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Hua CL, Nelson I, Cornell PY, White EM, Thomas KS. Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias. J Am Med Dir Assoc 2024; 25:105087. [PMID: 38885933 PMCID: PMC11283979 DOI: 10.1016/j.jamda.2024.105087] [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: 07/11/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES To examine the relationship between changes in nursing staff-hours per resident-day and injury-related emergency department (ED) visits among assisted living (AL) residents with Alzheimer disease and related dementias (ADRD). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We leveraged a data set of AL community characteristics in Ohio linked to Medicare claims data from 2007 to 2015. METHODS We estimated Poisson models examining the relationships of personal care aide, registered nurse (RN), licensed practical nurse (LPN), and total nursing hours with injury-related ED visits. Models were adjusted for resident characteristics (ie, age, race, sex, dual eligibility, presence and number of chronic conditions), AL community characteristics (percentage of residents on Medicaid, average resident acuity), year fixed effects, and assisted living fixed effects. We examined all injury-related ED visits and injury-related ED visits resulting in hospital admission as separate outcomes. RESULTS The sample included 122,700 person-months, representing 12,144 fee-for-service Medicare beneficiaries with ADRD within 455 different AL communities in Ohio between 2007 and 2015. Median total nursing hours increased from 1.34 in 2007 to 1.69 in 2015. In the fully adjusted model, an increase in 1 RN-hour per resident-day was associated with a decrease in the risk of any injury-related ED visit (incidence rate ratio 0.59, 95% CI 0.36-0.96), representing a 53% decrease. Changes in RN-hours were not associated with injury-related inpatient hospitalizations. Changes in total nursing, LPN, and personal care aide hours were not associated with changes in the risk of injury-related ED visits or inpatient hospitalizations. CONCLUSIONS AND IMPLICATIONS Increases in RN staffing hours were associated with reduced injury-related ED use among AL residents with ADRD. RNs provide surveillance and care oversight that may help mitigate injury risk, and they are able to physically assess residents at the time of a fall and/or injury, which can preempt unnecessary ED transfers.
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Affiliation(s)
- Cassandra L Hua
- Center for Health Statistics and Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA.
| | - Ian Nelson
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Portia Y Cornell
- Centre for the Digital Transformation of Health/Centre for Health Policy, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Elizabeth M White
- Center for Gerontology and Healthcare Research and the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Kali S Thomas
- Center for Equity in Aging, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Huang G, Wabe N, Raban MZ, Silva SSM, Seaman K, Nguyen AD, Meulenbroeks I, Westbrook JI. The relationship between participation in leisure activities and incidence of falls in residential aged care. PLoS One 2024; 19:e0302678. [PMID: 38662707 PMCID: PMC11045105 DOI: 10.1371/journal.pone.0302678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Active engagement in leisure activities has positive effects on individuals' health outcomes and social functioning; however, there is limited understanding of the link between participation in leisure activities, particularly non-exercise activities, and falls in older adults. This study aimed to determine the relationship between participation in leisure activities and the incidence of falls, and the variation of this relationship by dementia status in residential aged care facilities (RACFs). METHODS A retrospective longitudinal cohort study utilising routinely collected data (January 2021-August 2022) from 25 RACFs in Sydney, Australia, was conducted. The cohort included 3,024 older permanent residents (1,493 with dementia and 1,531 without) aged ≥65 and with a stay of ≥1 week. The level of participation in leisure activities was measured using the number of leisure activities per 1,000 resident days and divided into quartiles. Outcome measures were the incidence rate of all falls and injurious falls (i.e., number of falls per 1,000 resident days). We used multilevel negative binary regression to examine the relationship between leisure participation and fall incidence. RESULTS For the whole sample, leisure participation was significantly inversely associated with the incidence rate of all falls and injurious falls. For example, residents in the high leisure participation group were 26% less likely to experience a fall compared to those in the low leisure participation group after controlling for confounders (incidence rate ratio = 0.74, 95% confidence interval = 0.60, 0.91). Such inverse relationship was observed in both exercise and non-exercise activities and was stronger among residents without dementia. CONCLUSIONS Leisure participation is associated with a lower rate of falls, a key quality indicator by which RACFs are benchmarked and funded in Australia and many other countries. More recognition and attention are needed for the currently underfunded leisure activities in RACFs in future funding arrangement.
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Affiliation(s)
- Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Magdalena Z. Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - S. Sandun Malpriya Silva
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy D. Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Nordling Y, Sund R, Sirola J, Kröger H, Isanejad M, Rikkonen T. Body composition, balance, functional capacity and falls in older women. Aging Clin Exp Res 2024; 36:76. [PMID: 38512411 PMCID: PMC10957703 DOI: 10.1007/s40520-024-02719-5] [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: 10/08/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women. METHODS The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The women were assigned to exercise intervention (n = 457) and control groups (n = 457). Clinical measurements were conducted at baseline, 12 months and 24 months. RESULTS During the 2-year follow up, total of 546 women (59.7%) sustained a fall. The total number of falls was 1380 and out of these, 550 (40%) of falls were non-injurious and 745 (54%) were injurious. Higher femoral neck bone mineral density (BMD) was associated with a higher overall risk of falls [RR = 2.55 (95% CI = 1.70-3.84, p < 0.001)], but was a protective factor for severe fall injuries [RR = 0.03 (95% CI = 0.003-0.035, p < 0.01)]. Slower Timed Up and Go (TUG) was associated with an increased overall risk of falls [RR = 1.07 (95% CI = 1.05-1.10, p < 0.001)] and injuries requiring medical attention [RR = 1.10 (95% CI = 1.02-1.19, p = 0.02)]. Longer single leg standing time was a protective factor for falls [RR = 0.99 (95% CI = 0.99-1.00, p < 0.01)] and overall injurious falls [RR = 0.99 (95% CI = 0.99-1.00, p = 0.02)]. CONCLUSION For postmenopausal women with higher femoral neck BMD appear to sustain more falls, but have a lower risk of severe fall injuries. Better TUG and single leg standing time predict lower risk of falls and fall injuries.
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Affiliation(s)
- Yki Nordling
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, Department of Musculoskeletal and Ageing Sciences, University of Liverpool, 6 W Derby St, Liverpool, L7 8TX, UK
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
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4
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Nishimura T, Asai H, Otsubo S, Nakai S, Inaoka PT. Effect of controlled start position on the reach distance distribution range in the functional reach test among community-dwelling older adults. J Phys Ther Sci 2024; 36:102-110. [PMID: 38434991 PMCID: PMC10904222 DOI: 10.1589/jpts.36.102] [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: 10/16/2023] [Accepted: 11/25/2023] [Indexed: 03/05/2024] Open
Abstract
[Purpose] This study investigated the effect of controlled start position (CSP) on the reach distance distribution range (RDDR) in the functional reach test (FRT) in community-dwelling older adults. [Participants and Methods] The participants were 34 community-dwelling older adults. We compared the RDDR in CSP and non-CSP and analyzed the relationship between the mean reach distance (MRD) and the length of movement of the center of pressure (LMCOP). [Results] The RDDR in CSP condition was significantly lower than non-CSP condition. A significant positive correlation was observed only for CSP condition. In the non-CSP condition, MRD was not reflected in the LMCOP. [Conclusion] The FRT in the CSP effectively reflects the standing balance ability of community-dwelling older adults.
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Affiliation(s)
- Takaaki Nishimura
- Department of Community-based-Rehabilitation, Nanto
Municipal Hospital: 938 Inami, Nanto-shi, Toyama 932-0211, Japan
- Department of Physical Therapy, Graduate Course of
Rehabilitation Science, Division of Health Sciences, Graduate School of Medical Sciences,
Kanazawa University, Japan
| | - Hitoshi Asai
- Department of Physical Therapy, Graduate Course of
Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and
Health Sciences, Kanazawa University, Japan
| | - Sota Otsubo
- Department of Physical Therapy, Graduate Course of
Rehabilitation Science, Division of Health Sciences, Graduate School of Medical Sciences,
Kanazawa University, Japan
| | - Sachiko Nakai
- Department of Community-based-Rehabilitation, Nanto
Municipal Hospital: 938 Inami, Nanto-shi, Toyama 932-0211, Japan
| | - Pleiades Tiharu Inaoka
- Department of Physical Therapy, Graduate Course of
Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and
Health Sciences, Kanazawa University, Japan
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Promsri A. Age and Visual Contribution Effects on Postural Control Assessed by Principal Component Analysis of Kinematic Marker Data. Sports (Basel) 2023; 11:sports11050098. [PMID: 37234054 DOI: 10.3390/sports11050098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
Postural control, the ability to control the body's position in space, is considered a critical aspect of health outcomes. This current study aimed to investigate the effects of age and visual contribution on postural control. To this end, principal component analysis (PCA) was applied to extract movement components/synergies (i.e., principal movements, PMs) from kinematic marker data of bipedal balancing on stable and unstable surfaces with eyes closed and open, pooled from 17 older adults (67.8 ± 6.6 years) and 17 young adults (26.6 ± 3.3 years), one PCA-analysis for each surface condition. Then, three PCA-based variables were computed for each PM: the relative explained variance of PM-position (PP_rVAR) and of PM-acceleration (PA_rVAR) for measuring the composition of postural movements and of postural accelerations, respectively, and the root mean square of PM-acceleration (PA_RMS) for measuring the magnitude of neuromuscular control. The results show the age and visual contribution effects observed in PM1, resembling the anteroposterior ankle sway in both surface conditions. Specifically, only the greater PA1_rVAR and PA1_RMS are observed in older adults (p ≤ 0.004) and in closed-eye conditions (p < 0.001), reflecting their greater need for neuromuscular control of PM1 than in young adults and in open-eye conditions.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
- Unit of Excellence in Neuromechanics, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
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Huang G, Wabe N, Raban MZ, Seaman KL, Silva SM, Westbrook JI. The relationship between fall incidents and place of birth in residential aged care facilities: a retrospective longitudinal cohort study. BMC Geriatr 2023; 23:257. [PMID: 37118675 PMCID: PMC10148446 DOI: 10.1186/s12877-023-03954-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/05/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Older populations in residential aged care facilities (RACFs) in many immigrant-receiving countries are now being increasingly culturally and linguistically diverse (CALD). CALD populations require tailored social and health services to support their needs and improve health outcomes. Falls among the elderly are common and can have significant health and psychosocial consequences. There is some evidence to suggest that country of birth may influence risk of falls among older people, but such evidence has been scarce. This study aimed to determine the association between place of birth and the incidence of falls in RACFs. METHODS Routinely collected incident data relating to 5,628 residents aged ≥ 65 years in 25 RACFs in Sydney, New South Wales, Australia were used. RACF residents were classified into two groups, Australia-born (N = 4,086) and overseas-born (N = 1,542). Overseas-born RACF residents were further categorised into two subgroups: overseas-English-speaking-country (N = 743) and overseas-non-English-speaking-country (N = 799). Outcomes measures were rate of all falls, injurious falls and falls requiring hospitalisation. Multilevel binary negative regression was used to examine the relationship between fall risk and place of birth. RESULTS Incidence rates of all falls, injurious falls and falls requiring hospitalisation were 8.62, 3.72 and 1.07 incidents per 1,000 resident days, respectively, among the Australia-born RACF residents, but were higher at 11.02, 4.13 and 1.65, respectively, among the overseas-born RACF residents. Within those born overseas, fall rates were higher among the overseas-non-English-speaking-country-born residents (11.32, 4.29 and 2.22, respectively) than those overseas-English-speaking-country-born (10.70, 3.96 and 1.05, respectively). After controlling for confounders, the overseas-born RACF residents overall experienced a higher risk of all three types of falls (incidence rate ratios: [IRR] = 1.278, 95% confidence interval [CI] = 1.131, 1.443; injurious falls: IRR = 1.164 [95% CI = 1.013, 1.338]; falls requiring hospitalisation: IRR = 1.460 [95% CI = 1.199, 1.777]) than the Australia-born RACF residents. Among the overseas-born RACF residents, males, respite residents and those overseas-non-English-speaking-country-born experienced higher rates of falls. CONCLUSIONS Fall incidence in RACFs varies significantly by place of birth. With increasingly diverse RACF populations, fall intervention and prevention programs should consider cultural and linguistical backgrounds of RACF residents. Greater attention to understand the mechanisms for the differences by place of birth in risk profiles is warranted.
