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Zhou Y, Berridge C, Hooyman N, Mroz TM, Sadak T, Choi SW, Phelan EA. Care Partners' Engagement in Preventing Falls for Community-Dwelling Older People With Dementia. THE GERONTOLOGIST 2024; 64:gnae064. [PMID: 38832587 DOI: 10.1093/geront/gnae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about how to prevent falls in community-dwelling older people with dementia. Although their care partners adopt various behaviors to prevent their falls, it is unclear if these behaviors reduce falls for those with different levels of fall risk. RESEARCH DESIGN AND METHODS Linking the 2015 and 2016 National Health and Aging Trends Study and the 2015 National Study of Caregiving (NSOC), we identified 390 community-dwelling older people with dementia with 607 care partners. We selected 26 NSOC items representing fall risk management (FRM) behaviors. We examined the prevalence and dimensionality of these behaviors and investigated associations between care partners' behaviors in 2015 (T1) and older people's falls in 2016 (T2) stratified by their fall incidence at T1, adjusting for covariates. RESULTS Five domains of FRM were identified: mobility and safety assistance, medical service coordination, health management, social service coordination, and accommodation. For those who did not fall at T1, mobility and safety assistance and social service coordination were each associated with an increased risk of falling at T2 (adjusted incidence rate ratio [aIRR] = 1.39, 95% confidence interval [CI] = 1.06-1.83, p = .019, aIRR = 1.25, 95% CI = 1.01-1.55, p = .043). For those who had fallen at T1, social service coordination was associated with a decreased risk of falling at T2 (aIRR = 0.83, 95% CI = 0.73-0.94, p = .004). DISCUSSION AND IMPLICATIONS The different impacts of dementia care partners' FRM behaviors emphasize the need to address specific behaviors when involving care partners in preventing falls for older people with dementia at varying levels of fall risk.
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Affiliation(s)
- Yuanjin Zhou
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Clara Berridge
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Nancy Hooyman
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Tatiana Sadak
- Yale School of Nursing, Yale University, West Haven, Connecticut, USA
| | - Seung W Choi
- College of Education, University of Texas at Austin, Austin, Texas, USA
| | - Elizabeth A Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
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Pan G, Ni L, Yan H, Yao L. Association between the use of orexin receptor antagonists and falls or fractures: A meta-analysis. J Psychiatr Res 2024; 176:393-402. [PMID: 38944018 DOI: 10.1016/j.jpsychires.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
Evidence indicates that the use of sedative-hypnotics, including benzodiazepines and z-drugs, is linked to an increased risk of falls and fractures. Nonetheless, the potential exacerbation of this risk by orexin receptor antagonists, which are novel therapeutic agents for treating insomnia, remains uncertain despite their escalating prevalence in clinical practice. We systematically searched four electronic databases from inception to April 17, 2024. In addition, we performed a quality assessment; calculated pooled odds ratios (ORs) to assess the relationship between the use of orexin receptor antagonists and the occurrence of falls or fractures; evaluated heterogeneity across the included studies; and conducted sensitivity analyses. The meta-analysis encompassed eight papers, comprising a total of 46,636 subjects. These papers included 5 case-control studies and 3 randomized controlled trials (RCTs), collectively encompassing ten studies. Analysis of the included case-control studies (pooled adjusted OR = 0.75, 95% confidence interval [CI] = 0.00-1.50, I2 = 66.2%, k = 3) and RCTs (OR = 0.68, 95% CI = 0.31-1.50, I2 = 45.9%, k = 5) indicated that the use of orexin receptor antagonists did not elevate the risk of falls. Similarly, analysis of the included case-control studies revealed no significant increase in the risk of fractures associated with the use of orexin receptor antagonists (pooled adjusted OR = 1.01, 95% CI = 0.82-1.20, I2 = 40.1%, k = 2). This meta-analysis suggests that the use of orexin receptor antagonists for treating insomnia does not escalate the risk of falls or fractures, although the data for lemborexant and daridorexant are limited.
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Affiliation(s)
- Guobiao Pan
- Department of Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Lingzhi Ni
- Department of Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Haohao Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lan Yao
- Department of Medical Oncology Ward 3, Hangzhou Cancer Hospital, Hangzhou, 310002, Zhejiang, China.
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Wang C, Zhang Y, Wang J, Wan L, Li B, Ding H. A study on the falls factors among the older adult with cognitive impairment based on large-sample data. Front Public Health 2024; 12:1376993. [PMID: 38947354 PMCID: PMC11212509 DOI: 10.3389/fpubh.2024.1376993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population. Methods This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels. Results The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases. Discussion For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.
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Affiliation(s)
- Changying Wang
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Shanghai, China
| | - Yunwei Zhang
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Shanghai, China
| | - Jin Wang
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Shanghai, China
| | - Lingshan Wan
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Shanghai, China
| | - Bo Li
- Minhang Hospital, Fudan University, Shanghai, China
| | - Hansheng Ding
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Shanghai, China
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Koh V, Xuan LW, Zhe TK, Singh N, B Matchar D, Chan A. Performance of digital technologies in assessing fall risks among older adults with cognitive impairment: a systematic review. GeroScience 2024; 46:2951-2975. [PMID: 38436792 PMCID: PMC11009180 DOI: 10.1007/s11357-024-01098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Older adults with cognitive impairment (CI) are twice as likely to fall compared to the general older adult population. Traditional fall risk assessments may not be suitable for older adults with CI due to their reliance on attention and recall. Hence, there is an interest in using objective technology-based fall risk assessment tools to assess falls within this population. This systematic review aims to evaluate the features and performance of technology-based fall risk assessment tools for older adults with CI. A systematic search was conducted across several databases such as PubMed and IEEE Xplore, resulting in the inclusion of 22 studies. Most studies focused on participants with dementia. The technologies included sensors, mobile applications, motion capture, and virtual reality. Fall risk assessments were conducted in the community, laboratory, and institutional settings; with studies incorporating continuous monitoring of older adults in everyday environments. Studies used a combination of technology-based inputs of gait parameters, socio-demographic indicators, and clinical assessments. However, many missed the opportunity to include cognitive performance inputs as predictors to fall risk. The findings of this review support the use of technology-based fall risk assessment tools for older adults with CI. Further advancements incorporating cognitive measures and additional longitudinal studies are needed to improve the effectiveness and clinical applications of these assessment tools. Additional work is also required to compare the performance of existing methods for fall risk assessment, technology-based fall risk assessments, and the combination of these approaches.
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Affiliation(s)
- Vanessa Koh
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore.
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Lai Wei Xuan
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Tan Kai Zhe
- Future Health Technologies Programme, Singapore-ETH Centre, Singapore, Singapore
| | - Navrag Singh
- Future Health Technologies Programme, Singapore-ETH Centre, Singapore, Singapore
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - David B Matchar
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Future Health Technologies Programme, Singapore-ETH Centre, Singapore, Singapore
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA
| | - Angelique Chan
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Future Health Technologies Programme, Singapore-ETH Centre, Singapore, Singapore
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Middleton LE, Pelletier C, Koch M, Norman R, Dupuis S, Astell A, Giangregorio L, Freeman S. Dementia-Inclusive Choices for Exercise Toolkit: Impact on the Knowledge, Perspectives, and Practices of Exercise Providers. J Aging Phys Act 2024; 32:360-369. [PMID: 38262407 DOI: 10.1123/japa.2022-0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/23/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024]
Abstract
Physical activity improves the well-being of persons living with dementia but few exercise programs include them. The Dementia-Inclusive Choices for Exercise (DICE) toolkit aims to improve exercise providers' understanding of dementia and ability to support persons living with dementia in physical activity. We evaluated the co-designed DICE toolkit with exercise providers using a mixed-methods approach comprising pre/post questionnaires and interviews and reflection diaries. Among 16 participants, self-efficacy for exercise delivery to persons living with dementia and both knowledge and attitudes toward dementia significantly improved. Thematic analysis suggested participants (a) had a deeper understanding of the variability of dementia, (b) were planning for equitable access for persons living with dementia, (c) planned to promote social connection through exercise, and (d) were optimistic for future engagement with persons living with dementia. The DICE toolkit may improve exercise providers' knowledge and confidence to plan proactively to support persons living with dementia in programs and services.
