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Dormosh N, van de Loo B, Heymans MW, Schut MC, Medlock S, van Schoor NM, van der Velde N, Abu-Hanna A. A systematic review of fall prediction models for community-dwelling older adults: comparison between models based on research cohorts and models based on routinely collected data. Age Ageing 2024; 53:afae131. [PMID: 38979796 PMCID: PMC11231951 DOI: 10.1093/ageing/afae131] [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: 08/22/2023] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Prediction models can identify fall-prone individuals. Prediction models can be based on either data from research cohorts (cohort-based) or routinely collected data (RCD-based). We review and compare cohort-based and RCD-based studies describing the development and/or validation of fall prediction models for community-dwelling older adults. METHODS Medline and Embase were searched via Ovid until January 2023. We included studies describing the development or validation of multivariable prediction models of falls in older adults (60+). Both risk of bias and reporting quality were assessed using the PROBAST and TRIPOD, respectively. RESULTS We included and reviewed 28 relevant studies, describing 30 prediction models (23 cohort-based and 7 RCD-based), and external validation of two existing models (one cohort-based and one RCD-based). The median sample sizes for cohort-based and RCD-based studies were 1365 [interquartile range (IQR) 426-2766] versus 90 441 (IQR 56 442-128 157), and the ranges of fall rates were 5.4% to 60.4% versus 1.6% to 13.1%, respectively. Discrimination performance was comparable between cohort-based and RCD-based models, with the respective area under the receiver operating characteristic curves ranging from 0.65 to 0.88 versus 0.71 to 0.81. The median number of predictors in cohort-based final models was 6 (IQR 5-11); for RCD-based models, it was 16 (IQR 11-26). All but one cohort-based model had high bias risks, primarily due to deficiencies in statistical analysis and outcome determination. CONCLUSIONS Cohort-based models to predict falls in older adults in the community are plentiful. RCD-based models are yet in their infancy but provide comparable predictive performance with no additional data collection efforts. Future studies should focus on methodological and reporting quality.
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Affiliation(s)
- Noman Dormosh
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life & Methodology, Amsterdam, The Netherlands
| | - Bob van de Loo
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology & Personalized Medicine, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology & Quality of Care, Amsterdam, The Netherlands
| | - Stephanie Medlock
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life & Methodology, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life & Methodology, Amsterdam, The Netherlands
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Braendle K, Egli A, Bischoff-Ferrari H, Freystaetter G. Does living alone influence fall risk among Swiss older adults aged 60+? A pooled observational analysis of three RCTs on fall prevention. BMJ Open 2024; 14:e081413. [PMID: 38772577 PMCID: PMC11110580 DOI: 10.1136/bmjopen-2023-081413] [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: 10/27/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES Falling and living alone have been identified as public health challenges in an ageing society. Our study investigates whether living alone influences fall risk in community-dwelling older adults in Switzerland. DESIGN AND METHODS Secondary analysis of three randomised controlled trials investigating how different doses of vitamin D and an exercise programme may influence the risk of further falls in people 60+ at risk of falling. We used logistic regression to examine the association between living alone and the odds of becoming a faller, and negative binomial regression to examine the association between living alone and the rate of falls. We assessed both any falls and falls with injury. All analyses were adjusted for sex, body mass index, age, grip strength, comorbidities, use of walking aids, mental health, trial and treatment group. Predefined subgroups were by sex and age. RESULTS Among 494 participants (63% women; mean age was 74.7±7.5 years) 643 falls were recorded over 936.5 person-years, including 402 injurious falls. Living alone was associated with a 1.76-fold higher odds of becoming a faller (OR (95% CI)=1.76 (1.11 to 2.79)). While the odds did not differ by sex, older age above the median age of 74.6 years increased the odds to 2.19-fold (OR (95% CI)=2.19 (1.11 to 4.32)). The rate of total or injurious falls did not differ by living status. CONCLUSIONS Community-dwelling older adults living alone have a higher odds of becoming a faller. The increased odds is similar for men and women but accentuated with higher age. TRIAL REGISTRATION NUMBERS ZDPT: NCT01017354, NFP53: NCT00133640, OA: NCT00599807.
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Affiliation(s)
- Kilian Braendle
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Andreas Egli
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Heike Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
- IHU HealthAge, University Hospital Toulouse and University III Toulouse Paul Sabatier, Toulouse, France
| | - Gregor Freystaetter
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
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Wieczorek M, Isler M, Landau K, Becker MD, Dawson-Hughes B, Kressig RW, Vellas B, Orav EJ, Rizzoli R, Kanis JA, Armbrecht G, Da Silva JAP, Egli A, Freystätter G, Bischoff-Ferrari HA. Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study. J Am Med Dir Assoc 2024; 25:789-795.e2. [PMID: 38640962 DOI: 10.1016/j.jamda.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Although aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults. DESIGN Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. SETTING AND PARTICIPANTS Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. METHODS The numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids. RESULTS Among the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007). CONCLUSIONS AND IMPLICATIONS Our findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.
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Affiliation(s)
- Maud Wieczorek
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Marlis Isler
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias D Becker
- Department of Ophthalmology, City Hospital Zurich, Zurich, Switzerland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany; Spross Ophthalmology Research Institute, City Hospital Zurich, Zurich, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Centre on Aging, Tufts University, Boston, MA, USA
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, and University of Basel, Basel, Switzerland
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Endel John Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, United Kingdom; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Gabriele Armbrecht
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - José António P Da Silva
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra and Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreas Egli
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland
| | - Gregor Freystätter
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland; University Hospital Toulouse, IHU HealthAge Toulouse, France.
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Waterval NFJ, Claassen CM, van der Helm FCT, van der Kruk E. Predictability of Fall Risk Assessments in Community-Dwelling Older Adults: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:7686. [PMID: 37765742 PMCID: PMC10536675 DOI: 10.3390/s23187686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Fall risk increases with age, and one-third of adults over 65 years old experience a fall annually. Due to the aging population, the number of falls and related medical costs will progressively increase. Correct prediction of who will fall in the future is necessary to timely intervene in order to prevent falls. Therefore, the aim of this scoping review is to determine the predictive value of fall risk assessments in community-dwelling older adults using prospective studies. A total of 37 studies were included that evaluated clinical assessments (questionnaires, physical assessments, or a combination), sensor-based clinical assessments, or sensor- based daily life assessments using prospective study designs. The posttest probability of falling or not falling was calculated. In general, fallers were better classified than non-fallers. Questionnaires had a lower predictive capability compared to the other assessment types. Contrary to conclusions drawn in reviews that include retrospective studies, the predictive value of physical tests evaluated in prospective studies varies largely, with only smaller-sampled studies showing good predictive capabilities. Sensor-based fall risk assessments are promising and improve with task complexity, although they have only been evaluated in relatively small samples. In conclusion, fall risk prediction using sensor data seems to outperform conventional tests, but the method's validity needs to be confirmed by large prospective studies.
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Affiliation(s)
- N. F. J. Waterval
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - C. M. Claassen
- Biomechatronics & Human-Machine Control, Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - F. C. T. van der Helm
- Biomechatronics & Human-Machine Control, Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - E. van der Kruk
- Biomechatronics & Human-Machine Control, Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
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Kobayashi T, Morimoto T, Shimanoe C, Ono R, Otani K, Mawatari M. A Simplified Screening Tool for the One-Leg Standing Test to Determine the Severity of Locomotive Syndrome. Life (Basel) 2023; 13:life13051190. [PMID: 37240835 DOI: 10.3390/life13051190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
This study determined the cut-off time for the one-leg standing test (OLST) to simply screen the severity of locomotive syndrome (LS). We conducted this cross-sectional study on 1860 community-dwelling residents (age, 70.5 ± 9.5 years old; males, n = 826; females, n = 1034) who underwent the OLST and completed the 25-question geriatric locomotive function scale (GLFS-25). Multivariate linear regression and multivariate logistic regression analyses were conducted to assess the relationship between the OLST and the GLFS-25 score and LS after adjusting for age, sex, and body mass index. A receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal cut-off time of the OLST for determining LS severity. The multivariate linear regression and multivariate logistic regression analyses showed that the OLST was significantly associated with the GLFS-25 score and a diagnosis of LS. The optimal cut-off times of the OLST to screen LS-1, LS-2, and LS-3 were 42 s (sensitivity 65.8%, specificity 65.3%), 27 s (sensitivity 72.7%, specificity 72.5%), and 19 s (sensitivity 77.4%, specificity 76.8%), respectively. We developed a simplified screening tool for the OLST to determine LS severity.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Chisato Shimanoe
- Department of Pharmacy, Saga University Hospital, Saga 849-0937, Japan
| | - Rei Ono
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1, Toyama, Shinjuku-ku, Tokyo 162-8636, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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Vilpunaho T, Karinkanta S, Sievänen H, Kopra J, Kröger H, Rikkonen T. Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women. Aging Clin Exp Res 2023; 35:1205-1212. [PMID: 37145268 DOI: 10.1007/s40520-023-02423-w] [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: 01/26/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Falls are a substantial health problem among older adults. An accessible and reliable tool for assessing individual fall risk is needed. AIMS The predictive ability of a one-page self-rated fall risk assessment form (KaatumisSeula® [KS]) was evaluated among older women in its current form. METHODS A subsample (n = 384) of community-living older women (aged 72-84 years) participating in the Kuopio Fall Prevention Study (KFPS) completed the KS form. Participants' falls were prospectively registered for 12 months with SMS messages. Their group status and form-based fall risk category were compared to the verified fall events during the KFPS intervention. Negative binomial regression and multinomial regression analyses were used. Physical performance measurements (single leg stance, leg extension strength and grip strength) were used as covariates. RESULTS During the follow-up, 43.8% of women fell at least once. Among the fallers, 76.8% had at least one self-determined injurious fall, and 26.2% had falls requiring medical attention. According to KS, 7.6% of the women had low fall risk, 75.0% moderate, 15.4% substantial, and only 2.1% high fall risk. Women in the "moderate fall risk" group had 1.47-fold (95% CI 0.74-2.91; nonsignificant), in "substantial fall risk" 4.00-fold (1.93-8.3; p < 0.001) and in "high fall risk" 3.00-fold (0.97-9.22; nonsignificant) higher risk of falls compared to the "low fall risk" group. Performance in physical tests did not account for future falls. CONCLUSIONS The KS form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02665169, date of first registration 27/01/2016.
