gait variability and walking speed were assessed with the Five Meter Walk Test (5MWT). Four Microsoft™ Xbox® 360 Kinect™ interactive video games were chosen based on the apparent levels of visual attention demand. Results Visual attention (UFV and MOT) was significantly associated with performance in Xbox® Kinect™ games that appeared to have a high visual attention demand (p < 0.05), while there was minimal or no significant association with games with apparent low visual attention demand. Balance and mobility show correlations with visual attention, and with Xbox games. Conclusion The results suggest that there are relationships between visual attention, balance, mobility and Xbox® Kinect™ game performance. Since different Xbox® games were associated with different balance, mobility and visual attention scores, a variety of such games, rather than a single game, may be most effective for training for falls prevention.
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Affiliation(s)
- Mansour Alghamdi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, PO BOX 68953, Riyadh, Riyadh, 11537, Saudi Arabia. .,School of Optometry and Vision Science, University of Waterloo, 200, University Ave. West, Waterloo, ON, N2L 3G1, Canada.
| | - Lori Ann Vallis
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Susan Jennifer Leat
- School of Optometry and Vision Science, University of Waterloo, 200, University Ave. West, Waterloo, ON, N2L 3G1, Canada
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Nishchyk A, Chen W, Pripp AH, Bergland A. The Effect of Mixed Reality Technologies for Falls Prevention Among Older Adults: Systematic Review and Meta-analysis. JMIR Aging 2021; 4:e27972. [PMID: 34255643 PMCID: PMC8280833 DOI: 10.2196/27972] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Falling is one of the most common and serious age-related issues, and falls can significantly impair the quality of life of older adults. Approximately one-third of people over 65 experience a fall annually. Previous research has shown that physical exercise could help reduce falls among older adults and improve their health. However, older adults often find it challenging to follow and adhere to physical exercise programs. Interventions using mixed reality (MR) technology could help address these issues. MR combines artificial augmented computer-generated elements with the real world. It has frequently been used for training and rehabilitation purposes. OBJECTIVE The aim of this systematic literature review and meta-analysis was to investigate the use of the full spectrum of MR technologies for fall prevention intervention and summarize evidence of the effectiveness of this approach. METHODS In our qualitative synthesis, we analyzed a number of features of the selected studies, including aim, type of exercise, technology used for intervention, study sample size, participant demographics and history of falls, study design, involvement of health professionals or caregivers, duration and frequency of the intervention, study outcome measures, and results of the study. To systematically assess the results of the selected studies and identify the common effect of MR interventions, a meta-analysis was performed. RESULTS Seven databases were searched, and the initial search yielded 5838 results. With the considered inclusion and exclusion criteria, 21 studies were included in the qualitative synthesis and 12 were included in meta-analysis. The majority of studies demonstrated a positive effect of an MR intervention on fall risk factors among older participants. The meta-analysis demonstrated a statistically significant difference in Berg Balance Scale score between the intervention and control groups (ES: 0.564; 95% CI 0.246-0.882; P<.001) with heterogeneity statistics of I2=54.9% and Q=17.74 (P=.02), and a statistical difference in Timed Up and Go test scores between the intervention and control groups (ES: 0.318; 95% CI 0.025-0.662; P<.001) with heterogeneity statistics of I2=77.6% and Q=44.63 (P<.001). The corresponding funnel plot and the Egger test for small-study effects (P=.76 and P=.11 for Berg Balance Scale and Timed Up and Go, respectively) indicate that a minor publication bias in the studies might be present in the Berg Balance Scale results. CONCLUSIONS The literature review and meta-analysis demonstrate that the use of MR interventions can have a positive effect on physical functions in the elderly. MR has the potential to help older users perform physical exercises that could improve their health conditions. However, more research on the effect of MR fall prevention interventions should be conducted with special focus given to MR usability issues.
