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Miyajima S, Omaru T, Ishii T, Arima H, Shibata Y, Izaki T, Haga N. Real-World Evidence for Risk Factors of Bruises and Fractures from Falls in Patients with Overactive Bladder: A Medical Record Analysis. Int J Clin Pract 2023; 2023:3701823. [PMID: 38179145 PMCID: PMC10765161 DOI: 10.1155/2023/3701823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
Aim To identify the risk factors for bruises and fractures from falls in patients with overactive bladder (OAB). Methods We evaluated 1136 patients with OAB and aged ≥50 years who visited our hospital. Age, sex, frequency of nocturnal urination, and urinary incontinence type were investigated in the 360 eligible patients. Patients were divided into three groups: those patients without falls (no-fall group), those with fall bruises (bruise group), and those with fall fractures (fracture group). The risk factors for bruises and fractures in patients with OAB were evaluated using the logistic regression analysis. In addition, association between the bruises or fractures from falls and the behavior around urination during the night was investigated. Results The multivariate logistic regression analysis showed that female sex (odds ratio (OR) 2.888, p = 0.030) and nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.940; p = 0.040) were significantly associated with bruises. Nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.835; p = 0.026) and urge incontinence (OR 3.415, p = 0.016) were significantly associated with fractures. Behavior around urination during the night was significantly associated with fractures (p = 0.009). Conclusion In the real-world clinical setting, increasing nocturnal urination frequency is a common risk factor for bruises and fractures. Also, female sex and urge incontinence were the risk factors for bruises and fractures, respectively. OAB patients with urge incontinence would especially require aggressive intervention to prevent fractures during night-time voiding.
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Affiliation(s)
- Shigero Miyajima
- Department of Urology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Taisei Omaru
- Department of Urology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Tatsu Ishii
- Department of Urology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yozo Shibata
- Department of Orthopedic Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Teruaki Izaki
- Department of Orthopedic Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukuoka University, Fukuoka, Japan
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Schlitzer J, Friedhoff M, Nickel B, Frohnhofen H. Observed daytime sleepiness in in-hospital geriatric patients and risk of falls. Z Gerontol Geriatr 2023; 56:545-550. [PMID: 37222819 DOI: 10.1007/s00391-023-02191-2] [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: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Daytime sleepiness and falls are frequent in geriatric in-hospital patients; however, the relationship between both events is not clear. To test the hypothesis that observed daytime sleepiness is associated with falls in geriatric in-hospital patients data collected from medical records of patients who were admitted to an acute geriatric department were retrospectively analyzed. METHODS The data from the medical records of patients who were admitted to the geriatric department of the Alfried-Krupp-Hospital in Essen, Germany in the period from January 2018 to March 2020 were retrospectively analyzed. Personal data, data concerning the geriatric assessment, observed daytime sleepiness, and falls were recorded. RESULTS From a total of 1485 patients who were consecutively admitted to hospital, the data of 1317 (87%) patients could be included for further analysis. During the hospital stay 146 (11%) patients fell at least once, 35 (3%) patients had more than 1 fall and 64 falls (44%) occurred while patients were standing (bipedal fall). Daytime sleepiness was observed in 73% of the patients with bipedal falls and in 65% patients with nonbipedal falls (p < 0.01). Falls correlated significantly with the history of a recent fall, the length of hospital stay, the Barthel index (BI) on admission, the mini mental state examination (MMSE), dementia and observed daytime sleepiness. No correlation was found between falls and age, multimorbidity, and the number of drugs used. Drugs related to falls were medications to treat Parkinson's disease, antidepressants and neuroleptics. In a multiple logistic regression analysis in-hospital falls were significantly and independently associated with a history of falls, length of in-hospital stay, dementia, and observed daytime sleepiness. CONCLUSION Observed daytime sleepiness is associated with in-hospital falls in geriatric patients. Prospective interventional studies are needed to confirm this relationship, and to quantify the impact of sleepiness on the risk of falling. Additionally, the impact of treatment for observed daytime sleepiness on the risk of falling should be assessed. The assessment of sleepiness should become a routine task in geriatrics.
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Affiliation(s)
| | - Michaela Friedhoff
- Alfried-Krupp-Krankenhaus Essen, Alfried Krupp Str. 20, 45131, Essen, Germany
| | - Barbara Nickel
- Alfried-Krupp-Krankenhaus Essen, Alfried Krupp Str. 20, 45131, Essen, Germany
| | - Helmut Frohnhofen
- Klinik für Orthopädie und Unfallchirurgie, Heinrich Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany.
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Zhou T, Dai X, Yuan Y, Xue Q, Li X, Wang M, Ma H, Heianza Y, Qi L. Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging. Front Immunol 2023; 14:1234102. [PMID: 37662961 PMCID: PMC10470625 DOI: 10.3389/fimmu.2023.1234102] [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: 06/03/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background Autoimmune diseases are more common among people with unhealthy sleep behaviors, and these conditions have been linked to aging-related bone health. However, there have been few studies that examined the correlation between recently developed sleep patterns based on sleep duration, sleepiness, chronotype, snoring, insomnia, and the incidence of falls and fractures. Methods We used a newly developed sleep pattern with components of sleep 7 to 8 h per day, absence of frequent excessive daytime sleepiness, early chronotype, no snoring, and no frequent insomnia as healthy factors to study their relationship with the incidence of falls and fractures. The analysis was conducted among 289,000 participants from the UK Biobank. Results The mean follow-up period was 12.3 years (3.5 million person-years of follow-up), and 12,967 cases of falls and 16,121 cases of all fractures were documented. Compared to participants exhibiting an unfavorable sleep pattern, those adhering to a healthy sleep pattern experienced a 17% and 28% reduction in the risks of incident falls (hazard ratio [HR], 0.83; 95% CI, 0.74-0.93) and all fractures (HR, 0.72; 95% CI, 0.66-0.79) during follow-up. In addition, participants exhibiting a healthy sleep pattern, together with a high genetically determined bone mineral density (BMD), showed the lowest risks of falls and fractures. Conclusion A healthy sleep pattern was significantly linked to decreased risks of incident falls and fractures. The protective association was not modified by genetically determined BMD.
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Affiliation(s)
- Tao Zhou
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xue Dai
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yu Yuan
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Mengying Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Knechel NA, Chang PS. The relationships between sleep disturbance and falls: A systematic review. J Sleep Res 2022; 31:e13580. [PMID: 35288982 DOI: 10.1111/jsr.13580] [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: 10/28/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this systematic review was to examine critically the literature that addresses the association between sleep disturbance and falls. Electronic databases OVID MEDLINE, PubMed, and CINAHL were searched using MeSH terms "sleep" and "accidental falls." Search limits included adults, humans, and English. The articles selected for the final sample were assessed for methodological quality. Eleven key attributes of sleep disturbance were extracted. The search yielded 177 articles from OVID MEDLINE, 124 from PubMed, and 46 from CINAHL. The final sample included 42 papers. The mean methodological quality score was 7.5 (range 2-10). Those who self-report >11 h or ≤5 h of nocturnal sleep duration may have a greater fall risk, but variations in cutoff points, study designs, and data collection methods contribute to difficulty in comparing study results. Subjective sleep fragmentation is associated with falls. The few studies on obstructive sleep apnea and insomnia demonstrate evidence of an increased risk for falls. It remains unclear whether daytime sleepiness, self-reported sleep quality, snoring, or napping are associated with falls, since some but not all studies demonstrate an association and the study quality did not differ.
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İleri İ, Borazan FY, Cavusoglu C, Göker B. The relationship between the severity of insomnia and falls in the elderly. Psychogeriatrics 2022; 22:22-28. [PMID: 34608721 DOI: 10.1111/psyg.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Insomnia is associated with depression, cognitive impairment, hypertension, myocardial infarction, stroke, metabolic syndrome and prostate cancer in the elderly. The aim of this study is to investigate the relationship between severity of insomnia and falls. METHODS This cross-sectional study was conducted in a single geriatric outpatient clinic at a university teaching hospital. Patients with active infection, who could not complete insomnia severity index (ISI) test because of cognitive impairment and who could not perform handgrip strength and timed up and go (TUG) tests were excluded from the study. RESULTS A total of 215 patients were included in this study. Logistic regression analysis showed that there is significant relationship between poorer TUG performance, mild insomnia, moderate insomnia, severe insomnia and falls in the elderly (odds ratio (OR) = 1.04, CI: 1.00-1.09, P = 0.041, OR = 2.43, CI: 1.22-4.85, P = 0.011, OR = 3.84, CI:1.35-10.94, P = 0.012, OR = 5.81, CI:1.00-33.72, P = 0.050). CONCLUSIONS In this study we showed that there is a relationship between the severity of insomnia and falls.
