Risk factors for falls among older adults in India: A systematic review and meta-analysis

Balance Control is Sequentially Correlated with Proprioception, Joint Range of Motion, Strength, Pain, and Plantar Tactile Sensation Among Older Adults with Knee Osteoarthritis

BACKGROUND

Patients with knee osteoarthritis (KOA) are at high risk for falls, which is attributed to their impaired balance control. Identifying factors associated with balance control facilitates the development of precise KOA rehabilitation programs. This study was to investigate the correlations of balance control with proprioception, plantar tactile sensation (PTS), pain, joint range of motion (ROM), and strength among older adults with and without KOA, as well as the magnitudes and sequence of correlation of these factors to balance control.

METHODS

A total of 240 older adults with (n = 124, female: 84, age: 68.8 ± 4.0 years) and without (n = 116, female: 64, age: 67.9 ± 3.5 years) KOA were recruited and assigned to the KOA and control groups. Their proprioception, PTS, pain, ROM, and strength were measured. Pearson or Spearman correlations were used to test whether they were significantly related to their Berg Balance Scale (BBS), and factor analysis and multivariate linear regression were used to determine the degrees of correlation between each factor and the BBS.

RESULTS

Compared to the control group, the KOA group had lower BBS score, larger proprioception and PTS thresholds, smaller ROM, and less strength (p: 0.008, < 0.001-0.016, < 0.001-0.005, < 0.001-0.014, and < 0.001-0.002, respectively). In the KOA group, the BBS was weakly to moderately correlated with proprioception, PTS, pain, ROM, and strength (r: 0.332-0.501, 0.197-0.291, 0.340, 0.212-0.508, and 0.236-0.336, respectively). While in the control group, the BBS was correlated with proprioception and strength (r: 0.207-0.379, and 0.212-0.410). In the KOA group, BBS = 54.41+ (0.668*strength) - (0.579*PTS) - (1.141*proprioception) + (1.054* ROM) - (0.339*pain). While in the control group, BBS = 53.85+ (0.441*strength) - (0.677*proprioception).

CONCLUSION

Worse proprioception and PTS, smaller ROM, and less strength were detected among older adults with KOA, and their proprioception, PTS, pain, ROM, and strength were all related to balance control. Proprioception had the strongest correlations, followed by ROM, strength, pain, and PTS. Precise KOA rehabilitation programs may be proposed following the sequence of improving the five factors.

Development of artificial intelligence edge computing based wearable device for fall detection and prevention of elderly people

Elderly falls are a major concerning threat resulting in over 1.5-2 million elderly people experiencing severe injuries and 1 million deaths yearly. Falls experienced by Elderly people may lead to a long-term negative impact on their physical and psychological health conditions. Major healthcare research had focused on this lately to detect and prevent the fall. In this work, an Artificial Intelligence (AI) edge computing based wearable device is designed and developed for detection and prevention of fall of elderly people. Further, the various deep learning algorithms such as Convolutional Neural Network (CNN), Recurrent Neural Network (RNN), Long Short-Term Memory (LSTM), Gated Recurrent Unit (GRU) are utilized for activity recognition of elderly. Also, the CNN-LSTM, RNN-LSTM and GRU-LSTM with and without attention layer respectively are utilized and the performance metrics are analyzed to find the best deep learning model. Furthermore, the three different hardware boards such as Jetson Nano developer board, Raspberry PI 3 and 4 are utilized as an AI edge computing device and the best deep learning model is implemented and the computation time is evaluated. Results demonstrate that the CNN-LSTM with attention layer exhibits the accuracy, recall, precision and F1_Score of 97%, 98%, 98% and 0.98 respectively which is better when compared to other deep learning models. Also, the computation time of NVIDIA Jetson Nano is less when compared to other edge computing devices. This work appears to be of high societal relevance since the proposed wearable device can be used to monitor the activity of elderly and prevents the elderly falls which improve the quality of life of elderly people.

Risk factors of multimorbidity among older adults in India: A systematic review and meta-analysis

Background

Multimorbidity among older adults is a growing concern in India. Multimorbidity is defined as the coexistence of two or more chronic health conditions in an individual. Primary studies have been conducted on risk factors of multimorbidity in India, but no systematic review has been conducted on this topic. This systematic review aimed to synthesize the existing evidence on risk factors of multimorbidity among older adults in India.

Methods

The JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Several databases were searched for published and unpublished studies until August 03, 2022. The screening of titles and abstracts and full texts, data extraction, and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. Data synthesis was conducted using narrative synthesis and random effects meta-analysis, where appropriate.

