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Alenazi AM, Alhwoaimel NA, Alqahtani BA, Alshehri MM, Alhowimel AS, Khunti K, Alghamdi MS. Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: a Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:1407-1416. [PMID: 38828104 PMCID: PMC11141721 DOI: 10.2147/rmhp.s463570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/04/2024] [Indexed: 06/05/2024] Open
Abstract
Background Previous studies have suggested an association between falls and the presence of Multiple Long-Term Conditions (MLTC) or disabilities. However, there is limited understanding of how these factors independently or collectively contribute to the risk of falls and fear of falling among community-dwelling adults. Objective This study examined the independent association between MLTC and the presence of disability with the risk of falls among community adults. Methods A cross-sectional study included 324 adults (age ≥ 50). Demographic and clinical data included age, sex, body mass index (BMI), MLTC (≥ two chronic diseases) risk of fall (ie, history of fall in the previous 12-months, number of falls, and recurrent falls). The Barthel Index and Falls Efficacy Scale-International (FES-I) were used to assess disability and fear of fall, respectively. Results MLTC (Odds Ratio (OR) 2.50, 95% Confidence Interval (CI) [1.26, 4.95], p=0.009), and disability (OR 1.71, 95% CI [1.04, 2.79], p = 0.034) were independently associated with history of falls. MLTC (Incidence Rate Ratio (IRR) 2.87, 95% CI [1.93, 4.29], p < 0.001) and disability (IRR 1.86 95% CI [1.46, 2.36], p < 0.001) were independently associated with an increased number of falls. MLTC (OR 4.50, 95% CI [1.78, 11.36], p = 0.001) and disability (OR 2.82, 95% CI [1.58, 5.05], p < 0.001) were independently associated with recurrent falls. MLTC (B = 6.45, p < 0.001) and disability (B = 3.05, p = 0.025) were independently associated with increased fear of falling. Conclusion This study indicated that both MLTC and disability are independently associated with falls, number of falls and fear of falling in this population.
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Affiliation(s)
- Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Norah A Alhwoaimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK
| | - Mohammed S Alghamdi
- Department of Medical Rehabilitation Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
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Nakagawa K, Kanai S, Kitakaze S, Okamura H. Discriminant Accuracy of Standing Balance Tests for the Level of Gait Dependency in Hospitalized Patients with Alzheimer's Disease. Dement Geriatr Cogn Disord 2024; 53:135-142. [PMID: 38599186 DOI: 10.1159/000538541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/23/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION When determining the level of gait independence in patients with Alzheimer's disease (AD), detailed functional assessment is difficult in some patients. The previous literature has suggested simple standing balance tests for patients with AD due to their ease of implementation in clinical practice and relevance to gait. However, their usefulness for discriminating the level of gait independence remains unclear. This study aimed to investigate the discrimination accuracy of a simple standing balance test in the level of gait independence among hospitalized patients with AD. METHODS This cross-sectional study was a post hoc analysis of a study conducted on 63 inpatients with AD in a single hospital. Participants were divided into three groups according to their level of gait independence: independent, modified independent (independent, walking with walking aids), and dependent groups (supervision). Gait independence was determined using the Functional Independence Measure. Four standing balance tests were used - closed-leg, semi-tandem, tandem, and one-leg standings - and the discrimination accuracy of each test was calculated by receiver operating characteristic analysis. RESULTS One-leg standing was best at discriminating between the independent and modified independent groups (positive predictive value = 80.0%, negative predictive value = 94.1%). Tandem standing was best at discriminating between the modified independent and dependent groups (positive predictive value = 74.1%, negative predictive value = 93.3%). CONCLUSION A simple standing balance test may assist in the determining level of gait independence in patients with AD when it is difficult to perform a mobility assessment.