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Affiliation(s)
- İbrahim İleri
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Funda Yıldırım Borazan
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Cagatay Cavusoglu
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Berna Göker
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
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Moon S, Chung HS, Kim YJ, Kim SJ, Kwon O, Lee YG, Yu JM, Cho ST. The impact of urinary incontinence on falls: A systematic review and meta-analysis. PLoS One 2021; 16:e0251711. [PMID: 34010311 PMCID: PMC8133449 DOI: 10.1371/journal.pone.0251711] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Previous studies on the association between urinary incontinence (UI) and falls have reported conflicting results. We, therefore, aimed to evaluate and clarify this association through a systematic review and meta-analysis of relevant studies. METHODS We performed a literature search for relevant studies in databases including PubMed and EMBASE from inception up to December 13, 2020, using several search terms related to UI and falls. Based on the data reported in these studies, we calculated the pooled odds ratios (ORs) for falls and the corresponding 95% confidence intervals (CIs) using the Mantel-Haenszel method. RESULTS This meta-analysis included 38 articles and a total of 230,129 participants. UI was significantly associated with falls (OR, 1.62; 95% CI, 1.45-1.83). Subgroup analyses based on the age and sex of the participants revealed a significant association between UI and falls in older (≥65 years) participants (OR, 1.59; 95% CI, 1.31-1.93), and in both men (OR, 1.88; 95% CI, 1.57-2.25) and women (OR, 1.41; 95% CI, 1.29-1.54). Subgroup analysis based on the definition of falls revealed a significant association between UI and falls (≥1 fall event) (OR, 1.61; 95% CI, 1.42-1.82) and recurrent falls (≥2 fall events) (OR, 1.63; 95% CI, 1.49-1.78). According to the UI type, a significant association between UI and falls was observed in patients with urgency UI (OR, 1.76; 95% CI, 1.15-1.70) and those with stress UI (OR, 1.73; 95% CI, 1.39-2.15). CONCLUSIONS This meta-analysis, which was based on evidence from a review of the published literature, clearly demonstrated that UI is an important risk factor for falls in both general and older populations.
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Affiliation(s)
- Shinje Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hye Soo Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yoon Jung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sung Jin Kim
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ohseong Kwon
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jae Myung Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Associations between sleep duration, midday napping, depression, and falls among postmenopausal women in China: a population-based nationwide study. ACTA ACUST UNITED AC 2021; 28:554-563. [PMID: 33438896 DOI: 10.1097/gme.0000000000001732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore the independent and joint associations of sleep duration, midday napping, and depression with fall accidents in Chinese postmenopausal women. METHODS A total of 2,378 postmenopausal women aged ≥ 45 years from the baseline survey of the China Health and Retirement Longitudinal Study were enrolled in the study. Each participant provided data on falls, sleep duration, midday napping by a self-reporting approach. We employed the Chinese version of the Center for Epidemiologic Studies Depression Scale to assess depression. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to estimate the associations of predictor variables with falls using multivariate logistic regression. RESULTS Of the 2,378 postmenopausal women, 478 (20.10%) reported falls in the preceding 2 years. Compared with sleep duration of 7 to 8 h/night, sleep duration of 5 to 6 h/night (OR, 1.49; 95% CI, 1.03-2.15) and of ≤ 5 h/night (OR, 1.63; 95% CI, 1.18-2.25) were associated with a higher fall prevalence. However, no significant correlation was found between sleep duration of > 8 h/night and falls. Furthermore, participants with depression were more likely to report falls (OR, 1.78; 95% CI, 1.41-2.25) than their depression-free counterparts. The duration of midday napping was not independently associated with falls, but significant joint associations of sleeping ≤ 6 h/night and no napping (OR, 1.72; 95% CI, 1.07-2.76) or napping > 60 minutes (OR, 2.14; 95% CI, 1.18-3.89) with more falls were found. Similarly, a combined status of sleeping ≤ 6 h/night and depression was related to more falls (OR, 2.97; 95% CI, 1.86-4.74). CONCLUSION The present study demonstrates that short sleep duration and depression are independently associated with more falls among postmenopausal women in China. Moreover, short sleep duration combined with no or long napping, short sleep duration combined with depression are jointly correlated with more falls. Future longitudinal studies are warranted to confirm these findings.
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Li Y, Liu M, Sun X, Hou T, Tang S, Szanton SL. Independent and synergistic effects of pain, insomnia, and depression on falls among older adults: a longitudinal study. BMC Geriatr 2020; 20:491. [PMID: 33228605 PMCID: PMC7684923 DOI: 10.1186/s12877-020-01887-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Few studies have examined the relationship between falls and pain, insomnia and depressive symptoms which are common and risk factors in older adults. We aimed to examine the independent and synergistic effects of these risk factors on future falls among older adults. Methods We used data of 2558 community-dwelling older adults from 2011 (Y1) to 2015 (Y5) of the National Health and Aging Trends Study (NHATS). Pain was determined by whether participants reported bothersome pain in the last month. Insomnia was assessed by two questions about how often the participants had trouble falling asleep and maintaining sleep. Depressive symptoms were assessed by Patient Health Questionnaire-2. Generalized estimation equation (GEE) models were used to examine the independent effects of pain, insomnia and depressive symptoms at prior-wave (period y-1) on falls at current wave (period y) adjusting for covariates (age, sex, education, race/ethnicity, living arrangement, BMI, smoking, vigorous activities, number of chronic illnesses and hospitalization). The significance of the three-way interaction of these factors (pain*insomnia*depression) was tested using the aforementioned GEE models to determine their synergistic effects on falls. Results Overall, the participants were mainly 65–79 years old (68%), female (57%) and non-Hispanic White (70%). At Y1, 50.0% of the participants reported pain, 22.6% reported insomnia and 9.9% reported depressive symptoms. The incidence of falls from Y2 to Y5 was 22.4, 26.0, 28.3, and 28.9%, respectively. Participants with pain (Odds ratio [OR], 95% confidence interval [CI] = 1.36, 1.23–1.50) and depressive symptoms (OR, 95% CI = 1.43, 1.23–1.67) had high rates of falling adjusting for covariates. After further adjustment for insomnia and depressive symptoms, pain independently predicted falls (OR, 95% CI = 1.36, 1.22–1.51). Depressive symptoms also independently predicted falls after further adjusting for pain and insomnia (OR, 95% CI = 1.40, 1.20–1.63). After adjusting for pain and depression, the independent effects of insomnia were not significant. None of the interaction terms of the three risk factors were significant, suggesting an absence of their synergistic effects. Conclusions Pain and depressive symptoms independently predict falls, but synergistic effects seem absent. Further research is needed to develop effective strategies for reducing falls in older adults, particularly with pain and depressive symptoms.
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Affiliation(s)
- Yuxiao Li
- Central South University, Xiangya School of Nursing, Changsha, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | - Minhui Liu
- Central South University, Xiangya School of Nursing, Changsha, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China. .,Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Xiaocao Sun
- Central South University, Xiangya School of Nursing, Changsha, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | - Tianxue Hou
- Central South University, Xiangya School of Nursing, Changsha, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | - Siyuan Tang
- Central South University, Xiangya School of Nursing, Changsha, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Britting S, Artzi-Medvedik R, Fabbietti P, Tap L, Mattace-Raso F, Corsonello A, Lattanzio F, Ärnlöv J, Carlsson AC, Roller-Wirnsberger R, Wirnsberger G, Kostka T, Guligowska A, Formiga F, Moreno-Gonzalez R, Gil P, Martinez SL, Kob R, Melzer I, Freiberger E. Kidney function and other factors and their association with falls : The screening for CKD among older people across Europe (SCOPE) study. BMC Geriatr 2020; 20:320. [PMID: 33008307 PMCID: PMC7531089 DOI: 10.1186/s12877-020-01698-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls. Methods The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving community-dwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment. The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUTS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects. Results Our series consisted of 2256 SCOPE participants (median age = 79.5 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment. CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79–1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81–1.28 for eGFR< 45; OR = 1.08, 95%CI = 0.74–1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67–1.24 for eGFR< 60; OR = 0.93, 95%CI = 0.63–1.37 for eGFR< 45; OR = 1.19, 95%CI = 0.62–2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 1.56, 95%CI = 1.29–1.89) and injurious falls (OR = 1.58, 95%CI = 1.14–2.19), and such associations were confirmed in all multivariable models. Conclusions Cross-sectional data suggest that CKD may not be associated with history of falls or injurious falls, whereas LUTS is significantly associated with the outcomes. Trial registration This study was registered on 25th February 2016 at clinicaltrials.gov (NCT02691546).