Results

Out of 8781 records identified from the literature search, 16 and 15 studies were included in the systematic review and meta-analysis, respectively. All included studies were cross-sectional, and 10 met a critical appraisal score of more than 70%. Broadly, sociodemographic, lifestyle, and health conditions-related factors were explored in these studies. The pooled odds of multimorbidity were higher in people aged ≥70 years compared to 60-69 years (odds ratio (OR) 1.51; 95% confidence interval (CI) 1.20-1.91), females compared to males (1.38; 1.09-1.75), single, divorced, separated, and widowed compared to married (1.29; 1.11-1.49), economically dependent compared to economically independent (1.54; 1.21-1.97), and smokers compared to non-smokers (1.33; 1.16-1.52) and were lower in working compared to not working (0.51; 0.36-0.72).

Conclusion

This systematic review and meta-analysis provided a comprehensive picture of the problem by synthesizing the existing evidence on risk factors of multimorbidity among older adults in India. These synthesized sociodemographic and lifestyle factors should be taken into consideration when developing health interventions for addressing multimorbidity among older adults in India.

Health Consequences of Falls among Older Adults in India: A Systematic Review and Meta-Analysis

Research has been conducted on the prevalence of health consequences of falls among older adults (aged ≥60 years) in India, and our systematic review and meta-analysis aimed to synthe-size the existing evidence on this topic. The JBI guideline was followed for conducting this review work. Several databases were searched, and eight studies were included. The critical appraisal scores ("yes" responses) for the included studies ranged from 56% to 78%. Among older adults in India who fell, the pooled prevalence of injuries was 65.63% (95% confidence interval [38.89, 87.96]). Similarly, head and/or neck injuries was 7.55% (4.26, 11.62), upper extremity injuries was 19.42% (16.06, 23.02), trunk injuries was 9.98% (2.01, 22.47), lower extremity injuries was 34.36% (24.07, 45.44), cuts, lacerations, abrasions, grazes, bruises and/or contusions was 37.95% (22.15, 55.16), fractures was 12.50% (7.65, 18.30), dislocations and/or sprains was 14.31% (6.03, 25.26), loss of consciousness was 5.96% (0.75, 15.08), disabilities was 10.79% (7.16, 15.02), and hospital admissions was 19.68% (15.54, 24.16). Some of the high figures indicate the need for prioritizing and addressing the problem. Furthermore, high-quality studies on this topic should be conducted, including on psychological health consequences, health-related quality of life, length of hospital stay, and death. PROSPERO registration: CRD42022332903.

Unintentional domestic injuries among elderly in rural areas of Mandya: A community-based cross-sectional study in Southern Karnataka

Background

As the proportion of elderly in the population increases, they also become vulnerable to various types of intentional or unintentional injuries. Domestic accidents including falls among the elderly have been identified as a leading cause of injury-related morbidity and mortality in India and elsewhere.

Aim

This study aims to assess the burden and pattern of domestic accidents in a rural part of Southern India.

Methods and Setting

A community-based cross-sectional study among the elderly (≥60 years) was carried out in rural areas of Southern Karnataka. A semi-structured interview schedule was used to get the information on domestic accidents. Inferential statistical tests like the Chi-square test and logistic regression analysis were used.

Results

A total of 500 persons aged ≥60 years with a mean age of 69.09 ± 7.42 years (Range 60-92 years) were included. One-third of the subjects have had an incidence of domestic accidents in the past 1 year contributing to a 35% prevalence of domestic accidents. A higher prevalence of domestic accidents was seen in those subjects who were ill (47.9%). Overall prevalence of falls was 21.4% (P = 0.007). One-fifth of the subjects with domestic accidents had a residual illness.

Conclusion and Contribution

One-third of our subjects gave a history of one or the other form of domestic accidents in the previous 1 year. Our study highlights the problem of unintentional domestic injuries among the most vulnerable group of the elderly and calls for a continuous assessment of the burden and nature of injuries.

The risk of falls among the aging population: A systematic review and meta-analysis

Aim

This study aims to clarify the risk factors for falls to prevent severe consequences in older adults.

Methods

We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms "risk factors" OR "predicting factors" OR "predictor" AND "fall" OR "drop" to identify all relevant studies and compare their results. The study participants were divided into two groups, the "fall group" and the "control group", and differences in demographic characteristics, lifestyles, and comorbidities were compared.

Results

We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls.

Conclusion

Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.