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Affiliation(s)
- Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo,ON, Canada
| | - Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Melissa Koch
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Rebekah Norman
- Recreation and Leisure Studies, University of Waterloo, Waterloo, ON, Canada
| | - Sherry Dupuis
- Schlegel-UW Research Institute for Aging, Waterloo,ON, Canada
- Recreation and Leisure Studies, University of Waterloo, Waterloo, ON, Canada
| | - Arlene Astell
- Department of Psychiatry, University of Toronto, Toronto, ON, USA
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo,ON, Canada
| | - Shannon Freeman
- Department of Nursing, University of Northern British Columbia, Prince George, BC, Canada
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Sokołowska B, Świderski W, Smolis-Bąk E, Sokołowska E, Sadura-Sieklucka T. A machine learning approach to evaluate the impact of virtual balance/cognitive training on fall risk in older women. Front Comput Neurosci 2024; 18:1390208. [PMID: 38808222 PMCID: PMC11130377 DOI: 10.3389/fncom.2024.1390208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Novel technologies based on virtual reality (VR) are creating attractive virtual environments with high ecological value, used both in basic/clinical neuroscience and modern medical practice. The study aimed to evaluate the effects of VR-based training in an elderly population. Materials and methods The study included 36 women over the age of 60, who were randomly divided into two groups subjected to balance-strength and balance-cognitive training. The research applied both conventional clinical tests, such as (a) the Timed Up and Go test, (b) the five-times sit-to-stand test, and (c) the posturographic exam with the Romberg test with eyes open and closed. Training in both groups was conducted for 10 sessions and embraced exercises on a bicycle ergometer and exercises using non-immersive VR created by the ActivLife platform. Machine learning methods with a k-nearest neighbors classifier, which are very effective and popular, were proposed to statistically evaluate the differences in training effects in the two groups. Results and conclusion The study showed that training using VR brought beneficial improvement in clinical tests and changes in the pattern of posturographic trajectories were observed. An important finding of the research was a statistically significant reduction in the risk of falls in the study population. The use of virtual environments in exercise/training has great potential in promoting healthy aging and preventing balance loss and falls among seniors.
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Affiliation(s)
- Beata Sokołowska
- Bioinformatics Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Wiktor Świderski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Edyta Smolis-Bąk
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
| | - Ewa Sokołowska
- Department of Developmental Psychology, Faculty of Social Sciences, Institute of Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Teresa Sadura-Sieklucka
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Chantanachai T, Sturnieks DL, Lord SR, Menant J, Delbaere K, Sachdev PS, Brodaty H, Humburg P, Taylor ME. Cognitive and physical declines and falls in older people with and without mild cognitive impairment: a 7-year longitudinal study. Int Psychogeriatr 2024; 36:306-316. [PMID: 37078463 DOI: 10.1017/s1041610223000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI). DESIGN Prospective cohort study with assessments every 2 years (for up to 6 years). SETTING Community, Sydney, Australia. PARTICIPANTS Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232). MEASUREMENTS Cognitive and physical function measured over 2-6 years follow-up. Falls in the year following participants' final assessment. RESULTS In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample. CONCLUSIONS Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.
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Affiliation(s)
- Thanwarat Chantanachai
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Peter Humburg
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW, Australia
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Pšeničnik Sluga S, Kozinc Z. Sensorimotor and proprioceptive exercise programs to improve balance in older adults: a systematic review with meta-analysis. Eur J Transl Myol 2024; 34. [PMID: 38213185 PMCID: PMC11017176 DOI: 10.4081/ejtm.2024.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
The primary aim of this study was to systematically review and meta-analyze the impact of sensorimotor and proprioceptive exercises on balance in older adults. We also sought to define how researchers describe proprioceptive and sensory-motor training and their respective protocols. The review was conducted following the PRISMA guidelines, with searches performed in March 2023. Both authors carried out independent searches using the PubMed and PEDro databases. From a total of 320 identified records, 12 studies were deemed eligible for meta-analysis after screening and removal of duplicates. The average PEDro score was 5.11 ± 1.11 indicating overall fair quality of studies. Common outcome measures included the Berg balance scale, Timed up and go test, Tinetti balance scale, Functional reach test and various single-leg stance tests. All outcomes were significantly improved by the interventions (standard mean difference = 0.65 - 1.29), with little difference between proprioceptive and sensorimotor training. However, the quality of evidence ranged from "very low" to "low" based on GRADE guidelines, suggesting further high-quality studies are needed. This review underscores the potential benefits of sensorimotor and proprioceptive exercises for enhancing balance in older adults, while also highlighting the ambiguity and inconsistency regarding the usage of the terms proprioceptive and sensorimotor training.
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Affiliation(s)
| | - Ziga Kozinc
- University of Primorska, Faculty of Health Science, Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Koper.
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Luo S, Deng L, Chen Y, Zhou W, Canavese F, Li L. Does enhanced cognitive performance reduce fracture risk? a Mendelian randomization study. Aging (Albany NY) 2023; 15:14985-14995. [PMID: 38112588 PMCID: PMC10781472 DOI: 10.18632/aging.205325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE While observational studies have suggested a link between cognitive performance and fracture risk, the causality and site-specific nature are unclear. We applied Mendelian randomization (MR) to elucidate these associations. METHODS 147 single-nucleotide polymorphisms (SNPs) tied strongly to cognitive performance (p< 5e-8) were selected. We performed MR analysis to investigate the causal relationship between cognitive performance and fractures at specific sites, including the wrist, upper arm, shoulder, ribs, sternum, thoracic spine, lumbar spine, pelvis, femur, leg, and ankle. The primary estimate was determined using the inverse variance-weighted method. Additionally, we examined heterogeneity using the MR Pleiotropy RESidual Sum Outlier test and Cochran Q, and employed MR-Egger regression to identify horizontal pleiotropy. RESULTS MR analysis identified a causal association between cognitive performance and fractures at the lumbar-spine-pelvis (odds ratio [OR] = 0.727, 95% CI = 0.552-0.956, p = 0.023), and ribs-sternum-thoracic spine sites (OR = 0.774, 95% CI = 0.615-0.974, p = 0.029). However, no causal association was found for fractures at other sites. CONCLUSIONS This study provided evidence of a causal connection between cognitive performance and fracture risk at certain locations. These findings underline the potential of cognitive enhancement strategies as innovative and effective methods for fracture prevention.
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Affiliation(s)
- Shaoting Luo
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Linfang Deng
- Department of Nursing, Jinzhou Medical University, Jinzhou 121001, Liaoning, P.R. China
| | - Yufan Chen
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Lille 59000, Nord Department, France
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
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Qi L, Zhou M, Mao M, Yang J. The static balance ability on soft and hard support surfaces in older adults with mild cognitive impairment. PLoS One 2023; 18:e0295569. [PMID: 38079401 PMCID: PMC10712882 DOI: 10.1371/journal.pone.0295569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to assess the static balance ability of the older adults with mild cognitive impairment (MCI) while standing on soft and hard support surfaces. METHODS Forty older adults participated in this study (21 in the MCI group and 19 in the control group). Participants were required to perform balance tests under four conditions of standing: standing on a hard support surface with eyes open, standing on a soft support surface with eyes open, standing on a hard support surface with eyes closed, and standing on a soft support surface with eyes closed. Each test was measured in three trials and each trial lasted 30 seconds. Participants were asked to take off their shoes and place their feet in a parallel position with a 20-centimeter distance for bipedal support. The trajectories of the center of pressure (COP) were measured using a Kistler force platform with a frequency of 1000 Hz to assess balance while standing in both groups, with larger COP trajectories indicating poorer static balance in older adults. RESULTS With eyes open, the displacement of COP in the anterior-posterior direction(D-ap) (hard support surface: P = 0.003) and the 95% confidence ellipse area(95%AREA-CE) (soft support surface: P = 0.001, hard support surface: P < 0.001) of the COP in the MCI group standing on hard and soft support surfaces were significantly larger than the control group. The 95%AREA-CE (P < 0.001) of the COP in the MCI group on the soft support surface was significantly larger than on the hard support surface. With eyes closed, the root mean square distance(RDIST), root mean square distance-ML(RDISTml), and 95%AREA-CE of the COP were no significant between-group differences when standing on hard support surfaces. However, the RDIST (P = 0.014), RDISTml (P = 0.014), and 95%AREA-CE (P = 0.001) of the COP in the MCI group on the soft support surfaces were significantly larger than the control group. The 95%AREA-CE (P < 0.001), RDIST (P < 0.001), and RDISTml (P < 0.001) of the COP in the MCI group on the soft support surface were significantly larger than the hard support surface. CONCLUSION With eyes open, the older adults with MCI showed poorer static balance ability compared to the older adults with normal cognition on soft and hard support surfaces. With eyes closed, the older adults with MCI showed poorer static balance on soft support surfaces, but no differences on hard support surfaces compared with the older adults with normal cognition. With eyes open and closed, the older adults with MCI showed poorer static balance on soft support surfaces as compared to hard support surfaces.