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Affiliation(s)
- Sabine Britting
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rada Artzi-Medvedik
- Department of Nursing, Recanati School for Community Health Professions at the faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Paolo Fabbietti
- Italian National Research Center on Aging (IRCCS INRCA), Fermo and Cosenza, Ancona, Italy. .,Laboratory of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Via S. Margherita 5, 60124, Ancona, Italy.
| | - Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrea Corsonello
- Italian National Research Center on Aging (IRCCS INRCA), Fermo and Cosenza, Ancona, Italy
| | - Fabrizia Lattanzio
- Italian National Research Center on Aging (IRCCS INRCA), Fermo and Cosenza, Ancona, Italy
| | - Johan Ärnlöv
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Axel C Carlsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Gerhard Wirnsberger
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Lodz, Poland
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital - IDIBELL - L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital - IDIBELL - L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Gil
- Geriatric Department, Hospital Clínico San Carlos, Martín Lagos S/N, 28040, Madrid, Spain
| | - Sara Lainez Martinez
- Geriatric Department, Hospital Clínico San Carlos, Martín Lagos S/N, 28040, Madrid, Spain
| | - Robert Kob
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions at the faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Ellen Freiberger
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Takada S, Yamamoto Y, Shimizu S, Kimachi M, Ikenoue T, Fukuma S, Onishi Y, Takegami M, Yamazaki S, Ono R, Sekiguchi M, Otani K, Kikuchi SI, Konno SI, Fukuhara S. Association Between Subjective Sleep Quality and Future Risk of Falls in Older People: Results From LOHAS. J Gerontol A Biol Sci Med Sci 2019. [PMID: 28633472 DOI: 10.1093/gerona/glx123] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Inadequate sleep is correlated with morbidity and mortality among older adults. However, the longitudinal relationship between subjective sleep quality and risk of falls in the elderly population remains to be clarified. Methods Study participants were from Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) sites (1,071 community-dwelling people ≧65 years of age, mean: 71 years). Subjective sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Occurrence of falls (defined as experiencing at least one fall) during the subsequent year was ascertained by a self-reported questionnaire. Results Mean global PSQI score was 4.3 (SD 3.2), with 28.9% of participants rating their sleep quality as poor (PSQI > 5). A total of 210 participants (19.6%) fell at least once in the year following sleep examination. Multivariable analysis revealed that participants reporting worse subjective sleep quality had significantly higher odds of experiencing falls during the 1-year follow-up period (adjusted odds ratio [AOR] = 1.50 for each three-point increase in global PSQI score; 95% confidence interval [CI] = 1.20, 1.89). Participants in the highest global PSQI score (PSQI > 5) quartile had significantly increased odds of experiencing falls compared to those in the lowest global score quartile (PSQI < 2; AOR = 2.14; 95% CI = 1.09, 4.22). This association was similarly significant in subgroup analyses for older men and women, nonusers of sleep medication, and those without a history of falls at baseline. Conclusion Subjective poor sleep quality, as measured by the PSQI, is longitudinally associated with greater risk of experiencing falls in community-dwelling older adults.
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Affiliation(s)
- Shiho Takada
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Miho Kimachi
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shin Yamazaki
- Center for Environmental Health Science, National Institute for Environmental Studies, Tsukuba, Japan
| | - Rei Ono
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Miho Sekiguchi
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koji Otani
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shin-Ichi Kikuchi
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shin-Ichi Konno
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
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11
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Kulakci Altintas H, Korkmaz Aslan G. Incidence of falls among community-dwelling older adults in Turkey and its relationship with pain and insomnia. Int J Nurs Pract 2019; 25:e12766. [PMID: 31313430 DOI: 10.1111/ijn.12766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 03/06/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine the incidence of falls among community-dwelling older adults and the impact of pain and insomnia on falls. METHODS This cross-sectional study recruited 659 older adults. Pain was assessed by the Geriatric Pain Measure, and insomnia was assessed by the Insomnia Severity Index. The history of falls was assessed within the last 12 months. Risk factors for falls were determined using logistic regression analysis. RESULTS The incidence of falls within the last year was 37.2%. Based on the analyses, pain and insomnia were found to be risk factors for falls. CONCLUSION In this study, falls were observed as a common problem among community-dwelling older adults, and pain and insomnia were determined as risk factors for falls. Therefore, pain and insomnia should be addressed when prevention of falls among community-dwelling older adults are planned by health care professionals including nurses.
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12
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Yang Y, Hirdes JP, Dubin JA, Lee J. Fall Risk Classification in Community-Dwelling Older Adults Using a Smart Wrist-Worn Device and the Resident Assessment Instrument-Home Care: Prospective Observational Study. JMIR Aging 2019; 2:e12153. [PMID: 31518278 PMCID: PMC6716444 DOI: 10.2196/12153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/23/2019] [Accepted: 05/13/2019] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools such as the Resident Assessment Instrument-Home Care (RAI-HC). Objective This study aimed to (1) investigate the similarities and differences in physical activity (PA), heart rate, and night sleep in a sample of community-dwelling older adults with varying fall histories using a smart wrist-worn device and (2) create and evaluate fall risk classification models based on (i) wearable data, (ii) the RAI-HC, and (iii) the combination of wearable and RAI-HC data. Methods A prospective, observational study was conducted among 3 faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ≥2 falls) in a sample of older community-dwelling adults. Each participant was requested to wear a smart wristband for 7 consecutive days while carrying out day-to-day activities in their normal lives. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with 3 supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF). Results Of 40 participants aged 65 to 93 years, 16 (40%) had no previous falls, whereas 8 (20%) and 16 (40%) had experienced 1 and multiple (≥2) falls, respectively. Level of PA as measured by average daily steps was significantly different between groups (P=.04). In the 3 faller group classification, RF achieved the best accuracy of 83.8% using both wearable and RAI-HC data, which is 13.5% higher than that of using the RAI-HC data only and 18.9% higher than that of using wearable data exclusively. In discriminating between {G0+G1} and G2+, RF achieved the best area under the receiver operating characteristic curve of 0.894 (overall accuracy of 89.2%) based on wearable and RAI-HC data. Discrimination between G0 and {G1+G2+} did not result in better classification performance than that between {G0+G1} and G2+. Conclusions Both wearable data and the RAI-HC assessment can contribute to fall risk classification. All the classification models revealed that RAI-HC outperforms wearable data, and the best performance was achieved with the combination of 2 datasets. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments.
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Affiliation(s)
- Yang Yang
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Joel A Dubin
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Statistics and Actuarial Science, Faculty of Mathematics, University of Waterloo, Waterloo, ON, Canada
| | - Joon Lee
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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13
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McPhillips MV, Dickson VV, Cacchione PZ, Li J, Gooneratne N, Riegel B. Nursing Home Eligible, Community-Dwelling Older Adults' Perceptions and Beliefs About Sleep: A Mixed-Methods Study. Clin Nurs Res 2019; 29:177-188. [PMID: 31104492 DOI: 10.1177/1054773819849348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances are highly prevalent in older adults; little is known about sleep in those who remain living in the community despite qualifying for nursing home placement. We conducted a concurrent, nested, mixed-methods study to describe sleep characteristics and sleep disturbances in this population. Our final sample (n = 40) was Black (100%), female (85%) older adults with a mean (±SD) age of 72 ± 9.5 years. Of these, 35 had objectively measured short or long sleep duration, and 30 had subjectively reported poor sleep quality. Our evidence suggests that sleep disturbances are common in this group, and these older adults had adjusted their expectations and adapted to their sleep disturbances. Given that at-risk older adults may not perceive their sleep disturbances as problematic, clinicians must proactively assess sleep and educate about the importance of sleep. These results reveal modifiable factors with potential to improve health outcomes in this vulnerable population.