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Affiliation(s)
- Anna Nishchyk
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Weiqin Chen
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Are Hugo Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Da Silva FC, Rode MP, Vietta GG, Iop RDR, Creczynski-Pasa TB, Martin AS, Da Silva R. Expression levels of specific microRNAs are increased after exercise and are associated with cognitive improvement in Parkinson's disease. Mol Med Rep 2021; 24:618. [PMID: 34184078 PMCID: PMC8258464 DOI: 10.3892/mmr.2021.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
There is a consensus regarding the efficacy of physical exercise in maintaining or improving human health; however, there are few studies examining the effect of physical exercise on the expression levels of microRNAs (miRNA/miRs) in Parkinson's disease (PD). The aim of the present study was to investigate the effects of an interval training program on a cycle ergometer on the expression levels of miR‑106a‑5p, miR‑103a‑3p and miR‑29a‑3p in serum samples from men with PD. This was a quasi‑experimental study with pre‑ and post‑testing and with a non‑equivalent group design. The participants were selected based on the eligibility criteria and subsequently classified into two groups: Experimental group and control group. The evaluations were performed at the beginning of the study (week 0) and after 8 weeks of the intervention program (week 9). The interval training program was performed on a cycle ergometer for 30 min, three times a week during an 8‑week period. The expression levels of miR‑106a‑5p, miR‑103a‑3p and miR‑29a‑3p in the experimental group were increased after physical exercise and were associated with cognitive improvement in men with PD. However, further studies are required to clarify the potential use of these circulating miRNAs as markers of adaptation to physical exercise. Collectively, the present results indicated that these three miRNAs may be associated with the exercise response and cognitive improvement in men with PD.
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Affiliation(s)
- Franciele Cascaes Da Silva
- Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Santa Catarina State University, Florianópolis, Santa Catarina 88080‑350, Brazil
| | - Michele Patrícia Rode
- Pharmaceutical Sciences Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88010‑970, Brazil
| | - Giovanna Grunewald Vietta
- Nucleus of Epidemiology, University of Southern Santa Catarina, Palhoça, Santa Catarina 88137‑270, Brazil
| | - Rodrigo Da Rosa Iop
- Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Santa Catarina State University, Florianópolis, Santa Catarina 88080‑350, Brazil
| | - Tânia Beatriz Creczynski-Pasa
- Pharmaceutical Sciences Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina 88010‑970, Brazil
| | - Alessandra Swarowsky Martin
- Center for Health and Sport Sciences, Physical Therapy Department, Santa Catarina State University, Florianópolis, Santa Catarina 88080‑350, Brazil
| | - Rudney Da Silva
- Center for Health Sciences and Sports, Adapted Physical Activity Laboratory, Santa Catarina State University, Florianópolis, Santa Catarina 88080‑350, Brazil
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243
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Watkins CA, Higham E, Gilfoyle M, Townley C, Hunter S. Age suit simulation replicates in healthy young adults the functional challenges to balance experienced by older adults: an observational study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:581-585. [DOI: 10.1136/bmjstel-2021-000867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/04/2022]
Abstract
BackgroundAge simulation can have a positive effect on empathic understanding and perception of ageing. However, there is limited evidence for its ability to replicate objectively the physical and functional challenges of ageing.ObjectiveTo observe whether age suit simulation can replicate in healthy young adults the physical and physiological balance disturbance and falls risk experienced by older adults.MethodologyHealthy young adults aged 20–40 years (16 male) were recruited to the study using convenience sampling from a student population. Participants performed three validated balance tests—Functional Reach Test (FRT), Timed Up and Go (TUG) and Berg Balance Scale (BBS)—first without the age suit and then with the age suit, using a standardised protocol, following the same sequence.Results30 participants completed all tests. Statistically significant differences between without-age-suit and with-age-suit performance were recorded for FRT distance (p<0.000005), time taken to complete the TUG (p<0.0005) and BBS score (p<0.001). A comparison of participant scores with normative FRT and TUG scores identified that the suit had ‘aged’ the majority of participants to the normative values for older adults (60+), with some reaching the values for individuals aged 70–89. However, no scores achieved the values indicative of increased falls risk.ConclusionsThe age suit is a valid educational tool that extends the value of age simulation beyond a more general empathising role, enabling those working with an older population to experience and understand the functional challenges to balance experienced by older adults as part of their training.