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Affiliation(s)
- Keita Nakagawa
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Shusaku Kanai
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Sosuke Kitakaze
- Department of Rehabilitation, Maple-Hill Hospital, Hiroshima, Japan
| | - Hitoshi Okamura
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Alosaimi RM, Almegbas NR, Almutairi GR, Alqahtani MA, Batook SG, Alfageh IA, Alanazi SF, Alshehri MM, Alhowimel AS, Alqahtani BA, Alenazi AM. The Five Times Sit-to-Stand Test is associated with both history of falls and fear of falling among community adults aged 50 years and older. Ir J Med Sci 2023; 192:2533-2540. [PMID: 36701043 DOI: 10.1007/s11845-023-03287-9] [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: 09/01/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Limited evidence has examined the association between balance and mobility measures with risk of fall. AIM To determine the prevalence and balance measures associated with falls and fear of falling among community adults aged 50 years and older. METHODS This cross-sectional study included community-dwelling adults aged ≥ 50 years, living in Saudi Arabia. The participants were asked to report any history of falls in the past 12 months and fear of falling using the Falls Efficacy Scale (FES-I). Balance/mobility measures included the Timed Up and Go (TUG) test, Functional Reach Test (FRT), 10-m walk test (10-MWT), 6-min walk test (6-MWT), and Five Times Sit-to-Stand Test (5XSST). RESULTS Two hundred and six participants, including 96 women, were included. The prevalence of falls was 12.6%, and the 5XSST was the only balance measure significantly associated with falls (OR 1.17, 95% CI [1.03, 1.33], p = 0.019) with a cutoff score of 13.93 s or more, a sensitivity of 0.73, and a specificity of 0.58. An increase in 5XSST time was associated with an increase in FES-I score, while a decrease in other balance measures (10-MWT, TUG, FRT, and 6-MWT) was associated with an increase in FES-I scores. CONCLUSION Adults living in Saudi Arabia had a low prevalence of falls. The 5XSST was the only significant balance/mobility measure that distinguished fallers from non-fallers.
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Affiliation(s)
- Rawan M Alosaimi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Noura R Almegbas
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Gamar R Almutairi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Maha A Alqahtani
- Department of Research and Innovation, King Abdullah International Medical Research Center, Riyadh, 13223, Saudi Arabia
| | - Saleh G Batook
- East Jeddah General Hospital, Western Region, Jeddah, 22253, Saudi Arabia
| | | | | | - Mohammed M Alshehri
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.
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Alenazi AM. Number of medications and polypharmacy are associated with risk of fall in Saudi community-dwelling adults. Saudi Pharm J 2023; 31:185-190. [PMID: 36942268 PMCID: PMC10023536 DOI: 10.1016/j.jsps.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background This study primarily aimed to examine the association between the number of medications and polypharmacy with fall history and fear of falling among Saudi community-dwelling adults aged 50 years and older. A secondary objective was to determine the cutoff score of the number of medications associated with a history of falls within this population. Methods This cross-sectional study included community-dwelling adults aged ≥ 50 years living in Saudi Arabia. The participants were asked to report any history of falls in the past 12 months; the Falls Efficacy Scale (FES-I) was used to measure the fear of falling. The number of medications was obtained by interviewing the participants and was recorded as a number. Polypharmacy was defined as the use of ≥ 4 medications. Binary logistic regression and linear regression analyses were performed. Receiver operator characteristics and area under the curve were used to determine the cut-off scores for the number of medications that distinguished fallers from non-fallers. Results A total of 206 participants (96 women) were included. The prevalence of falls was 12.6 %. Number of medications was associated with a history of falls (OR 1.55, 95 % CI [1.16, 2.07], p = 0.003) after adjustments for age, sex, body mass index, education, employment status, marital status, and number of chronic conditions. Polypharmacy was associated with a history of falls (OR 9.06, 95 % CI [2.56, 32.04], p = 0.012) after adjusting for covariates. Neither the number of medications nor polypharmacy was associated with fear of falling, as measured by FES-I. The number of medications with a cutoff of ≥ 2 or more medications was associated with a history of fall with a sensitivity of 69.23 % and specificity of 66.67 %. Conclusion This study found that the number of medications and polypharmacy were associated with a history of falls among community-dwelling adults aged ≥ 50 years. A cutoff score was identified of 2 or more medications that distinguished fallers from non-fallers in this population. This cut-off score was below the polypharmacy threshold.