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Affiliation(s)
| | | | | | - Junxin Li
- Johns Hopkins University, Baltimore, MD, USA
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14
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Wiedemann A, Kirschner-Hermanns R, Heppner HJ. [Palliative long-term urinary bladder drainage: the uro-geriatric point of view]. Urologe A 2019; 58:389-397. [PMID: 30810772 DOI: 10.1007/s00120-019-0883-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A serious voiding disorder or urinary incontinence represent indications for long-term catheterization of the urinary bladder. Treatment by a transurethral or suprapubic bladder catheter for life-long bladder drainage is accompanied by technical short-term complications and long-term sequelae. The mortality risk associated with inserting a suprapubic catheter is approximately 2% due to an incorrect bladder puncture. Long-term consequences of life-long bladder drainage are hematuria, infection, spasms, stone formation, obstruction, catheter loss, risk of falls and automanipulation especially in cognitively impaired persons. These constitute frequent reasons for emergency treatment or hospitalization. Further problem areas are dependency on caregivers to perform the catheter change and dermal problems in the area of the fistula stoma. To what extent this limits the quality of life of those affected remains unclear up to now. The acute complications and the long-term consequences of life-long bladder drainage make careful decision-making necessary after other therapeutic options have failed, are not appropriate or not desired.
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Affiliation(s)
- A Wiedemann
- Urologische Abteilung, Evangelisches Krankenhaus Witten, Pferdebachstr. 27, 58455, Witten, Deutschland. .,Lehrstuhl für Geriatrie der Universität Witten/Herdecke, Witten, Deutschland.
| | - R Kirschner-Hermanns
- Neuro-Urologie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms Universität, Bonn, Deutschland.,Neurologisches Rehabilitationszentrum der Godeshöhe, Bonn, Deutschland
| | - H J Heppner
- Lehrstuhl für Geriatrie der Universität Witten/Herdecke, Witten, Deutschland.,Geriatrische Klinik und Tagesklinik, Helios-Klinikum, Schwelm, Deutschland.,Institut für Biomedizin des Alterns der FAU Erlangen-Nürnberg, Nürnberg, Deutschland
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15
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Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women. Sleep Med 2019; 53:94-100. [DOI: 10.1016/j.sleep.2018.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 01/11/2023]
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16
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Kim HJ, Kim JW, Jang SN, Kim KD, Yoo JI, Ha YC. Urinary Incontinences Are Related with Fall and Fragility Fractures in Elderly Population: Nationwide Cohort Study. J Bone Metab 2018; 25:267-274. [PMID: 30574471 PMCID: PMC6288612 DOI: 10.11005/jbm.2018.25.4.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 01/16/2023] Open
Abstract
Background This prospective cohort study used nationwide claims data to investigate the incidence of fall and fragility fractures in association with urinary incontinence (UI) in the elderly, and to compare mortality after fragility fractures in elderly patients with or without incontinence. Methods A total of 39,854 Korean adults (age, 66-80 years) who participated in health examinations between 2007 and 2012 and were followed up until 2015 were analyzed. Patient and comparison groups were classified according to the presence or absence of UI. The cumulative incidence of osteoporotic fragility fractures and falls in the 2 groups was assessed and compared. Hazard ratios for fragility fractures were calculated for the risk of UI in association with falls using a Cox proportional hazards model. Results Of 39,854 elderly participants, 5,703 were classified in the UI group, while 34,151 were placed in the comparison group. Fall rates were significantly higher (20.8%) in the incontinence group than in the comparison group (4.7%) (P<0.001). Women in the incontinence group (13.9%) showed a significantly higher incidence of all types of fragility fractures than those in the comparison group (11.8%) (P=0.005). After adjustment for confounders, UI was not a significant risk factor for fragility fractures in men (P=0.878) or women (P=0.324). Conclusions This study demonstrated that elderly women with UI have a significantly higher incidence of osteoporotic fragility fractures. In addition, elderly women are at higher risk for falls.
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Affiliation(s)
- Hye-Jin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Kyung Do Kim
- Departments of Urology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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17
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Szabo SM, Gooch KL, Walker DR, Johnston KM, Wagg AS. The Association Between Overactive Bladder and Falls and Fractures: A Systematic Review. Adv Ther 2018; 35:1831-1841. [PMID: 30255417 PMCID: PMC6223978 DOI: 10.1007/s12325-018-0796-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Urinary symptoms are associated with an increased risk of falls, but few studies have focused on patients with overactive bladder (OAB). This study aimed to synthesize estimates of the risk of falls and fractures in patients with OAB. METHODS Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were systematically searched for observational studies that focused on patients with OAB. When available, data from a non-OAB comparison sample were included. Double independent review and data extraction were performed. Falls and fractures data were summarized by unadjusted and adjusted risks, and percent attributable risk (PAR) of falls and fractures associated with OAB. RESULTS Fifteen studies were included in the analyses. The proportion of patients with OAB experiencing at least one fall over a year ranged from 18.9% to 50.0%, and the proportion of patients with OAB experiencing recurrent or serious falls ranged from 10.2% to 56.0%. In studies that included a non-OAB comparison sample, a higher risk of falls was observed in patients with OAB compared to those without. A significantly increased (1.3- to 2.3-fold) adjusted OAB-associated risk of falls was reported, while unadjusted PARs for OAB associated falls ranged from 3.7% to 15.5%. Risk was higher among women and those 65 years of age or older. While analysis of fractures showed elevated point estimates, most studies were underpowered to detect a statistically significant difference between groups. CONCLUSIONS Evidence from the published literature clearly demonstrates the importance of OAB and its symptoms as risk factors for falls and fractures. FUNDING Astellas.
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Affiliation(s)
- Shelagh M Szabo
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada.
| | | | - David R Walker
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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18
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Sex Differences in Lower Urinary Tract Symptoms in Older Korean Adults Living in Rural Areas: Prevalence, Quality of Life, and Associated Factors. Int Neurourol J 2018; 22:212-219. [PMID: 30286585 PMCID: PMC6177734 DOI: 10.5213/inj.1836100.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/29/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose Urinary incontinence (UI) is associated with nursing home admission, functional decline, and risk of death among community-dwelling older adults. Little information, however, is available on sex differences in lower urinary tract symptoms (LUTS) in older Korean adults exclusively living in rural areas. This study examined sex-related differences in LUTS, factors associated with UI in older adults living in rural areas, and health-related quality of life (HRQoL) in incontinent older adults. Methods This was a cross-sectional study in which face-to-face interviews were conducted at 15 rural community-health centres. A total of 323 older adults aged ≥65 years from rural areas of Korea participated. LUTS prevalence was evaluated and HRQoL was measured using the King’s Health Questionnaire. The chi-square test and t -test were used to examine sex differences in characteristics, LUTS, and HRQoL. Multivariable logistic regression was used to identify risk factors associated with UI. Results Nocturia was the most prevalent symptom, affecting 87% of men and 86% of women. Women (53%) had significantly more UI of any kind than did men (35%) (P=0.007). Urgency UI was the most frequent type of UI in men, whereas stress UI was the most frequent in women. Regarding HRQoL, men had significantly higher scores in the domains of sleep/energy disturbances (P=0.032) than did women, and women reported greater effects from the severity of incontinence (P=0.001) than did men. Arthritis was the only factor associated with UI in men (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.46–32.36). However, women with diabetes mellitus were less likely to have UI than those without (OR, 0.43; 95% CI, 0.23–0.82). Conclusions LUTS were found to be highly prevalent in community-dwelling older Korean adults in rural areas. Interventions to improve sleep and to reduce UI severity are needed for incontinent men and women, respectively.
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19
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Altintas HK, Aslan GK, Sısman NY, Kesgin MT. Effects of Pain and Sleep Quality on Falls Among Nursing Home Residents in Turkey. Res Gerontol Nurs 2018; 11:257-264. [PMID: 30230519 DOI: 10.3928/19404921-20180810-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/06/2018] [Indexed: 11/20/2022]
Abstract
The current study was conducted to detect the incidence of falls among individuals in nursing homes, as well as the impact of pain and sleep quality on falls. The sample for this cross-sectional study comprised 291 older adults. Pain was assessed using the Geriatric Pain Measure and insomnia was assessed using the Insomnia Severity Index. Incidence of falls within the past 1 year was 40.9%. Risk factors for falling were determined using logistic regression analysis. Based on the analysis, being single (odds ratio [OR] = 2.502, 95% confidence interval [CI] [1.155, 6.195]) and experiencing pain (OR = 2.841, 95% CI [1.195-6.754]) were risk factors for falling. In the current study, falling was seen as a common problem among older adults. Pain in particular should be addressed when planning the prevention of falls in nursing homes. [Res Gerontol Nurs. 2018; 11(5):257-264.].