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Affiliation(s)
- Liuxin Qi
- Graduate School of Education, Shandong Sport University, Jinan, Shandong, China
| | - Mian Zhou
- Medical Department, Weishan County People’s Hospital, Jining, Shandong, China
| | - Min Mao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jie Yang
- College of Sports and Health, Shandong Sport University, Jinan, Shandong, China
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Hill KD, Meyer C, Burton E, Hunter SW, Suttanon P, Dawes H, Lee DCA. Examining gait aid use and user safety by older people with dementia: Perspectives of informal carers to inform practice. Disabil Rehabil 2023; 45:4279-4287. [PMID: 36444878 DOI: 10.1080/09638288.2022.2148302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine gait aid use and decision-making related to usage in people with dementia, and examine factors influencing (1) gait aid use or not; and (2) falls in past year. MATERIALS AND METHODS A survey of informal carers of older people with dementia in the community. Closed questions on gait aid use, falls, timing and sources of gait aid acquisition, and advice received to support use were used. Chi-squared tests (Fisher's Exact) compared: (1) gait aid users vs non-users and carers' report of (i) unsteadiness in walking/turning, (ii) dementia severity, (iii) falls in past year, and (2) fallers vs non-fallers and (i) timing of gait aid commencement relative to dementia diagnosis, (ii) whether health professional advice was received regarding use, and iii) regularity of use. RESULTS Forty-seven completed surveys, 63.8% of care recipients used a gait aid; 56.9% had ≥2 falls in past year; 66.7% commenced use after dementia diagnosis; 25% acquired their aids from non-health professionals; and 37% did not receive advice regarding use. Gait aid users and non-users differed on carer ratings of unsteadiness in walking/turning (p = 0.02). CONCLUSION Carers reported important aspects regarding gait aid acquisition, safe gait aid use and benefits which warrant further investigation.IMPLICATIONS FOR REHABILITATIONIn our small sample, use of gait aids by people with dementia was related to the level of unsteadiness in walking and/or turning, and not associated with falling in the past year.People with dementia do not routinely receive professional advice about how to use gait aids, highlighting the potential value of maximizing health professional involvement in gait aid prescription and training.Deterioration in the ability of gait aid use after the diagnosis of dementia indicates a need for re-assessment or re-training of gait aid use over time.Clinical guidelines to facilitate decision-making regarding under what conditions gait aids are beneficial, what duration and aspects require instruction to ensure effective use by people with dementia are needed.
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Affiliation(s)
- Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- Bolton Clarke Research Institute, Brisbane, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Plaiwan Suttanon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Helen Dawes
- Intersect@Exeter, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Den-Ching A Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
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Shao L, Shi Y, Xie XY, Wang Z, Wang ZA, Zhang JE. Incidence and Risk Factors of Falls Among Older People in Nursing Homes: Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:1708-1717. [PMID: 37433427 DOI: 10.1016/j.jamda.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Falls are common among older people in nursing homes, and the assessment of fall risk factors is critical for the success of fall prevention interventions. This study aimed to systematically assess the incidence and risk factors of falls in older people living in nursing homes. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Older people living in nursing homes. METHODS Literature searches were conducted independently by 2 researchers in 8 databases. Qualities of included studies were assessed using the Newcastle-Ottawa Scale. The prevalence and risk factors of falls were analyzed with a random effects model. All analyses were performed by R software, x64 4.2.2. RESULTS In 18 prospective studies addressing older adults living in nursing homes, the pooled incidence of falls was 43% (95% CI 38%-49%), and the meta-regression analysis indicated that the incidence generally decreased from 1998 to 2021. The following risk factors had a strong association with all falls: fall history, impaired ADL performance, insomnia, and depression. Risk factors with low to moderate correlation were vertigo, walking aids, poor balance, use of antidepressants, use of benzodiazepines, use of antipsychotics, use of anxiolytics, polypharmacy, dementia, unsteady gait, hearing problems, and gender (being male). Having bed rails was identified as a protective environmental factor. CONCLUSIONS AND IMPLICATIONS The results from our meta-analysis suggest that the incidence of falls of older adults living in nursing homes is high, and the risk factors for falls are various. Assessments of balance and mobility, medical condition, and use of medications should be included as key elements in the fall risk assessments of older people in nursing homes. Environmental risk factors still need to be explored in future studies. Tailored fall prevention strategies should be implemented by addressing the modifiable risk factors.
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Affiliation(s)
- Lu Shao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Ying Shi
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xi-Yan Xie
- Nursing Department, Home for the Aged Guangzhou, Guangzhou, China
| | - Zhong Wang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Zhang-An Wang
- Research Center of Health Management, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
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13
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Schlitzer J, Friedhoff M, Nickel B, Frohnhofen H. Observed daytime sleepiness in in-hospital geriatric patients and risk of falls. Z Gerontol Geriatr 2023; 56:545-550. [PMID: 37222819 DOI: 10.1007/s00391-023-02191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Daytime sleepiness and falls are frequent in geriatric in-hospital patients; however, the relationship between both events is not clear. To test the hypothesis that observed daytime sleepiness is associated with falls in geriatric in-hospital patients data collected from medical records of patients who were admitted to an acute geriatric department were retrospectively analyzed. METHODS The data from the medical records of patients who were admitted to the geriatric department of the Alfried-Krupp-Hospital in Essen, Germany in the period from January 2018 to March 2020 were retrospectively analyzed. Personal data, data concerning the geriatric assessment, observed daytime sleepiness, and falls were recorded. RESULTS From a total of 1485 patients who were consecutively admitted to hospital, the data of 1317 (87%) patients could be included for further analysis. During the hospital stay 146 (11%) patients fell at least once, 35 (3%) patients had more than 1 fall and 64 falls (44%) occurred while patients were standing (bipedal fall). Daytime sleepiness was observed in 73% of the patients with bipedal falls and in 65% patients with nonbipedal falls (p < 0.01). Falls correlated significantly with the history of a recent fall, the length of hospital stay, the Barthel index (BI) on admission, the mini mental state examination (MMSE), dementia and observed daytime sleepiness. No correlation was found between falls and age, multimorbidity, and the number of drugs used. Drugs related to falls were medications to treat Parkinson's disease, antidepressants and neuroleptics. In a multiple logistic regression analysis in-hospital falls were significantly and independently associated with a history of falls, length of in-hospital stay, dementia, and observed daytime sleepiness. CONCLUSION Observed daytime sleepiness is associated with in-hospital falls in geriatric patients. Prospective interventional studies are needed to confirm this relationship, and to quantify the impact of sleepiness on the risk of falling. Additionally, the impact of treatment for observed daytime sleepiness on the risk of falling should be assessed. The assessment of sleepiness should become a routine task in geriatrics.
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Affiliation(s)
| | - Michaela Friedhoff
- Alfried-Krupp-Krankenhaus Essen, Alfried Krupp Str. 20, 45131, Essen, Germany
| | - Barbara Nickel
- Alfried-Krupp-Krankenhaus Essen, Alfried Krupp Str. 20, 45131, Essen, Germany
| | - Helmut Frohnhofen
- Klinik für Orthopädie und Unfallchirurgie, Heinrich Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany.
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Kim GS, Kim N, Won CW, Shim MS, Park MK, Kim M, Lee S. Cross-Lagged Panel Analysis between Physical Frailty, Cognitive Function, and Falls by Sex. J Am Med Dir Assoc 2023; 24:1541-1548.e1. [PMID: 37579927 DOI: 10.1016/j.jamda.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/10/2023] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later. DESIGN Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS). SETTING AND PARTICIPANTS A total of 2318 community-dwelling older adults aged 70-84 years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men. METHODS PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used. RESULTS The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β) = 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β = 0.041, 95% CI 0.006-0.076; P = .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β = 0.063, 95% CI 0.012-0.114; P = .015). CONCLUSIONS AND IMPLICATIONS Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement and maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea.