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Affiliation(s)
- Guogui Huang
- Centre for Health Systems and Safety Research, Macquarie University, North Ryde, NSW, 2109, Macquarie, Australia.
| | - Nasir Wabe
- Centre for Health Systems and Safety Research, Macquarie University, North Ryde, NSW, 2109, Macquarie, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Macquarie University, North Ryde, NSW, 2109, Macquarie, Australia
| | - Karla L Seaman
- Centre for Health Systems and Safety Research, Macquarie University, North Ryde, NSW, 2109, Macquarie, Australia
| | - Sandun Malpriya Silva
- Centre for Health Systems and Safety Research, Macquarie University, North Ryde, NSW, 2109, Macquarie, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Macquarie University, North Ryde, NSW, 2109, Macquarie, Australia
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7
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Promsri A, Cholamjiak P, Federolf P. Walking Stability and Risk of Falls. Bioengineering (Basel) 2023; 10:bioengineering10040471. [PMID: 37106658 PMCID: PMC10135799 DOI: 10.3390/bioengineering10040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Walking stability is considered a necessary physical performance for preserving independence and preventing falls. The current study investigated the correlation between walking stability and two clinical markers for falling risk. Principal component analysis (PCA) was applied to extract the three-dimensional (3D) lower-limb kinematic data of 43 healthy older adults (69.8 ± 8.5 years, 36 females) into a set of principal movements (PMs), showing different movement components/synergies working together to accomplish the walking task goal. Then, the largest Lyapunov exponent (LyE) was applied to the first five PMs as a measure of stability, with the interpretation that the higher the LyE, the lower the stability of individual movement components. Next, the fall risk was determined using two functional motor tests-a Short Physical Performance Battery (SPPB) and a Gait Subscale of Performance-Oriented Mobility Assessment (POMA-G)-of which the higher the test score, the better the performance. The main results show that SPPB and POMA-G scores negatively correlate with the LyE seen in specific PMs (p ≤ 0.009), indicating that increasing walking instability increases the fall risk. The current findings suggest that inherent walking instability should be considered when assessing and training the lower limbs to reduce the risk of falling.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
| | - Prasit Cholamjiak
- Department of Mathematics, School of Sciences, University of Phayao, Phayao 56000, Thailand
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
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8
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O'Brien C, Holtzer R. Physical reserve: construct development and predictive utility. Aging Clin Exp Res 2023; 35:1055-1062. [PMID: 36848030 DOI: 10.1007/s40520-023-02371-5] [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: 12/07/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Physical reserve (PR) refers to one's ability to maintain physical functioning despite age, illness, or injury. The measurement and predictive utility of PR, however, are not well established. AIMS We quantified PR using a residual measurement approach by extracting standardized residuals from gait speed, while accounting for demographic and clinical/disease variables, and used it to predict fall-risk. METHODS Participants (n = 510; age ≥ 70ys) were enrolled in a longitudinal study. Falls were assessed annually (in-person) and bimonthly (via structured telephone interview). RESULTS General Estimating Equations (GEE) revealed that higher baseline PR was associated with reduced odds of reporting falls over repeated assessments in the total sample, and incident falls among those without fall's history. The protective effect of PR against fall risk remained significant when adjusting for multiple demographic and medical confounders. DISCUSSION/CONCLUSION We propose a novel framework to assessing PR and demonstrate that higher PR is protective against fall-risk in older adults.
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Affiliation(s)
- Catherine O'Brien
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
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Sex Differences in Falls: The Mediating Role of Gait Stability Ratio and Body Balance in Vulnerable Older Adults. J Clin Med 2023; 12:jcm12020450. [PMID: 36675379 PMCID: PMC9864613 DOI: 10.3390/jcm12020450] [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: 11/11/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
This study, conducted on a large sample of older adults at elevated fall risk (1), aimed to verify statistical differences in gait stability ratio (GSR) and body balance (BB) according to sex, (2) to examine and compare GSR and BB performance between older adult fallers and non-fallers, (3) to determine an association between GSR and BB according to the history of falls, and (4) to explore whether GSR and BB mediate the association between sex and falls. We included 619 individuals (69.8 ± 5.6 years) living in the Autonomous Region of Madeira, Portugal. The frequency of falls was obtained by self-report. BB was determined by the Fullerton Advanced Balance scale, while GSR was established by dividing cadence by gait speed and data collected during the 50-foot walk test. Males indicated a lower prevalence of falls in the last 12 months (23.6%), while females had a higher score (48.7%), as well as a lower balance performance (p < 0.001) and higher GSR scores (p < 0.001). Lower BB control (p < 0.001), as well as higher GSR, were more expressive for fallers (p < 0.001). We found a large, negative and significant correlation between GSR and BB for historical falls (r = −0.560; p < 0.001), and between male and female cohorts (r = −0.507; p < 0.001). The total effect of sex on falls mediated by GSR and BB was 16.4%. Consequently, GSR and BB mediated this association by approximately 74.0% and 22.5%, respectively.
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10
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Rossler A, Wheeler J, Thiamwong L. A Multidimensional Approach for Nurse Practitioners to Screen Fall Risk and Fear of Falling in Community-Dwelling Older Adults. J Nurse Pract 2023; 19:104436. [PMID: 37008257 PMCID: PMC10062692 DOI: 10.1016/j.nurpra.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Nurse practitioners are essential in the care of the older adult population. Older adults are at high risk for falls; therefore, nursing assessment should include psychological and physiological measures. Fear of falling is a primary psychological contributor to fall risk. The Falls Efficacy Scale International short; Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries fall risk scale; and Balance Tracking System (BTrackS) balance test are reliable, efficient tools for assessment. Data obtained from these multifactoral tools may inform mobility interventions and education for the patient, further meeting a national safety goal of reducing falls in the older adult population.
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Affiliation(s)
- Aleatha Rossler
- PhD student at the University of Central Florida, Orlando, FL
| | - Jenna Wheeler
- PhD student at the University of Central Florida, Orlando, FL
| | - Ladda Thiamwong
- associate professor in the College of Nursing at the University of Central Florida, Orlando, FL
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11
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Sun QQ, Tan K, Tang HY, Liu YY, Zhu H, Qin H, Xia X, Zhang M, Chen YY, Nie SS, Wang S. Incidence and predictive value of social frailty among community-dwelling older adults in Southwest China: A prospective cohort study. Front Public Health 2023; 11:1103651. [PMID: 36891342 PMCID: PMC9986618 DOI: 10.3389/fpubh.2023.1103651] [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: 11/20/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Background Few studies have focused on the incidence and correlation of social frailty (SF) with adverse health events in Southwest China. This study aims to explore the predictive value of SF for adverse health events. Methods A 6-year prospective cohort study was employed, a total of 460 community-dwelling older adults aged 65 years and above were analyzed to provide a baseline in 2014. Participants completed two longitudinal follow-ups at 3 (2017, 426 participants involved) and 6 (2020, 359 participants involved) years later. A modified social frailty screening index was used in this study, and adverse health events such as physical frailty (PF) deterioration, disability, hospitalization, falls, and mortality were evaluated. Results Among these participants in 2014, the median age was 71 years, 41.1% were male, and 71.1% were married or cohabiting, up to 112 (24.3%) of them were classified as SF. It was observed that aging (OR = 1.04, 95% CI = 1.00-1.07, P = 0.047) and having family members die in the past year (OR = 2.60, 95% CI = 0.93-7.25, P = 0.068) were risk factors of SF, whereas having a mate (OR = 0.40, 95% CI = 0.25-0.66, P = 0.000) and having family members to help with care (OR = 0.53, 95% CI = 0.26-1.11, P = 0.092) were protective factors of SF. The cross-sectional study demonstrated that SF was only significantly associated with disability (OR = 12.89, 95% CI = 2.67-62.13, P = 0.001) at wave 1. Baseline SF significantly explained the incidence of mortality at the 3-year (medium-term, OR = 4.89, 95% CI = 2.23-10.71, P = 0.000) and 6-year follow-ups (long-term, OR = 2.22, 95% CI = 1.15-4.28, P = 0.017). Conclusion SF prevalence was higher in the Chinese older population. Older adults with SF had a significantly increased incidence of mortality at the longitudinal follow-up. Consecutive comprehensive health management of SF (e.g., avoiding living alone and increasing social engagement) is urgently needed for the purposes of early prevention and multidimensional intervention in adverse health events, including disability and mortality.