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20
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Nazaripanah NS, Momtaz YA, Mokhtari F, Sahaf R. Urinary incontinence and sleep complaints in community dwelling older adults. ACTA ACUST UNITED AC 2018; 11:106-111. [PMID: 30083298 PMCID: PMC6056063 DOI: 10.5935/1984-0063.20180020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disorder is associated with poor quality of life in old age. Therefore, it
is imperative to identify contributing factors leading to sleep disorder. The
current study aimed to examine the impact of urinary incontinence on sleep
complaint after controlling for potential sociodemographic and health
covariates. Materials and Methods: A cross-sectional study was
conducted on a sample of 184 community dwelling older adults 60 years and older
in Yazd, Iran, 2016. In order to obtain the sample a multistage proportional
random sampling technique was employed. Sociodemographic characteristics, sleep
complaint, and urinary incontinence were collected from medical records.
Statistical analyses were performed using SPSS version 24. A multiple logistic
regression analysis was used to examine the impact of urinary incontinence on
sleep complaint after controlling for potential covariates.
Findings: A total of 184 respondents with a mean age of
68.48±6.65 years (age range, 60-87 years) were included in the study.
About 70% of the respondents were women, 72.8% were married, 68.5% were not
formally educated, and 21.7% were living alone. The prevalence of sleep
complaint and urinary incontinence were 27.2% (95% CI: 21-34) and 22.3% (95% CI:
17-29), respectively. The results of the multiple logistic regression analysis
revealed respondents with urinary incontinence were four times more likely to
suffer from sleep complaint than those without urinary incontinence after
adjusting for potential covariates (AOR=4.04, 95% CI: 1.74-9.35,
p<0.001). Conclusion: Based on the results
of this present study, which showed that urinary incontinence independently
contributed to sleep complaint among older adults, it is necessary to employ
effective interventions for controlling urinary incontinence to reduce sleep
complaints.
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Affiliation(s)
- Neda Sadat Nazaripanah
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| | - Yadollah Abolfathi Momtaz
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Gerontology - Serdang - Selangor - Malaysia
| | - Farideh Mokhtari
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| | - Robab Sahaf
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
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21
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Ma T, Shi G, Zhu Y, Wang Y, Chu X, Jiang X, Liu Z, Cai J, Wang H, Jin L, Wang Z, Wang X. Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study. Arch Gerontol Geriatr 2017; 73:8-14. [DOI: 10.1016/j.archger.2017.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/04/2017] [Accepted: 07/05/2017] [Indexed: 12/26/2022]
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22
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Wu L, Sun D. Sleep duration and falls: a systemic review and meta-analysis of observational studies. J Sleep Res 2017; 26:293-301. [PMID: 28220576 DOI: 10.1111/jsr.12505] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/19/2016] [Indexed: 11/27/2022]
Abstract
Several epidemiological studies have linked sleep duration with falls; however, the findings yielded inconsistent results. No quantitative analysis has specifically assessed the influence of sleep duration on falls. PubMed and Embase were screened for observational studies from inception to 13 September 2016. A generic inverse-variance method was used to pool the outcome data for sleep duration categories of the lowest category versus reference, and the highest category versus reference with a random-effects model. Dose-response analysis was performed to evaluate the potential relationship of sleep duration with falls. Finally, seven eligible observational studies involving a total of 212 829 participants were included in the present meta-analysis. Compared with the reference category, both short and long sleep duration were significantly associated with falls, and the pooled odds ratios (95% confidence intervals) were 1.32 (1.21, 1.46) and 1.35 (1.17, 1.56), respectively, both with evidence of significant heterogeneity. An approximately 'U-shaped' curve was observed, and the lowest risk of falls was shown at 7-8 h day-1 of sleep duration. Further subgroup analysis found that the association of long sleep duration and falls was more pronounced among Caucasians. The present study is limited to its small number of included studies, considerable heterogeneity, observational study design and the large contribution of a single article. Further researches are still needed to confirm the causal association between sleep duration and falls in populations with different gender, age and ethnicity.
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Affiliation(s)
- Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Dali Sun
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, USA
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23
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Min Y, Slattum PW. Poor Sleep and Risk of Falls in Community-Dwelling Older Adults: A Systematic Review. J Appl Gerontol 2016; 37:1059-1084. [DOI: 10.1177/0733464816681149] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Concerns about sleep problems and falls in older adults are significant. This article reviews the association between sleep problems and falls in community-dwelling adults aged 65 years or older. Multiple databases were searched from inception until 2015 using sleep, sleep disorders, and falls as keywords, limiting to studies published in English in peer-reviewed journals. After screening and assessing for eligibility, 18 articles were selected based on the inclusion and exclusion criteria. Findings of an association between sleep problems and risk of falls are conflicting, but some specific sleep problems such as extremely short sleep duration, daytime sleepiness and naps appear to be significantly related to falls in older adults. Methodological limitations including variability in covariates included in the analyses and measurement of the exposure and outcome variables were identified. The results of this review identified the need to have comparable definitions, validated tools, and rigorous design of future studies.
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Affiliation(s)
- Yaena Min
- Virginia Commonwealth University, Richmond, USA
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24
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Tyagi S, Perera S, Brach JS. Balance and Mobility in Community-Dwelling Older Adults: Effect of Daytime Sleepiness. J Am Geriatr Soc 2016; 65:1019-1025. [PMID: 27991662 DOI: 10.1111/jgs.14735] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the effect of self-reported daytime sleepiness on performance-based balance measures and self-reported balance confidence in community-dwelling older adults. DESIGN Cross-sectional secondary analysis of an observational cohort study designed to develop and refine measures of balance and mobility in community-dwelling older adults. SETTING Community. PARTICIPANTS Older adults (aged 78.2 ± 5.9) (n = 120). MEASUREMENTS The performance-based gait and balance measures included gait speed, double support time, and step width. Narrow walk, obstacle walk, and timed standing balance were also assessed. The Activities-Specific Balance Confidence Scale was included as a self-reported measure. Daytime sleepiness was defined as an Epworth Sleepiness Scale score of 9 or greater. Body mass index, fall-related comorbidities, and use of central nervous system (CNS) medications were considered as covariates. RESULTS Forty-five percent of participants reported daytime sleepiness. Participants reporting daytime sleepiness differed significantly from those without in gait speed (adjusted difference (standard error (SE)) -0.09 (0.04) m/s, P = .03), step width (adjusted difference (SE) 0.02 (0.01), P = .03), and self-reported balance confidence (adjusted difference (SE) -1.02 (0.38), P = .01) even after adjusting for covariates. Two-way analysis of variance of CNS medication use and daytime sleepiness showed no significant interaction effects. CONCLUSION Self-reported daytime sleepiness is associated with slower gait speed and poor balance confidence in community-dwelling older adults. Subjective sleep assessment should be considered when assessing balance and implementing interventions for improving balance in older adults. Further study is needed to examine the role of CNS medication use.
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Affiliation(s)
- Shachi Tyagi
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer S Brach
- Department of Physical Therapy, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Fung CH, Vitiello MV, Alessi CA, Kuchel GA. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health, and Functioning. J Am Geriatr Soc 2016; 64:e238-e247. [PMID: 27858974 PMCID: PMC5173456 DOI: 10.1111/jgs.14493] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its eighth Bedside-to-Bench research conference, entitled "Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health and Functioning," October 4 to 6, 2015, in Bethesda, Maryland. Part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm (SCR) disturbance, and voiding dysfunction-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these three geriatric syndromes. The conference provided a forum for discussing current sleep, circadian rhythm, and aging research; identifying gaps in knowledge; and developing a research agenda to inform future investigative efforts. The conference also promoted networking among developing researchers, leaders in the field of SCR and aging, and National Institutes of Health program personnel.