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Min Kyung Park
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seoyoon Lee
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
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Tzeng HM, Downer B, Li CY, Raji M, Haas A, Kuo YF. Association Between Cognitive Impairment and Repeat Fractures in Medicare Beneficiaries Recently Hospitalized for Hip Fracture. J Gerontol A Biol Sci Med Sci 2023; 78:1677-1682. [PMID: 36810779 PMCID: PMC10460551 DOI: 10.1093/gerona/glad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Repeat fractures contribute substantially to fracture incidents in older adults. We examined the association between cognitive impairment and re-fractures during the first 90 days after older adults with hip fractures were discharged home from a skilled nursing facility rehabilitation short stay. METHODS Multilevel binary logistic regression was used to analyze 100% of U.S. national postacute-care fee-for-service Medicare beneficiaries who had a hospital admission for hip fracture from January 1, 2018, to July 31, 2018; were admitted for a skilled nursing facility stay within 30 days of hospital discharge; and were discharged to the community after a short stay. Our primary outcome was rehospitalization for any re-fractures within 90 days of skilled nursing facility discharge. Cognitive status assessed at skilled nursing facility admission or before discharge was classified as either intact or having mild or moderate/severe impairment. RESULTS In 29 558 beneficiaries with hip fracture, odds of any re-fracture were higher in those with minor (odds ratio: 1.48; 95% confidence interval: 1.19-1.85; p < .01) and moderate/major cognitive impairment (odds ratio: 1.42; 95% confidence interval: 1.07-1.89; p = .0149) than in those classified as intact. CONCLUSIONS Beneficiaries with cognitive impairment were more likely than their counterparts with no cognitive impairment to experience re-fractures. Community-dwelling older adults with minor cognitive impairment may experience a higher likelihood of experiencing a repeat fracture leading to rehospitalization.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
| | - Brian Downer
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- School of Health Professions, University of Texas Medical Branch, Galveston, USA
| | - Chih-Ying Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- School of Health Professions, University of Texas Medical Branch, Galveston, USA
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- Department of Internal Medicine, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Allen Haas
- Office of Biostatics, University of Texas Medical Branch, Galveston, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- Office of Biostatics, University of Texas Medical Branch, Galveston, USA
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, USA
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Sempere-Bigorra M, Julián-Rochina I, Pérez-Ros P, Navarro-Flores E, Martínez-Arnau FM, Cauli O. Relationship between Cognitive Impairment and Depressive Symptoms with Somatosensory Functions in Diabetic and Non-Diabetic Older Adults and Its Impact on Quality of Life. Life (Basel) 2023; 13:1790. [PMID: 37763194 PMCID: PMC10532541 DOI: 10.3390/life13091790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
Aging is an inevitable process that impacts the peripheral and central nervous systems and is considered one of the strongest risk factors for neurodegenerative diseases. In addition, when it also presents with diabetes mellitus, the risk of neurological damage may be further increased. This current study aimed to explore the relationships between peripheral sensory system decline and cognitive functions, the symptoms of depression, and quality of life (QoL) as metrics of central nervous system impairment in institutionalized older adults. A total of 95 individuals participated in this case-control study, which included diabetics and non-diabetics. The superficial sensory pathway was assessed in terms of thermal sensation, nociception, and non-discriminative touch, and the deep sensory pathway was evaluated by assessing vibration and light touch-pressure sensations. To assess function at the intellectual level, the Mini-Mental State Examination (MMSE) and Trail Making Test (TMT) cognitive functional tests were used, while the symptoms of depression and QoL were explored by employing the Yesavage Geriatric Depression Scale and EuroQol 5D questionnaire (EQ-5D), respectively. In the overall population analyses, altered thermal sensation was significantly associated with cognitive impairment (CI; p < 0.05). In turn, bivariate analyses and a binary logistic regression showed that the symptoms of depression and QoL were significantly related to altered vibratory sensation when assessed using a medical tuning fork (p < 0.05). In the group of diabetic patients, those with CI also had significantly lower thermal sensation (p < 0.05) and non-discriminative touch sensation, although this was only a trend (p = 0.055). Diabetics with depression had a significantly worse non-discriminative touch (p < 0.05) and vibratory sensation when tested with a tuning fork (p < 0.05). In addition, poorer QoL was associated with reduced sensitivity to heat (p < 0.05), light touch pressure (p < 0.05), and vibrations when assessed either with a tuning fork (p < 0.05) or a biothesiometer (p < 0.05). In contrast, no relationships were found between sensory functions and cognitive assessments in non-diabetic patients. These findings indicate that superficial sensitivity damage was related to CI, while deep sensation alterations were related to depression and poor QoL, with diabetes apparently further strengthening these relationships.
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Affiliation(s)
- Mar Sempere-Bigorra
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Iván Julián-Rochina
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Pilar Pérez-Ros
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Emmanuel Navarro-Flores
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Francisco Miguel Martínez-Arnau
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
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Zhang T, Yang C, Shu G, Gao C, Ma H, Zou L, Zuo J, Liu S, Yan J, Hu Y. The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults. Front Med (Lausanne) 2023; 10:1190831. [PMID: 37359023 PMCID: PMC10285398 DOI: 10.3389/fmed.2023.1190831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Background Cognitive impairment has been reported to be associated with falls in older adults. However, the complex relationship among falls, cognitive impairment and its associated factors, which could be targeted with specific interventions, remains to be elucidated. This study aimed to examine the direct effects of cognitive impairment on falls, to identify the factors associated with cognitive impairment and to explore the mediation role of cognitive impairment in the association of fall with cognition related factors. Methods This 1-year follow-up cohort study enrolled old adults aged 60 years or over. Information about demographic and anthropometric characteristics, fall outcomes, function and nutritional status were collected through face-to-face interview. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Multivariable regression analyses were used to test the association between cognitive impairment and falls and to identify the factors related to cognitive impairment. Additionally, we conduct causal mediation analyses to estimate the mediation effects of cognitive impairment in the pathways of fall occurrence. Results Of the 569 participants included in this study, 366 (64.32%) had cognitive impairment, 96 (16.87%) had fall history in the past 1 year, 81 (14.24%) experienced fall and 47 (8.26%) received treatment because of falling during the 1-year follow-up. The association between cognitive impairment and 1-year fall risk was confirmed after adjusting for multiple covariates [odds ratio (OR):2.03, 95% confidence interval (CI): 1.13-3.80]. IADL disability, depression and low grip strength were associated with a higher prevalence of cognitive impairment. While overweight, higher education and higher income level were found to be related to a lower risk of cognitive impairment. Among these associated factors, cognitive impairment mediated the positive association of falling with IADL ability and depression, and a negative relationship with education and income level. Conclusion Our study not only confirmed the direct influence of cognitive impairment on fall risk in older adults, but also suggested a mediating role that cognitive impairment played in the pathways of fall occurrence. Our finding could help develop more specific interventions for fall prevention.
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Affiliation(s)
- Tianyi Zhang
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing, China
| | - Cunmei Yang
- Geriatric Health Care Department 4th of The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Gangming Shu
- Geriatric Health Care Department 4th of The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Chang Gao
- Geriatric Health Care Department 4th of The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hongying Ma
- Geriatric Health Care Department 4th of The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Lin Zou
- Geriatric Health Care Department 1st of The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Zuo
- Geriatric Health Care Department 1st of The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shaoni Liu
- Geriatric Health Care Department 1st of The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jin Yan
- Graduate School of Chinese PLA General Hospital, Beijing, China
| | - Yixin Hu
- Geriatric Health Care Department 4th of The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Zou M, Lu R, Jiang Y, Liu P, Tian B, Liang Y, Wang X, Jiang L. Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study. BMJ Open 2023; 13:e065544. [PMID: 37263694 DOI: 10.1136/bmjopen-2022-065544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES This study aimed to explore the potential risk factors associated with toileting-related falls in community-dwelling older adults who presented to the emergency department and were subsequently hospitalised. DESIGN This was a cross-sectional study. SETTING AND PARTICIPANTS This study was conducted in two teaching hospitals in Shanghai, China between October 2019 and December 2021 among community-dwelling adults aged ≥60 years. METHODS In-person interviews, physical assessment and medical record review were performed to collect data on the characteristics and risk factors of falls. Associations of toileting-related falls with demographic characteristics and geriatric syndromes were examined using logistic regression models. MAIN OUTCOME MEASURES Potential risk factors for toileting-related falls. RESULTS This study included 419 older patients with a mean age of 73.8±9.7 years. Among 60 (14.3%) patients with toileting-related falls (mean age: 78.8±9.2 years), 63.3% of toileting-related falls, mainly occurred between 00:00 and 05:59 hours, compared with 17.3% of non-toileting-related falls, which primarily occurred during the daytime. The rate of recurrent falls (35%) was significantly higher in the toileting-related falls group than in the non-toileting-related falls group (21.2%) (p=0.02). Logistic regression showed that visual impairment (OR 2.7, 95% CI 1.1 to 7.1), cognitive impairment (OR 3.3, 95% CI 1.3 to 8.4), gait instability (OR 3.1, 95% CI 1.1 to 8.8) and urinary incontinence (OR 3.4, 95% CI 1.2 to 9.9) were strongly associated with toileting-related falls. Twenty-three (38.3%) patients in the toileting-related falls group had moderate and severe injuries, compared with 71.7% in the non-toileting-related falls group (p<0.05). CONCLUSIONS This study revealed that patients who reported toileting-related falls were more likely to have cognitive impairment, urinary incontinence, gait instability, visual impairment than patients who fell during other activities. Social and healthcare professionals should prioritise the management of toileting activities in older patients and provide targeted interventions to those in the high-risk group.