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Affiliation(s)
- Qian-Qian Sun
- The Center of Gerontology and Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China.,National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ke Tan
- Department of Epidemiology and Health Statistics, Sichuan University West China Fourth Hospital, Chengdu, Sichuan, China.,Department of Clinic Development and Medical Affairs, Fosun Adgenvax Biopharmaceutical Co., Ltd., Chengdu, Sichuan, China
| | - Hui-Yu Tang
- The Center of Gerontology and Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yan-Yan Liu
- The Center of Gerontology and Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Huan Zhu
- The Center of Gerontology and Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Hai Qin
- Internal Medicine Department, Pingyi Community Health Service Center, Dujiangyan, Sichuan, China
| | - Xin Xia
- National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Min Zhang
- Department of Geriatrics, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Chengdu, Sichuan, China
| | - Yan-Yu Chen
- Department of Rheumatology and Immunology, Chongqing Emergency Medical Center, Chongqing, China
| | - Shuang-Shuang Nie
- Department of General Medicine, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuang Wang
- The Center of Gerontology and Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China.,National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
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12
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Miller TA, Paul R, Forthofer M, Wurdeman SR. Stability and Falls Evaluations in AMPutees (SAFE-AMP 2): Reduced functional mobility is associated with a history of injurious falls in lower limb prosthesis users. Ann Phys Rehabil Med 2022; 66:101679. [PMID: 35667624 DOI: 10.1016/j.rehab.2022.101679] [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: 10/15/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Injurious falls have a high cost and economic impact on an individual and the health system. Several studies have assessed performance-based functional mobility in lower limb prosthesis (LLP) users and fall risk including fall history. However, limited data exist regarding the relationship between functional mobility and a history of injurious falls in individuals who use a LLP. Such information could inform clinical practice and decision making from prosthesis design to policy. The purpose of this study was to identify factors associated with a history of injurious falls among LLP users using a clinical outcomes database. METHODS Retrospective (2016-2018) observational study. Logistic regression applied. RESULTS A final sample of 12,044 LLP users was included for analysis. Within the sample, 1,529 individuals reported a history of an injurious fall within the previous 6 months. Self-reported functional mobility was stratified into low, middle, and high levels: differences were found between levels for history of an injurious fall. The lowest mobility level was associated with 2.29 higher odds of a history of an injurious fall (95% CI: 1.96-2.69) indicating a potentially greater serious fall risk compared to those with higher mobility levels while controlling for covariates (sex, cause of amputation and level of amputation). CONCLUSION(S) Self-reported functional mobility was associated with a history of injurious falls in LLP users. The Prosthetic Limb Users Survey of Mobility is an accessible tool that prosthetists could use to identify individuals with a high risk of falls; this can inform care planning. Rehabilitation plans and prosthesis designs that target LLP users who report low functional mobility may positively impact health outcomes.
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Affiliation(s)
- Taavy A Miller
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA; Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Melinda Forthofer
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Shane R Wurdeman
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA
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13
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Burke A, Gupta A, Houchens N. Quality and Safety in the Literature: September 2022. BMJ Qual Saf 2022; 31:689-694. [PMID: 35981736 DOI: 10.1136/bmjqs-2022-015160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Anna Burke
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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14
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Sánchez-Sánchez JL, Udina C, Medina-Rincón A, Esbrí-Victor M, Bartolomé-Martín I, Moral-Cuesta D, Marín-Epelde I, Ramon-Espinoza F, Latorre MS, Idoate F, Goñi-Sarriés A, Martínez-Martínez B, Bonet RE, Librero J, Casas-Herrero Á. Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial. BMC Geriatr 2022; 22:612. [PMID: 35870875 PMCID: PMC9308197 DOI: 10.1186/s12877-022-03214-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/15/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. METHODS This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. DISCUSSION This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes. TRIAL REGISTRATION NCT04911179 02/06/2021.
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Affiliation(s)
- Juan Luis Sánchez-Sánchez
- grid.7759.c0000000103580096MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain ,grid.410476.00000 0001 2174 6440Health Sciences Department, Universidad Pública de Navarra (UPNA), Pamplona, Spain ,grid.411175.70000 0001 1457 2980Insitut de Viellissement, CHU Toulouse, Gerontopole de Toulouse, Toulouse, France
| | - Cristina Udina
- grid.510965.eParc Sanitari Pere Virgili, Barcelona, Spain ,grid.430994.30000 0004 1763 0287RE-FiT Bcn Research Group, Vall Hebron Research Institute, Barcelona, Spain
| | - Almudena Medina-Rincón
- grid.510965.eParc Sanitari Pere Virgili, Barcelona, Spain ,grid.430994.30000 0004 1763 0287RE-FiT Bcn Research Group, Vall Hebron Research Institute, Barcelona, Spain
| | - Mariano Esbrí-Victor
- grid.411839.60000 0000 9321 9781Geriatrics Department, Complejo Hospitalario Universitario de Albacete (CHUA), Albacete, Spain
| | - Irene Bartolomé-Martín
- grid.411098.50000 0004 1767 639XGeriatrics Department, Hospital Universitario de Guadalajara (HUG), Guadalajara, Spain
| | - Débora Moral-Cuesta
- grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain
| | - Itxaso Marín-Epelde
- grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain
| | | | - Marina Sánchez- Latorre
- grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain
| | | | | | | | | | - Julián Librero
- grid.410476.00000 0001 2174 6440Health Sciences Department, Universidad Pública de Navarra (UPNA), Pamplona, Spain ,grid.508840.10000 0004 7662 6114Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Álvaro Casas-Herrero
- grid.410476.00000 0001 2174 6440Health Sciences Department, Universidad Pública de Navarra (UPNA), Pamplona, Spain ,grid.411730.00000 0001 2191 685XGeriatrics Department, Hospital Universitario de Navarra (HUN), C/Irunlarrea s/n 31008, Pamplona, Spain ,grid.508840.10000 0004 7662 6114Navarra Institute for Health Research (IdiSNA), Pamplona, Spain ,grid.413448.e0000 0000 9314 1427CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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15
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Gülhan Güner S, Nural N, Erden A. A Multidisiplinary Program on Falling and Quality of Life in Older Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2095072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Seçil Gülhan Güner
- Faculty of Health Sciences, Department of Internal Medicine Nursing, Karadeniz Technical University, Trabzon, Turkey
| | - Nesrin Nural
- Faculty of Health Sciences, Department of Internal Medicine Nursing, Karadeniz Technical University, Trabzon, Turkey
| | - Arzu Erden
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey
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16
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Wu REY, Khan FM, Hockin BCD, Lobban TCA, Sanatani S, Claydon VE. Faintly tired: a systematic review of fatigue in patients with orthostatic syncope. Clin Auton Res 2022; 32:185-203. [PMID: 35689118 PMCID: PMC9186485 DOI: 10.1007/s10286-022-00868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Orthostatic syncope (transient loss of conscious when standing-fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing fatigue, sometimes with "brain fog", which may further impact their quality of life, but the incidence and severity of fatigue in patients with syncope remain unclear. In this systematic review, we report evidence on the associations between fatigue and conditions of orthostatic syncope. METHODS We performed a comprehensive literature search of four academic databases to identify articles that evaluated the association between orthostatic syncope [postural orthostatic tachycardia syndrome (POTS), vasovagal syncope (VVS), orthostatic hypotension (OH)] and fatigue. Studies were independently screened using a multi-stage approach by two researchers to maintain consistency and limit bias. RESULTS Our initial search identified 2797 articles, of which 13 met our inclusion criteria (POTS n = 10; VVS n = 1; OH n = 1; VVS and POTS n = 1). Fatigue scores were significantly higher in patients with orthostatic syncope than healthy controls, and were particularly severe in those with POTS. Fatigue associated with orthostatic syncope disorders spanned multiple domains, with each dimension contributing equally to increased fatigue. "Brain fog" was an important symptom of POTS, negatively affecting productivity and cognition. Finally, fatigue was negatively associated with mental health in patients with POTS. CONCLUSION In conditions of orthostatic syncope, fatigue is prevalent and debilitating, especially in patients with POTS. The consideration of fatigue in patients with orthostatic disorders is essential to improve diagnosis and management of symptoms, thus improving quality of life for affected individuals.