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Affiliation(s)
- Constance H Fung
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Michael V Vitiello
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - George A Kuchel
- Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
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Bladder Control Problems in Elders. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhang Y, Cifuentes M, Gao X, Amaral G, Tucker KL. Age- and gender-specific associations between insomnia and falls in Boston Puerto Rican adults. Qual Life Res 2016; 26:25-34. [PMID: 27448438 DOI: 10.1007/s11136-016-1374-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE This study evaluated the age- and gender-specific associations between insomnia and falls in community-dwelling Puerto Rican adults, independently of multiple covariates. METHODS Cross-sectional data were collected from 954 Puerto Ricans, aged 46-79 years, in Boston, Massachusetts. In-person interviews were conducted to collect information on sociodemographics and lifestyle, mental status, medication use, comorbidities, sleep duration, insomnia symptoms, and falls and fractures. Blood and urine samples, and bone density measures were collected to assess C-reactive protein, serum interleukin-6, urinary cortisol, and bone mineral density. RESULTS Multivariate robust Poisson regressions suggested that adults with insomnia had a 32 % increased likelihood of having falls (PR 1.32, p < 0.05), after adjustment for multiple covariates. Age and gender modified the effect of insomnia on risk of falls. Insomnia was significantly associated with higher risk of falls in adults of 60 years or older (PR 1.49, p < 0.05) and in women (PR 1.36, p < 0.05), but not in adults younger than 60 years or in men. Insomnia was not associated with recurrent falls or fractures. CONCLUSIONS Age and gender need to be taken into account when considering treatment of insomnia in preventing geriatric falls. Well-designed evidence-based interventions to treat insomnia and improve sleep quality may reduce the risk of falls in this population.
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Affiliation(s)
- Yuan Zhang
- School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Lowell, MA, 01854, USA.
| | - Manuel Cifuentes
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA, 01545, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Gina Amaral
- School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Lowell, MA, 01854, USA
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, 3 Solomont Way, Lowell, MA, 01854, USA
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The Association between Sleep Problems, Sleep Medication Use, and Falls in Community-Dwelling Older Adults: Results from the Health and Retirement Study 2010. J Aging Res 2016; 2016:3685789. [PMID: 27547452 PMCID: PMC4980537 DOI: 10.1155/2016/3685789] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/21/2016] [Accepted: 05/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls among community-dwelling older adults. The objective of this study was to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. Methods. The study population comprised a nationally representative sample of noninstitutionalized older adults participating in the 2010 Health and Retirement Study. Proportion of adults reporting sleep problems, sleep medication use, and fall was calculated. Multiple logistic regression models were constructed to examine the impact of sleep problems and sleep medication use on the risk of falls after controlling for covariates. Results. Among 9,843 community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the participants. Older adults who do have sleep problems and take sleep medications had a significant high risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. The other two groups also had significantly greater risk for falls. Conclusion. Sleep problems added to sleep medication use increase the risk of falls. Further prospective studies are needed to confirm these observed findings.
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Noguchi N, Chan L, Cumming RG, Blyth FM, Handelsman DJ, Seibel MJ, Waite LM, Le Couteur DG, Naganathan V. Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project. J Urol 2016; 196:1694-1699. [PMID: 27350076 DOI: 10.1016/j.juro.2016.06.085] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE We sought to determine which lower urinary tract symptoms are associated with incident falls in community dwelling older men. MATERIALS AND METHODS The Concord Health and Ageing in Men Project involves a representative sample of community dwelling men 70 years old or older in a defined geographic region in Sydney, New South Wales, Australia. Included in analysis were 1,090 men without neurological diseases, poor mobility or dementia at baseline. Lower urinary tract symptoms were assessed using I-PSS (International Prostate Symptom Score) and incontinence was assessed using ICIQ (International Consultation on Incontinence Questionnaire) at baseline. I-PSS subscores were calculated for storage and voiding symptoms. Incident falls in 1 year were determined by telephone followup every 4 months. RESULTS I-PSS storage and voiding subscores were associated with falls. Urgency incontinence was associated with falls (adjusted incidence rate ratio 2.57, 95% CI 1.54-4.30). In addition, intermediate to high I-PSS storage subscores without urgency incontinence were associated with falls (adjusted incidence rate ratio 1.72, 95% CI 1.24-2.38). Other types of incontinence and urgency alone without urgency incontinence were not associated with falls. CONCLUSIONS Lower urinary tract storage and voiding symptoms were associated with falls in community dwelling older men. Of the symptoms of overactive bladder urgency incontinence carried a high risk of falls. Storage symptoms also contributed to the fall risk independently of urgency incontinence. Circumstances of falls among men with lower urinary tract symptoms should be explored to understand how lower urinary tract symptoms increase the fall risk and generate hypotheses regarding potential interventions. Furthermore, trials to treat lower urinary tract symptoms in older men should include falls as an end point.
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Affiliation(s)
- Naomi Noguchi
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia.
| | - Lewis Chan
- Department of Urology, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia; School of Public Health, University of Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Markus J Seibel
- ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia; ANZAC Research Institute, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, and Ageing and Alzheimer's Institute, New South Wales, Australia
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Min Y, Kirkwood CK, Mays DP, Slattum PW. The Effect of Sleep Medication Use and Poor Sleep Quality on Risk of Falls in Community-Dwelling Older Adults in the US: A Prospective Cohort Study. Drugs Aging 2016; 33:151-8. [DOI: 10.1007/s40266-015-0339-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kim SY, Kim SG, Sim S, Park B, Choi HG. Excessive Sleep and Lack of Sleep Are Associated With Slips and Falls in the Adult Korean Population: A Population-Based Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e2397. [PMID: 26825881 PMCID: PMC5291551 DOI: 10.1097/md.0000000000002397] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Few studies have evaluated the impacts of excessive sleep duration on falls. This study investigated the associations between sleep duration and falls among Korean adults in a wide range of age groups while adjusting for numerous confounding factors. Data collected from study participants ranging in age from 19 to 109 years old were analyzed from the 2013 Korean Community Health Survey (KCHS). Sleep duration was divided into 5 groups: ≤5, 6, 7, 8, and ≥9 hours per day. The relations between sleep duration and falls (≥1 time or ≥2 times per year) were analyzed using simple and multiple logistic regression analyses with complex sampling. Age, sex, days of vigorous or moderate physical activity, income, education, alcohol use, smoking, stress, obesity, hypertension, diabetes mellitus, hyperlipidemia, stroke, angina or myocardial infarction, arthritis, and asthma were controlled for as confounding factors. Associations between sleep duration and falls were analyzed in 19 to 40, 41 to 60, and 61+ year age groups. Furthermore, the relations between sleep duration and indoor versus outdoor falls were analyzed. Both ≤6 and ≥8 hours of sleep per day were significantly associated with an increased incidence of falls (≥1 time and ≥2 times per year) in the overall adult population (P < 0.001 in both instances). In a subgroup analysis, sleep durations of ≤5 and ≥9 hours were significantly associated with an increased incidence of falls (≥1 time a year) in each age group. Six hours of sleep was not significantly associated with falls (≥2 times per year) in the 61+ year age group, and 8 and 9 hours of sleep were not significantly associated with falls (≥2 times a year) in the 19 to 40 year age group. This study demonstrated that long as well as short sleep durations are associated with an increased incidence of falls. However, these relations were not evident in elderly populations with short sleep durations or in young adults with long sleep durations.