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Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Saija Karinkanta
- The UKK Institute for Health Promotion Research, Tampere, Finland
- The Social Insurance Institution of Finland, Research Unit, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Juho Kopra
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
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Blodgett JM, Hardy R, Davis DHJ, Peeters G, Hamer M, Kuh D, Cooper R. Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort study. Front Sports Act Living 2023; 4:1066913. [PMID: 36699981 PMCID: PMC9869374 DOI: 10.3389/fspor.2022.1066913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction The one-legged balance test is a common screening tool for fall risk. Yet, there is little empirical evidence assessing its prognostic ability. The study aims were to assess the prognostic accuracy of one-legged balance performance in predicting falls and identify optimal cut-points to classify those at greater risk. Methods Data from up to 2,000 participants from a British birth cohort born in 1,946 were used. The times an individual could stand on one leg with their eyes open and closed were recorded (max: 30 s) at ages 53 and 60-64. Number of falls in the past year was self-reported at ages 53, 60-64 and 68; recurrent falls (0-1 vs. 2+) and any fall (0 vs. 1+) were considered binary outcomes. Four longitudinal associations between balance times and subsequent falls were investigated (age 53 → 60-64; age 53 → 68; age 60-64 → 68; age 53 & 60-64 → 68). For each temporal association, areas under the curve (AUC) were calculated and compared for a base sex-only model, a sex and balance model, a sex and fall history model and a combined model of sex, balance and fall history. The Liu method was used to identify optimal cut-points and sensitivity, specificity, and AUC at corresponding cut-points. Results Median eyes open balance time was 30 s at ages 53 and 60-64; median eyes closed balance times were 5 s and 3 s, respectively. The predictive ability of balance tests in predicting either fall outcome was poor (AUC range for sex and balance models: 0.577-0.600). Prognostic accuracy consistently improved by adding fall history to the model (range: 0.604-0.634). Optimal cut-points ranged from 27 s to 29 s for eyes open and 3 s to 5 s for eyes closed; AUC consistently indicated that using "optimal" cut-points to dichotomise balance time provided no discriminatory ability (AUC range:0.42-0.47), poor sensitivity (0.38-0.61) and poor specificity (0.23-0.56). Discussion Despite previous observational evidence showing associations between better one-legged balance performance and reduced fall risk, the one-legged balance test had limited prognostic accuracy in predicting recurrent falls. This contradicts ongoing translation of this test into clinical screening tools for falls and highlights the need to consider new and existing screening tools that can reliably predict fall risk.
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Affiliation(s)
- Joanna M. Blodgett
- Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, University College London, London, UK
| | - Rebecca Hardy
- School of Sport, Exercise and Health Sciences,Loughborough University, Loughborough, UK
- Social Research Institute, University College London, London, UK
| | | | - Geeske Peeters
- Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Mark Hamer
- Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, University College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University Institute of Sport, Manchester, UK
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Williams D, Martin AE. Predicting fall risk using multiple mechanics-based metrics for a planar biped model. PLoS One 2023; 18:e0283466. [PMID: 36972264 PMCID: PMC10042378 DOI: 10.1371/journal.pone.0283466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
For both humans and robots, falls are undesirable, motivating the development of fall prediction models. Many mechanics-based fall risk metrics have been proposed and validated to varying degrees, including the extrapolated center of mass, the foot rotation index, Lyapunov exponents, joint and spatiotemporal variability, and mean spatiotemporal parameters. To obtain a best-case estimate of how well these metrics can predict fall risk both individually and in combination, this work used a planar six-link hip-knee-ankle biped model with curved feet walking at speeds ranging from 0.8 m/s to 1.2 m/s. The true number of steps to fall was determined using the mean first passage times from a Markov chain describing the gaits. In addition, each metric was estimated using the Markov chain of the gait. Because calculating the fall risk metrics from the Markov chain had not been done before, the results were validated using brute force simulations. Except for the short-term Lyapunov exponents, the Markov chains could accurately calculate the metrics. Using the Markov chain data, quadratic fall prediction models were created and evaluated. The models were further evaluated using differing length brute force simulations. None of the 49 tested fall risk metrics could accurately predict the number of steps to fall by themselves. However, when all the fall risk metrics except the Lyapunov exponents were combined into a single model, the accuracy increased substantially. These results suggest that multiple fall risk metrics must be combined to obtain a useful measure of stability. As expected, as the number of steps used to calculate the fall risk metrics increased, the accuracy and precision increased. This led to a corresponding increase in the accuracy and precision of the combined fall risk model. 300 step simulations seemed to provide the best tradeoff between accuracy and using as few steps as possible.
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Affiliation(s)
- Daniel Williams
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - Anne E Martin
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
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Arai T, Fujita H, Maruya K, Morita Y, Asahi R, Ishibasi H. Loss of height predicts fall risk in elderly Japanese: a prospective cohort study. J Bone Miner Metab 2023; 41:88-94. [PMID: 36513883 DOI: 10.1007/s00774-022-01383-x] [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: 03/16/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The purpose of this study was to explore whether height loss is associated with future falls and whether the combination of height loss and fall experience is associated with future falls. MATERIALS AND METHODS In this prospective observational study, a total of 765 individuals (354 men, 411 women) agreed to join the study. Baseline data on demographics, comorbidities, physical performance, and previous falls were assessed. Height loss was calculated as the difference between the self-reported height at a younger age and the current height and was divided into two groups: < 2 cm and ≥ 2 cm. Approximately 15 months after the baseline evaluation, follow-up questionnaires were used to assess the fall history. Participants were classified as either "non-fallers" or "fallers." Multiple logistic regression was used to evaluate the association between falls and each factor and to obtain adjusted odds ratio estimates. RESULTS The follow-up questionnaire was returned by 668 participants, 74 of whom (11.1%) fell at least once during the observation period. Multiple logistic regression analysis found that height loss of > 2 cm was a significant predictor of future falls, even after adjusting for other factors. Additionally, the combination of height loss and previous falls was a risk factor for falls. CONCLUSIONS We suggest that height loss of ≥ 2 cm is a predictor of future falls in older adults, and the combination of height loss and fall experiences may be a useful screening tool for determining fall risk.
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Affiliation(s)
- Tomoyuki Arai
- Department of Physical Therapy Faculty of Health and Medical Care, Saitama Medical University, 981, Kawakado, Iruma, Saitama, 350-0436, Japan.
| | - Hiroaki Fujita
- Department of Physical Therapy Faculty of Health and Medical Care, Saitama Medical University, 981, Kawakado, Iruma, Saitama, 350-0436, Japan
| | - Kohei Maruya
- Department of Physical Therapy Faculty of Health and Medical Care, Saitama Medical University, 981, Kawakado, Iruma, Saitama, 350-0436, Japan
| | - Yasuhiro Morita
- Department of Physical Therapy Faculty of Health and Medical Care, Saitama Medical University, 981, Kawakado, Iruma, Saitama, 350-0436, Japan
| | - Ryoma Asahi
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Science, 2-555, Suga, Satte, Saitama, Japan
| | - Hideaki Ishibasi
- Ina Hospital Orthopedics, 9419, Ina, Kitaadati, Saitama, 362-0806, Japan
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10
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Ibeneme SC, Eze JC, Okonkwo UP, Ibeneme GC, Fortwengel G. Evaluating the discriminatory power of the velocity field diagram and timed-up-and-go test in determining the fall status of community-dwelling older adults: a cross-sectional observational study. BMC Geriatr 2022; 22:658. [PMID: 35948869 PMCID: PMC9367093 DOI: 10.1186/s12877-022-03282-2] [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: 11/30/2021] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Systematic reviews demonstrated that gait variables are the most reliable predictors of future falls, yet are rarely included in fall screening tools. Thus, most tools have higher specificity than sensitivity, hence may be misleading/detrimental to care. Therefore, this study aimed to determine the validity, and reliability of the velocity field diagram (VFD -a gait analytical tool), and the Timed-up-and-go test (TUG)-commonly used in Nigeria as fall screening tools, compared to a gold standard (known fallers) among community-dwelling older adults. Method This is a cross-sectional observational study of 500 older adults (280 fallers and 220 non-fallers), recruited by convenience sampling technique at community health fora on fall prevention. Participants completed a 7-m distance with the number of steps and time it took determined and used to compute the stride length, stride frequency, and velocity, which regression lines formed the VFD. TUG test was simultaneously conducted to discriminate fallers from non-fallers. The cut-off points for falls were: TUG times ≥ 13.5 s; VFD’s intersection point of the stride frequency, and velocity regression lines (E1) ≥ 3.5velots. The receiver operating characteristic (ROC) area under the curves (AUC) was used to explore the ability of the E1 ≥ 3.5velots to discriminate between fallers and non-fallers. The VFD’s and TUG’s sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Alpha was set at p < 0.05. Results The VFD versus TUG sensitivity, specificity, PPV and NPV were 71%, 27%, 55%, and 42%, versus 39%, 59%, 55%, and 43%, respectively. The ROC’s AUC were 0.74(95%CI:0.597,0.882, p = 0.001) for the VFD. The optimal categorizations for discrimination between fallers/non-fallers were ≥ 3.78 versus ≤ 3.78 for VFD (fallers versus non-fallers prevalence is 60.71% versus 95.45%, respectively), with a classification accuracy or prediction rate of 0.76 unlike TUG with AUC = 0.53 (95% CI:0.353,0.700, p = 0.762), and a classification accuracy of 0.68, and optimal characterization of ≥ 12.81 s versus ≤ 12.81 (fallers and non-fallers prevalence = 92.86% versus 36.36%, respectively). Conclusion The VFD demonstrated a fair discriminatory power and greater reliability in identifying fallers than the TUG, and therefore, could replace the TUG as a primary tool in screening those at risk of falls.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria. .,Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. .,Department of Nursing Sciences, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. .,Faculty III/Mid-Research Group, Hochschule Hannover - University of Applied Sciences and Arts, Hannover, Expo Plaza 12, 30539, Hannover, Germany. .,Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Joy Chinyere Eze
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | | | | | - Gerhard Fortwengel
- Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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11
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Ong MF, Soh KL, Saimon R, Myint WW, Pawi S, Saidi HI. Falls risk screening tools intended to reduce fall risk among independent community‐dwelling older adults: A systematic review. Int J Nurs Pract 2022:e13083. [PMID: 35871775 DOI: 10.1111/ijn.13083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults. METHODS A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors. RESULTS Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings. CONCLUSION The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.