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Affiliation(s)
- Ryan E Y Wu
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Farhaan M Khan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Brooke C D Hockin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Trudie C A Lobban
- Syncope Trust and Reflex Anoxic Seizures Group (STARS) and Arrhythmia Alliance, Stratford-upon-Avon, Warwickshire, UK
| | - Shubhayan Sanatani
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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17
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Wabe N, Seaman KL, Nguyen A, Siette J, Raban MZ, Hibbert P, Close J, Lord SR, Westbrook JI. Epidemiology of Falls in 25 Australian Residential Aged Care Facilities: A Retrospective Longitudinal Cohort Study Using Routinely Collected Data. Int J Qual Health Care 2022; 34:6589456. [PMID: 35588391 DOI: 10.1093/intqhc/mzac050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/31/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls are frequent among older adults and have significant health and economic consequences. There have been few studies on the epidemiology of falls in residential aged care facilities (RACFs). This study aimed to determine the incidence of falls in RACFs using longitudinal routinely collected incident data over five years (Jul 2014-Dec 2019). METHODS A retrospective cohort study using fall incident data from 25 RACFs in Sydney, NSW, Australia. Incidents relating to a population of 6,163 aged care residents aged ≥65 years were included. Outcome measures were incidents of all falls; injurious falls, and requiring hospitalisation. Risk-adjusted incidence rate (IR) for each outcome indicator for each of the 25 facilities was calculated. RESULTS A total of 27,878 falls were reported over 3,906,772 resident days (a crude rate of 7.14/1000 resident days; 95% confidence interval (CI) 6.81-7.48). Of these, 10,365 (37.2%) were injurious and 2,733 (9.8%) required hospitalisation. The crude IR for injurious falls was 2.65/1000 resident days (95% CI 2.53-2.78) and 0.70 (95% CI 0.66-0.74) for falls requiring hospitalisation. The incidence of falls was significantly higher in respite compared to permanent residents for all falls (adjusted incident rate ratio (aIRR) 1.33; 95% CI 1.18-1.51) and injurious falls (aIRR 1.30; 95% CI 1.14-1.48) and for men compared to women for all outcomes (all falls aIRR 1.69; 95% CI 1.54-1.86; injurious falls aIRR 1.87; 95% CI 1.71-2.04 and falls requiring hospitalisation aIRR 1.29; 95% CI 1.12-1.48). The risk-adjusted IRs per 1000 resident days between facilities varied substantially (all falls 0.57-12.93 falls; injurious falls 0.25-4.47 and falls requiring hospitalisation 0.10-1.70). CONCLUSION Falls are frequent in RACFs, often resulting in injury and hospitalisation. The study provides robust and comprehensive information that may help inform future initiatives to minimise the incidence of falls in RACFs.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karla L Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Allied Health and Human Performance, South Australian Health & Medical Research Institute (SAHMRI), University of South Australia, Adelaide, South Australia, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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18
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Effect of 6 weeks of balance training on different heights of medium-density foam in geriatric population. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In older adults, progressive aging leads to a gradual decrease in physical and mental well-being, increasing the risk of fall-associated injuries and ultimately changing the quality of life. This increase in fall accidents is due to the impaired balance in older adults. To prevent such incidents, the incorporation of balance training in the rehabilitation of the geriatric population will help in challenging the vestibular system and activates the mechanoreceptors that lead to enhancing the postural stability on an unstable surface. The foam-based balance training helps to effectively improve balance; however, the height and type of foam used for the treatment and assessment purpose varies, and the suitable height of foam required for balance training is still unexplored. Hence, the study aims to determine the efficacy of various heights of medium-density foam for balance training in community-dwelling older adults.
Methods
Forty older adults ranged between 60 to 75 years were randomly chosen and divided into intervention and control groups. Both the group practiced balance training on a firm surface for 2 weeks and later intervention group received foam-based balance training on either 1″, 2″, and 3″ medium-density foam. The balance and fear of fall were measured using Mini-BesTest Scale (MBS) and Fall Efficacy Scale-I (FES-I) respectively. Furthermore, the MBS and FES-I scores were recorded on the pre-, post-2 weeks, and post-6 weeks of foam-based balance training.
Results
The MBS and FES-I show a statistically significant difference (<0.05) in pre- and post-interventions and control groups. The components of MBS merely show a significant difference in effect size in the intervention group, and it indicates poor clinical relevance in using a specific height of foam for balance training in older adults. However, within group analysis, the 3″-inch medium-density foam shows the medium effect size (>0.5) in all components of MBS as compared to other groups.
Conclusion
The specific height of foam used for foam-based balance training does not effectively differ the clinical decision-making in planning rehabilitation; rather, a long duration of balance training helps to improve balance in older adults.
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19
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Multidomain Integrated Exercises Decreased the Risk of Falls of Community-Dwelling Older Adults. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Assi R, Schwab C, El Abd A, Fernandez C, Hindlet P. Which Potentially Inappropriate Medications List Can Detect Patients At Risk of Readmissions in the Older Adult Population Admitted for Falls? An Observational Multicentre Study Using a Clinical Data Warehouse. Drugs Aging 2022; 39:175-182. [PMID: 35118603 DOI: 10.1007/s40266-022-00921-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Hospital readmissions are common in the older adult population and potentially inappropriate medications are known to be involved in these readmissions. Several lists of potentially inappropriate medications have been published in diverse countries in order to adapt the lists to local specificities. Among them, the Beers Criteria® were first published in 1991 in the USA, followed by the French Laroche list, the Norwegian NORGEP criteria, the German PRISCUS list, the Austrian consensus panel list and the European list, EU-7. The main objective was to detect which potentially inappropriate medications list can better detect hospital readmissions within 30 days in the older adult population hospitalised for fall-related injuries. METHODS We conducted a multicentre, observational, retrospective cohort study. Data from older patients initially hospitalised for falls in 2019 and discharged home were retrieved from the Clinical Data Warehouse. Exposure to potentially inappropriate medications was classified according to the six lists mentioned above. The local ethics committee approved the study protocol (number CER-2020-79). RESULTS After adjustments using propensity score matching, taking a potentially inappropriate medication as per the Laroche and PRISCUS lists was associated with a 30-day hospital readmission with an odds ratio of 1.58 (95% confidence interval 1.06-2.37) and 1.68 (95% confidence interval 1.13-2.50), respectively, while the other four studied lists showed no associations with readmissions. CONCLUSIONS Our study evidenced that not all lists published allow the accurate prediction of hospital readmissions to the same extent. We found that the Laroche and PRISCUS lists were associated with increased 30-day all-cause hospital readmissions after an index admission with a fall-related injury.
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Affiliation(s)
- Rouba Assi
- GHU AP-HP, Sorbonne Université, Hôpital Saint Antoine, Pharmacie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Camille Schwab
- GHU AP-HP, Sorbonne Université, Hôpital Saint Antoine, Pharmacie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France. .,Département de Pharmacie Clinique, Faculté de Pharmacie, Université Paris-Saclay, Chatenay-Malabry, France.
| | - Asmae El Abd
- GHU AP-HP, Sorbonne Université, Hôpital Saint Antoine, Pharmacie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Christine Fernandez
- GHU AP-HP, Sorbonne Université, Hôpital Saint Antoine, Pharmacie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Département de Pharmacie Clinique, Faculté de Pharmacie, Université Paris-Saclay, Chatenay-Malabry, France
| | - Patrick Hindlet
- GHU AP-HP, Sorbonne Université, Hôpital Saint Antoine, Pharmacie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Département de Pharmacie Clinique, Faculté de Pharmacie, Université Paris-Saclay, Chatenay-Malabry, France
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21
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Ouyang S, Zheng C, Lin Z, Zhang X, Li H, Fang Y, Hu Y, Yu H, Wu G. Risk factors of falls in elderly patients with visual impairment. Front Public Health 2022; 10:984199. [PMID: 36072374 PMCID: PMC9441862 DOI: 10.3389/fpubh.2022.984199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To examine the risk factors for falls in elderly patients with visual impairment (VI) and assess the predictive performance of these factors. METHODS Between January 2019 and March 2021, a total of 251 elderly patients aged 65-92 years with VI were enrolled and then prospectively followed up for 12 months to evaluate outcomes of accidental falls via telephone interviews. Information of demographics and lifestyle, gait and balance deficits, and ophthalmic and systemic conditions were collected during baseline visits. Forward stepwise multivariable logistic regression analysis was performed to identify independent risk factors of falls in elderly patients with VI, and a derived nomogram was constructed. RESULTS A total of 143 falls were reported in 251 elderly patients during follow-up, with an incidence of 56.97%. The risk factors for falls in elderly patients with VI identified by multivariable logistic regression were women [odds ratio (OR), 95% confidence interval (CI): 2.71, 1.40-5.27], smoking (3.57, 1.34-9.48), outdoor activities/3 months (1.31, 1.08-1.59), waking up frequently during the night (2.08, 1.15-3.79), disorders of balance and gait (2.60, 1.29-5.24), glaucoma (3.12, 1.15-8.44), other retinal degenerations (3.31, 1.16-9.43) and best-corrected visual acuity (BCVA) of the better eye (1.79, 1.10-2.91). A nomogram was developed based on the abovementioned multivariate analysis results. The area under receiver operating characteristic curve of the predictive model was 0.779. CONCLUSIONS Gender, smoking, outdoor activities, waking up at night, disorders of balance and gait, glaucoma, other retinal degeneration and BCVA of the better eye were independent risk factors for falls in elderly patients with VI. The predictive model and derived nomogram achieved a satisfying prediction of fall risk in these individuals.
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Affiliation(s)
- Shuyi Ouyang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunwen Zheng
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Graduate School, Shantou University Medical College, Shantou, China
| | - Zhanjie Lin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Graduate School, Shantou University Medical College, Shantou, China
| | - Xiaoni Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haojun Li
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Fang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yijun Hu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Yijun Hu
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Honghua Yu
| | - Guanrong Wu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- Guanrong Wu
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22
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Okpalauwaekwe U, Tzeng HM. Adverse Events and Their Contributors Among Older Adults During Skilled Nursing Stays for Rehabilitation: A Scoping Review. Patient Relat Outcome Meas 2021; 12:323-337. [PMID: 34803416 PMCID: PMC8599876 DOI: 10.2147/prom.s336784] [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: 08/30/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify factors that contribute to adverse events among older adults during short stays at skilled nursing facilities (SNFs) for rehabilitation (ie, up to 100 resident days). Adults aged 65 years and older are at serious risk for adverse events throughout their continuum of care. Over 33% of older adults admitted to SNFs experienced an adverse event (eg, falls) within the first 35 days of their stay. Design A scoping review. Setting and Participants Older adults admitted for short stays in SNFs. Methods Eligibility criteria were peer-reviewed original articles published between 1 January 2015 and 30 May 2021, written in English, and containing any of the following key terms and synonyms: “skilled nursing facilities”, “adverse events”, and “older adults”. These terms were searched in PubMed, MEDLINE, CINAHL, EBSCOHost, and the ProQuest Nursing and Allied Health Database. We summarized the findings using the Joanna Briggs Institute and PRISMA-ScR reporting guidelines. We also used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavioral change as a framework to guide the content, thematic, and descriptive analyses of the results. Results Eleven articles were included in this scoping review. Intrinsic and extrinsic contributors to adverse events (ie, falls, medication errors, pressure ulcers, and acute infections) varied for each COM-B domain. The most frequently mentioned capacity-related intrinsic contributors to adverse events were frailty and reduced muscle strength due to advancing age. Inappropriate medication usage and polypharmacy were the most common capacity-related extrinsic factors. Opportunity-related extrinsic factors contributing to adverse events included environmental hazards, poor communication among SNF staff, lack of individualized resident safety plans, and overall poor care quality owing to racial bias and organizational and administrative issues. Conclusion These findings shed light on areas that warrant further research and may aid in developing interventional strategies for adverse events during short SNF stays.