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Affiliation(s)
- So Young Kim
- From the Department of Otorhinolaryngology-Head and Neck Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul (SYK); Department of Internal Medicine, College of Medicine, Hallym University, Anyang (S-GK); Department of Statistics, Hallym University, Chuncheon (SS); and Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea (BP, HGC)
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Moreno Morales MP. [Sleepiness repercussion on gait and balance]. Rev Esp Geriatr Gerontol 2015; 51:182-3. [PMID: 26653012 DOI: 10.1016/j.regg.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/06/2015] [Indexed: 10/22/2022]
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Lima CA, Soares WJDS, Bilton TL, Dias RC, Ferrioll E, Perracini MR. Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18:607-17. [DOI: 10.1590/1980-5497201500030007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/30/2014] [Indexed: 01/14/2023] Open
Abstract
Excessive daytime sleepiness (EDS) imposes a wide range of adverse health-related outcomes in older people, such as disability, which impair everyday activities and may increase the risk of fall. Few studies have explored EDS in Brazilian older people living in the community who are typically cared in primary health services. This study aims to investigate the prevalence of EDS and its sociodemographic, physical and mental health correlates among community-dwelling older adults. This is an exploratory, population-based study derived from Frailty in Brazilian Older Adults (FIBRA) study including adults aged 65 years and older. Participants with a score ≥ 11 points on the Epworth Sleepiness Scale were considered as having excessive daytime sleepiness. A structured, multidimensional questionnaire was used to investigate sociodemographic, physical and mental health, and self-rated health variables. The sample was composed of 776 older adults, of whom 21% (n = 162) presented excessive daytime sleepiness. Multivariate regression analysis revealed that EDS is associated with obesity (OR = 1.50; 95%CI 1.02 - 2.20), urinary incontinence (OR = 1.53; 95%CI 1.01 - 2.31), poor self-rated health (OR = 1.54; 95%CI 1.06 - 2.24), and depression symptoms (OR = 1.49; 95%CI 1.00 - 2.20). Our results suggest that healthcare professionals should identify older adults with EDS and implement intervention strategies to minimize the negative impact of the co-occurrence of this condition with obesity, depression and urinary incontinence over health and quality of life.
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Hayley AC, Williams LJ, Kennedy GA, Holloway KL, Berk M, Brennan-Olsen SL, Pasco JA. Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample. BMC Geriatr 2015; 15:74. [PMID: 26141865 PMCID: PMC4491238 DOI: 10.1186/s12877-015-0068-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/03/2015] [Indexed: 01/11/2023] Open
Abstract
Background Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. Methods This study assessed 367 women aged 60-93years (median 72, interquartile range 65-79) and 451 men aged 60-92years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of ≥ 10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. Results Among women, 50 (13.6 %) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR = 2.54, 95 % CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p < .001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR = 2.63, 95 % CI 1.31-5.30). Among men, 72 (16.0 %) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p = 0.06), however, age explained this relationship (age adjusted OR = 2.20, 95 % CI 1.03-1.10). Conclusions For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.
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Affiliation(s)
- Amie C Hayley
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia.
| | - Lana J Williams
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia.
| | - Gerard A Kennedy
- School of Psychology, Counselling & Psychotherapy, Cairnmillar Institute, 993 Burke Road, Camberwell, Australia. .,Institute for Breathing and Sleep, Bowen Centre, Austin Health, PO Box 5555, Heidelberg, Melbourne, Australia.
| | - Kara L Holloway
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia.
| | - Michael Berk
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,Department of Psychiatry, The University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, Australia. .,Orygen, the National Centre of Excellence for Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia. .,Florey Institute for Neuroscience and Mental Health, 30 Royal Parade, Parkville, Melbourne, Australia.
| | - Sharon L Brennan-Olsen
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia.
| | - Julie A Pasco
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia.
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Abrahamsen B, Jørgensen HL, Laulund AS, Nybo M, Bauer DC, Brix TH, Hegedüs L. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register-based time-resolved cohort analysis. J Bone Miner Res 2015; 30:898-905. [PMID: 25431028 DOI: 10.1002/jbmr.2416] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/11/2014] [Accepted: 11/27/2014] [Indexed: 11/10/2022]
Abstract
The long-term relationship between hypothyroidism and fracture risk is challenging to dissect because of the modifying influence of subsequent thyroxine replacement with the potential for excessive replacement doses. We studied changes in serum thyrotropin concentration (TSH) over time and association with fracture risk in real-world patients presenting with elevated TSH. All TSH determinations were done in the same laboratory, which served all hospitals and general practices. The study population consisted of all adults with a first measurement of TSH >4.0 mIU/L (n = 8414) or normal TSH (n = 222,138; comparator). We used a Cox proportional hazards analysis incorporating additional time-dependent covariates to represent initiation of thyroxine replacement and cumulative number of periods with high versus low TSH after index date with a mean follow-up of 7.2 years. Elevated baseline TSH was not associated with an increased risk of hip fracture (HR 0.90; 95% CI, 0.80 to 1.02) or major osteoporotic fractures (HR 0.97; 95% CI, 0.90 to 1.05), nor was subsequent thyroxine prescription predictive of increased risk of fractures. The number of subsequent 6-month periods with low TSH-suggesting excessive thyroxine dosing-was significantly associated with increased risk of both hip fracture (HR 1.09; 95% CI, 1.04 to 1.15) and major osteoporotic fracture (HR 1.10; 95% CI, 1.06 to 1.14). When gender- and age-stratified analyses for major osteoporotic fractures were undertaken, hyperthyroid time was identified as a predictor of fracture risk in postmenopausal women whereas hypothyroid time predicted increased fracture risk in men below age 75 years. In conclusion, among patients who present with an elevated TSH, the long-term risk of hip and other osteoporotic fractures is strongly related to the cumulative duration of periods with low TSH-likely from excessive replacement. An independent effect of elevated TSH could only be observed in young and middle-aged men, suggesting gender-discrepant consequences on risk.
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Affiliation(s)
- Bo Abrahamsen
- Odense Patient data Explorative Network (OPEN), Institute of Clinical Research University of Southern Denmark, Odense, Denmark; Department of Medicine M, Research Centre for Ageing and Osteoporosis, Glostrup Hospital, Glostrup, Denmark
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Wagg A, Oelke M, Angulo JC, Scholfield D, Arumi D. Review of the efficacy and safety of fesoterodine for treating overactive bladder and urgency urinary incontinence in elderly patients. Drugs Aging 2015; 32:103-25. [PMID: 25673122 DOI: 10.1007/s40266-014-0237-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Overactive bladder (OAB) is a common condition, with prevalence rates increasing with advancing age. Symptoms of OAB, including urgency urinary incontinence (UUI), are associated with various co-morbidities in elderly individuals (e.g., falls and fractures, functional impairment, and depression). The current mainstay of pharmacological therapy for OAB is antimuscarinic agents. Until recently, few studies had specifically evaluated the efficacy and safety of antimuscarinics in the treatment of OAB symptoms in elderly patients. This review summarises available evidence from the medical literature on the efficacy and safety of fesoterodine in elderly patients with OAB symptoms, including UUI. The data from unique placebo-controlled fesoterodine trials of elderly and vulnerable elderly patients, together with age-stratified data from post hoc analyses of fesoterodine trials, demonstrate that treatment with fesoterodine 4 or 8 mg results in statistically and clinically significant improvements in OAB symptoms and patient-reported outcomes in many elderly patients. The data indicate that the efficacy of fesoterodine in elderly patients is comparable with that in younger patients. Fesoterodine is generally well tolerated in elderly and vulnerable elderly patients, with low rates of urinary retention and little evidence of central nervous system events or impaired cognition. The data support a favourable benefit-to-risk ratio for fesoterodine in elderly and medically complex vulnerable elderly patients with OAB.
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Affiliation(s)
- Adrian Wagg
- University of Alberta, 1-116 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, T6G 2P4, Canada,
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Eshkoor SA, Hamid TA, Nudin SSH, Mun CY. Association between dentures and the rate of falls in dementia. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:225-30. [PMID: 25018658 PMCID: PMC4074183 DOI: 10.2147/mder.s63220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Poor oral health, chronic diseases, functional decline, and low cognitive ability can increase the risk of falls in the elderly. Objectives The current study aimed to show the effects of oral health, diabetes mellitus (DM), hypertension (HT), heart disease, functional status, and sociodemographic factors on the risk of falls in elderly with dementia. Materials and methods The sample comprised 1,210 Malaysian elderly who were demented and noninstitutionalized. This study was a national cross-sectional survey entitled “Determinants of Health Status among Older Malaysians”. The effects of age, ethnicity, sex differences, marital status, educational level, oral health, DM, HT, heart disease, and functional status on the risk of falls were evaluated. The multiple logistic regression model was used to estimate the effects of contributing variables on the risk of falls in samples. Results The prevalence of falls was approximately 17% in subjects. It was found that age (odds ratio [OR] 1.02), non-Malay ethnicity (OR 1.66), heart disease (OR 1.92), and functional decline (OR 1.58) significantly increased the risk of falls in respondents (P<0.05). Furthermore, having teeth (OR 0.59) and dentures (OR 0.66) significantly decreased the rate of falls (P<0.05). Conclusion It was concluded that age, non-Malay ethnicity, functional decline, heart disease, and oral health significantly affected falls in dementia.