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Vision, Eye Disease, and the Onset of Balance Problems: The Canadian Longitudinal Study on Aging. Am J Ophthalmol 2021; 231:170-178. [PMID: 34157278 DOI: 10.1016/j.ajo.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/13/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To understand the relationship between visual impairment, self-reported eye disease, and the onset of balance problems. DESIGN Population-based prospective cohort study. METHODS Baseline and 3-year follow-up data were used from the Canadian Longitudinal Study on Aging. The Comprehensive Cohort included 30,097 adults aged 45 to 85 years recruited from 11 sites across 7 provinces. Balance was measured using the 1-leg balance test. Those who could not stand on 1 leg for at least 60 seconds failed the balance test. Presenting visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart. Participants were asked about a previous diagnosis of cataract, macular degeneration, or glaucoma. Logistic regression was used. RESULTS Of the 12,158 people who could stand for 60 seconds on 1 leg at baseline, 18% were unable to do the same 3 years later. For each line worse of visual acuity, there was a 15% higher odds of failing the balance test at follow-up (odds ratio [OR] = 1.15, 95% confidence interval [CI] 1.10, 1.20) after adjustment. Those with a report of a former (OR = 1.59, 95% CI 1.17, 2.16) or current cataract (OR = 1.31, 95% CI 1.01, 1.68) were more likely to fail the test at follow-up. Age-related macular degeneration and glaucoma were not associated with failure on the balance test. CONCLUSION These data provide longitudinal evidence that vision loss increases the odds of balance problems over a 3-year period. Efforts to prevent avoidable vision loss are needed, as are efforts to improve the balance of visually impaired people.
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Borges-Machado F, Barros D, Teixeira L, Ribeiro Ó, Carvalho J. Health-related physical indicators and self-rated quality of life in older adults with neurocognitive disorder. Qual Life Res 2021; 30:2255-2264. [PMID: 33778911 DOI: 10.1007/s11136-021-02828-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE This study aimed to identify the association between health-related physical indicators-sarcopenia-related factors, physical fitness, independence in activities of daily living (ADL) and habitual physical activity-and self-rated quality of life (QoL) in people with neurocognitive disorder (NCD). METHODS This cross-sectional study included 115 participants (78.22 ± 7.48 years; 74.8% female) clinically diagnosed with NCD. Self-rated QoL was evaluated using The Quality of Life-Alzheimer's Disease (QoL-AD). Dual energy X-ray Absorptiometry, handgrip strength, Short Physical Performance Battery, and the 6-m Walk test were used to assess sarcopenia-related factors. Senior Fitness Test and One Leg Balance test, Barthel Index, Baecke Modified Habitual Physical Activity Questionnaire were used to determine physical fitness, independence in ADL and physical activity, respectively. Regressions analyses were performed to examine associations between these variables and QoL-AD. RESULTS Data from univariable linear regression analysis revealed that self-rated QoL was associated with sarcopenia-related factors (lower body function, handgrip strength, gait speed, and appendicular skeletal muscle mass index-ASMI), physical fitness (upper-and-lower-body strength, agility/dynamic balance, cardiorespiratory fitness and body mass index), habitual physical activity and independence in ADL. Results from multivariable regression analysis showed that ASMI (B = 1.846, 95% CI 0.165-3.527, p = 0.032) and lower body function (B = 0.756, 95% CI 0.269-1.242, p = 0.003) were positively associated with self-rated QoL. These variables explained 20.1% of the variability seen in self-rated QoL, controlling for age, sex, marital status and education. CONCLUSION Sarcopenia-related factors, namely lower body function and ASMI, should be acknowledged in future research studies as critical health-related indicators associated with QoL in people with NCD. TRIAL REGISTRATION ClinicalTrials.gov-identifier number NCT04095962.