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Affiliation(s)
- Mei Fong Ong
- Department of Nursing Universiti Putra Malaysia Serdang Malaysia
- Department of Nursing Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Kim Lam Soh
- Department of Nursing Universiti Putra Malaysia Serdang Malaysia
| | - Rosalia Saimon
- Community Medicine and Public Health Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Wai Wai Myint
- Medicine and Rehabilitation Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Saloma Pawi
- Department of Nursing Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Hasni Idayu Saidi
- Department of Biomedical Science Universiti Putra Malaysia Serdang Malaysia
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12
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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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13
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Bartos LJ, Meek GA, Berger BG. Effectiveness of Yoga versus Exercise for Reducing Falling Risk in Older Adults: Physical and Psychological Indices. Percept Mot Skills 2022; 129:1245-1269. [PMID: 35613041 DOI: 10.1177/00315125221100820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our purpose in this study was to examine the effectiveness of yoga to address multiple risk factors of falling in active and low active older adults. Community-dwelling older adults (N = 35) over the age of 65 actively participated in either a yoga program, an exercise program, or a no-program control. Participants completed measures associated with falling risks. Physical measures included lower body strength, static balance, and lower body flexibility. Psychological measures included perceived self-efficacy with respect to falls and health-related quality of life. We determined between-group differences using planned comparisons, effect size, confidence intervals, and probability of superiority. Results of planned comparisons and practical significance testing indicated that yoga participants scored higher than the exercise and control participants on both right and left lower body flexibility tests. Yoga participants also scored higher than the control participants on right leg static balance, and the right and left lower body flexibility tests. The exercise participants scored higher than yoga participants on the RAND-36 Quality of Life subscales of Energy/Fatigue, Pain, and General Health. The probability of superiority results indicated that the no-program older adult participants would benefit by enrolling in the yoga rather than the exercise program to reduce physical risks of falling. These findings were discussed in relation to promoting physical activity programs to reduce risks of falling, and the roles of the protocol, practical significance, and measures employed when determining program effectiveness.
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Affiliation(s)
- Luis J Bartos
- School of Human Movement, Sport and Leisure Studies, 1888Bowling Green State University, Bowling Green, Ohio, USA
| | - Geoffrey A Meek
- School of Human Movement, Sport and Leisure Studies, 1888Bowling Green State University, Bowling Green, Ohio, USA
| | - Bonnie G Berger
- School of Human Movement, Sport and Leisure Studies, 1888Bowling Green State University, Bowling Green, Ohio, USA
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14
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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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15
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Discriminative Ability of the Four Balance Measures for Previous Fall Experience in Turkish Community-Dwelling Older Adults. J Aging Phys Act 2022; 30:980-986. [PMID: 35303710 DOI: 10.1123/japa.2021-0415] [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: 10/18/2021] [Revised: 12/25/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aimed to compare the discriminative properties (discriminative effect, sensitivity, specificity, and cutoff values) of four commonly used balance measures for nonfallers, fallers, and multiple fallers among Turkish community-dwelling older adults. METHODS Three hundred fifty-one community-dwelling older adults (122 fallers and 229 nonfallers) were evaluated with the timed up and go test, functional reach test, one-leg stance test, and Berg Balance Scale (BBS). RESULTS Timed up and go test and functional reach test were not sensitive in detecting group differences between fallers and nonfallers, and BBS and one-leg stance test had significant but limited discriminative power with cutoff values of 53.5 points and 7.50 s, respectively. In addition, timed up and go test, functional reach test, and one-leg stance test had significant but limited discriminative power, and BBS had acceptable discriminative power for older adults who fell multiple times. CONCLUSIONS These findings suggest that BBS is the most suitable tool for assessing the fall risk of Turkish community-dwelling older adults.
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16
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Mitchell A, Martin AE. Quantifying the effect of sagittal plane joint angle variability on bipedal fall risk. PLoS One 2022; 17:e0262749. [PMID: 35081142 PMCID: PMC8791504 DOI: 10.1371/journal.pone.0262749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022] Open
Abstract
Falls are a major issue for bipeds. For elderly adults, falls can have a negative impact on their quality of life and lead to increased medical costs. Fortunately, interventional methods are effective at reducing falls assuming they are prescribed. For biped robots, falls prevent them from completing required tasks. Thus, it is important to understand what aspects of gait increase fall risk. Gait variability may be associated with increased fall risk; however, previous studies have not investigated the variation in the movement of the legs. The purpose of this study was to determine the effect of joint angle variability on falling to determine which component(s) of variability were statistically significant. In order to investigate joint angle variability, a physics-based simulation model that captured joint angle variability as a function of time through Fourier series was used. This allowed the magnitude, the frequency mean, and the frequency standard deviation of the variability to be altered. For the values tested, results indicated that the magnitude of the variability had the most significant impact on falling, and specifically that the stance knee flexion variability magnitude was the most significant factor. This suggests that increasing the joint variability magnitude may increase fall risk, particularly if the controller is not able to actively compensate. Altering the variability frequency had little to no effect on falling.
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Affiliation(s)
- Amy Mitchell
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - Anne E. Martin
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
- * E-mail:
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17
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Brew-Sam N, Chib A, Torres AYF, Ng JXJ, Wong YTJ, Sze-G Y. An Integrated mHealth Campaign to Reduce the Risk of Falling for Older Adults. J Appl Gerontol 2022; 41:1336-1347. [DOI: 10.1177/07334648211062877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The number of falls among older adults is rising due to an aging population worldwide. An integrated communication campaign utilizing mHealth (mobile health) encouraged older adults to perform strength, balance, and flexibility exercises to reduce their risk of falling. Campaign development was guided by a mixed-method approach which incorporated expert interviews ( N = 3), qualitative interviews ( N = 22), and a quantitative baseline pre-campaign survey ( N = 274) with older adults. We evaluated the campaign impact with a pre-post survey analysis (post n = 141). Impact was measured by knowledge, attitudes, self-efficacy, and behaviors as key Social Cognitive Theory factors to exercise adoption. Results showed that respondents with campaign exposure had a significant increase in all factor scores from pre- to post-campaign survey, which was significantly higher in the group with campaign exposure. The impact evaluation illustrated how digital mobile channels effectively provide means to reach older adults to reduce their risk of falling.
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Affiliation(s)
- Nicola Brew-Sam
- Our Health in Our Hands, Health Experience Team, Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Arul Chib
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | | | - Jing Xuan Joshua Ng
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Yi Ting Jade Wong
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Yeo Sze-G
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
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18
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van Gulick DJJ, Perry SIB, van der Leeden M, van Beek JGM, Lucas C, Stuiver MM. A Prediction Model for Falls in Community-Dwelling Older Adults in Podiatry Practices. Gerontology 2022; 68:1214-1223. [PMID: 34979512 DOI: 10.1159/000520962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Falls are a worldwide health problem among community-dwelling older adults. Emerging evidence suggests that foot problems increase the risk of falling, so the podiatrist may be crucial in detecting foot-related fall risk. However, there is no screening tool available which can be used in podiatry practice. The predictive value of existing tools is limited, and the implementation is poor. The development of risk models for specific clinical populations might increase the prediction accuracy and implementation. Therefore, the aim of this study was to develop and internally validate an easily applicable clinical prediction model (CPM) that can be used in podiatry practice to predict falls in community-dwelling older adults with foot (-related) problems. METHODS This was a prospective study including community-dwelling older adults (≥65 years) visiting podiatry practices. General fall-risk variables, and foot-related and function-related variables were considered as predictors for the occurrence of falls during the 12-month follow-up. Logistic regression analysis was used for model building, and internal validation was done by bootstrap resampling. RESULTS 407 participants were analyzed; the event rate was 33.4%. The final model included fall history in the previous year, unsteady while standing and walking, plantarflexor strength of the lesser toes, and gait speed. The area under the receiver operating characteristic curve was 0.71 (95% CI: 0.66-0.76) in the sample and estimated as 0.65 after shrinkage. CONCLUSION A CPM based on fall history in the previous year, feeling unsteady while standing and walking, decreased plantarflexor strength of the lesser toes, and reduced gait speed has acceptable accuracy to predict falls in our sample of podiatry community-dwelling older adults and is easily applicable in this setting. The accuracy of the model in clinical practice should be demonstrated through external validation of the model in a next study.