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Affiliation(s)
- Udoka Okpalauwaekwe
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Huey-Ming Tzeng
- The University of Texas Medical Branch at Galveston, School of Nursing, Galveston, TX, USA
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Imaginário C, Martins T, Araújo F, Rocha M, Machado P. Risk Factors Associated with Falls among Nursing Home Residents: A Case-Control Study. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000520491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand the behaviour and health conditions of older adults living in nursing homes. Objective: This study had two main objectives. The first was to find significant predictors for falls in older adults living in nursing homes. The second main goal was to build a predictive model to find the best predictors for falls. Methods: Out of 56 nursing homes with the same legal statute, 25 agreed to participate. The sample was randomly selected and only the independent or slight/moderately dependent participants were included in the study (n = 325). Results: There was a mean of 1.47 ± 0.99 falls (range from 1 to 7) per resident in nursing homes. By using the t test and odds ratio analysis, ten factors related to falls were identified. Through the binary logistic regression, a model was tested identifying four robust predictors: static balance, resorting to emergency services, polypharmacy, and an independent self-care profile. Conclusions: The present study replicated the main results of contemporary research on the risk factors of falls. More importantly, it suggests that the self-care profile model should be taken into account in future studies and early interventions. It is crucial to implement preventive measures consistent with safer environments and to establish an individual plan for integrated activities according to older adults’ health needs.
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Pérez-Ros P, Sanchis-Aguado MA, Durá-Gil JV, Martínez-Arnau FM, Belda-Lois JM. FallSkip device is a useful tool for fall risk assessment in sarcopenic older community people. Int J Older People Nurs 2021; 17:e12431. [PMID: 34652070 DOI: 10.1111/opn.12431] [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: 06/04/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Fall prevention is a major health concern for the ageing population. Sarcopenia is considered a risk factor for falls. Some instruments, such as Time Up and Go (TUG), are used for screening risk. The use of sensors has also been shown to be a viable tool that can provide accurate, cost-effective, and easy to manage assessment of fall risk. One novel sensor for assessing fall risk in older people is the Fallskip device. The present study evaluates the performance of the FallSkip device against the TUG method in fall risk screening and assesses its measurement properties in sarcopenic older people. METHODS A cross-sectional study was made in a sample of community-dwelling sarcopenic and non-sarcopenic older people aged 70 years or over. RESULTS The study sample consisted of 34 older people with a mean age of 77.03 (6.58) years, of which 79.4% (n = 27) were females, and 41.2% (n = 14) were sarcopenic. The Pearson correlation coefficient between TUG time and FallSkip time was 0.70 (p < 0.001). The sarcopenic individuals took longer in performing both TUG and FallSkip. They also presented poorer reaction time, gait and sit-to-stand - though no statistically significant differences were observed. The results in terms of feasibility, acceptability, reliability and validity in sarcopenic older people with FallSkip were acceptable. CONCLUSIONS The FallSkip device has suitable metric properties for the assessment of fall risk in sarcopenic community-dwelling older people. FallSkip analyses more parameters than TUG in assessing fall risk and has greater discriminatory power in evaluating the risk of falls.
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Affiliation(s)
- Pilar Pérez-Ros
- Department of Nursing, University of Valencia, Valencia, Spain.,Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, Valencia, Spain
| | | | - Juan V Durá-Gil
- Instituto de Biomecánica de Valencia, Universitat Politècnica de València, Valencia, Spain
| | - Francisco M Martínez-Arnau
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan M Belda-Lois
- Instituto de Biomecánica de Valencia, Universitat Politècnica de València, Valencia, Spain
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Moreira RP, Guerra FVG, Ferreira GDO, Cavalcante TF, Felício JF, Ferreira LCC, Guedes NG. Effects of the nursing intervention Fall prevention in older adults with arterial hypertension using NANDA-I, NIC, and NOC. Int J Nurs Knowl 2021; 33:147-161. [PMID: 34519446 DOI: 10.1111/2047-3095.12346] [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: 05/04/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To measure the effects of the NIC intervention fall prevention on the magnitude of the NANDA-I Risk for falls' risk factors and of NOC indicators related to falls in older adults with arterial hypertension. BACKGROUND Nurses can use nursing taxonomies to provide effective care in preventing falls in specific populations. METHODS Clinical, randomized, open, parallel, and multicenter trial following the CONSORT recommendations for nonpharmacological trials. The clinical trial was registered. The research was conducted with 118 older adults allocated to intervention and control groups and matched by sex and age. The intervention was conducted in the participants' homes in three different moments and consisted of nursing activities belonging to the NIC Fall prevention and implemented with the aid of a protocol with operational definitions. FINDINGS Three months after the intervention, there was a significant intergroup difference in the frequency of Risk for falls and of the following factors/conditions: cluttered environment, unfamiliar setting, exposure to unsafe weather-related condition, insufficient anti-slip material in the bathroom, history of falls, acute illness, orthostatic hypotension, hearing impairment, and impaired vision. There was also a positive change in the magnitude of the following NOC indicators: risk control, cognitive orientation, knowledge: fall prevention, safe home environment, comfort level, vision compensation behavior, and leisure participation. CONCLUSIONS The NIC intervention Fall prevention was effective in modifying risk factors belonging to Risk for falls and NOC indicators related to falls in older adults. IMPLICATIONS FOR NURSING PRACTICE The tested intervention is important and should be instituted, mainly by nurses from primary care services who make home visits to older adults.
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Affiliation(s)
- Rafaella Pessoa Moreira
- Health Sciences Institute, College of Nursing, University for International Integration of the Afro-Brazilian Lusophony, Redencao, Brazil
| | | | | | - Tahissa Frota Cavalcante
- Health Sciences Institute, College of Nursing, University for International Integration of the Afro-Brazilian Lusophony, Redencao, Brazil
| | - Janiel Ferreira Felício
- College of Nursing, University for International Integration of the Afro-Brazilian Lusophony, Redencao, Brazil
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Leceta A, García A, Sologuren A, Campo C. Bilastine 10 and 20 mg in paediatric and adult patients: an updated practical approach to treatment decisions. Drugs Context 2021; 10:dic-2021-5-1. [PMID: 34457015 PMCID: PMC8366504 DOI: 10.7573/dic.2021-5-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background Bilastine, a non-sedating H1-antihistamine, is indicated to treat the symptoms of allergic disorders (e.g. rhinoconjunctivitis and urticaria) in adults and adolescents and, more recently, in children. Following its marketing approval, many questions regarding the ideal use of bilastine in various clinical practice situations have been received by the Medical Information Department (MID) of Faes Farma Spain. This article is an update of a previous review, with a focus on recent clinical information on the use of bilastine in paediatric and other populations. Methods Results of recent clinical studies in paediatric and other populations as well as questions received and responses provided by the Faes Farma MID. Results The information regarding the use of bilastine in paediatric patients is the most relevant aspect of this updated review. The stepwise approval of the paediatric formulations in various countries started with the European Medicines Agency approval in 2017 in accordance with a 2009 Paediatric Investigation Plan, followed by approval in other countries. The queries that are most commonly received by the Faes Farma MID include the potential for drug interactions involving bilastine and other frequently used drugs, and the use of bilastine in special populations or to treat specific symptoms related to allergic conditions. As the concomitant use of many medications is not permitted during clinical trials, the advice provided regarding the concomitant use of other medications with bilastine considers the pharmacological properties of both the drug in question and bilastine, as well as expert opinion. Likewise, advice regarding the use of bilastine in special populations (e.g. patients with renal impairment, obesity, lactose intolerance, and elderly or pregnant individuals) or to treat specific symptoms (e.g. treatment-resistant urticaria, pruritus or BASCULE syndrome) considers the best evidence from a variety of sources, including clinical studies, real-world experience, guideline recommendations and expert opinion. Conclusion This updated review provides current data regarding the best use of bilastine in specific situations and patients and identifies areas in which further knowledge is required. Although decisions regarding the use of bilastine may be aided by expert opinion that relies on knowledge of the underlying science, additional research and evidence are required to answer certain queries regarding the use of bilastine.
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Affiliation(s)
- Amalia Leceta
- Medical Affairs Department, Faes Farma SA, Bizkaia, Spain
| | | | | | - Cristina Campo
- Head of Clinical Research Medical Affairs Department, Faes Farma SA, Bizkaia, Spain
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Kuo CT, Chen DR, Chen YM, Chen PY. Validation of the short falls efficacy scale-international for Taiwanese community-dwelling older adults: Associations with fall history, physical frailty, and quality of life. Geriatr Nurs 2021; 42:1012-1018. [PMID: 34256149 DOI: 10.1016/j.gerinurse.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/21/2023]
Abstract
The FES-I is widely used to measure the fear of falling. However, studies linking the Chinese version of the FES-I to frailty and quality of life among older adults are still limited. Thus, this study examined the association of the full 16-item FES-I and the 7-item short FES-I with fall history, physical frailty, and quality of life among older Taiwanese adults. A total of 751 community-dwelling older adults in Taipei City participated in this study. Data analyses included logistic and linear regression models. The 16-item and the short FES-I were strongly correlated (Spearman rho = 0.963), and both scales are reliable. The 7-item FES-I was positively associated with fall history and physical frailty and negatively associated with the physical (b = -0.65, p < 0.001) and mental (b = -0.59, p < 0.001) components of health-related quality of life, independent of physical frailty. Thus, the short FES-I can be used to increase the feasibility of health screenings of older adults in Chinese-speaking contexts.