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Affiliation(s)
- Flávia Borges-Machado
- CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Duarte Barros
- CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Laetitia Teixeira
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,CINTESIS, Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal
| | - Óscar Ribeiro
- Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
| | - Joana Carvalho
- CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal. .,Faculdade de Desporto, Universidade do Porto, Porto, Portugal.
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Baker J, de Laat D, Kruger E, McRae S, Trung S, Zottola C, Omaña H, Hunter SW. Reliable and valid measures for the clinical assessment of balance and gait in older adults with dementia: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1788638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jacqueline Baker
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Danielle de Laat
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Emily Kruger
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Sarah McRae
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Sabrina Trung
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Carly Zottola
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Humberto Omaña
- Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Susan W. Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Canada
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Wang DX, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle 2020; 11:3-25. [PMID: 31788969 PMCID: PMC7015244 DOI: 10.1002/jcsm.12502] [Citation(s) in RCA: 291] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are essential for independent living and are predictors of morbidity and mortality in older populations. Older adults who are dependent in ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities. The aim of this systematic review and meta-analysis was to determine if muscle measures are predictive of ADL and IADL in older populations. Methods A systematic search was conducted using four databases (MEDLINE, EMBASE, Cochrane, and CINAHL) from date of inception to 7 June 2018. Longitudinal cohorts were included that reported baseline muscle measures defined by muscle mass, muscle strength, and physical performance in conjunction with prospective ADL or IADL in participants aged 65 years and older at follow-up. Meta-analyses were conducted using a random effect model. Results Of the 7760 articles screened, 83 articles were included for the systematic review and involved a total of 108 428 (54.8% female) participants with a follow-up duration ranging from 11 days to 25 years. Low muscle mass was positively associated with ADL dependency in 5/9 articles and 5/5 for IADL dependency. Low muscle strength was associated with ADL dependency in 22/34 articles and IADL dependency in 8/9 articles. Low physical performance was associated with ADL dependency in 37/49 articles and with IADL dependency in 9/11 articles. Forty-five articles were pooled into the meta-analyses, 36 reported ADL, 11 reported IADL, and 2 reported ADL and IADL as a composite outcome. Low muscle mass was associated with worsening ADL (pooled odds ratio (95% confidence interval) 3.19 (1.29-7.92)) and worsening IADL (1.28 (1.02-1.61)). Low handgrip strength was associated with both worsening ADL and IADL (1.51 (1.34-1.70); 1.59 (1.04-2.31) respectively). Low scores on the short physical performance battery and gait speed were associated with worsening ADL (3.49 (2.47-4.92); 2.33 (1.58-3.44) respectively) and IADL (3.09 (1.06-8.98); 1.93 (1.69-2.21) respectively). Low one leg balance (2.74 (1.31-5.72)), timed up and go (3.41 (1.86-6.28)), and chair stand test time (1.90 (1.63-2.21)) were associated with worsening ADL. Conclusions Muscle measures at baseline are predictors of future ADL and IADL dependence in the older adult population.
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Affiliation(s)
- Daniel X.M. Wang
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Jessica Yao
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Yasar Zirek
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Esmee M. Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Andrea B. Maier
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
- Department of Human Movement Sciences, @AgeAmsterdamVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
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van der Wardt V, Logan P, Conroy S, Harwood R, Gladman J. Antihypertensive Treatment in People With Dementia. J Am Med Dir Assoc 2014; 15:620-9. [DOI: 10.1016/j.jamda.2014.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/27/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
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Malmstrom TK, Morley JE. The Frail Brain. J Am Med Dir Assoc 2013; 14:453-5. [DOI: 10.1016/j.jamda.2013.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
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