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Affiliation(s)
- Danique J J van Gulick
- Department of Science and Data-analysis, RondOm Podotherapeuten, Podiatric Primary Care Center, Leusden, The Netherlands.,Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander I B Perry
- Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jolan G M van Beek
- Department of Science and Data-analysis, RondOm Podotherapeuten, Podiatric Primary Care Center, Leusden, The Netherlands
| | - Cees Lucas
- Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, University Medical Center Amsterdam, Amsterdam, The Netherlands
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19
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Blodgett JM, Ventre JP, Mills R, Hardy R, Cooper R. A systematic review of one-legged balance performance and falls risk in community-dwelling adults. Ageing Res Rev 2022; 73:101501. [PMID: 34748974 DOI: 10.1016/j.arr.2021.101501] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this systematic review was to synthesise all published evidence on associations between one-legged balance performance and falls. METHODS Medline, EMBASE, CINAHL and Web of Science were systematically searched (to January 2021) to identify peer-reviewed, English language journal articles examining the association between one-legged balance performance and falls in community-dwelling adults. RESULTS Of 4310 records screened, 55 papers were included (n = 36954 participants). There was considerable heterogeneity between studies including differences in study characteristics, ascertainment of balance and falls, and analytical approaches. A meta-analysis of the time that individuals could maintain the one-legged balance position indicated that fallers had worse balance times than non-fallers (standardised mean difference: -0.29 (95%CI:-0.38,-0.20) in cross-sectional analyses; -0.19 (-0.28, -0.09) in longitudinal analyses), although there was no difference in the pooled median difference. Due to between-study heterogeneity, regression estimates between balance and fall outcomes could not be synthesised. Where assessed, prognostic accuracy indicators suggested that one-legged balance was a poor discriminator of fall risk; for example, 5 of 7 studies demonstrated poor prognostic accuracy (Area Under the Curve <0.6), with most studies demonstrating poor sensitivity. CONCLUSIONS This systematic review identified 55 papers that examined associations between balance and fall risk, the majority in older aged adults. However, the evidence was commonly of low quality and results were inconsistent. This contradicts previous perceptions of one-legged balance as a useful fall risk tool and highlights crucial gaps that must be addressed in order to translate such assessments to clinical settings.
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Affiliation(s)
- Joanna M Blodgett
- Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, University College London, 170 Tottenham Court Road, W1T 7HA, London, UK.
| | - Jodi P Ventre
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK; Department of Psychology, Health, Psychology and Communities Research Centre, Manchester Metropolitan University, Bonsall Street, M15 6GX, Manchester, UK
| | - Richard Mills
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK
| | - Rebecca Hardy
- CLOSER, Social Research Institute, University College London, 55-59 Gordon Square, WC1H 0NU, London, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK
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20
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Dormosh N, Schut MC, Heymans MW, van der Velde N, Abu-Hanna A. Development and internal validation of a risk prediction model for falls among older people using primary care electronic health records. J Gerontol A Biol Sci Med Sci 2021; 77:1438-1445. [PMID: 34637510 PMCID: PMC9255681 DOI: 10.1093/gerona/glab311] [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: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Currently used prediction tools have limited ability to identify community-dwelling older people at high risk for falls. Prediction models utilizing electronic health records (EHRs) provide opportunities but up to now showed limited clinical value as risk stratification tool, because of among others the underestimation of falls prevalence. The aim of this study was to develop a fall prediction model for community-dwelling older people using a combination of structured data and free text of primary care EHRs and to internally validate its predictive performance. Methods We used EHR data of individuals aged 65 or older. Age, sex, history of falls, medications, and medical conditions were included as potential predictors. Falls were ascertained from the free text. We employed the Bootstrap-enhanced penalized logistic regression with the least absolute shrinkage and selection operator to develop the prediction model. We used 10-fold cross-validation to internally validate the prediction strategy. Model performance was assessed in terms of discrimination and calibration. Results Data of 36 470 eligible participants were extracted from the data set. The number of participants who fell at least once was 4 778 (13.1%). The final prediction model included age, sex, history of falls, 2 medications, and 5 medical conditions. The model had a median area under the receiver operating curve of 0.705 (interquartile range 0.700–0.714). Conclusions Our prediction model to identify older people at high risk for falls achieved fair discrimination and had reasonable calibration. It can be applied in clinical practice as it relies on routinely collected variables and does not require mobility assessment tests.
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Affiliation(s)
- Noman Dormosh
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam UMC - Location VU, VU University Medical Center, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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21
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Deng ZH, Xu J, Long LJ, Chen F, Chen K, Lu W, Wang DP, Peng LQ. Association between hip and knee osteoarthritis with falls: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14537. [PMID: 34132007 DOI: 10.1111/ijcp.14537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/13/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the association between hip and knee osteoarthritis (OA) and falls. Potentially relevant articles that examine the association between hip, knee, radiological, and self-reported OA and falls were retrieved from PubMed, EMBASE, Scopus, and Web of Science up until March of 2020. METHODS The pooled risk ratios (RRs) as well as their related 95% confidence intervals (CIs) were calculated. Statistic and subgroup analyses were performed. A total of 21 studies involving 146 965 participants were included. RESULTS No association was found between hip OA and falls. The pooled RRs value suggested a higher prevalence of falls in knee OA patients (RR = 1.35, 95% CI: 1.20 to 1.51, P < .00001) and self-reported OA (RR = 1.33, 95% CI: 1.23 to 1.45, P < .00001) than in non-OA subjects. The pooled RR value suggested no difference between prevalence of falls in radiological OA patients compared to non-OA subjects (RR = 1.82, 95% CI: 0.89 to 3.73, P = .10). Both radiological and self-reported knee OA seem to be positively associated with falls, while no obvious association was found between hip OA and falls. CONCLUSIONS Therefore, knee OA is a risk factor for falls which should be closely monitored.
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Affiliation(s)
- Zhen-Han Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
- School of Medicine, Shenzhen University, Shenzhen, China
- Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Tissue Engineering of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
- Clinical College of Anhui Medical University Affiliated Shenzhen Second People's Hospital, Shenzhen, China
| | - Jian Xu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Lu-Jue Long
- Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Fei Chen
- Key Laboratory of Tissue Engineering of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Kang Chen
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei Lu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Da-Ping Wang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
- School of Medicine, Shenzhen University, Shenzhen, China
- Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Tissue Engineering of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
- Clinical College of Anhui Medical University Affiliated Shenzhen Second People's Hospital, Shenzhen, China
| | - Liang-Quan Peng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
- School of Medicine, Shenzhen University, Shenzhen, China
- Key Laboratory of Tissue Engineering of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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22
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Omaña H, Bezaire K, Brady K, Davies J, Louwagie N, Power S, Santin S, Hunter SW. Functional Reach Test, Single-Leg Stance Test, and Tinetti Performance-Oriented Mobility Assessment for the Prediction of Falls in Older Adults: A Systematic Review. Phys Ther 2021; 101:6317705. [PMID: 34244801 DOI: 10.1093/ptj/pzab173] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/15/2021] [Accepted: 05/14/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The authors sought to systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations. METHODS The PubMed, EMBASE, and CINAHL databases were searched (inception-July 2020). Inclusion criteria were participants aged 60 years or more, prospectively recorded falls, and the reporting of falls-related predictive validity. Manuscripts not published in English were excluded. Methodological quality of reporting was assessed using the Tooth Scale. RESULTS Of 1071 studies reviewed, 21 met the inclusion criteria (12 POMA, 8 FRT, 6 SLST). Seven studies (58.3%) used a modified version of the POMA, and 3 (37.5%) used a modified FRT. For the outcome of any fall, the respective ranges of sensitivity and specificity were 0.076 to 0.615 and 0.695 to 0.97 for the POMA, 0.27 to 0.70 and 0.52 to 0.83 for the modified POMA, 0.73 and 0.88 for the FRT, 0.47 to 0.682 and 0.59 to 0.788 for the modified FRT, and 0.51 and 0.61 for the SLST in community-dwelling older adults. For the SLST, the sensitivity and specificity for recurrent falls in the community-dwelling setting were 0.33 and 0.712, respectively. CONCLUSION All the clinical tests of balance demonstrated an overall low diagnostic accuracy and a consistent inability to correctly identify fallers. None of these tests individually are able to predict future falls in older adults. Future research should develop a better understanding of the role that clinical tests of balance play in the comprehensive assessment of falls risk in older adults. IMPACT Neither the FRT, SLST, nor POMA alone shows consistent evidence of being able to correctly identify fallers across fall types, settings, or older adult subpopulations. These clinical tests of balance cannot substitute a comprehensive falls risk assessment and thus should be incorporated in practice solely to identify and track balance impairment in older adults.
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Affiliation(s)
- Humberto Omaña
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Kari Bezaire
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Kyla Brady
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Jayme Davies
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Nancy Louwagie
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Sean Power
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Sydney Santin
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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23
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Meekes WM, Korevaar JC, Leemrijse CJ, van de Goor IA. Practical and validated tool to assess falls risk in the primary care setting: a systematic review. BMJ Open 2021; 11:e045431. [PMID: 34588228 PMCID: PMC8483054 DOI: 10.1136/bmjopen-2020-045431] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Although several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently. DESIGN A systematic review based on prospective studies. METHODS An extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included. RESULTS Six falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%-83.3%, specificity:28.4%-96.6%). CONCLUSIONS Given that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history. TRIAL REGISTRAION NUMBER The Netherlands Trial Register, NL7917; Pre-results.
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Affiliation(s)
- Wytske Ma Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | - Ien Am van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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24
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Contactless Gait Assessment in Home-like Environments. SENSORS 2021; 21:s21186205. [PMID: 34577412 PMCID: PMC8473097 DOI: 10.3390/s21186205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
Gait analysis is an important part of assessments for a variety of health conditions, specifically neurodegenerative diseases. Currently, most methods for gait assessment are based on manual scoring of certain tasks or restrictive technologies. We present an unobtrusive sensor system based on light detection and ranging sensor technology for use in home-like environments. In our evaluation, we compared six different gait parameters, based on recordings from 25 different people performing eight different walks each, resulting in 200 unique measurements. We compared the proposed sensor system against two state-of-the art technologies, a pressure mat and a set of inertial measurement unit sensors. In addition to test usability and long-term measurement, multi-hour recordings were conducted. Our evaluation showed very high correlation (r>0.95) with the gold standards across all assessed gait parameters except for cycle time (r=0.91). Similarly, the coefficient of determination was high (R2>0.9) for all gait parameters except cycle time. The highest correlation was achieved for stride length and velocity (r≥0.98,R2≥0.95). Furthermore, the multi-hour recordings did not show the systematic drift of measurements over time. Overall, the unobtrusive gait measurement system allows for contactless, highly accurate long- and short-term assessments of gait in home-like environments.
