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Vitorino LM, Marques‐Vieira C, Low G, Sousa L, Cruz JP. Fear of falling among Brazilian and Portuguese older adults. Int J Older People Nurs 2019; 14:e12230. [DOI: 10.1111/opn.12230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/27/2019] [Accepted: 02/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Luciano M. Vitorino
- Faculty of Medicine of Itajubá Itajubá Brazil
- Faculty of Medicine Federal University of Juiz de Fora – UFJF Juiz de Fora Brazil
| | - Cristina Marques‐Vieira
- School of Nursing of Lisbon, Institute of Health Sciences Universidade Católica Portuguesa Lisbon Portugal
- CIIS Lisbon Portugal
| | - Gail Low
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
| | - Luís Sousa
- Nurse at Curry Cabral Hospital Central Lisbon Hospital Center Lisbon Portugal
- Atlântica Higher School of Health Sciences Atlântica University Barcarena Portugal
| | - Jonas P. Cruz
- Nursing Department, College of Applied Medical Sciences Shaqra University Al Dawadmi Saudi Arabia
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Souza CDO, Voos MC, Barbosa AF, Chen J, Francato DCV, Milosevic M, Popovic M, Fonoff ET, Chien HF, Barbosa ER. Relationship Between Posturography, Clinical Balance and Executive Function in Parkinson´s Disease. J Mot Behav 2018; 51:212-221. [PMID: 29683777 DOI: 10.1080/00222895.2018.1458279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study aimed to evaluate the relationship between posturography, clinical balance, and executive function tests in Parkinson´s disease (PD). Seventy-one people participated in the study. Static posturography evaluated the center of pressure fluctuations in quiet standing and dynamic posturography assessed sit-to-stand, tandem walk, and step over an obstacle. Functional balance was evaluated by Berg Balance Scale, MiniBESTest, and Timed Up and Go test. Executive function was assessed by Trail Making Test (TMT) and semantic verbal fluency test. Step over obstacle measures (percentage of body weight transfer and movement time) were moderately correlated to Timed Up and Go, part B of TMT and semantic verbal fluency (r > 0.40; p < 0.05 in all relationships). Stepping over an obstacle assesses the responses to internal perturbations. Participants with shorter movement times and higher percentage of body weight transfer (higher lift up index) on this task were also faster in Timed Up and Go, part B of TMT, and semantic verbal fluency. All these tasks require executive function (problem solving, sequencing, shifting attention), which is affected by PD and contribute to postural assessment.
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Affiliation(s)
- Carolina de Oliveira Souza
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Mariana Callil Voos
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Alessandra Ferreira Barbosa
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Janini Chen
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Debora Cristina Valente Francato
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Matija Milosevic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Milos Popovic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Erich Talamoni Fonoff
- b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Hsin Fen Chien
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Egberto Reis Barbosa
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
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Eckstrom E, Parker EM, Lambert GH, Winkler G, Dowler D, Casey CM. Implementing STEADI in Academic Primary Care to Address Older Adult Fall Risk. Innov Aging 2017; 1:igx028. [PMID: 29955671 PMCID: PMC6016394 DOI: 10.1093/geroni/igx028] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives Falls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation of the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire. Design and Methods We systematically incorporated STEADI into routine patient care via team training, electronic health record tools, and tailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (Stay Independent), and comparison with a 3-item subset of this questionnaire (three key questions). Results Eighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170 (22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment, orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gait impairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequate vitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questions compared to the full Stay Independent questionnaire decreased screening burden, but increased the number of high-risk patients. Discussion and Implications We successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients received recommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge. Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.
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Affiliation(s)
- Elizabeth Eckstrom
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Erin M Parker
- U.S. Public Health Service, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gwendolyn H Lambert
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Gray Winkler
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - David Dowler
- Program Design and Evaluation Services, Multnomah County Health Department and Oregon Public Health Division, Portland
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Bruce J, Ralhan S, Sheridan R, Westacott K, Withers E, Finnegan S, Davison J, Martin FC, Lamb SE. The design and development of a complex multifactorial falls assessment intervention for falls prevention: The Prevention of Falls Injury Trial (PreFIT). BMC Geriatr 2017; 17:116. [PMID: 28571563 PMCID: PMC5455136 DOI: 10.1186/s12877-017-0492-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 04/25/2017] [Indexed: 11/28/2022] Open
Abstract
Background This paper describes the design and development of a complex multifactorial falls prevention (MFFP) intervention for implementation and testing within the framework of a large UK-based falls prevention randomised controlled trial (RCT). Methods A complex intervention was developed for inclusion within the Prevention of Falls Injury Trial (PreFIT), a multicentre pragmatic RCT. PreFIT aims to compare the clinical and cost-effectiveness of three alternative primary care falls prevention interventions (advice, exercise and MFFP), on outcomes of fractures and falls. Community-dwelling adults, aged 70 years and older, were recruited from primary care in the National Health Service (NHS), England. Results Development of the PreFIT MFFP intervention was informed by the existing evidence base and clinical guidelines for the assessment and management of falls in older adults. After piloting and modification, the final MFFP intervention includes seven falls risk factors: a detailed falls history interview with consideration of ‘red flags’; assessment of balance and gait; vision; medication screen; cardiac screen; feet and footwear screen and home environment assessment. This complex intervention has been fully manualised with clear, documented assessment and treatment pathways for each risk factor. Each risk factor is assessed in every trial participant referred for MFFP. Referral for assessment is based upon a screening survey to identify those with a history of falling or balance problems. Intervention delivery can be adapted to the local setting. Conclusion This complex falls prevention intervention is currently being tested within the framework of a large clinical trial. This paper adheres to TIDieR and CONSORT recommendations for the comprehensive and explicit reporting of trial interventions. Results from the PreFIT study will be published in due course. The effectiveness and cost-effectiveness of the PreFIT MFFP intervention, compared to advice and exercise, on the prevention of falls and fractures, will be reported at the conclusion of the trial. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0492-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK.
