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Portlock GE, Smith MD, van Poelgeest EP, Welsh TJ. Therapeutic dilemmas: cognitive enhancers and risk of falling in older adults-a clinical review. Eur Geriatr Med 2023; 14:721-732. [PMID: 37418063 PMCID: PMC10447592 DOI: 10.1007/s41999-023-00821-x] [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: 02/09/2023] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Cognitive enhancers are the primary pharmacological therapy prescribed to those with dementia, comprising of memantine and the acetylcholinesterase inhibitors (AChEIs). The long-term cognitive and behavioural benefits of these medications, as well as their potential contribution to falls is currently debated, with recent Delphi studies being unable to reach consensus on whether these medications should be deprescribed. In this narrative clinical review, as part of a series on deprescribing in people at risk of falls, we explore the potential falls-related side effects experienced in people taking cognitive enhancers, alongside situations where deprescribing may be appropriate. METHODS We undertook a literature search of PubMed and Google Scholar, using terms capturing falls and cognitive enhancers, as well as consulting the British National Formulary and published Summary of Medicinal Product Characteristics. These searches informed the subsequent clinical review. RESULTS Cognitive enhancers should be subject to regular review, including confirmation of appropriate treatment indication, and occurrence of side effects in the context of falls. AChEIs, in particular, are associated with a broad range of side effects that can contribute to increased falls risk. These include bradycardia, syncope and neuromuscular effects. Where these have been identified, deprescribing should be considered, as well as alternative treatment options. Deprescribing studies have shown mixed results, likely due to considerable methodological heterogeneity. Several suggested guidelines exist to aid deprescribing decisions, many of which are highlighted in this review. CONCLUSIONS The use of cognitive enhancers should be regularly reviewed and decisions to deprescribe made on a case-by-case basis, considering both the risks and benefits of stopping these medications.
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Affiliation(s)
| | - Matthew D Smith
- Bristol Medical School, University of Bristol, Bristol, UK
- The Research Institute for the Care of Older People (RICE), The RICE Centre Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | | | - Tomas James Welsh
- Bristol Medical School, University of Bristol, Bristol, UK.
- The Research Institute for the Care of Older People (RICE), The RICE Centre Royal United Hospital, Combe Park, Bath, BA1 3NG, UK.
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
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Moran R, Ramirez M, Woods G, Hofflich H, Wing, MS D, Nichols J. Shared-Medical Appointment for Screening and Risk Assessment for Fall Prevention. Gerontol Geriatr Med 2023; 9:23337214231186460. [PMID: 37435005 PMCID: PMC10331223 DOI: 10.1177/23337214231186460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Background: The median age of Americans is rising and fall risk increases with age. While the causes of falls are multifactorial, falls risk can be reduced. Only a small percentage of older-adults report being asked about fall risk or falls. The CDC has initiated a Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit, but penetration into practice has been slow. To address this, we implemented a Falls Prevention Shared Medical Appointment (SMA) at an academic internal medicine clinic. Methods: Patients were referred to the SMA and scheduled per their preference virtually or in-person. Patients attended a nurse visit for appropriate fallrisk related screening, followed by the SMA with two physicians for review of medical history, fall screening results and implementation of fall reduction strategies. Follow-up survey of the patients assessed program effectiveness. Results: Fifty-two patients were seen/assessed between November 2021 and February 2023 with SMAs ranging from 3 to 5 patients with an average age of 77 (=/- 6.7). Questionnaire self-reported risk factors, self-reported strength, and polypharmacy were associated with objective markers of increased fall risk. Survey results indicate acceptability of this model. Conclusion: Falls prevention SMAs can be effective. More work is needed to further delineate and refine cohort selection.