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25
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Cecins E, Hill K, Taaffe DR, Manners D, Hill AM, Newton RU, Galvão DA, Cavalheri V. Feasibility, tolerance and effects of adding impact loading exercise to pulmonary rehabilitation in people with chronic obstructive pulmonary disease: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:151. [PMID: 34344482 PMCID: PMC8330032 DOI: 10.1186/s40814-021-00893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a disorder linked with a multitude of extra pulmonary manifestations (also known as treatable traits), including low bone mineral density (BMD). To date, no specific guidelines exist for the management of BMD in this population. Impact loading exercise has been identified as an intervention that improves or maintains BMD in other populations. However, the feasibility of and tolerance to impact loading exercise has not been tested in people with COPD. The aim of the proposed study will be to investigate the feasibility and tolerance of adding impact loading exercise to a standard pulmonary rehabilitation programme (PRP) in people with COPD and report its effects on bone health, balance and falls risk. METHODS This is a protocol for a pilot feasibility and tolerance randomised controlled trial (RCT). Fifty-eight people with COPD will be randomly allocated, on a 1:1 ratio, to either the experimental or control group. Initially, participants in both groups will complete a standard 8-week (twice-weekly) PRP followed by a 32-week period of maintenance exercises. Over the initial 8-week period, participants allocated to the experimental group will also undertake targeted lower limb resistance exercises and commence a programme of impact loading exercises (e.g. bounding and drop jumps). On completion of the initial 8-week PRP, in addition to the standard maintenance exercises, participants in the experimental group will continue with home-based impact loading exercises, four times a week, for the extra 32 weeks. The primary outcome of this study is feasibility of and tolerance to impact loading exercises. Feasibility will be measured using data collected pertaining to recruitment, withdrawal and completion. Adherence to the exercises will be collected using exercise logs. Tolerance to the exercises will be determined using outcomes to assess pain, recording any adverse effects such as a fall and feedback from the participants in semi-structured interviews on completing of the trial. The effects of the 40-week experimental intervention on bone health, balance and falls risk will be reported. DISCUSSION This pilot RCT will test the feasibility and tolerance of an intervention that has never been trialed in people with COPD. It will also provide initial information regarding the size of the effect this intervention has on outcomes such as BMD, balance and falls risk. These data will be critical when designing a definitive RCT to advance this area of research. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR): 12620001085965 (20/10/2020).
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Affiliation(s)
- Erin Cecins
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Physiotherapy Department, St John of God Midland Hospital, Perth, WA Australia
| | - Kylie Hill
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Institute for Respiratory Health, Perth, WA Australia
| | - Dennis R. Taaffe
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - David Manners
- Respiratory Medicine, St John of God Midland Hospital, Perth, WA Australia
| | - Anne-Marie Hill
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
| | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Institute for Respiratory Health, Perth, WA Australia
- Allied Health, South Metropolitan Health Service, Perth, Australia
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26
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Chauvin S, Durocher E, Richardson J, Beauchamp MK. Experiences of a home-based fall prevention exercise program among older adults with chronic lung disease. Disabil Rehabil 2021; 44:5513-5519. [PMID: 34190012 DOI: 10.1080/09638288.2021.1938246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Individuals with chronic obstructive pulmonary disease (COPD) often have mobility limitations; these may include challenges with balance and being at high risk of falling. Risk of falling can be reduced through exercise programs targeting balance; however, older adults with COPD may experience many barriers to exercise adherence. In this paper we present qualitative findings about the feasibility of a six-month home-based fall-prevention exercise program for older adults with COPD. The aim of the study is to describe the experiences of older adults with COPD who participated in a home-based fall prevention exercise program in order to determine their perceived facilitators and barriers to participation. METHODS 15 participants with COPD who had completed the six-month home-based program participated in one-on-one semi-structured interviews over the phone. Interpretive description methodology and thematic analysis were used. RESULTS Two major themes emerged with respect to participants' perspectives of the intervention and facilitators and barriers to participation: program personalization based on each individual's characteristics, lifestyles, and preferences; and self-motivation and support from family, friends, and healthcare providers. CONCLUSIONS Fall prevention exercise programs that are personalized and focus on providing support for older adults with COPD may help to improve adherence and reduce participants' risk of falling.Implications for rehabilitationIndividuals with COPD often have balance problems and a high risk of falling.Fall prevention programs can improve balance, but adherence is a commonly cited challenge.Patient experiences suggest that fall prevention programs should be personalized and incorporate social support to improve adherence to fall prevention exercises.
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Affiliation(s)
- Stephanie Chauvin
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Evelyne Durocher
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, Canada
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.,Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Canada
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27
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Gade GV, Jørgensen MG, Ryg J, Riis J, Thomsen K, Masud T, Andersen S. Predicting falls in community-dwelling older adults: a systematic review of prognostic models. BMJ Open 2021; 11:e044170. [PMID: 33947733 PMCID: PMC8098967 DOI: 10.1136/bmjopen-2020-044170] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/24/2021] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To systematically review and critically appraise prognostic models for falls in community-dwelling older adults. ELIGIBILITY CRITERIA Prospective cohort studies with any follow-up period. Studies had to develop or validate multifactorial prognostic models for falls in community-dwelling older adults (60+ years). Models had to be applicable for screening in a general population setting. INFORMATION SOURCE MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and Web of Science for studies published in English, Danish, Norwegian or Swedish until January 2020. Sources also included trial registries, clinical guidelines, reference lists of included papers, along with contacting clinical experts to locate published studies. DATA EXTRACTION AND RISK OF BIAS Two authors performed all review stages independently. Data extraction followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Risk of bias assessments on participants, predictors, outcomes and analysis methods followed Prediction study Risk Of Bias Assessment Tool. RESULTS After screening 11 789 studies, 30 were eligible for inclusion (n=86 369 participants). Median age of participants ranged from 67.5 to 83.0 years. Falls incidences varied from 5.9% to 59%. Included studies reported 69 developed and three validated prediction models. Most frequent falls predictors were prior falls, age, sex, measures of gait, balance and strength, along with vision and disability. The area under the curve was available for 40 (55.6%) models, ranging from 0.49 to 0.87. Validated models' The area under the curve ranged from 0.62 to 0.69. All models had a high risk of bias, mostly due to limitations in statistical methods, outcome assessments and restrictive eligibility criteria. CONCLUSIONS An abundance of prognostic models on falls risk have been developed, but with a wide range in discriminatory performance. All models exhibited a high risk of bias rendering them unreliable for prediction in clinical practice. Future prognostic prediction models should comply with recent recommendations such as Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis. PROSPERO REGISTRATION NUMBER CRD42019124021.
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Affiliation(s)
- Gustav Valentin Gade
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Johannes Riis
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Katja Thomsen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Tahir Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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28
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Accuracy of the 4-Stage Balance Test and Sensor-Based Trunk Sway as Fall Risk Assessment Tools in the Emergency Department. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Kim T, Choi SD, Xiong S. Epidemiology of fall and its socioeconomic risk factors in community-dwelling Korean elderly. PLoS One 2020; 15:e0234787. [PMID: 32559206 PMCID: PMC7304594 DOI: 10.1371/journal.pone.0234787] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
Although falls in older people are a major public health problem globally, to date there are scarce reports on socioeconomic risk factors for falls. The aim of the present study was to investigate the epidemiology of fall, its associated socioeconomic risk factors and relative importance among community-dwelling Korean elderly. Secondary analysis of national survey data with 31,684 community-dwelling Korean elderly was performed. Eleven socioeconomic factors (age, gender, household type, marital status, education level, current occupation, past occupation, income, wealth, number of children, and relationship satisfaction) were selected for analysing their associations with the epidemiology of fall through complex sample analysis and logistic regressions. Results showed that 15.9%~25.1% of community-dwelling Korean elderly experienced fall yearly. The groups with significantly higher fall risks were identified as older aged, being female, not married or widowed, less educated, unemployed, and having lower relationship satisfaction. Gender (adjusted odds ratio-AOR = 1.548) and relationship satisfaction (AOR = 1.276) were the utmost important fall risk factors, indicating being older female with lower relationship satisfaction were the foremost socioeconomic characteristics for risk of falling. These findings could contribute to better understanding of the socioeconomic fall risk profiles among Korean elderly and effective strategies for fall prevention.
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Affiliation(s)
- Taekyoung Kim
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Yuseong-gu, Daejoen, Republic of Korea
| | - Sang D. Choi
- Department of Occupational and Environmental Safety and Health, University of Wisconsin, Whitewater, Wisconsin, United States of America
| | - Shuping Xiong
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Yuseong-gu, Daejoen, Republic of Korea
- * E-mail:
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30
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Villumsen M, Grarup B, Christensen SWMP, Palsson TS, Hirata RP. "Study protocol for the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (the NOCfao study)". BMC Geriatr 2020; 20:198. [PMID: 32513121 PMCID: PMC7278063 DOI: 10.1186/s12877-020-01535-6] [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: 07/06/2019] [Accepted: 03/25/2020] [Indexed: 01/06/2023] Open
Abstract
Background Accidental falls are common among community-dwellers, probably due to the level of physical activity and impaired postural stability. Today, fall risk prediction tools’ discriminative validity are only moderate. In order to increase the accuracy, multiple variables such as highly validated objective field measurements of physical activity and impaired postural stability should be adressed in order to predict falls. The main aim of this paper is to describe the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (NOCfao) investigating the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. Methods The study consists of a baseline session where the participants are asked to respond to three questionnaires, perform physical tests (i.e., measuring strength in the upper and lower extremities, balance, and walking speed), participate in an assessment of pain sensitivity, and to wear an ankle mounted pedometer for measuring physical activity for 5 days. Subsequently, the fall incidences and the circumstances surrounding the falls during the previous 1 to 2 months will be recorded throughout a one-year follow-up period. Discussion This study will add to the present-day understanding of the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. These data will provide valid and reliable information on the relationship between these variables and their significance for community-dwelling older adults. Trial registration ClinicalTrials.gov identifier: NCT2995317. Registered December 13th, 2016.