| | - Shvaita Ralhan
- Oxford University Hospitals NHS Trust, The John Radcliffe Hospital, Headley Way, Headington, Oxfordshire, OX3 9DU, UK
| | - Ray Sheridan
- Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Katharine Westacott
- University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Emma Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - John Davison
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE1 4LP, UK
| | - Finbarr C Martin
- Guys and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK.,Botnar Research Centre, Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
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Ziemssen F, Lemmen K, Bertram B, Hammes HP, Agostini H. Nationale Versorgungsleitlinie (NVL) Diabetische Retinopathie. Ophthalmologe 2016; 113:623-38. [DOI: 10.1007/s00347-016-0315-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Barkhausen T, Junius-Walker U, Hummers-Pradier E, Mueller CA, Theile G. "It's MAGIC"--development of a manageable geriatric assessment for general practice use. BMC FAMILY PRACTICE 2015; 16:4. [PMID: 25608946 PMCID: PMC4320637 DOI: 10.1186/s12875-014-0215-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022]
Abstract
Background Geriatric assessments are established tools in institutional care since they enable standardized detection of relevant age-related disorders. Geriatric assessments could also be helpful in general practice. However, they are infrequently used in this setting, mainly due to their lengthy administration. The aim of the study was the development of a “manageable geriatric assessment – MAGIC”, specially tailored to the requirements of daily primary care. Methods MAGIC was developed based on the comprehensive Standardized Assessment for Elderly People in Primary Care (STEP), using four different methodological approaches: We relied on A) the results of the PRISCUS study by assessing the prevalence of health problems uncovered by STEP, the importance of the respective problems rated by patients and general practitioners, as well as the treatment procedures initiated subsequently to the assessment. Moreover, we included findings of B) a literature analysis C) a review of the STEP assessment by experienced general practitioners and D) focus groups with general practitioners. Results The newly created MAGIC assessment consists of 9 items and covers typical geriatric health problems and syndromes: function, falls, incontinence, cognitive impairment, impaired ears and eyes, vaccine coverage, emotional instability and isolation. Conclusions MAGIC promises to be a helpful screening instrument in primary care consultations involving elderly multimorbid patients. Applicable within a minimum of time it still covers health problems highly relevant with regard to a potential loss of autonomy. Feasibility will be tested in the context of a large, still ongoing randomized controlled trial on “reduction of potentially inadequate medication in elderly patients” (RIME study; DRKS-ID: DRKS00003610) in general practice.
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Affiliation(s)
- Tanja Barkhausen
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Ulrike Junius-Walker
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Eva Hummers-Pradier
- Department of General Practice, University Medical Centre Goettingen, Humboldtallee 38, 37073, Goettingen, Germany.
| | - Christiane A Mueller
- Department of General Practice, University Medical Centre Goettingen, Humboldtallee 38, 37073, Goettingen, Germany.
| | - Gudrun Theile
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. .,Santémed Health Center, Seebahnstrasse 89, 8036, Zuerich-Wiedikon, Switzerland.
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Influence of educational status on executive function and functional balance in individuals with Parkinson disease. Cogn Behav Neurol 2013; 26:6-13. [PMID: 23538567 DOI: 10.1097/wnn.0b013e31828c5956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated whether educational status influenced how people with Parkinson disease (PD) performed on Parts A, B, and DELTA of the Trail Making Test (TMT) and on the Berg Balance Scale (BBS). BACKGROUND Recent studies have shown that educational status may influence cognitive and motor test performance. METHODS We gave the TMT and the BBS to assess executive function and functional balance in 28 people with PD (Hoehn and Yahr score between 2 and 3) and 30 healthy elderly people. Participants reported their number of years of formal education. We divided each group of participants by educational status: low (4 to 10 years of education) or high (≥11 years). RESULTS In both the PD (P=0.018) and control (P=0.003) groups, participants with low educational status performed worse on the TMT Part B than did those with high educational status. Within the PD group, the less-educated participants scored worse on the BBS than did the more educated (P<0.001); this difference was not significant between the more- and less-educated controls (P=0.976). CONCLUSIONS Whether or not they had PD, less-educated people performed worse than more-educated people on the TMT Part B. Educational status affected executive function, but PD status did not. Among individuals with PD, educational status influenced functional balance.
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Carpenter CR, Scheatzle MD, D'Antonio JA, Ricci PT, Coben JH. Identification of fall risk factors in older adult emergency department patients. Acad Emerg Med 2009; 16:211-9. [PMID: 19281493 DOI: 10.1111/j.1553-2712.2009.00351.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED). METHODS This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence. RESULTS A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one's own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55). CONCLUSIONS Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non-fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one's own toenails, and previous falls are all associated with falls after ED discharge.
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Young JS. Age-related eye diseases: a review of current treatment and recommendations for low-vision aids. HOME HEALTHCARE NURSE 2008; 26:464-473. [PMID: 18787486 DOI: 10.1097/01.nhh.0000335604.38353.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Judith S Young
- Dixon School of Nursing, Abington Memorial Hospital, Willow Grove, PA 19090, USA.
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