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Affiliation(s)
- Min Zou
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Emergency Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Lu
- Emergency Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijun Jiang
- Department of Pharmaceutics, Shanghai Pharmaceutical School, Shanghai, China
| | - Ping Liu
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bingjie Tian
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Liang
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - XiaoLing Wang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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19
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Rodrigues RG, Dalboni MA, Correia MDA, Dos Reis LM, Moyses RMA, Elias RM. Calf Circumference Predicts Falls in Older Adults on Hemodialysis. J Ren Nutr 2023; 33:363-367. [PMID: 36155086 DOI: 10.1053/j.jrn.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/06/2022] [Accepted: 08/21/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Older patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis are at a higher risk of falling. However, there is no standard method to screen patients at higher risk. We have evaluated whether calf circumference (CC) measurement would be able to predict falls in this population. METHODS This is a prospective study that enrolled patients aged ≥65 years on conventional hemodialysis, followed for 6 months. The presence of falls was associated with demographical, clinical, and biochemical data. Reduced CC was set at <34 cm for men and <33 cm for women. We evaluated physical status using Duke activity status index (DASI) and hand grip strength (HGS). RESULTS Ninety-one patients were included (age 73.7 ± 5.4 years, 69.2% men, 56% with diabetes). Mean CC was 32.6 ± 3.7 cm, with a high prevalence of reduced CC (61.5%). During the follow-up, 13 falls were identified (1 had a fracture and died). These patients were older and heavier (P = .017 and P = .025, respectively). Most falls occurred in patients with sarcopenic obesity (BMI >27 kg/m2 plus reduced HGS or reduced CC). In a logistic regression model, reduced CC (hazard ratio (HR) 7.81, confidence interval (CI): 1.13-53.86, P = .037), higher age (HR 1.19, CI: 1.04-1.36, P = .011), and higher body weight (relative risk (RR) 1.13, CI: 1.04-1.22, P = .003) were independently associated with falls in a fully adjusted model. CONCLUSION CC measurement, an easy and nonexpensive tool, was able to predict falls in older patients on HD. Further studies should test the inclusion of CC in a fall risk assessment in older patients on hemodialysis.
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Affiliation(s)
| | | | | | - Luciene M Dos Reis
- LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Rosa M A Moyses
- LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Rosilene M Elias
- Post Graduation, Universidade Nove de Julho (UNINOVE), Brazil; LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil.
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20
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Lee DCA, Burton E, Meyer C, Haines TP, Hunter S, Dawes H, Suttanon P, Fullarton S, Connelly F, Stout JC, Hill KD. The Potential for Effect of a Six-Week Training Program for Gait Aid Use in Older People with Dementia with Unsteadiness of Gait: A Pilot Study. J Clin Med 2023; 12:jcm12041574. [PMID: 36836110 PMCID: PMC9967216 DOI: 10.3390/jcm12041574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
This study examined the potential for effect of a six-week gait aid training program for people with dementia on spatiotemporal gait outcomes, perception of use, and falls with gait aid use. The program utilised four 30-min physiotherapy home visits, scheduled at weeks 1/2/3/6, and was enhanced by carer-supervised practice. Falls and the physiotherapist's clinical judgement of participants achieving safe gait aid use during and after the program were described. Perception ratings at each visit were measured using Likert scales which, along with the spatiotemporal outcomes using the gait aid (Time-Up-and-Go-Test, 4-m-walk-test, Figure-of-8-Walk-Test with/without a cognitive task) at weeks 1 and 6, and at weeks 6 and 12 (6-week post-program), were examined with ordinal logistic regression analyses. Twenty-four community-dwelling older people with dementia and their carers participated. Twenty-one (87.5%) older people achieved safe gait aid use. Twenty falls occurred, and only one faller was using their gait aid when they fell. Walking speed, step length, and cadence significantly improved when walking with the gait aid at week 6 compared with week 1. No significant improvements in spatiotemporal outcomes were retained at week 12. Physiotherapists were more likely to agree that gait aid use had improved walking safety among older people with dementia with subsequent training visits. Larger studies of the gait aid training program are needed for this clinical group.
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Affiliation(s)
- Den-Ching A. Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
- Correspondence: ; Tel.: +613-9904-4662
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, VIC 3199, Australia
- Bolton Clarke Research Institute, Forest Hill VIC 3131, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, VIC 3086, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Terry P. Haines
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia
| | - Susan Hunter
- School of Physical Therapy, University of Western Ontario, London, ON N6G 1H1, Canada
| | - Helen Dawes
- NIHR Exeter BRC, Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Plaiwan Suttanon
- Thammasat University Research Unit in Health, Physical Performance, Movement, and Quality of Life for Longevity Society, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand
| | - Stephanie Fullarton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Fiona Connelly
- Department of Geriatric Medicine, Armadale Kalamuda Group, Armadale Health Service, Perth, WA 6112, Australia
| | - Julie C. Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
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21
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Donnell DO, Romero-Ortuno R, Kennelly SP, O’Neill D, Donoghue PO, Lavan A, Cunningham C, McElwaine P, Kenny RA, Briggs R. The 'Bermuda Triangle' of orthostatic hypotension, cognitive impairment and reduced mobility: prospective associations with falls and fractures in The Irish Longitudinal Study on Ageing. Age Ageing 2023; 52:7024511. [PMID: 36735845 PMCID: PMC9897301 DOI: 10.1093/ageing/afad005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Orthostatic hypotension (OH), cognitive impairment (Cog) and mobility impairment (MI) frequently co-occur in older adults who fall. This study examines clustering of these three geriatric syndromes and ascertains their relationship with future falls/fractures in a large cohort of community-dwelling people ≥ 65 years during 8-year follow-up. METHODS OH was defined as an orthostatic drop ≥ 20 mmHg in systolic blood pressure (from seated to standing) and/or reporting orthostatic unsteadiness. CI was defined as Mini Mental State Examination ≤ 24 and/or self-reporting memory as fair/poor. MI was defined as Timed Up and Go ≥12 s. Logistic regression models, including three-way interactions, assessed the longitudinal association with future falls (explained and unexplained) and fractures. RESULTS Almost 10% (88/2,108) of participants had all three Bermuda syndromes. One-fifth of participants had an unexplained fall during follow-up, whereas 1/10 had a fracture. There was a graded relationship with incident unexplained falls and fracture as the number of Bermuda syndromes accumulated. In fully adjusted models, the cluster of OH, CI and MI was most strongly associated with unexplained falls (odds ratios (OR) 4.33 (2.59-7.24); P < 0.001) and incident fracture (OR 2.51 (1.26-4.98); P = 0.045). Other clusters significantly associated with unexplained falls included OH; CI and MI; MI and OH; CI and OH. No other clusters were associated with fracture. DISCUSSION The 'Bermuda Triangle' of OH, CI and MI was independently associated with future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.
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Affiliation(s)
- Desmond O Donnell
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Roman Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Sean P Kennelly
- Age-Related Health Care, Tallaght University Hospital, Dublin 24, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Desmond O’Neill
- Age-Related Health Care, Tallaght University Hospital, Dublin 24, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Patrick O Donoghue
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Amanda Lavan
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Conal Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Paul McElwaine
- Age-Related Health Care, Tallaght University Hospital, Dublin 24, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Rose Anne Kenny
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Robert Briggs
- Address correspondence to: Robert Briggs. Tel: (+35) 314284105.