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Affiliation(s)
- Morten Villumsen
- Department of Elderly and Health, Section of Training and Activity, Aalborg Municipality, Aalborg, Denmark.,Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark
| | - Bo Grarup
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark.
| | - Steffan Wittrup Mc Phee Christensen
- Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark
| | | | - Rogerio Pessoto Hirata
- Performance and Technology, Department of Health Science and Technology Aalborg University, Niels Jernes Vej 12, 9220, Aalborg East, Denmark
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31
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Psychoactive drug use and falls among community-dwelling Turkish older people. North Clin Istanb 2020; 7:260-266. [PMID: 32478298 PMCID: PMC7251276 DOI: 10.14744/nci.2019.30316] [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: 02/18/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Data on the relationship between fall and psychoactive drug use among Turkish older people are limited. This study aims to investigate the prevalence of falls and the associations between psychoactive drug use and falls in community-dwelling Turkish older people. METHODS: This single center study was performed using the medical records of subjects aged over 65 years admitted to the geriatric care unit. Demographic and lifestyle factors, clinical characteristics, medications, and data on mood, cognitive status, and functional performance were obtained from the comprehensive geriatric assessment records. Based on a fall history in the last 12 months, subjects were grouped as fallers and non-fallers. Subjects treated with a psychoactive drug were identified. RESULTS: Among the total of 429 subjects, there were 184 (42.9%) fallers and 245 (57.1%) non-fallers. Of those, 33.3% were on psychoactive drug treatment. The proportion of psychoactive drug users was higher in the fallers group compared to non-fallers (45.1% vs. 24.5%, p<0.001). Multivariable logistic regression analysis showed age ≥75 years (OR=1.83;CI: 1.09–3.09; p=0.023), female gender (OR=2.70;CI: 1.6–4.50; p<0.001), and psychoactive drug use (OR=2.14;CI 1.32–3.48; p=0.002) as independent predictors of falls. CONCLUSION: We found that about one-third of geriatric outpatients were on psychoactive drug treatment in Turkey that was independently associated with the risk of falls.
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32
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The Mini-Balance Evaluation System Test Can Predict Falls in Clinically Stable Outpatients With COPD. J Cardiopulm Rehabil Prev 2019; 39:391-396. [DOI: 10.1097/hcr.0000000000000427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parry S, Denehy L, Granger C, McGinley J, Files DC, Berry M, Dhar S, Bakhru R, Larkin J, Puthucheary Z, Clark R, Morris P. The fear and risk of community falls in patients following an intensive care admission: An exploratory cohort study. Aust Crit Care 2019; 33:144-150. [PMID: 31495638 DOI: 10.1016/j.aucc.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/03/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Muscle weakness and impairments in physical functioning are well-recognised sequelae after critical illness. Whether individuals have a higher risk of community falls and a fear of falling has not been examined amongst individuals after critical illness. OBJECTIVES The objective of this study was to explore the prevalence of falls, fear of falling, and fall risk in intensive care unit (ICU) survivors over a 6-month period after hospital discharge. METHODS This was a nested exploratory study within a medical ICU. Fall prevalence was measured in line with established guidelines over 6 months after ICU discharge. Fear of falling and prediction of fall risk were assessed at 2, 4, and 6 months after discharge. RESULTS Twelve individuals were included. Half of the cohort (n = 6) had at least one fall, with one-third sustaining more than one fall. There were 17 falls reported across the six individuals. Injuries requiring medical intervention were reported with five falls. Almost one-third were classified as 'moderate' to 'severe' injurious falls. Loss of balance and fatigue were reported as the main contributors to the falls. All individuals who had a fall reported a severe fear of falling at 2 months. Individuals classified as having 'moderate' to 'high' risk of falls at 2 months were more likely to have at least one fall. CONCLUSIONS This study suggests that ICU survivors may have a high fall risk, fear of falling, and fall prevalence, which can result in significant injury.
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Affiliation(s)
- Selina Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Catherine Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia; Department of Physiotherapy, Royal Melbourne Hospital, Victoria, Australia
| | - Jennifer McGinley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - D Clark Files
- Pulmonary, Critical Care, Allergy and Immunology Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael Berry
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Sanjay Dhar
- Section on Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Rita Bakhru
- Pulmonary, Critical Care, Allergy and Immunology Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jane Larkin
- Department of Physiotherapy, Royal Melbourne Hospital, Victoria, Australia
| | - Zudin Puthucheary
- Royal Free Hospital, NHS Foundation Trust, London, United Kingdom; Centre for Health and Human Performance, University College Hospital London, United Kingdom
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Queensland, Australia
| | - Peter Morris
- Section on Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
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Kato S, Murakami H, Demura S, Yoshioka K, Shinmura K, Yokogawa N, Igarashi T, Yonezawa N, Shimizu T, Tsuchiya H. Abdominal trunk muscle weakness and its association with chronic low back pain and risk of falling in older women. BMC Musculoskelet Disord 2019; 20:273. [PMID: 31159812 PMCID: PMC6547466 DOI: 10.1186/s12891-019-2655-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have indicated that trunk muscle strength decreases with chronic low back pain, and is associated with poor balance, poor functional performance, and falls in older adults. Strengthening exercises for chronic low back pain are considered the most effective intervention to improve functional outcomes. We developed an innovative exercise device for abdominal trunk muscles that also measures muscle strength. The correlation between muscle weakness, as measured by our device, the presence of chronic low back pain, and decreased physical ability associated with a risk of falling were evaluated in older women. Methods Thirty-eight elderly women, who could walk without support during daily activities and attended our outpatient clinic for treatment of chronic low back pain, knee or hip arthritis, or osteoporosis, were included in this study. Anthropometric measurements were performed. Grip power and one-leg standing time with eyes open were measured, and abdominal trunk muscle strength was measured using our device. History of falling in the previous 12 months was noted. Subjects with chronic low back pain (visual analog scale score ≥ 20 mm) for over 3 months were assigned to the low back pain group (n = 21). The remaining subjects formed the non-low back pain group (n = 17). Results Abdominal muscle strength of subjects in the low back pain group, and with history of falling, was significantly lower compared with that of subjects in the non-low back pain group, and in subjects without a history of falling, respectively. There was a moderate positive correlation between abdominal trunk muscle strength and one-leg standing time with eyes open. Conclusion We measured abdominal muscle strength in older women with chronic low back pain using our device, and it was significantly lower than that of those without chronic low back pain. Muscle weakness was associated with a history and risk of falling.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kazuya Shinmura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Takashi Igarashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Noritaka Yonezawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Matsuzawa R, Kamiya K, Hamazaki N, Nozaki K, Tanaka S, Maekawa E, Matsunaga A, Masuda T, Ako J. Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease. Gerontology 2019; 65:128-135. [PMID: 30650429 DOI: 10.1159/000493527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The detection of impaired physical performance in older adults with cardiovascular disease is essential for clinical management and therapeutic decision-making. There is a requirement for an assessment tool that can be used conveniently, rapidly, and securely in clinical practice for screening decreased physical performance. OBJECTIVE The present study was performed to evaluate the association of office-based physical assessments with decreased physical performance and to compare the prognostic capability of these assessments in older adults with cardiovascular disease. METHODS A total of 1,040 patients aged 75 years and older with cardiovascular disease were included in this analysis. One-leg standing time (OLST) and handgrip strength were measured as office-based physical assessment tools, and short physical performance battery (SPPB), 6-min walk distance, and usual gait speed were also measured at hospital discharge as measurements of physical performance. All-cause mortality was assessed by death registry at the hospital. We examined the association of office-based measures with physical performance and all-cause mortality. RESULTS The areas under the curve of OLST for SPPB < 10, 6-min walk distance < 300 m, and usual gait speed < 1.0 m/s were 0.87 (95% CI 0.83-0.91), 0.83 (95% CI 0.80-0.86), and 0.81 (95% CI 0.78-0.85), respectively. The discrimination abilities of OLST for decreased physical performance were significantly higher than those of handgrip strength. After adjusting for the effects of patient characteristics, the hazard ratio for all-cause mortality in the < 3 s group for OLST was 1.68 (95% CI 1.06-2.67, p = 0.03). Handgrip strength, however, was not significantly associated with mortality risk in these participants. CONCLUSION Short OLST, in particular < 3 s, is associated with decreased physical performance and elevated mortality risk in elderly patients with cardiovascular disease. OLST can be conveniently measured in the clinician's office as a screening tool for impaired physical performance.