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Affiliation(s)
- Ryan Moran
- University of California, San Diego, La Jolla, USA
| | | | - Gina Woods
- University of California, San Diego, La Jolla, USA
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Effect of Gait Alteration on Fatigability during Walking in Adult Women with High Body Fat Composition. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010085. [PMID: 36676709 PMCID: PMC9866334 DOI: 10.3390/medicina59010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
Background and Objective: The risk factors for injury due to alterations in gait efficiency and fatigability during walking are a rising concern. Therefore, the aims of this study were to characterize the changes in gait pattern and performance fatigability among adult women with a high body fat percentage and to study the association between the gait pattern and performance fatigability during walking. Materials and Methods: A total of 160 adult women were enrolled in the study and were divided into two groups: a high-body-fat percentage group (HBF; n = 80; fat% = 42.49 ± 3.51) and a comparison group with a normal body fat percentage (NBF; n = 80; fat% = 29.68 ± 4.30). The 10 min walking test (10-MWT) was used to measure performance fatigability. Treadmill-based gait analysis was used for the acquisition of gait parameters. The correlation between the variables was examined using Pearson’s correlation coefficient. Forward stepwise linear regression was carried out to examine the association between all independent variables, and performance fatigability was adjusted for age and height. The level of statistical significant was set at p-value < 0.05 in all analyses. Results: The mean performance fatigability during the 10-MWT was reported to be high (1.4 ± 0.13) among the participants with HBF, as compared with a fatigability of 1.25 ± 0.11 in the NBF group. The data analysis of the spatial parameters indicated that stride length and step length were statistically smaller in the participants with HBF, as compared with the NBF group. The effects of average maximum force, speed, cadence, step length, and stride length explained the variation in the performance fatigability by 61% (p = 0.007). Conclusion: The findings of this study showed that gait alteration due to excess body fat induced a reduction in performance, as reflected by the high fatigability performance during walking. The study demonstrated a significant association between the severity of performance fatigability and spatial gait parameters.
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Angioni D, Cesari M, Raffin J, Virecoulon Giudici K, Mangin JF, Bouyahia A, Chupin M, Fischer C, Gourieux E, Rolland Y, De Breucker S, Vellas B, de Souto Barreto P. Neuroimaging correlates of persistent fatigue in older adults: A secondary analysis from the Multidomain Alzheimer Preventive Trial (MAPT) trial. Aging Ment Health 2022; 26:1654-1660. [PMID: 34082625 DOI: 10.1080/13607863.2021.1932737] [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: 10/21/2022]
Abstract
OBJECTIVES Fatigue has been suggested as a marker of biological aging. It seems plausible that this symptom might be associated with changes in brain health. The objective of this study was to examine the associations between persistent fatigue and neuroimaging correlates in a non-disease-specific population of community-dwelling older adults. METHODS We performed a cross-sectional analysis using data from The Multidomain Alzheimer Preventive Trial (MAPT). We included 458 subjects. Persistent fatigue was defined as meeting exhaustion criterion of Fried frailty phenotype in two consecutive clinical visits six months apart between study baseline and one year. Brain imaging correlates, assessed by magnetic resonance imaging (MRI), were the outcomes. The associations between persistent fatigue and brain correlates were explored using mixed model linear regressions with random effect at the center level. RESULTS The mean age of the participants was 74.8 ± 4 years old, and 63% of the subjects were women. Forty-seven participants (10%) exhibited a persistent fatigue profile. People with persistent fatigue were older compared to subjects without persistent fatigue (76.2 years ± 4.3 vs.74.7 ± 3.9 p = 0.009). Persistent fatigue was associated with higher white matter hyperintensity volume in the fully adjusted analysis. We did not find any cross-sectional association between persistent fatigue and sub-cortical volumes and global and regional cortical thickness. CONCLUSION Persistent fatigue was cross-sectionnally associated with higher white matter hyperintensity volume in older adults. Further longitudinal studies, using an assessment tool specifically designed and validated for measuring fatigue, are needed to confirm our findings.