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Affiliation(s)
- Chun-Tung Kuo
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Duan-Rung Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Peng-Yu Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
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Uncertainties around COVID-19 from the perspectives of oral health care workers during the first wave of SARS-CoV-2 infections in British Columbia, Canada. PLoS One 2021; 16:e0249186. [PMID: 33886570 PMCID: PMC8061945 DOI: 10.1371/journal.pone.0249186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 12/23/2022] Open
Abstract
Background The first wave of COVID-19 infections caused disturbances in all aspects of personal and professional lives. The aim of this study was to explore the ways in which that first wave of novel coronavirus infections resulted in uncertainties, as experienced by members of the oral health care workforce in British Columbia, Canada. Methods This qualitative inquiry purposefully recruited frontline oral health care workers, including dentists, dental hygienists, certified dental assistants, and administrative staff, via remote semi-structured interviews between April 20 and May 4, 2020. Coding, categories, and themes were inductively assigned. Results A total of 45 interviews, lasting between 39 and 74 minutes each, were conducted involving 18 dentists (6 females), 12 dental hygienists (11 females), 6 certified dental assistants (all females), and 9 administrators/front-desk staff (7 females). Fifty-one hours of audio recordings and more than 650 single-spaced pages of transcripts were produced. Five main themes emerged pertaining to uncertainties surrounding COVID-19, patient care, personal lives and infectiousness, concern for the future, and variations among different pandemics. Certitudes were less evident, but surfaced mostly when considering a potential new normal resulting from the pandemic. Conclusion Participants indicated that the uncertainties they felt were dependent upon what is known, and unknown, about the pandemic and the provision of oral health care during the first wave of infections. Future studies are needed to include the viewpoints of oral health care workers from other provinces, as well the perceptions of patients who received oral health care during the height of the first wave of the pandemic.
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The association between social isolation and musculoskeletal health in older community-dwelling adults: findings from the Hertfordshire Cohort Study. Qual Life Res 2021; 30:1913-1924. [PMID: 33595825 PMCID: PMC8233263 DOI: 10.1007/s11136-021-02784-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Social isolation has been associated with both physical and psychological adverse outcomes and is prevalent in older adults. We investigated the impact of social isolation on bone mineral density (BMD) and physical capability in community-dwelling older adults. METHODS Data were collected in 2011 and 2017 from the Hertfordshire Cohort Study. In 2011, we assessed social isolation using the six-item Lubben Social Network Scale (LSNS-6) and the Maastricht Social Participation Profile (MSSP) and depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). Physical capability was assessed by performing tests of gait speed, chair stands, timed up and go and balance at both time points. BMD was assessed using dual X-ray absorptiometry (DXA) at both time points. RESULTS Data were available from 369 participants in 2011 and 184 in 2017. Forty percent of men and 42.4% of women were socially isolated. Isolated participants had higher odds of depressive disorder (OR 3.01, 95% CI 1.27-7.11, p < 0.02). Social isolation at baseline was associated with poor physical capability scores at follow-up (OR 5.53, 95% CI 1.09-27.99, p < 0.04). No associations were found between social isolation and BMD at either time point. CONCLUSIONS Social isolation was associated with higher odds of having depressive symptoms and predicted the development of poor physical capability 6 years later. Further longitudinal studies that include loneliness as a covariate are warranted.
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Tabatabaei HR, Ahmadipour H. Fall-Risk Assessment in the Elderly Using the Persian Version of Fall-Risk Screening Tool: A Population-Based Study. Int J Prev Med 2020; 11:153. [PMID: 33209223 PMCID: PMC7643577 DOI: 10.4103/ijpvm.ijpvm_198_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/14/2019] [Indexed: 10/27/2022] Open
Abstract
Background Falling is a serious challenge for public health and a leading cause of morbidity and mortality among the elderly. This study conducted to evaluate the psychometric properties of the Persian version of fall risk screening tool (P-FRST). Methods A cross-sectional study carried out from September 2018 to March 2019 on 537 elders who referred to urban health centers in Kerman, Iran. Demographic data recorded and fall-risk assessment was performed using P-FRST and the timed up and go test (TUG). The maximum possible score is 33 for P-FRST and score ≥18 is considered as high risk. The time ≥12 s in TUG test considered as a risk for falling. Data analyzed by SPSS using t-test, analysis of variance, and linear regression. Results The mean age of participants was 67.18 ± 6.93. According to P-FRST, 22% of the elderly were high risk and 62% had a moderate risk for falling. The mean score for falling risk was significantly higher in the females, illiterates, income <10 million IRRLs, and the unemployed. Conclusions Due to the risk of falling in the elderly, it is suggested that in the comprehensive health care for the elderly, to assess the risk of falling, especially in high-risk groups, so that preventive interventions can be made.
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Affiliation(s)
- Hoorasa Razavi Tabatabaei
- Department of Community and Family Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Habibeh Ahmadipour
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Rommens PM, Hopf JC, Herteleer M, Devlieger B, Hofmann A, Wagner D. Isolated Pubic Ramus Fractures Are Serious Adverse Events for Elderly Persons: An Observational Study on 138 Patients with Fragility Fractures of the Pelvis Type I (FFP Type I). J Clin Med 2020; 9:jcm9082498. [PMID: 32756494 PMCID: PMC7463797 DOI: 10.3390/jcm9082498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Fractures of the pubic ramus without involvement of the posterior pelvic ring represent a minority of fragility fractures of the pelvis (FFP). The natural history of patients suffering this FFP Type I has not been described so far. Material and methods: All patients, who were admitted with isolated pubic ramus fractures between 2007 and mid-2018, have been reviewed. Epidemiologic data, comorbidities, in-hospital complications, and one-year mortality were recorded. Of all surviving patients, living condition before the fracture and at follow-up was noted. Mobility was scored with the Parker Mobility Score, quality of life with the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L), subjective sensation of pain with the Numeric Rating Scale (NRS). Results: A consecutive series of 138 patients was included in the study. There were 117 women (84.8%) and 21 men (15.2%). Mean age was 80.6 years (SD 8.6 years). 89.1% of patients presented with comorbidities, 81.2% of them had cardiovascular diseases. Five patients (4%) died during hospital-stay. Median in-hospital stay was eight days (2–45 days). There were in-hospital complications in 16.5%, urinary tract infections, and pneumonia being the most frequent. One-year mortality was 16.7%. Reference values for the normal population of the same age are 5.9% for men and 4.0% for women. One-year mortality rate was 22.2% in the patient group of 80 years or above and 8.8% in the patient group below the age of 80. The rate of surviving patients living at home with or without assistance dropped from 80.5% to 65.3%. The median EQ-5D-Index Value was 0.62 (0.04–1; IQR 0.5–0.78). Reference value for the normal population is 0.78. Average PMS was 4 and NRS 3. Within a two-year period, additional fragility fractures occurred in 21.2% and antiresorptive medication was taken by only 45.2% of patients. Conclusion. Pubic ramus fractures without involvement of the posterior pelvis (FFP Type I) are serious adverse events for elderly persons. During follow-up, there is an excess mortality, a loss of independence, a restricted mobility, and a decreased quality of life. Pubic ramus fractures are indicators for the need to optimize the patient’s general condition.
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Affiliation(s)
- Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (J.C.H.); (M.H.); (B.D.); (D.W.)
- Correspondence: ; Tel.: +49-6131-177292
| | - Johannes Christof Hopf
- Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (J.C.H.); (M.H.); (B.D.); (D.W.)
| | - Michiel Herteleer
- Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (J.C.H.); (M.H.); (B.D.); (D.W.)
| | - Benjamin Devlieger
- Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (J.C.H.); (M.H.); (B.D.); (D.W.)
| | - Alexander Hofmann
- Department of Orthopedics and Traumatology, Westpfalz Klinikum Kaiserslautern, Hellmut-Hartert Straße 1, 67655 Kaiserslautern, Germany;
| | - Daniel Wagner
- Department of Orthopedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (J.C.H.); (M.H.); (B.D.); (D.W.)
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Tomas-Carus P, Rosado H, Pereira C, Marmeleira J, Veiga G, Collado-Mateo D. Differences between two types of dual tasks according to the educational level in older adults. Arch Gerontol Geriatr 2020; 91:104216. [PMID: 32771884 DOI: 10.1016/j.archger.2020.104216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION For dual-task paradigms, the timed up and go (TUG) test along with other cognitive or motor tasks has been used to evaluate and predict the risk of falling in older adults. However, the interference between motor-cognitive tasks can differ by the cognitive task. OBJECTIVE To evaluate the performance of the TUG test under a single task condition and two dual-task conditions in older adults and to explore the effect of educational level on task performance. METHODS A total of 418 older adults (328 females) voluntarily participated in this study. The TUG test was administered as a single task and a dual task with one secondary simultaneous task: counting aloud backward from 100 or naming animals. Comparisons were performed to determine the interference caused by each cognitive task on the motor task, and correlation analysis was performed to explore the role of educational level. RESULTS The animal task led to a poorer TUG performance and a higher dual-task cost than did the counting task. Furthermore, the motor task led to a higher percentage of errors and cognitive stops in the animal task. Educational level plays a significant role in the interaction between tasks. CONCLUSIONS Between-task interference differs by the type of cognitive task performed and the educational level of the participants. The results of the present study should be considered when dual-task assessments are planned for older adults.