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Affiliation(s)
- Ryota Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan,
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.,Department of Cardio-Angiology, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shinya Tanaka
- Department of Cardio-Angiology, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Takashi Masuda
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Trevisan C, Crippa A, Ek S, Welmer AK, Sergi G, Maggi S, Manzato E, Bea JW, Cauley JA, Decullier E, Hirani V, LaMonte MJ, Lewis CE, Schott AM, Orsini N, Rizzuto D. Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2018; 20:569-582.e7. [PMID: 30554987 DOI: 10.1016/j.jamda.2018.10.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/18/2018] [Accepted: 10/21/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the association between nutritional status, defined on the basis of a multidimensional evaluation, and body mass index (BMI) with the risk of falls and recurrent falls in community-dwelling older people. DESIGN Systematic literature review and meta-analysis. SETTING AND PARTICIPANTS Community-dwelling older adults. MEASURES A systematic literature review was conducted on prospective studies identified through electronic and hand searches until October 2017. A random effects meta-analysis was used to evaluate the relative risk (RR) of experiencing falls and recurrent falls (≥2 falls within at least 6 months) on the basis of nutritional status, defined by multidimensional scores. A random effects dose-response meta-analysis was used to evaluate the association between BMI and the risk of falls and recurrent falls. RESULTS People who were malnourished or those at risk for malnutrition had a pooled 45% higher risk of experiencing at least 1 fall than were those well-nourished (9510 subjects). Increased falls risk was observed in subjects malnourished versus well-nourished [RR 1.64, 95% confidence interval (CI) 1.18-2.28; 3 studies, 8379 subjects], whereas no substantial results were observed for risk of recurrent falls. A U-shaped association was detected between BMI and the risk for falls (P < .001), with the nadir between 24.5 and 30 (144,934 subjects). Taking a BMI of 23.5 as reference, the pooled RR of falling ranged between 1.09 (95% CI 1.04-1.15) for a BMI of 17, to 1.07 (95% CI 0.92-1.24) for a BMI of 37.5. No associations were observed between BMI and recurrent falls (120,185 subjects). CONCLUSIONS/IMPLICATIONS The results of our work suggest therefore that nutritional status and BMI should be evaluated when assessing the risk for falls in older age.
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Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
| | - Alessio Crippa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy
| | - Jennifer W Bea
- Department of Medicine, College of Medicine, Tucson, AZ; Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
| | - Vasant Hirani
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Anne-Marie Schott
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France; Université de Lyon, EA Health Services and Performance Research (HESPER), Lyon, France
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Kang L, Chen X, Han P, Ma Y, Jia L, Fu L, Yu H, Wang L, Hou L, Yu X, An Z, Wang X, Li L, Zhang Y, Zhao P, Guo Q. A Screening Tool Using Five Risk Factors Was Developed for Fall-Risk Prediction in Chinese Community-Dwelling Elderly Individuals. Rejuvenation Res 2018; 21:416-422. [PMID: 29191108 DOI: 10.1089/rej.2017.2005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Li Kang
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Rehabilitation Medicine, Tianjin Children Hospital, Tianjin, China
| | - Xiaoyu Chen
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Peipei Han
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Yixuan Ma
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Liye Jia
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Liyuan Fu
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Hairui Yu
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Lu Wang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Lin Hou
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Xing Yu
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Zongyang An
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Xuetong Wang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Lu Li
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Yuanyuan Zhang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Peng Zhao
- Department of Rehabilitation Medicine, Tianjin Children Hospital, Tianjin, China
| | - Qi Guo
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
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Safarpour M, Hosseini SR, Mohamadzade M, Bijani A, Fotouhi A. Predictors of Incidence of Fall in Elderly Women; A Six-Month Cohort Study. Bull Emerg Trauma 2018; 6:226-232. [PMID: 30090818 PMCID: PMC6078482 DOI: 10.29252/beat-060307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To determine the incidence and predictive factors of the falls in elderly women in Northern Iran. Methods: A total of 717 elderly women aged 60 years and above in Amirkola, Northern of Iran participated in this study. Age, history of falls during the 12 months leading to the study, accompanying diseases, status of balance, cognitive status, orthostatic hypotension, state of depressive symptoms, strength of quadriceps muscles and serum vitamin D level were assessed as independent variables during baseline measurement. Incidence of fall (dependent variable) was recorded during a six-month follow-up period. Results: Of the participants, 7.8% had experience of fall, out of which 50.0% experienced it once, 25.0% twice, and the rest three times or more. With aging, the incidence of orthostatic hypotension also increased and symptomatic depression became aggravated. In the final model, the variables of the number of accompanying diseases (RR=1.78, 95% CI: 1.00-3.18), severe cognitive impairment (RR=12.70, 95% CI: 3.05-52.86), and depressive symptoms (RR=3.19, 95% CI: 1.48-6.86) remained as strong associated variables for incidence of fall. Conclusion: With increasing severity of depressive symptoms and cognitive impairment along with the comorbidities, incidence of fall also increases in the elderly. Thus, psychological aspects of the elderly and comorbidities in this group should be taken care of seriously.
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Affiliation(s)
- Mehdi Safarpour
- Health Deputy, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Reza Hosseini
- Department of Community Medicine, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | | | - Ali Bijani
- Children's Non-Communicable Diseases Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KK. Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability. J Geriatr Phys Ther 2018; 40:1-36. [PMID: 27537070 PMCID: PMC5158094 DOI: 10.1519/jpt.0000000000000099] [Citation(s) in RCA: 304] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls. PURPOSE First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination. DATA SOURCES To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (≥65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults. STUDY SELECTION Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality. DATA EXTRACTION Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35. DATA SYNTHESIS Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus. LIMITATIONS Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests. CONCLUSIONS No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (≤50 points), Timed Up and Go times (≥12 seconds), and 5 times sit-to-stand times (≥12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls. Shortfalls identified during review will direct researchers to address knowledge gaps.
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Affiliation(s)
- Michelle M Lusardi
- 1Department of Physical Therapy and Human Movement Science, College of Health Professions, Sacred Heart University, Fairfield, Connecticut 2Department of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia 3Division of Rehabilitation Sciences and Center for Recovery, Physical Activity and Nutrition, University of Texas Medical Branch, Galveston 4Department of Physical Therapy, Winston Salem State University, Winston Salem, North Carolina 5University of Vermont Medical Center, Colchester 6University of North Carolina Memorial Hospitals, Chapel Hill 7Physical Therapy Program, Chatham University, Pittsburgh, Pennsylvania 8Care One at the Highlands, Edison, New Jersey 9Geriatric Residency Program, Brooks Rehabilitation Institute of Higher Learning, Jacksonville, Florida 10School of Physical Therapy, Pacific University, Hillsboro, Oregon
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Saftari LN, Kwon OS. Ageing vision and falls: a review. J Physiol Anthropol 2018; 37:11. [PMID: 29685171 PMCID: PMC5913798 DOI: 10.1186/s40101-018-0170-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 03/28/2018] [Indexed: 01/12/2023] Open
Abstract
Background Falls are the leading cause of accidental injury and death among older adults. One of three adults over the age of 65 years falls annually. As the size of elderly population increases, falls become a major concern for public health and there is a pressing need to understand the causes of falls thoroughly. Main body of the abstract While it is well documented that visual functions such as visual acuity, contrast sensitivity, and stereo acuity are correlated with fall risks, little attention has been paid to the relationship between falls and the ability of the visual system to perceive motion in the environment. The omission of visual motion perception in the literature is a critical gap because it is an essential function in maintaining balance. In the present article, we first review existing studies regarding visual risk factors for falls and the effect of ageing vision on falls. We then present a group of phenomena such as vection and sensory reweighting that provide information on how visual motion signals are used to maintain balance. Conclusion We suggest that the current list of visual risk factors for falls should be elaborated by taking into account the relationship between visual motion perception and balance control.
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Affiliation(s)
- Liana Nafisa Saftari
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, 44919, South Korea
| | - Oh-Sang Kwon
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, 44919, South Korea.
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Knee osteoarthritis at the early stage: The four-week effect of lateral wedge insole on pain and risk of falls. Med J Islam Repub Iran 2018; 32:17. [PMID: 30159268 PMCID: PMC6108274 DOI: 10.14196/mjiri.32.17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Knee osteoarthritis (KOA) is associated with a decrease in function, increase in pain and risk of falls. Lateral wedge insole (LWI) is commonly prescribed in KOA to improve pain and function. Our study aimed to 1) evaluate the clinical symptoms and risk of falls in early KOA and compare with controls; 2) evaluate the immediate and four-week effect of LWI. Methods: A sample of 20 Persian dwelling individuals with early KOA and 19 matched controls were recruited. Pain with Visual Analogue Scale (VAS), Quality of life (QOL) with the knee injury and osteoarthritis outcome score, risk of falls with the Timed Up and Go (TUG) and static One-leg Balance (OLB) tests were assessed. The four-week effect of 5º LWI was considered for individuals with KOA. Independent t-test was done to report the between-group differences, and paired t-test was used to report the four-week effect of LWI. Results: At baseline, statistically significant higher scores for pain, lower scores for QOL, and higher risk of falls were observed in KOA compared to controls (p< 0.001). A significant statistical decrease was observed in pain, and risk of falls, and an increase in QOL in KOA after four-week effect of LWI compared to baseline (p< 0.001). Conclusion: People with early KOA showed higher pain and lower level of QOL that were associated with higher risk of falls. LWI may have the potential to improve clinical symptoms and reduce the risk of falls at the early stage of KOA.
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Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M, Wermelink AMAT, van der Velde N. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others. J Am Med Dir Assoc 2018; 19:372.e1-372.e8. [PMID: 29402646 DOI: 10.1016/j.jamda.2017.12.099] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications. METHODS AND DESIGN A systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately. RESULTS In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association). CONCLUSION Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations.
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Affiliation(s)
- Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Esther M M van de Glind
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Joost G Daams
- Medical library, Academic Medical Center, Amsterdam, the Netherlands
| | - Kimberley J Ploegmakers
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Max de Vries
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Anne M A T Wermelink
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
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Pyrgeli M, Agapiou E, Pyrgelis ES, Manaras D, Dionyssiotis Y, Dontas I. The correlation of specific medication groups and falls risk in elderly. A medication logbook survey. J Frailty Sarcopenia Falls 2017; 2:92-98. [PMID: 32300687 PMCID: PMC7155368 DOI: 10.22540/jfsf-02-092] [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] [Accepted: 11/27/2017] [Indexed: 11/23/2022] Open
Abstract
Falls among elderly are a common and major public health problem. Even though most falls do not lead to injury, they threaten the independence of older people causing functional decline in activities of daily living (ADLs) with substantial socioeconomic consequences. According to current literature several risk factors have been identified. Falls rarely have a single cause and the majority of them are due to a complex interaction of the age-related changes, the underlying medical condition and the medications. Some medications due to their side effects are usually called fall-risk-increasing drugs (FRIDs). We conducted a retrospective, multicentre, observational chart review study of elderly aged over 60, which aims to reveal any correlation between specific groups of medications given for the most common diseases, and falls in elderly. The sample consists of 827 participants. The data were collected by using a medication logbook which includes information about sex, age, residency, underlying diseases and the corresponding medications, incidents of fall during the last 2 years and possible fracture as a consequence of the fall.