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Affiliation(s)
- Davide Angioni
- Gerontopole of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Matteo Cesari
- IRCCS Istituti Clinici Scientifici Maugeri, Università degli Studi di Milano, Milan, Italy
| | - Jeremy Raffin
- Gerontopole of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | | | - Jean François Mangin
- CATI Multicenter Neuroimaging Platform, Neurospin, CEA, CNRS, Université Paris-Saclay, Gif sur Yvette, France
| | - Ali Bouyahia
- CATI, ICM, CNRS, Sorbonne Université, Paris, France
| | - Marie Chupin
- CATI, ICM, CNRS, Sorbonne Université, Paris, France
| | - Clara Fischer
- CATI Multicenter Neuroimaging Platform, Neurospin, CEA, CNRS, Université Paris-Saclay, Gif sur Yvette, France
| | - Emmanuelle Gourieux
- CATI Multicenter Neuroimaging Platform, Neurospin, CEA, CNRS, Université Paris-Saclay, Gif sur Yvette, France
| | - Yves Rolland
- Gerontopole of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France
| | - Sandra De Breucker
- Erasmus Hospital, Geriatric Unit, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Bruno Vellas
- Gerontopole of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France
| | - Philipe de Souto Barreto
- Gerontopole of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France
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He Y, Zhang H, Song M, Wu H, Pi H. Association Between Fatigue and Falls Risk Among the Elderly Aged Over 75 Years in China: The Chain Mediating Role of Falls Efficacy and Lower Limb Function. Front Public Health 2022; 10:850533. [PMID: 35372221 PMCID: PMC8965592 DOI: 10.3389/fpubh.2022.850533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although fatigue has been shown to be strongly associated with falls risk, very few studies have focused on its mechanism involved in community-dwelling older subjects. The purpose of this study was to explore the relationship between fatigue and falls risk and its internal mechanism by constructing a chain mediation model. Methods A cross-sectional study design was adopted. A convenience sample of 270 older adults was recruited from July to October 2021 in an urban community, in Beijing, China. The participants completed the 14-item Fatigue Scale (FS-14), Falls Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB) and Fall-Risk Self-Assessment Questionnaire (FRQ) to measure fatigue, falls efficacy, lower limb function and falls risk. The theory of unpleasant symptoms was used as a conceptual framework. Structural equation modeling (SEM) was utilized to test the hypothetical model. Results The overall fit of final model was found to be satisfactory: χ2/df = 1.61, CFI = 0.971, TLI = 0.962, RMSEA = 0.049 (95% CI 0.030/0.066) and SRMR = 0.023. Fatigue had a direct effect on falls risk (β = 0.559, S.E. = 0.089, 95% CI 0.380/0.731), and it also had indirect effects on falls risk (β = 0.303, S.E. = 0.072, 95% CI 0.173/0.460) through mediating factors. Falls efficacy and lower limb function were the main mediating variables, and there was a chain mediating effect (β = 0.015, S.E. = 0.010, 95% CI 0.003/0.046). Conclusions Our study suggests that fatigue can influence falls risk among the elderly in China. There are many mediating paths between fatigue and falls risk. These results may help healthcare professionals to better understand the inherent relationship between fatigue and fall risk that may benefit older adults.
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Affiliation(s)
- Yudi He
- Medical School of Chinese PLA, Beijing, China
| | - Huaguo Zhang
- Department of Nursing, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mi Song
- Medical School of Chinese PLA, Beijing, China
| | - Hongyi Wu
- Department of Nursing, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongying Pi
- Medical Service Training Center, Chinese PLA General Hospital, Beijing, China
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Blodgett JM, Ventre JP, Mills R, Hardy R, Cooper R. A systematic review of one-legged balance performance and falls risk in community-dwelling adults. Ageing Res Rev 2022; 73:101501. [PMID: 34748974 DOI: 10.1016/j.arr.2021.101501] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this systematic review was to synthesise all published evidence on associations between one-legged balance performance and falls. METHODS Medline, EMBASE, CINAHL and Web of Science were systematically searched (to January 2021) to identify peer-reviewed, English language journal articles examining the association between one-legged balance performance and falls in community-dwelling adults. RESULTS Of 4310 records screened, 55 papers were included (n = 36954 participants). There was considerable heterogeneity between studies including differences in study characteristics, ascertainment of balance and falls, and analytical approaches. A meta-analysis of the time that individuals could maintain the one-legged balance position indicated that fallers had worse balance times than non-fallers (standardised mean difference: -0.29 (95%CI:-0.38,-0.20) in cross-sectional analyses; -0.19 (-0.28, -0.09) in longitudinal analyses), although there was no difference in the pooled median difference. Due to between-study heterogeneity, regression estimates between balance and fall outcomes could not be synthesised. Where assessed, prognostic accuracy indicators suggested that one-legged balance was a poor discriminator of fall risk; for example, 5 of 7 studies demonstrated poor prognostic accuracy (Area Under the Curve <0.6), with most studies demonstrating poor sensitivity. CONCLUSIONS This systematic review identified 55 papers that examined associations between balance and fall risk, the majority in older aged adults. However, the evidence was commonly of low quality and results were inconsistent. This contradicts previous perceptions of one-legged balance as a useful fall risk tool and highlights crucial gaps that must be addressed in order to translate such assessments to clinical settings.