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Affiliation(s)
- Pablo Tomas-Carus
- Departamento de Desporto e Saúde, Escola de Ciências e Tecnologia, Universidade de Évora, Portugal; Comprehensive Health Research Center (CHRC), University of Évora, Portugal.
| | - Hugo Rosado
- Departamento de Desporto e Saúde, Escola de Ciências e Tecnologia, Universidade de Évora, Portugal; Comprehensive Health Research Center (CHRC), University of Évora, Portugal
| | - Catarina Pereira
- Departamento de Desporto e Saúde, Escola de Ciências e Tecnologia, Universidade de Évora, Portugal; Comprehensive Health Research Center (CHRC), University of Évora, Portugal
| | - José Marmeleira
- Departamento de Desporto e Saúde, Escola de Ciências e Tecnologia, Universidade de Évora, Portugal; Comprehensive Health Research Center (CHRC), University of Évora, Portugal
| | - Guida Veiga
- Departamento de Desporto e Saúde, Escola de Ciências e Tecnologia, Universidade de Évora, Portugal; Comprehensive Health Research Center (CHRC), University of Évora, Portugal
| | - Daniel Collado-Mateo
- Centre for Sport Studies, Rey Juan Carlos University, 28943, Fuenlabrada, Madrid, Spain
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Clynes MA, Bevilacqua G, Jameson KA, Cooper C, Dennison EM. Does self-report of multimorbidity in later life predict impaired physical functioning, and might this be useful in clinical practice? Aging Clin Exp Res 2020; 32:1443-1450. [PMID: 32056154 PMCID: PMC7452933 DOI: 10.1007/s40520-020-01500-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/28/2020] [Indexed: 12/24/2022]
Abstract
Background Multimorbidity has been shown in several studies to relate to impaired physical function in later life. Aims To examine if self-report of multimorbidity predicts impaired physical functioning, as assessed by formal physical function testing, in community-dwelling older adults. Methods Non-communicable diseases (NCDs) were self-reported by 443 older community-dwelling UK adults via questionnaire, asking the question: ‘Have you been told by a doctor that you have any of the following conditions?’ Assessments of walking speed, chair stands and balance allowed us to create a composite score (0–12) on which impaired physical functioning was defined as ≤ 9. Results The mean age of participants was 75.5 ± 2.5 years for men and 75.8 ± 2.6 for women. The proportion of individuals with impaired physical functioning was 71.2% in women and 56.9% in men. Having four or more NCDs was associated with an increased risk of poor physical function in men and women (p < 0.05). The number of medications and medicated systems was associated with gait speed (p < 0.03 and < 0.02, respectively) and timed up-and-go tests (p < 0.03 and < 0.02, respectively) in women but not men. Discussion and conclusion Self-report of 4 or more NCDs was associated with an increased risk of poor physical function, an outcome which has previously been associated with adverse clinical sequelae. This observation may inform development of a simple screening tool to look for poor physical function in older adults. Electronic supplementary material The online version of this article (10.1007/s40520-020-01500-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael A Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Karen A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LE, UK.
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Victoria University of Wellington, Wellington, New Zealand
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Gadelha AB, Neri SGR, Vainshelboim B, Ferreira AP, Lima RM. Dynapenic abdominal obesity and the incidence of falls in older women: a prospective study. Aging Clin Exp Res 2020; 32:1263-1270. [PMID: 31489597 DOI: 10.1007/s40520-019-01318-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/10/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dynapenic abdominal obesity (D/AO) has been associated with negative outcomes in older people, including trait of falls. AIMS To assess the association between D/AO and the incidence of falls over 18 months in older community-dwelling women. METHODS A total of 201 older women (67.97 ± 6.02 years; 27.70 kg/m2) underwent waist circumference measurement, and had handgrip strength assessed using a hydraulic dynamometer. Dynapenia was classified using the lower tertile of handgrip strength, while abdominal obesity was considered as a waist circumference > 88 cm. D/AO was the combination of both aforementioned criteria. Volunteers were classified into four groups: normal, abdominal obesity, dynapenic, and D/AO. Participants were then tracked by phone calls for ascertainment of falls during a follow-up period of 18 months. Chi-square and multivariable Cox proportional regressions were conducted. RESULTS The overall incidence of falls over the follow-up was 27.5%; and for normal, dynapenic, abdominal obesity, and D/AO were 14.7%, 17.2%, 27.5%, and 40.4% (X2 = 8.341; P = 0.039), respectively. D/AO was associated with a higher risk of falls (hazard ratio: 3.595 [95% CI: 1.317-9.815], even after adjustments for age, body mass index, physical activity level, regular use of medications, peripheral sensation, chronic diseases, and history of lower-limbs pain. CONCLUSIONS D/AO is more closely related to falls than either dynapenia or abdominal obesity alone, and is independently associated with an increased incidence of falls in older women. These results provide support for the concept that the combined evaluation of muscle strength and central obesity may be clinically relevant in this population.
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Affiliation(s)
- André Bonadias Gadelha
- Department of Physical Education and Sports, Federal Institute of Education, Science and Technology Goiano, Rod. Geraldo Silva Nascimento, Km-2,5, Zona Rural, Urutaí, Goiás, 75790-000, Brazil.
| | - Silvia G R Neri
- Faculdade de Educação Física, University of Brasília, Campus Darcy Ribeiro, Asa Norte, Brasília, 70910-900, Distrito Federal, Brazil
| | - Baruch Vainshelboim
- Master of Cancer Care Program, School of Health Sciences, Saint Francis University, Loretto, PA, USA
| | | | - Ricardo M Lima
- Faculdade de Educação Física, University of Brasília, Campus Darcy Ribeiro, Asa Norte, Brasília, 70910-900, Distrito Federal, Brazil
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Need and Rationale for Geriatric Fracture Programs. Orthop Nurs 2020; 39:162-164. [PMID: 32443088 DOI: 10.1097/nor.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Fragility fractures among the older adult population are common, costly, and one of the top acute care facility diagnoses for this age group. Approximately 150,000 older adults in the United States are admitted to a hospital for treatment of a fragility hip fracture annually, with an estimated cost of more than $10 billion to the healthcare system. On admission to the hospital, patient treatment may be delayed, fragmented, or inadequate, adversely impacting length of stay and short- and long-term patient outcomes. Development of a geriatric fracture program implementing standardized, evidence-based guidelines can streamline clinical pathways and care processes and has been demonstrated to be a cost-effective method to improve patient outcomes.
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Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients. Aging Clin Exp Res 2019; 31:1435-1442. [PMID: 30515724 DOI: 10.1007/s40520-018-1082-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA). AIM To verify the association of SPPB and POMA scores with falls in older outpatients. METHODS 451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller. RESULTS 245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627-0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627-0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76-0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91-0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42-5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores. CONCLUSIONS SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.
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Mandalaywala MD, Crawford KM, Pinto SM. Management of Traumatic Brain Injury: Special Considerations for Older Adults. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lee Y, Lee HH, Uhm KE, Jung HJ, Kim YS, Shin J, Choi J, Han SH, Lee J. Early Identification of Risk Factors for Mobility Decline Among Hospitalized Older Patients. Am J Phys Med Rehabil 2019; 98:699-705. [PMID: 31318751 DOI: 10.1097/phm.0000000000001180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of the study was to identify the risk factors for mobility decline among hospitalized older patients early. DESIGN This is a prospective cohort study. A total of 875 older patients were divided into two groups: older patients with and without mobility decline. The mobility level was measured using the item of functional mobility in the Geriatric Screening for Care 10. The change in mobility between admission and discharge was determined as the dependent variable. There were a total of 18 independent variables, which consisted of three demographic variables, 10 most problematic domains of geriatric care, and five other health-related variables. A multivariable logistic regression analysis was conducted to identify the risk factors for mobility decline during hospitalization. RESULTS Of the 875 older patients, 135 (15.4%) experienced mobility decline during hospitalization. The multivariable logistic regression analysis revealed female sex, cognitive impairment, and underweight as the risk factors for mobility decline during hospitalization. CONCLUSIONS The identified risk factors should be considered to identify patients at a risk of mobility decline early and to provide targeted interventions, which can prevent mobility decline.
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Affiliation(s)
- Yejin Lee
- From the Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea (YL, H-HL, KEU, HJJ, JL); Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri (YL); Department of Quality Improvement, Konkuk University Medical Center, Seoul, South Korea (Y-SK); Department of Family Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea (JS, JC); Department of Neurology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea (S-HH); and Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea (JL)
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Abstract
Appropriate selection and dosing of medications is essential when prescribing for older adults. Opioids are commonly employed to treat pain but must be approached with caution due to potentially dangerous adverse reactions. This article provides strategies for safely prescribing opioids for pain in older adults.
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Brown T, Robinson JM, Renfro CP, Blalock SJ, Ferreri S. Analysis of the relationship between patients’ fear of falling and prescriber acceptance of community pharmacists’ recommendations. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1615719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Tenley Brown
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica M. Robinson
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chelsea P. Renfro
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Susan J. Blalock
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefanie Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kim H, Zhao YL, Kim N, Ahn YH. Home modifications for older people with cognitive impairments: Mediation analysis of caregivers' information needs and perceptions of fall risks. Int J Older People Nurs 2019; 14:e12240. [PMID: 31099499 DOI: 10.1111/opn.12240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/13/2019] [Accepted: 04/15/2019] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES The aims were to (a) identify how many older people with cognitive impairments are living in modified homes and (b) explore associated factors, and (c) examine the mediating effects that their caregivers' information needs and perceptions of fall risk and other factors. BACKGROUND Older people and their informal caregivers may consider implementing home modifications as an effective strategy for fall prevention. However, there is a lack of information on which older people's homes receive modifications and the various factors associated with such modifications among community-dwelling older people with cognitive impairments. DESIGN This cross-sectional and correlational study utilises a secondary data analysis. METHODS The data for this secondary analysis were taken from the 2015 National Online Survey of Caregivers, which includes information provided by 226 adult caregivers for older people with cognitive impairments. Descriptive analyses, hierarchical binary logistic regression and structural equation modelling were performed based on the Andersen and Newman framework of health services utilisation. RESULTS Overall, 46.5% of the older people lived in modified homes. Older people's impaired activities for daily living (ADLs), caregivers' information needs and perceptions of fall risk were all associated with home modifications (all p values<0.05). Caregivers' information needs mediated the relationship between impaired ADLs and home modifications (indirect effect = 0.026, p < 0.05), whereas the caregivers' perceptions of fall risk did not. CONCLUSIONS Older people with both cognitive and functional impairments are more likely to modify their home on behalf of care recipient's staying at home. Caregivers' information needs should thus be prioritized when considering home modifications to facilitate caring for older people with impaired ADLs. IMPLICATION FOR PRACTICE Nurses and other healthcare professionals should be prepared to offer appropriate information and comprehensive assessments of older people's conditions with regard to home modifications.