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Affiliation(s)
| | - Eleni Agapiou
- Department of Physical and Rehabilitation Medicine, "Asklepieion Voulas" General Hospital, Athens Greece
| | - Efstratios-Stylianos Pyrgelis
- 1 Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, 'Eginition' Hospital, Athens, Greece
| | | | - Yannis Dionyssiotis
- Physical Medicine & Rehabilitation Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Ismene Dontas
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
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Kang L, Han P, Wang J, Ma Y, Jia L, Fu L, Yu H, Chen X, Niu K, Guo Q. Timed Up and Go Test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China. Clin Interv Aging 2017; 12:2009-2016. [PMID: 29238175 PMCID: PMC5716394 DOI: 10.2147/cia.s138287] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Falling is a major health problem in community-dwelling elderly individuals. The aim of the present study was to conduct a prospective investigation to evaluate the accuracy of the Timed Up and Go Test (TUGT), 4-meter walking test, and grip strength test to screen for the risk of falls and to determine a cutoff point to be used clinically. Patients and methods This was a prospective study that included 541 participants. The fall data were obtained via face-to-face interview, and the date, site, and circumstances of any falls were recorded. TUGTs were recorded as part of a comprehensive geriatric assessment. We collected the same data at baseline and after follow-up via comprehensive geriatric assessment. Results The incidence of falls of our study subjects was 20.8%. The recurrent-fall group had a fall rate of 6.8% during the follow-up year. The standard area under the curve (AUC) of our screening tool was >0.70, and hence our tool can be used for clinical purposes. After adjusting for age and gender, the AUC of TUGT became 0.642, so it cannot be used as a predictive tool for measuring any types of falls. However, when recurrent falls were adjusted for age and gender, the TUGT’s AUC improved to 0.733 and a score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals. Conclusion Future falls were best predicted by TUGT in recurrent fallers at baseline. A score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals.
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Affiliation(s)
- Li Kang
- Department of Rehabilitation Medicine, Tianjin Economic-Technological Development Area International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University.,Department of Rehabilitation Medicine
| | | | | | - Yixuan Ma
- Department of Rehabilitation Medicine
| | - Liye Jia
- Department of Rehabilitation Medicine
| | - Liyuan Fu
- Department of Rehabilitation Medicine
| | - Hairui Yu
- Department of Rehabilitation Medicine
| | | | - Kaijun Niu
- Nutritional Epidemiology Institute.,School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Tianjin Economic-Technological Development Area International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University.,Department of Rehabilitation Medicine
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Exposure to anticholinergic and sedative medicines as indicators of high-risk prescriptions in the elderly. Int J Clin Pharm 2017; 39:1237-1247. [DOI: 10.1007/s11096-017-0533-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/14/2017] [Indexed: 11/25/2022]
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Ibrahim A, Singh DKA, Shahar S, Omar MA. Timed up and go test combined with self-rated multifactorial questionnaire on falls risk and sociodemographic factors predicts falls among community-dwelling older adults better than the timed up and go test on its own. J Multidiscip Healthc 2017; 10:409-416. [PMID: 29138571 PMCID: PMC5667639 DOI: 10.2147/jmdh.s142520] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Early detection of falls risk among older adults using simple tools may assist in fall prevention strategies. The aim of this study was to identify the best parameters associated with previous falls, either the timed up and go (TUG) test combined with sociodemographic factors and a self-rated multifactorial questionnaire (SRMQ) on falls risk or the TUG on its own. Falls risk was determined based on parameters associated with previous falls. DESIGN This was a retrospective cohort study. SETTING The study was conducted in a community setting. PARTICIPANTS The participants were 1,086 community-dwelling older adults, with mean age of 69.6±5.6 years. Participants were categorized into fallers and nonfallers based on their history of falls in the past 12 months. METHOD Participants' sociodemographic data was taken, and SRMQ consisting of five falls-related questions was administered. Participants performed the TUG test twice, and the mean was taken as the result. RESULTS A total of 161 participants were categorized as fallers (14.8%). Multivariate logistic regression analysis showed that the model (χ2(6)=61.0, p<0.001, Nagelkerke R2=0.10) consisting of the TUG test, sociodemographic factors (gender, cataract/glaucoma and joint pain), as well as the SRMQ items "previous falls history" (Q1) and "worried of falls" (Q5), was more robust in terms of falls risk association compared to that with TUG on its own (χ2(1)=10.3, p<0.001, Nagelkerke R2=0.02). CONCLUSION Combination of sociodemographic factors and SRMQ with TUG is more favorable as an initial falls risk screening tool among community-dwelling older adults. Subsequently, further comprehensive falls risk assessment may be performed in clinical settings to identify the specific impairments for effective management.
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Affiliation(s)
- Azianah Ibrahim
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
- Pantai Integrated Rehab Services Sendirian Berhad, Pandan Indah
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
| | - Suzana Shahar
- Community Rehabilitation and Ageing Research Centre, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
| | - Mohd Azahadi Omar
- Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia
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Moyer HS, Gale J, Severe S, Braden HJ, Hasson S. Outcome measures correlated with falls in nursing home residents—A pilot study. Physiother Theory Pract 2017; 33:725-732. [DOI: 10.1080/09593985.2017.1345027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Heidi S. Moyer
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - Jeffrey Gale
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - Stephen Severe
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - Heather J. Braden
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
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48
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Longitudinal Evaluation of Johns Hopkins Fall Risk Assessment Tool and Nurses' Experience. J Nurs Care Qual 2017; 32:242-251. [DOI: 10.1097/ncq.0000000000000235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Melillo P, Orrico A, Chirico F, Pecchia L, Rossi S, Testa F, Simonelli F. Identifying fallers among ophthalmic patients using classification tree methodology. PLoS One 2017; 12:e0174083. [PMID: 28334052 PMCID: PMC5363841 DOI: 10.1371/journal.pone.0174083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 03/04/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To develop and validate a tool aiming to support ophthalmologists in identifying, during routine ophthalmologic visits, patients at higher risk of falling in the following year. METHODS A group of 141 subjects (age: 73.2 ± 11.4 years), recruited at our Eye Clinic, underwent a baseline ophthalmic examination and a standardized questionnaire, including lifestyles, general health, social engagement and eyesight problems. Moreover, visual disability was assessed by the Activity of Daily Vision Scale (ADVS). The subjects were followed up for 12 months in order to record prospective falls. A subject who reported at least one fall within one year from the baseline assessment was considered as faller, otherwise as non-faller. Different tree-based algorithms (i.e., C4.5, AdaBoost and Random Forests) were used to develop automatic classifiers and their performances were evaluated by the cross-validation approach. RESULTS Over the follow-up, 25 falls were referred by 13 patients. The logistic regression analysis showed the following variables as significant predictors of prospective falls: pseudophakia and use of prescribed eyeglasses as protective factors, recent worsening of visual acuity as risk factor. Random Forest ranked best corrected visual acuity, number of sleeping hours and job type as the most important features. Finally, AdaBoost enabled the identification of subjects at higher risk of falling in the following 12 months with a sensitivity rate of 69.2% and a specificity rate of 76.6%. CONCLUSIONS The current study proposes a novel method, based on classification trees applied to self-reported factors and health information assessed by a standardized questionnaire during ophthalmological visits, to identify ophthalmic patients at higher risk of falling in the following 12 months. The findings of the current study pave the way to the validation of the proposed novel tool for fall risk screening on a larger cohort of patients with visual impairment referred to eye clinics.
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Affiliation(s)
- Paolo Melillo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
- * E-mail:
| | - Ada Orrico
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Franco Chirico
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Settimio Rossi
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Bongue B, Hugues J, Achour É, Colvez A, Sass C. [Improving fall prevention in the elderly]. SOINS. GÉRONTOLOGIE 2017; 21:24-9. [PMID: 27449306 DOI: 10.1016/j.sger.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The prevention of falls in the elderly requires action on several levels. Firstly, it is essential to identify those at risk of a fall. They must then be encouraged to do appropriate physical and sports activities, a factor of prevention. Social workers have a major role to play in supporting elderly people and encouraging them to participate in such programmes.
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Affiliation(s)
- Bienvenu Bongue
- Centre technique d'appui et de formation des Centres d'examens de santé (Cetaf), 67-69 avenue de Rochetaillée, 42100 Saint-Étienne, France; Laboratoire EA 4607, SNA-EPIS, CHU Nord niveau 6, 42055 Saint-Etienne cedex 2, France.
| | - Julie Hugues
- Caisse nationale d'assurance vieillesse (Cnav), 110 avenue de Flandre, 75951 Paris cedex 19, France
| | - Émilie Achour
- Laboratoire EA 4607, SNA-EPIS, CHU Nord niveau 6, 42055 Saint-Etienne cedex 2, France; Service de gérontologie clinique, CHU Saint Etienne, Hôpital la Charité, 44 rue Pointe-Cadet, 42055 Saint Etienne, France
| | - Alain Colvez
- CRHU, La Colombière, 39 avenue Charles-Flahault, 34000 Montpellier, France; Centre technique d'appui et de formation des Centres d'examens de santé (Cetaf), 67-69 avenue de Rochetaillée, 42100 Saint-Étienne, France
| | - Catherine Sass
- Centre technique d'appui et de formation des Centres d'examens de santé (Cetaf), 67-69 avenue de Rochetaillée, 42100 Saint-Étienne, France
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