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Leroy V, Martinet V, Nunkessore O, Dentel C, Durand H, Mockler D, Puisieux F, Fougère B, Chen Y. The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2628. [PMID: 36767992 PMCID: PMC9915123 DOI: 10.3390/ijerph20032628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment. METHODS According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist. RESULTS We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another. CONCLUSION It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
- Memory Clinic, Tours University Hospital, 37000 Tours, France
| | - Valérie Martinet
- Department of Geriatrics, Saint-Pierre Hospital, ULB, 1000 Brussels, Belgium
| | | | | | - Hélène Durand
- Department of Neurology, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - David Mockler
- Medical Library, Trinity Centre for the Health Sciences, St James’ Hospital, D08 W9RT Dublin, Ireland
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- EA2694, Lille University, 59000 Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University of Lille, 59000 Lille, France
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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23
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Li Y, Hou L, Zhao H, Xie R, Yi Y, Ding X. Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis. Front Med (Lausanne) 2023; 9:1019094. [PMID: 36687461 PMCID: PMC9853191 DOI: 10.3389/fmed.2022.1019094] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/02/2022] [Indexed: 01/09/2023] Open
Abstract
Background and objective The prevalence of falls among older adults living in the community is ~30% each year. The impacts of falls are not only confined to the individual but also affect families and the community. Injury from a fall also imposes a heavy financial burden on patients and their families. Currently, there are different reports on the risk factors for falls among older adults in the community. A retrospective analysis was used in this study to identify risk factors for falls in community-dwelling older adults. This research aimed to collect published studies to find risk factors for falls in community-dwelling older adults. Methods We searched for literature from the founding of PubMed, EMBASE, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Periodicals Database (VIP), and the Wanfang database until September 2022. The studies were selected using inclusion and exclusion criteria. We collected information from relevant studies to compare the impact of potential risk factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorder on falls among community-dwelling older adults. Results A total of 31 studies were included with 70,868 community seniors. A significant risk factor for falls in the community of older adults was dementia (2.01, 95% CI: 1.41-2.86), age (1.15, 95% CI: 1.09-1.22), female gender (1.52, 95% CI: 1.27-1.81), fear of falling (2.82, 95% CI: 1.68-4.74), history of falls (3.22, 95% CI: 1.98-5.23), vision unclear (1.56, 95% CI: 1.29-1.89), depression (1.23, 95% CI: 1.10-1.37), and balance disorder (3.00, 95% CI: 2.05-4.39). Conclusion This study provides preliminary evidence that falls among community-dwelling older adults are associated with factors such as age, female gender, fear of falling, history of falls, unclear vision, depression, and balance disorders. The results of this research may help improve clinician awareness, risk stratification, and fall prevention among community-dwelling older adults. Systematic review registration identifier INPLASY2022120080.
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Affiliation(s)
- Ying Li
- School of Nursing, Weifang University of Science and Technology, Weifang, Shandong, China
| | - Lingyu Hou
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Hanping Zhao
- School of Nursing, Weifang University of Science and Technology, Weifang, Shandong, China
| | | | - Yue Yi
- Department of Neurology, Shandong Guoxin Senior Care Group Laiwu Central Hospital, Jinan, China
| | - Xiaorong Ding
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, China
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24
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Ming X, Guo R, Liu M, He X, Guo F, Gao S. Associations of Household Solid Fuel Use With Falls and Fall-Related Injuries in Middle-Aged and Older Population in China: A Cohort Study. Int J Public Health 2023; 67:1605425. [PMID: 36686388 PMCID: PMC9852047 DOI: 10.3389/ijph.2022.1605425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
Objective: This study evaluated the associations of solid fuels with incidence of falls and fall-related injuries. Methods: Data were taken from wave 1∼4 of the China Health and Retirement Longitudinal Study, including 15,651 participants aged 45 years and older. Modified Poisson regression was used to examine the associations of solid fuels with falls and fall-related injuries. Results: Modified Poisson regression analysis showed that solid fuels users for cooking had an increasing incidence of falls and fall-related injuries, with RR of 1.211 (95% CI: 1.124, 1.305) and 1.248 (95% CI: 1.107, 1.408); for heating had an incidence, with RR of 1.178 (95% CI: 1.062, 1.306) and 1.134 (95% CI: 0.963, 1.335); combined for cooking and heating, with RR of 1.247 (95% CI: 1.105, 1.408) and 1.185 (95% CI: 0.982, 1.431). Conclusion: Our study suggests that solid fuel use is associated with a higher incidence of falls and fall-related injuries among adults aged 45 years and older in China. It is necessary to restrict solid fuel use to reduce household air pollution and make stronger environmental protection policies to improve household environment.
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Affiliation(s)
- Xing Ming
- Pathophysiology Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Ruixiao Guo
- Pathophysiology Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Mengli Liu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China
| | - Xiaoman He
- Pathophysiology Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Feifei Guo
- Pathophysiology Department, School of Basic Medicine, Qingdao University, Qingdao, China,*Correspondence: Feifei Guo, ; Shengli Gao,
| | - Shengli Gao
- Biomedical Center, Qingdao medical College, Qingdao University, Qingdao, China,*Correspondence: Feifei Guo, ; Shengli Gao,
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25
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Abstract
The frontal lobe is crucial and contributes to controlling truncal motion, postural responses, and maintaining equilibrium and locomotion. The rich repertoire of frontal gait disorders gives some indication of this complexity. For human walking, it is necessary to simultaneously achieve at least two tasks, such as maintaining a bipedal upright posture and locomotion. Particularly, postural control plays an extremely significant role in enabling the subject to maintain stable gait behaviors to adapt to the environment. To achieve these requirements, the frontal cortex (1) uses cognitive information from the parietal, temporal, and occipital cortices, (2) creates plans and programs of gait behaviors, and (3) acts on the brainstem and spinal cord, where the core posture-gait mechanisms exist. Moreover, the frontal cortex enables one to achieve a variety of gait patterns in response to environmental changes by switching gait patterns from automatic routine to intentionally controlled and learning the new paradigms of gait strategy via networks with the basal ganglia, cerebellum, and limbic structures. This chapter discusses the role of each area of the frontal cortex in behavioral control and attempts to explain how frontal lobe controls walking with special reference to postural control.
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Affiliation(s)
- Kaoru Takakusaki
- Department of Physiology, Division of Neuroscience, Asahikawa Medical University, Asahikawa, Japan.
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26
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Levin O, Vints WAJ, Ziv G, Katkutė G, Kušleikienė S, Valatkevičienė K, Sheoran S, Drozdova-Statkevičienė M, Gleiznienė R, Pääsuke M, Dudonienė V, Himmelreich U, Česnaitienė VJ, Masiulis N. Neurometabolic correlates of posturography in normal aging and older adults with mild cognitive impairment: Evidence from a 1H-MRS study. Neuroimage Clin 2023; 37:103304. [PMID: 36580713 PMCID: PMC9827054 DOI: 10.1016/j.nicl.2022.103304] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/03/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) holds promise for revealing and understanding neurodegenerative processes associated with cognitive and functional impairments in aging. In the present study, we examined the neurometabolic correlates of balance performance in 42 cognitively intact older adults (healthy controls - HC) and 26 older individuals that were diagnosed with mild cognitive impairment (MCI). Neurometabolite ratios of total N-acetyl aspartate (tNAA), glutamate-glutamine complex (Glx), total choline (tCho) and myo-inositol (mIns) relative to total creatine (tCr) were assessed using single voxel 1H-MRS in four different brain regions. Regions of interest were the left hippocampus (HPC), dorsal posterior cingulate cortex (dPCC), left sensorimotor cortex (SM1), and right dorsolateral prefrontal cortex (dlPFC). Center-of-pressure velocity (Vcop) and dual task effect (DTE) were used as measures of balance performance. Results indicated no significant group differences in neurometabolite ratios and balance performance measures. However, our observations revealed that higher tCho/tCr and mIns/tCr in hippocampus and dPCC were generic predictors of worse balance performance, suggesting that neuroinflammatory processes in these regions might be a driving factor for impaired balance performance in aging. Further, we found that higher tNAA/tCr and mIns/tCr and lower Glx/tCr in left SM1 were predictors of better balance performance in MCI but not in HC. The latter observation hints at the possibility that individuals with MCI may upregulate balance control through recruitment of sensorimotor pathways.