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Affiliation(s)
- Heejung Kim
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Seodaemun-gu, Seoul, Korea
| | | | - Namhee Kim
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, Korea
| | - Yong Han Ahn
- Department of Architecture and Architectural Engineering, Hanyang University-ERICA, Ansan, Sangnok-gu, Korea
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Axmon A, Ahlström G, Sandberg M. Falls resulting in health care among older people with intellectual disability in comparison with the general population. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:193-204. [PMID: 30407691 PMCID: PMC7379981 DOI: 10.1111/jir.12564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 09/25/2018] [Accepted: 10/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Falls are common among older people with intellectual disability (ID) and are also a major contributor to injuries in this population. Yet, fall characteristics have only been sparsely studied, and the results are inconsistent. The aim of the present study was to investigate type of falls, places where they occurred and activities that caused them, as well as health outcomes and health utilisation patterns after falls, among older people with ID in comparison with their age peers in the general population. METHODS We established an administrative cohort of people with ID aged 55 years, or more, and alive at the end of 2012 (ID cohort; n = 7936). A cohort from the general population, one-to-one matched by sex and year of birth, was used as referents. Data regarding fall-induced health care episodes in inpatient and outpatient specialist care were collected from the National Patient Register for the period 2002-2012. RESULTS With the exception of falls from one level to another (i.e. fall on and from stairs and steps, ladder and scaffolding; fall from, out of or through building or structure; fall from tree or cliff and diving or jumping into water; or other fall from one level to another), people in the ID cohort were more likely to fall and fall more often than those in the general population cohort. Falls during a vital activity (e.g. attending to personal hygiene or eating) were twice as common among people with ID compared with the general population. When falling, people with ID were more likely to injure their head and legs but less likely to sustain injuries to the thorax and elbow/forearm. They were more likely to have superficial injuries, open wounds and fractures but less likely to have dislocations, sprain and strains. Fall-related health care visits among people with ID were more likely to be in inpatient care and be unplanned. People with ID were also more likely than those in the general population to have a readmission within 30 days. CONCLUSIONS People with ID are more likely to require specialist care after a fall and also more likely to obtain injuries to the head, compared with the general population. This is important to consider when taking preventive measures to reduce falls and fall-related injuries.
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Affiliation(s)
- A. Axmon
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of MedicineLund UniversityLundSweden
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - G. Ahlström
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - M. Sandberg
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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Dual task performance and history of falls in community-dwelling older adults. Exp Gerontol 2019; 120:35-39. [PMID: 30825548 DOI: 10.1016/j.exger.2019.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/24/2019] [Accepted: 02/25/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Falls are a common problem for older adults, and the identification of people at high risk of falling is a major challenge to health systems. OBJECTIVE To evaluate the association between the history of falls and single-task Timed Up and Go Test (single TUG) or dual-task TUG variables. METHODS Three hundred seventy seven community-dwelling older persons, with ages ranging from 65 and 92 years, participated in this cross-sectional study. Each participant performed two tests: single TUG and dual TUG. The cognitive task for dual TUG consisted of counting backward by one from 100 while performing the test. The number of cognitive errors, cognitive stops and motor stops were recorded. A new variable comprising time, errors and stops in the dual TUG was computed. RESULTS The number of falls was significantly associated with mean single and dual TUG performance, mean cognitive errors, mean cognitive stops and mean motor stops. The score in the single TUG time was not able to significantly classify participants as fallers or non-fallers in any of the sexes. On the other hand, the variable "dual TUG time spent adding cognitive stops and cognitive errors" achieved the best ability to classify women as fallers or non-fallers, while "dual task cost" and "dual TUG time spent adding cognitive stops" were the best variables to classify men. CONCLUSIONS Dual TUG including cognitive stops and cognitive errors may be more capable than the single TUG to detect differences and accurately classify fallers and non-fallers in the elderly.
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Rejón T, Serra-Prat M, Burdoy E, Cabré M. [Gender differences in the risk factors of falls in the elderly]. Rev Esp Geriatr Gerontol 2019; 54:238-240. [PMID: 30765115 DOI: 10.1016/j.regg.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Tatiana Rejón
- ABS Cirera Molins, Consorci Sanitari del Maresme, Mataró, Barcelona, España
| | - Mateu Serra-Prat
- Unidad de Investigación, Consorci Sanitari del Maresme, Mataró, Barcelona, España.
| | - Emili Burdoy
- ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró, Barcelona, España
| | - Mateu Cabré
- Servicio de Medicina Interna, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, España
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Sattar S, Alibhai SM, Spoelstra SL, Puts MT. The assessment, management, and reporting of falls, and the impact of falls on cancer treatment in community-dwelling older patients receiving cancer treatment: Results from a mixed-methods study. J Geriatr Oncol 2019; 10:98-104. [DOI: 10.1016/j.jgo.2018.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
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Sun W, Ma X, Wang L, Zhang C, Song Q, Gu H, Mao D. Effects of Tai Chi Chuan and Brisk Walking Exercise on Balance Ability in Elderly Women: A Randomized Controlled Trial. Motor Control 2019; 23:100-114. [PMID: 30008242 DOI: 10.1123/mc.2017-0055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/29/2018] [Accepted: 03/02/2018] [Indexed: 11/18/2022]
Abstract
This study aims to investigate the effects of Tai Chi Chuan (TCC) and brisk walking (BW) on balance and training duration for the two exercises to significantly improve balance. A total of 48 elderly women were randomly divided into three groups. The TCC and BW groups completed a 60-min intervention training program with five sessions weekly for 16 weeks. Single-leg standing balance was tested every 4 weeks. Results showed that all the variables with eyes open improved on the eighth week (p < .05) in the TCC group and on the 12th week (p < .01) in the BW group. All variables with eyes closed improved on the 12th week (p < .01) in the TCC group and on the 16th week (p < .05) in the BW group. The results showed that 12 and 16 weeks of TCC and BW, respectively were essential to improve balance with eyes closed among the women aged 60-70 years.
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Affiliation(s)
- Wei Sun
- Shanghai University of Sport
- Shandong Institute of Sport Science
| | - Xiujie Ma
- Shanghai University of Sport
- Handan University
| | | | - Cui Zhang
- Shanghai University of Sport
- Shandong Institute of Sport Science
| | | | | | - Dewei Mao
- Shanghai University of Sport
- Shandong Sport University
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Lawson K, Vinluan CM, Oganesyan A, Gonzalez EC, Loya A, Strate JJ. A retrospective analysis of prescription medications as it correlates to falls for older adults. Pharm Pract (Granada) 2018; 16:1283. [PMID: 30637029 PMCID: PMC6322985 DOI: 10.18549/pharmpract.2018.04.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/14/2018] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES To determine the correlation between falls and two medication factors: the class of medications and potentially inappropriate medications (PIMs) prescribed to community-dwelling older adults aged 55 and older. METHODS Retrospective, cross-sectional study. Home health patients residing in a Texas/Mexico border community and reporting at least one fall within the past month. Medication use, medication classification, and potentially inappropriate medications (PIM) recorded by level of falls; non-fallers and recurrent fallers. RESULTS Of 99 participants, 13.1% reported falling once and 86.9% reported two or more falls. Participant's average number of medications used was 10.51 (SD 5.75) with 93.9% having four or more prescribed medications. Average number of PIMs prescribed per participant was 1.42 (SD 1.51) with at least one PIM prescribed to 65.6% of participants. Twenty three out of 83 identified classes of prescribed medications met criteria for the study's analyses but resulted in no significant association to falls when comparing NF to RF. Agents acting on the renin-angiotensin system and lipid modifying agents were the most frequently prescribed medication classes (N=55, 55.6%). Ibuprofen was the PIM most frequently prescribed (n=13, 13.1%). The correlation between use of a prescribed PIM and number of falls was not statistically significant (p=0.128). CONCLUSIONS There was no correlation between classes of medication and level of falls. Recurrent fallers were more likely to have been prescribed a PIM than non-fallers (not significant). Although the analyses conducted for this study did not result in statistical significance, the high prevalence of polypharmacy and prescribed PIMs observed in these participants warrants a thorough review of medications to reduce fall risks among older adults.
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Affiliation(s)
| | | | | | | | - Amanda Loya
- University of Texas at El Paso. El Paso, TX (United States).
| | - Justin J Strate
- University of Texas at El Paso. El Paso, TX (United States).
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Baris VK, Seren Intepeler S. Views of key stakeholders on the causes of patient falls and prevention interventions: A qualitative study using the international classification of functioning, disability and health. J Clin Nurs 2018; 28:615-628. [DOI: 10.1111/jocn.14656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/30/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Veysel Karani Baris
- Nursing Faculty Nursing Management Department Dokuz Eylul University Izmir Turkey
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Witt S, Englander E, Kumlien C, Axelsson M. Mismatch between risk factors and preventive interventions? A register study of fall prevention among older people in one Swedish county. Int J Older People Nurs 2018; 13:e12209. [PMID: 30187674 DOI: 10.1111/opn.12209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/06/2018] [Accepted: 07/22/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Falls are a common and often a devastating health hazard for older people, causing suffering, morbidity and mortality. Falls are costly for society in terms of both resources and direct medical costs. Although knowledge about falls and fall prevention is well known, falls among older people are still a major problem. AIM AND OBJECTIVES The aim was to estimate the prevalence of the risk of falls among older people receiving municipal health care. A further aim was to investigate the consistency between fall risk factors and preventive nursing interventions. DESIGN A cross-sectional register study. METHODS Data containing risk assessments based on the Downton Fall Risk Index (DFRI) and planned interventions by the municipal health care were collected from the Swedish national quality registry, Senior Alert. Data were analysed using descriptive and analytic statistics. RESULTS In the sample of 5,427 older people, the prevalence of the risk of falling was 79%. There was a difference in prevalence between the different types of municipal health care, sex and age. The most common preventive intervention was environment adjustments, and the least planned intervention was information/education about falls. Physical activity as an intervention was planned among 13.2% of the participants. Approximately 27% of the older people did not have any planned interventions despite being at risk of falling. Planned interventions did not always correspond with the risk factors; for instance, only 35.4% of those at risk of falling due to medication obtained pharmaceutical reviews as a preventive measure to decrease the risk. CONCLUSION The risk of falling is common among older people, and the preventive interventions do not sufficiently follow current evidence. This implies that systematic implementation of fall-prevention guidelines is needed in municipal care. IMPLICATION FOR PRACTICE A better match between identified risk factors and preventive interventions is warranted.
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Affiliation(s)
- Sofia Witt
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Health Center Fågelbacken, Malmö, Sweden
| | - Emma Englander
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Christine Kumlien
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Cardio-Thoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden
| | - Malin Axelsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
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