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Affiliation(s)
- Joanna M Blodgett
- Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, University College London, 170 Tottenham Court Road, W1T 7HA, London, UK.
| | - Jodi P Ventre
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK; Department of Psychology, Health, Psychology and Communities Research Centre, Manchester Metropolitan University, Bonsall Street, M15 6GX, Manchester, UK
| | - Richard Mills
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK
| | - Rebecca Hardy
- CLOSER, Social Research Institute, University College London, 55-59 Gordon Square, WC1H 0NU, London, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK
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Martínez-Arnau FM, Prieto-Contreras L, Pérez-Ros P. Factors associated with fear of falling among frail older adults. Geriatr Nurs 2021; 42:1035-1041. [PMID: 34256153 DOI: 10.1016/j.gerinurse.2021.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.
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Affiliation(s)
- Francisco M Martínez-Arnau
- Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010, Valencia, Spain; Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain
| | - Lucía Prieto-Contreras
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Espartero 7, 46007, Valencia, Spain
| | - Pilar Pérez-Ros
- Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain; Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Meléndez y Pelayo s/n, 46010 Valencia, Spain.
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Pana A, Sourtzi P, Kalokairinou A, Pastroudis A, Chatzopoulos ST, Velonaki VS. Association between self-reported or perceived fatigue and falls among older people: A systematic review. Int J Orthop Trauma Nurs 2021; 43:100867. [PMID: 34399107 DOI: 10.1016/j.ijotn.2021.100867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/18/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
AIM The aim of the present review was to examine the evidence of the relationship between self-reported or perceived fatigue and falls among older adults. METHODS A systematic review, following the PRISMA recommendations, was performed. PubMed, Scopus, Web of Science, and Cinahl were searched from February 2021 until March 2021, without any limitation on publication date. The methodological quality of the recruited studies was assessed with the Newcastle-Ottawa scale. RESULTS Of the 2,296 initially retrieved records, 20 met the inclusion criteria; 11 cohort and 9 cross-sectional studies. They were classified as "good or very good" studies. Data on 59,852 older adults was reported. Most studies reported a strong association between fatigue and incidence or risk of falls, with odds ratios ranging from 1.04 to 3.53. Evidence obout the relationship between fatigue and recurrent, as well as injurious, falls is limited. CONCLUSIONS Self-reported or perceived fatigue is associated with the incidence of falls or risk of falling among older adults. Nurses could contribute to decreasing the inicdence of falls through prevention and proper geriatric assessment, including the management of fatigue in their daily clinical practice. The evidence about the potential effect of fatigue on falls-related injuries is inconclusive and on recurrent falls remains to be further defined.
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Affiliation(s)
- Anastasia Pana
- National and Kapodistrian University of Athens, Department of Nursing, Greece; Hellenic Association of Gerontology and Geriatrics, Athens, Greece; General Hospital Asklepieio, Voula, Greece.
| | - Panayota Sourtzi
- National and Kapodistrian University of Athens, Department of Nursing, Greece; Hellenic Association of Gerontology and Geriatrics, Athens, Greece
| | - Athina Kalokairinou
- National and Kapodistrian University of Athens, Department of Nursing, Greece
| | - Alexandros Pastroudis
- Hellenic Association of Gerontology and Geriatrics, Athens, Greece; General Hospital Asklepieio, Voula, Greece
| | | | - Venetia Sofia Velonaki
- National and Kapodistrian University of Athens, Department of Nursing, Greece; Hellenic Association of Gerontology and Geriatrics, Athens, Greece
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