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Affiliation(s)
- Oron Levin
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium
| | - Wouter A J Vints
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University P.O. Box 616, 6200 MD Maastricht, the Netherlands; Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, The Netherlands.
| | - Gal Ziv
- The Academic College at Wingate, Netanya 4290200, Israel
| | - Gintarė Katkutė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Simona Kušleikienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Kristina Valatkevičienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Samrat Sheoran
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | | | - Rymantė Gleiznienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mati Pääsuke
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Estonia
| | - Vilma Dudonienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Uwe Himmelreich
- Biomedical MRI Unit, Department of Imaging and Pathology, Group Biomedical Sciences, KU Leuven, Leuven 3000, Belgium
| | - Vida J Česnaitienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Nerijus Masiulis
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Science, Vilnius University, Vilnius, Lithuania
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Six-month change in gait speed to discriminate between those with and without falls history in older people with Mild Cognitive Impairment and mild Alzheimer disease. Geriatr Nurs 2022; 48:274-279. [PMID: 36335854 DOI: 10.1016/j.gerinurse.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE The purposes of this study were to identify differences in gait speed performance over 6 months between older people with Preserved Cognition (PrC), with Mild Cognitive Impairment (MCI) and with Alzheimer disease (AD) in mild stage; and to verify if the change in gait speed could discriminate fallers in older people with MCI and AD in a mild stage METHODS: A longitudinal study was conducted with community-dwelling older adults, including 40 with PrC, 36 with MCI and 34 with AD in the mild stage. Gait speed (in m/s) changes were captured through a 10-meter walk test. We documented the number of self-reported falls by monthly calendars that were returned after a 6-month follow-up. During this period, the participants received monthly telephone calls to remind them to fill in the calendar RESULTS: There was a significant difference in terms of sex and age between the groups: 23%, 31% and 19% were female and had a mean age of 72.8, 75.9 and 76.9 years in the PrC, MCI and AD groups respectively. During the follow-up, 45%, 52.7% and 52.9% of the PrC, MCI and AD groups fell. The MCI and AD groups presented lower gait speed compared to the PrC Group at both moments. There was no significant difference in the change of gait speed between groups. In the model adjusted by age, the change in gait speed failed to discriminate fallers in older people with MCI and with AD CONCLUSION: Older people with MCI and AD in the mild stage present lower gait speed compared to older people with PrC. Changes in gait speed over a short period of time do not discriminate fallers in older people with MCI or AD in a mild stage.
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Conduction Velocity of Spinal Reflex in Patients with Acute Lateral Ankle Sprain. Healthcare (Basel) 2022; 10:healthcare10091794. [PMID: 36141406 PMCID: PMC9498455 DOI: 10.3390/healthcare10091794] [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: 07/27/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
Recent literature has highlighted altered spinal-reflex excitability following acute lateral ankle sprain (ALAS), yet there is little information on the conduction velocity of spinal reflex pathways (CV-SRP) in these patients. Therefore, we aimed to investigate the effects of ALAS on the CV-SRP. We employed a cross-sectional study with two groups: ALAS (n = 30) and healthy controls (n = 30). The CV-SRP of the soleus, fibularis longus, and tibialis anterior was assessed using the H-index method. As secondary outcomes, H-reflex and M-wave latencies were assessed as well as acute symptoms including ankle swelling, pain, and self-reported ankle function. Separate group-by-limb ANOVA with repeated measures revealed a significant interaction for soleus CV-SRP (p < 0.001) and H-reflex latency (p < 0.001), showing significant slower CV-SRP and longer H-reflex latency in the involved limb of the ALAS group compared with both limbs in the control group. However, there was no significant interaction or main effect in any other ankle muscles (p > 0.05). A further correlation analysis showed a significant relationship between CV-SRP and acute symptoms, including ankle swelling (r = −0.37, p = 0.048) and self-reported ankle function (r = 0.44, p = 0.017) in ALAS patients. These results suggest a disrupted functionality of the afferent pathway and/or synaptic transmission following ALAS. Level of Evidence: 4.
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Zhou Y, Li LD. Exercise training for cognitive and physical function in patients with mild cognitive impairment: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30168. [PMID: 36042589 PMCID: PMC9410583 DOI: 10.1097/md.0000000000030168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This systematic review evaluates the effect of exercise training in the treatment of patients with mild cognitive impairment (MCI). METHODS PubMed, Medline, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to Oct 2021 in order to identify randomized controlled trials (RCTs) which evaluated the effects of physical exercise in persons with MCI. Changes of cognitive and physical function were tested using pre- and postMMSE and TUG scores, and were compared with control intervention. RESULTS A total of 10 RCTs involving 635 MCI patients were included in the meta-analysis. Physical exercise improved MMSE scores (MD 0.71, 95 % CI 0.57 to 0.85, P < .00001, I2 = 95 %) and TUG performance (MD -0.82, 95 % CI -1.20 to -0.45, P < .00001, I2 = 12 %) in patients with MCI. CONCLUSIONS This meta-analysis demonstrated a positive effect of exercise training in people with MCI in relation to cognitive and physical function. These findings suggest exercise interventions be persistent, and reveal that more high-quality researches are needed.
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Affiliation(s)
- Yue Zhou
- Department of Neurology, The People’s Hospital Affiliated to Ningbo University, Ningbo 315040, Zhejiang Province, China
- *Correspondence: Yue Zhou (e-mail: )
| | - Liang-da Li
- Department of Neurology, The People’s Hospital Affiliated to Ningbo University, Ningbo 315040, Zhejiang Province, China
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Nakhostin-Ansari A, Naghshtabrizi N, Naghdi S, Ghafouri M, Khalifeloo M, Mohammadzadeh M, Vezvaei P, Nakhostin Ansari N. Normative values of functional reach test, single-leg stance test, and timed “UP and GO” with and without dual-task in healthy Iranian adults: A cross-sectional study. Ann Med Surg (Lond) 2022; 80:104053. [PMID: 36045774 PMCID: PMC9422043 DOI: 10.1016/j.amsu.2022.104053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Balance impairment is a common problem in all age groups. There are several tools to assess balance. Functional reach test (FRT), single-leg stance (SLS) test, timed up and go (TUG) test, and TUG with the cognitive dual-task (TUGcog) are commonly employed balance tests. The current study aimed to determine the normative values of FRT, SLST, TUG, and TUGcog across age groups and genders in healthy Iranian adults. Methods We designed a cross-sectional study, and 240 healthy adults (120 males and 120 females) in six age groups (18–29, 30–39, 40–49, 50–59, 60–69, ≥70 years) completed FRT, SLST, TUG, and TUGcog based on the Persian version of BESTest instructions. Results There were significant age-specific declines in balance performances. Gender had effects on 18–29 years and older adults (≥60 years), and males performed better than females. Male and females had similar performance on the TUG and TUGcog tests in 60–69 years (p > 0.05). Conclusions The normative values of FRT, SLS, TUG, and TUGcog provided for healthy Iranian adults increase the clinical utility of tests, and serve as a reference to estimating the individuals’ balance performance across age and gender groups. This study provided reference values of four balance tests for Iranian adults. Performance in balance tests declines with age among Iranian adults. In most age groups, there is no significant difference between males and females regarding their balance.
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Beck Jepsen D, Robinson K, Ogliari G, Montero-Odasso M, Kamkar N, Ryg J, Freiberger E, Tahir M. Predicting falls in older adults: an umbrella review of instruments assessing gait, balance, and functional mobility. BMC Geriatr 2022; 22:615. [PMID: 35879666 PMCID: PMC9310405 DOI: 10.1186/s12877-022-03271-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background To review the validated instruments that assess gait, balance, and functional mobility to predict falls in older adults across different settings. Methods Umbrella review of narrative- and systematic reviews with or without meta-analyses of all study types. Reviews that focused on older adults in any settings and included validated instruments assessing gait, balance, and functional mobility were included. Medical and allied health professional databases (MEDLINE, PsychINFO, Embase, and Cochrane) were searched from inception to April 2022. Two reviewers undertook title, abstract, and full text screening independently. Review quality was assessed through the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS). Data extraction was completed in duplicate using a standardised spreadsheet and a narrative synthesis presented for each assessment tool. Results Among 2736 articles initially identified, 31 reviews were included; 11 were meta-analyses. Reviews were primarily of low quality, thus at high risk of potential bias. The most frequently reported assessments were: Timed Up and Go, Berg Balance Scale, gait speed, dual task assessments, single leg stance, functional Reach Test, tandem gait and stance and the chair stand test. Findings on the predictive ability of these tests were inconsistent across the reviews. Conclusions In conclusion, we found that no single gait, balance or functional mobility assessment in isolation can be used to predict fall risk in older adults with high certainty. Moderate evidence suggests gait speed can be useful in predicting falls and might be included as part of a comprehensive evaluation for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03271-5.