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Koppelaar H, Kordestani-Moghadam P, Kouhkani S, Irandoust F, Segers G, de Haas L, Bantje T, van Warmerdam M. Proof of Concept of Novel Visuo-Spatial-Motor Fall Prevention Training for Old People. Geriatrics (Basel) 2021; 6:66. [PMID: 34210015 PMCID: PMC8293049 DOI: 10.3390/geriatrics6030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Falls in the geriatric population are one of the most important causes of disabilities in this age group. Its consequences impose a great deal of economic burden on health and insurance systems. This study was conducted by a multidisciplinary team with the aim of evaluating the effect of visuo-spatial-motor training for the prevention of falls in older adults. The subjects consisted of 31 volunteers aged 60 to 92 years who were studied in three groups: (1) A group under standard physical training, (2) a group under visuo-spatial-motor interventions, and (3) a control group (without any intervention). The results of the study showed that visual-spatial motor exercises significantly reduced the risk of falls of the subjects.
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Affiliation(s)
- Henk Koppelaar
- Faculty of Electric and Electronic Engineering, Mathematics and Computer Science, Delft University of Technology, 2628 CD Delft, The Netherlands
| | | | - Sareh Kouhkani
- Department of Mathematics, Islamic University Shabestar Branch, Shabestar, Iran;
| | - Farnoosh Irandoust
- Department of Ophtalmology, Lorestan University of Medical Sciences, Korramabad, Iran;
| | - Gijs Segers
- Gymi Sports & Visual Performance, 4907 BC Oosterhout, The Netherlands;
| | - Lonneke de Haas
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
| | - Thijmen Bantje
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
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245
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Seppala LJ, Petrovic M, Ryg J, Bahat G, Topinkova E, Szczerbińska K, van der Cammen TJM, Hartikainen S, Ilhan B, Landi F, Morrissey Y, Mair A, Gutiérrez-Valencia M, Emmelot-Vonk MH, Mora MÁC, Denkinger M, Crome P, Jackson SHD, Correa-Pérez A, Knol W, Soulis G, Gudmundsson A, Ziere G, Wehling M, O’Mahony D, Cherubini A, van der Velde N. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs. Age Ageing 2021; 50:1189-1199. [PMID: 33349863 PMCID: PMC8244563 DOI: 10.1093/ageing/afaa249] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.
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Affiliation(s)
- Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics (section of Geriatrics), Ghent University, Ghent, Belgium
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark and Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gulistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, Istanbul, Turkey
| | - Eva Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic and Faculty of Health and Social Sciences, South Bohemian University, Česke Budějovice, Czech Republic
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Şişli Hamidiye Etfal Training and Research Hospital, University of Medical Sciences, Istanbul, Turkey
| | - Francesco Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Yvonne Morrissey
- Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | | | - Marielle H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - María Ángeles Caballero Mora
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real and CIBER de Fragilidad y Envejecimiento Saludable, Spain
| | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Centre Ulm, Ulm, Germany
| | - Peter Crome
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Adalsteinn Gudmundsson
- Landspitali University Hospital, Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gijsbertus Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands and Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Martin Wehling
- Institute for Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany
| | - Denis O’Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland and Department of Medicine, University College Cork, Cork, Ireland
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Collins CE, Schultz K, Mathew P, Chandra A, Nguyen B, Chen T, Renshaw S, Rose KM, Santry HP. A personalized approach empowering successful aging: Patient perspective on fall prevention education. PM R 2021; 14:786-792. [PMID: 34181824 DOI: 10.1002/pmrj.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Falls are the leading cause of fatal injury, and the most common cause of nonfatal trauma, among older adults. However, patient perspectives on preferences for obtaining fall education are not well reported. OBJECTIVE To identify components of successful fall prevention education. DESIGN Prospective qualitative study. SETTING Tertiary care center; institutional. PARTICIPANTS Adults aged 65 years or older with a history of falls who received services from inpatient trauma or outpatient geriatric services. INTERVENTIONS One-hour face-to-face semistructured interview. MAIN OUTCOME MEASURE Semistructured interviews sought to determine participants' history of fall education and perceived strengths and weaknesses of various formats of fall education. RESULTS Nearly all participants (9/10) indicated they had not received fall prevention education of any kind. Many participants (6/10) reported that, despite not receiving any formal education about falls, they had either given or received information about falls from other older adults in their communities. Participants indicated that framing fall education as a part of healthy aging would be more desirable and mentioned involving participants' families as part of the education. The majority of participants (7/10) suggested fall education be delivered through in-person discussion with providers, and most (9/10) indicated this would provide a personalized approach with opportunity for questions. Participants specified fall education should consist of both environmental modifications (5/10) and awareness of one's surroundings (4/10). CONCLUSIONS Despite histories of falls, nearly all participants reported they had not received formal fall education. However, many indicated they received fall information informally through their communities. Participants agreed successful fall prevention education would be delivered in an empowering way by a trusted member of the care team.