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Affiliation(s)
- D Beck Jepsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - K Robinson
- Department of Health Care for Older People (HCOP), Research and Innovation, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. .,School of Medicine, University of Nottingham, Nottingham, UK.
| | - G Ogliari
- Department of Health Care for Older People (HCOP), Research and Innovation, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, SLawson Health Research Institute, London, ON, Canada.,Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario London, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - N Kamkar
- Gait and Brain Lab, Parkwood Institute, SLawson Health Research Institute, London, ON, Canada
| | - J Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - E Freiberger
- Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nuremberg, Germany
| | - Masud Tahir
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Health Care for Older People (HCOP), Research and Innovation, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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32
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Burns ER, Lee R, Hodge SE, Pineau VJ, Welch B, Zhu M. Validation and comparison of fall screening tools for predicting future falls among older adults. Arch Gerontol Geriatr 2022; 101:104713. [PMID: 35526339 PMCID: PMC10543920 DOI: 10.1016/j.archger.2022.104713] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Falls are the leading cause of injuries among older adults in the United States (US). Falls are preventable and clinicians are advised to screen for fall risk yearly. There are many falls screening tools and not all have been validated for their ability to predict future falls. METHODS We enrolled 1905 community-dwelling older adults into a 13-month study using a probability-based representative panel of the US population recruited from NORC at the University of Chicago's National Frame. Respondents completed a baseline survey, 11 monthly fall calendars, and a final survey. The baseline survey included six falls screening tools (the Stay Independent, Three Key Questions (3KQ), a modified American Geriatric/British Geriatric tool, the short Falls Efficacy-1[FES-I]) and two single screening questions ("I have fallen in the past year" and "How many times did you fall in the past 12 months?"). The baseline and final survey collected demographic and health information, including falls. Sensitivity, specificity, positive and negative likelihood ratios, and corresponding 95% confidence intervals were calculated in SAS using weighted proportions. RESULTS There were 1563 respondents who completed the final survey (completion rate 82%). Sensitivity estimates ranged from 22.5% for the short FES-I to 68.7% for the 3KQ. Specificity estimates ranged from 57.9% for the 3KQ to 89.4% for the short FES-I. CONCLUSIONS Falls screening tools have varying sensitivity and specificity for predicting the occurrence of a fall in the following 12 months.
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Affiliation(s)
- Elizabeth R Burns
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States.
| | - Robin Lee
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
| | | | | | - Bess Welch
- NORC at the University of Chicago, United States
| | - Meimeizi Zhu
- NORC at the University of Chicago, United States
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Zhou R, Li J, Chen M. The Association Between Cognitive Impairment and Subsequent Falls Among Older Adults: Evidence From the China Health and Retirement Longitudinal Study. Front Public Health 2022; 10:900315. [PMID: 35784248 PMCID: PMC9240660 DOI: 10.3389/fpubh.2022.900315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Previous studies have suggested that cognitive impairment is associated with falls in older adults. However, the consistency of results among different subgroups defined by multiple characteristics of the elderly has not yet been tested. Additionally, results are inconsistent regarding the effects of different cognitive domains on falls. Therefore, this study sought to use representative data from a nationwide study to better understand the longitudinal association between cognitive impairment and subsequent falls in older adults. Methods The current study was conducted based on the China Health and Retirement Longitudinal Study (CHARLS) data of respondents aged ≥60 years in 2015 and the fall data in 2018. The respondents were divided into subgroups according to different demographic characteristics. Multiple logistic regression analysis was conducted to adjust for various confounding factors and evaluate the association between cognitive impairment and falls. Results Of the 5,110 respondents included in this study, 1,093 (21.39%) had falls within the last 2 years. A significant association was found between cognitive impairment and subsequent falls (OR = 0.97, 95% CI 0.95–0.99, P = 0.001) after adjusting for all of the covariates related to falls. Analysis of different cognitive domains showed that orientation (OR = 0.94, 95% CI 0.90–0.99, P = 0.013) and memory (OR = 0.93, 95% CI 0.90–0.97, P = 0.001) were significantly associated with falls. In subgroup analysis, the ORs of people aged 60–74 years, male, with lower education level were 0.97 (95% CI 0.95–0.99, P = 0.008), 0.96 (95% CI 0.93–0.98, P = 0.001), and 0.97 (95% CI 0.95–0.99, P = 0.001), respectively, suggesting that the associations were also statistically significant in these subgroups. There was also a significant association both in urban (OR = 0.97, 95% CI 0.95–0.99, P = 0.001) and in rural residents (OR = 0.97, 95% CI 0.95–0.99, P = 0.003). Conclusions Our results suggest that the associations between cognition and falls vary depending on the different demographic characteristics of older adults. These findings may be useful for designing more accurate identification and intervention for the fall risk for specific high-risk groups.
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Affiliation(s)
- Rong Zhou
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiayu Li
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Meiling Chen
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Meiling Chen
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Chantanachai T, Taylor ME, Lord SR, Menant J, Delbaere K, Sachdev PS, Kochan NA, Brodaty H, Sturnieks DL. Risk factors for falls in community-dwelling older people with mild cognitive impairment: a prospective one-year study. PeerJ 2022; 10:e13484. [PMID: 35663527 PMCID: PMC9161814 DOI: 10.7717/peerj.13484] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/03/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Mild cognitive impairment (MCI) is considered an intermediate stage between normal cognitive function and dementia. Fall risk is increased in this group, but there is limited literature exploring specific fall risk factors that may be addressed in fall prevention strategies. The aim of this study was to examine risk factors for falls in older people with MCI, focusing on cognitive, psychological and physical factors. Methods Participants (n = 266, 45% women) were community-dwelling older people aged 70-90 years who met the criteria for MCI. Cognitive, psychological, sensorimotor and physical assessments, physical activity levels, medication use, general health and disability were ascertained at baseline. Falls were monitored prospectively for 12 months. Results During follow-up, 106 (40%) participants reported one or more falls. Poorer visual contrast sensitivity, increased postural sway, lower levels of weekly walking activity, higher levels of depressive symptoms and psychotropic medication use were significantly associated with faller status (≥1 falls) in univariable analyses. Of these factors, poor visual contrast sensitivity, increased postural sway and psychotropic medication use were found to be significant independent predictors of falls in multivariable analysis while controlling for age and sex. No measures of cognitive function were associated with falls. Conclusions Poor visual contrast sensitivity, impaired balance and psychotropic medication use predicted falls in community-dwelling people with MCI. These risk factors may be amenable to intervention, so these factors could be carefully considered in fall prevention programs for this population.
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Affiliation(s)
- Thanwarat Chantanachai
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E. Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S. Sachdev
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia,Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Nicole A. Kochan
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Daina L. Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Maitre Y, Mahalli R, Micheneau P, Delpierre A, Amador G, Denis F. Evidence and Therapeutic Perspectives in the Relationship between the Oral Microbiome and Alzheimer's Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111157. [PMID: 34769677 PMCID: PMC8583399 DOI: 10.3390/ijerph182111157] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 02/06/2023]
Abstract
This review aims to clarify the nature of the link between Alzheimer’s disease and the oral microbiome on an epidemiological and pathophysiological level, as well as to highlight new therapeutic perspectives that contribute to the management of this disease. We performed a systematic review, following the Preferred Reporting Items for Systematic Reviews checklist, from January 2000 to July 2021. The terms “plaque,” “saliva,” and “mouth” were associated with the search term “oral diseases” and used in combination with the Boolean operator “AND”/“OR”. We included experimental or clinical studies and excluded conferences, abstracts, reviews, and editorials. A total of 27 articles were selected. Evidence for the impact of the oral microbiome on the pathophysiological and immunoinflammatory mechanisms of Alzheimer’s disease is accumulating. The impact of the oral microbiome on the development of AD opens the door to complementary therapies such as phototherapy and/or the use of prebiotic compounds and probiotic strains for global or targeted modulation of the oral microbiome in order to have a favourable influence on the evolution of this pathology in the future.
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Affiliation(s)
- Yoann Maitre
- Emergency Department, Montpellier University Hospital, 34090 Montpellier, France;
- EA 2415, Aide à la Décision pour une Médecine Personnalisée, Université de Montpellier, 34093 Montpellier, France
| | - Rachid Mahalli
- Department of Odontology, Tours University Hospital, 37000 Tours, France; (R.M.); (P.M.); (A.D.)
| | - Pierre Micheneau
- Department of Odontology, Tours University Hospital, 37000 Tours, France; (R.M.); (P.M.); (A.D.)
| | - Alexis Delpierre
- Department of Odontology, Tours University Hospital, 37000 Tours, France; (R.M.); (P.M.); (A.D.)
| | - Gilles Amador
- Faculty of Dentistry, Nantes University, 44000 Nantes, France;
| | - Frédéric Denis
- Department of Odontology, Tours University Hospital, 37000 Tours, France; (R.M.); (P.M.); (A.D.)
- Faculty of Dentistry, Nantes University, 44000 Nantes, France;
- EA 75-05 Education, Ethique, Santé, Faculté de Médecine, Université François-Rabelais, 37044 Tours, France
- Correspondence: ; Tel.: +33-6-7715-6968
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