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Affiliation(s)
- Courtney E Collins
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
| | - Kurt Schultz
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Pawan Mathew
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Arnav Chandra
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bryan Nguyen
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tiffany Chen
- Department of Family Medicine, Sutter Health, Sacramento, California, USA
| | - Savannah Renshaw
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
| | - Karen M Rose
- College of Nursing, Ohio State University, Columbus, Ohio, USA.,Center for Healthy Aging, Self-Management and Complex Care, Ohio State University, Columbus, Ohio, USA
| | - Heena P Santry
- Department of Surgery, Ohio State University, Columbus, Ohio, USA.,Center for Surgical Health Assessment, Research & Policy, Ohio State University, Columbus, Ohio, USA
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247
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van Gameren M, Bossen D, Bosmans JE, Visser B, Frazer SWT, Pijnappels M. The (cost-)effectiveness of an implemented fall prevention intervention on falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: protocol for the in balance randomized controlled trial. BMC Geriatr 2021; 21:381. [PMID: 34162353 PMCID: PMC8220122 DOI: 10.1186/s12877-021-02334-3] [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: 05/10/2021] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background Falls and fall-related injuries among older adults are a serious threat to the quality of life and result in high healthcare and societal costs. Despite evidence that falls can be prevented by fall prevention programmes, practical barriers may challenge the implementation of these programmes. In this study, we will investigate the effectiveness and cost-effectiveness of In Balance, a fourteen-week, low-cost group fall prevention intervention, that is widely implemented in community-dwelling older adults with an increased fall risk in the Netherlands. Moreover, we will be the first to include cost-effectiveness for this intervention. Based on previous evidence of the In Balance intervention in pre-frail older adults, we expect this intervention to be (cost-)effective after implementation-related adjustments on the target population and duration of the intervention. Methods This study is a single-blinded, multicenter randomized controlled trial. The target sample will consist of 256 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group receives the In Balance intervention as it is currently widely implemented in Dutch healthcare, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group receives general written physical activity recommendations. Primary outcomes are the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consist of physical performance measures, physical activity, confidence, health status, quality of life, process evaluation and societal costs. Mixed model analyses will be conducted for both primary and secondary outcomes and will be stratified for non-frail and pre-frail adults. Discussion This trial will provide insight into the clinical and societal impact of an implemented Dutch fall prevention intervention and will have major benefits for older adults, society and health insurance companies. In addition, results of this study will inform healthcare professionals and policy makers about timely and (cost-)effective prevention of falls in older adults. Trial registration Netherlands Trial Register: NL9248 (registered February 13, 2021).
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Affiliation(s)
- Maaike van Gameren
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Daniël Bossen
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bart Visser
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Sanne W T Frazer
- Consumer Safety Institute (VeiligheidNL), Amsterdam, Netherlands
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
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248
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Views, experiences and attitudes of community-living older people towards the FIT-at-Home fall prevention programme: A qualitative interview study / Sichtweisen, Erfahrungswerte und Einstellungen von sturzgefährdeten Menschen im höheren Lebensalter zum FIT-at-Home-Sturzpräventionsprogramm: Eine qualitative Interviewstudie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2021. [DOI: 10.2478/ijhp-2021-0004] [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
Abstract
Background
For older people, poor balance and strength as well as environmental hazards are a major risk factor for falls. A lifestyle-integrated home-based physical exercise training and home modification intervention were developed for older people at risk of falling.
Aim
This study aimed to examine older people's perceptions of the FIT-at-Home fall prevention intervention in order to further develop the intervention's content, procedures and mode of delivery.
Methods
We conducted semi-structured interviews with individuals who participated in the falls prevention programme using the problem-centred interview method. The interviews were analysed in a deductive-inductive approach following Mayring's qualitative content analysis.
Results
Seven themes emerging from the data described different facets of older people's perceptions towards the intervention. Findings suggested that the participants accepted the FIT-at-Home intervention. Overall, the individuals regard the intervention as feasible and practicable. From the older people's view, it was an advantage that the exercises could be implemented at any time without additional aids or equipment in-house and it was not necessary to visit the occupational therapy practice. Older people's experiences showed that feelings of success have a positive effect on the willingness to exercise. A perceived barrier influencing the implementation of exercises among older people was their own laziness, their general state of health and illnesses, their daily mood or meteor sensitivity.
Conclusion
The FIT-at-Home intervention comprising balance and strength exercises and home modification is feasible and acceptable for community-living older people. Older people's feedback will help us to further refine the intervention.
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249
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Cost-Effectiveness of an Exercise Programme That Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65-80: A Secondary Data Analysis. Healthcare (Basel) 2021; 9:healthcare9060714. [PMID: 34200873 PMCID: PMC8230501 DOI: 10.3390/healthcare9060714] [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: 05/14/2021] [Revised: 05/31/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.
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250
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López-Soto PJ, López-Carrasco JDLC, Fabbian F, Miñarro-Del Moral RM, Segura-Ruiz R, Hidalgo-Lopezosa P, Manfredini R, Rodríguez-Borrego MA. Chronoprevention in hospital falls of older people: protocol for a mixed-method study. BMC Nurs 2021; 20:88. [PMID: 34092223 PMCID: PMC8183051 DOI: 10.1186/s12912-021-00618-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Accidental falls in hospitals are serious events concerning the safety of the patients. Recent studies demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. The aim of the study is to determine the effect of the application of a programme of preventive measures based on the temporal patterns of the risk factors on the hospital fall occurrence. Methods A mixed-method research design. The following three phases will be carried out: 1) Longitudinal prospective study in two parts: (a) audits and seminars of healthcare professionals focused on an effective and efficient hospital falls register. Multi-Component and Single Cosinor analyses will be performed to obtain the temporal patterns of hospital falls and their related variables and (b) implementation of a based-temporal patterns, multidimensional prevention programme. 2) Retrospective study of falls registered in institutional databases. 3) Qualitative study based on focus groups (physicians, nurses and nursing assistants). The study protocol was approved in 2018. Discussion With regard to the safety of patients, hospital falls are serious events. Recent studies have demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. It is imperative to study temporal patterns of hospital falls to effectively and comprehensively define the aetiology of falls and, therefore, design preventive strategies. A reduction of the number of in-hospital falls and related injuries is expected, as well as an improvement in the quality of life of patients. Considering temporal patterns and levels of mood and sleep of healthcare professionals will achieve an improvement in patient safety. Trial registration Retrospectively registered in ClinicalTrials.gov ID: NCT04367298. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00618-y.
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Affiliation(s)
- Pablo Jesús López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Área de Enfermería, Faculty of Medicine and Nursing, University of Cordoba, Avda. Menéndez Pidal s/n, 14071, Córdoba, Spain. .,Hospital Universitario Reina Sofía de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Juan de la Cruz López-Carrasco
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Área de Enfermería, Faculty of Medicine and Nursing, University of Cordoba, Avda. Menéndez Pidal s/n, 14071, Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Fabio Fabbian
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy.,Center for Studies on Gender Medicine, University of Ferrara, via Fossato di Mortara 64/b, 44121, Ferrara, Italy
| | - Rosa María Miñarro-Del Moral
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Rocío Segura-Ruiz
- Hospital Universitario Reina Sofía de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Pedro Hidalgo-Lopezosa
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Área de Enfermería, Faculty of Medicine and Nursing, University of Cordoba, Avda. Menéndez Pidal s/n, 14071, Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Roberto Manfredini
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Via L. Ariosto 35, 44121, Ferrara, Italy.,Center for Studies on Gender Medicine, University of Ferrara, via Fossato di Mortara 64/b, 44121, Ferrara, Italy
| | - María Aurora Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Área de Enfermería, Faculty of Medicine and Nursing, University of Cordoba, Avda. Menéndez Pidal s/n, 14071, Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
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