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Affiliation(s)
| | | | | | - Chan Yoke Mun
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Malaysia
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Stone KL, Blackwell TL, Ancoli-Israel S, Cauley JA, Redline S, Marshall LM, Ensrud KE. Sleep disturbances and risk of falls in older community-dwelling men: the outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study. J Am Geriatr Soc 2014; 62:299-305. [PMID: 24428306 DOI: 10.1111/jgs.12649] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To test the hypothesis that subjective and objective sleep disturbances are associated with risk of incident falls in older men. DESIGN The prospective observational MrOS Sleep Study. SETTING Six academic clinical centers in the United States. PARTICIPANTS Community-dwelling men aged 67 and older (mean 76) (n = 3,101). MEASUREMENTS Subjective sleep measurements included daytime sleepiness (Epworth Sleepiness Scale (ESS)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), and total sleep time (TST). Objective sleep measurements included actigraphic TST and sleep efficiency (an index of fragmentation) and sleep disordered breathing (measured using in-home polysomnography). Fall frequency during the subsequent year was ascertained three times per year using questionnaires. Recurrent falling was defined as having two or more falls in the subsequent year. RESULTS In multivariable-adjusted models, participants with excessive daytime sleepiness (ESS > 10) but not poor subjective sleep quality (PSQI > 5) had greater odds of experiencing two or more falls in the subsequent year (odds ratio (OR) = 1.52 95% confidence interval (CI) = 1.14-2.03). Based on actigraphic recordings, the odds of having recurrent falls was higher for men who slept 5 hours or less (OR = 1.79, 95% CI = 1.22-2.60) than for those who slept 7 to 8 hours. Actigraphically measured sleep efficiency was also associated with greater risk of falls, as was nocturnal hypoxemia (≥ 10% of sleep time with arterial oxygen saturation <90%; OR = 1.62, 95% CI = 1.17-2.24) but not apnea hypopnea index. CONCLUSION Subjective and objective sleep disturbances were associated with risk of falls in older men, independent of confounders.
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Affiliation(s)
- Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
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John G, Gerstel E, Jung M, Dällenbach P, Faltin D, Petoud V, Zumwald C, Rutschmann OT. Urinary incontinence as a marker of higher mortality in patients receiving home care services. BJU Int 2013; 113:113-9. [DOI: 10.1111/bju.12359] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Gregor John
- Department of Internal Medicine; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Eric Gerstel
- Department of Epidemiology; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Michel Jung
- Department of Internal Medicine; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Patrick Dällenbach
- Department of Gynecology and Obstetrics; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Daniel Faltin
- Department of Gynecology and Obstetrics; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Véronique Petoud
- Institution Genevoise de Maintien à Domicile (IMAD); Geneva Switzerland
| | - Catherine Zumwald
- Institution Genevoise de Maintien à Domicile (IMAD); Geneva Switzerland
| | - Olivier T. Rutschmann
- Department of Community, Primary Care and Emergency Medicine; Geneva School of Medicine; Geneva University Hospitals; Geneva Switzerland
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Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Comorbidities and personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract 2013; 67:1015-33. [PMID: 24073974 DOI: 10.1111/ijcp.12164] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/21/2013] [Indexed: 11/30/2022] Open
Abstract
AIMS Studies on the burden and comorbidities associated with urgency urinary incontinence (UUI) are difficult to compare, partly because of the evolution of definitions for lower urinary tract symptoms and the various instruments used to assess health-related quality of life (HRQL). This article summarises published evidence on comorbidities and the personal burden associated specifically with UUI to provide clinicians with a clear perspective on the impact of UUI on patients. METHODS A PubMed search was conducted using the terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR quality of life OR well-being OR depression OR mental health OR sexual health OR comorbid), with limits for English-language articles published between 1991 and 2011. RESULTS Of 1364 identified articles, data from 70 retained articles indicate that UUI is a bothersome condition that has a marked negative impact on HRQL, with the severity of UUI a predictor of HRQL. UUI is significantly associated with falls in elderly individuals, depression, urinary tract infections, increased body mass index, diabetes and deaths. The burden of UUI appears to be greater than that of stress urinary incontinence or overactive bladder symptoms without UUI. UUI adversely impacts physical and mental health, sexual function and work productivity. CONCLUSIONS UUI is associated with numerous comorbid conditions and inflicts a substantial personal burden on many aspects of patients' lives. Healthcare providers should discuss UUI with patients and be aware of the impact of UUI and its associated comorbidities on patients' lives.
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Affiliation(s)
- K S Coyne
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA
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Helbig AK, Döring A, Heier M, Emeny RT, Zimmermann AK, Autenrieth CS, Ladwig KH, Grill E, Meisinger C. Association between sleep disturbances and falls among the elderly: results from the German Cooperative Health Research in the Region of Augsburg-Age study. Sleep Med 2013; 14:1356-63. [PMID: 24157099 DOI: 10.1016/j.sleep.2013.09.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 08/31/2013] [Accepted: 09/04/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to examine the association between various sleep disturbances and falls among older individuals from the general population while considering the influence of age and dizziness. METHODS Data were derived from the population-based cross-sectional KORA (Cooperative Health Research in the Region of Augsburg)-Age study, whereby information was conducted in standardized telephone interviews with 4127 men and women aged ⩾65years in 2008 and 2009. Unstratified and stratified (by age and dizziness) multivariable logistic regression model analyses were performed. RESULTS The multivariable analysis showed a marginally significant association between trouble staying asleep and ⩾1 fall in the previous year (odds ratio [OR], 1.23 [95% confidence interval (CI), 1.01-1.50]). This association was more pronounced in participants older than the age of 75years (OR, 1.58 [95% CI, 1.16-2.16]) and in individuals without dizziness (OR, 1.35 [95% CI, 1.04-1.76]). There was no association between daytime sleepiness and falls in the fully-adjusted models, but the odds of falls in the previous year in individuals older than the age of 75years were significantly higher for individuals with difficulty falling asleep. Although sleep duration was not associated with falls in multivariable analyses when stratified by dizziness, sleep duration of 9h daily was significantly associated with higher odds of experiencing at least one fall in the previous year. CONCLUSIONS Our study suggested that the positive relationship between a trend towards longer sleep duration, trouble falling and staying asleep, and falls is strongest in older individuals and in individuals who did not experience dizziness in the previous year.
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Affiliation(s)
- A Katharina Helbig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
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Hedman AMR, Fonad E, Sandmark H. Older people living at home: associations between falls and health complaints in men and women. J Clin Nurs 2013; 22:2945-52. [DOI: 10.1111/jocn.12279] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Edit Fonad
- Department of Neurobiology; Karolinska Institutet; Care Sciences and Society; Stockholm Sweden
| | - Hélène Sandmark
- School of Health; Mälardalen University; Care and Social Welfare, Public Health Sciences; Västerås Sweden
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Batchelor FA, Dow B, Low MA. Do continence management strategies reduce falls? a systematic review. Australas J Ageing 2013; 32:211-6. [PMID: 24373039 DOI: 10.1111/ajag.12047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Urinary incontinence is associated with increased fall risk, and fall prevention programs include recommendations to manage continence as one component of fall reduction. However, the evidence to support this recommendation is unclear. The aim of this study was to identify continence management interventions that are effective in decreasing falls. A systematic review of the literature was conducted. Studies were included if they evaluated the effect of any type of continence management strategy on falls in older adults. The included studies were assessed for quality, and data relating to participants, interventions and outcomes were extracted by two independent reviewers. Four articles met the inclusion criteria. Two studies were randomised controlled trials, one a retrospective cohort study and one an uncontrolled intervention study. Interventions included pharmacological agents, a toileting regime combined with physical activity and an individualised continence program. Only the study evaluating the combination of physical activity and prompted voiding found an effect on falls. It is surprising that there has been so little research into continence management interventions that include fall outcomes. A toileting regime combined with physical activity may reduce falls in residential care. There is a need for further studies investigating the impact of continence management on falls.
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Eshkoor SA, Hamid TA, Nudin SSH, Mun CY. The effects of sleep quality, physical activity, and environmental quality on the risk of falls in dementia. Am J Alzheimers Dis Other Demen 2013; 28:403-7. [PMID: 23698600 PMCID: PMC10852720 DOI: 10.1177/1533317513488921] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to identify the effects of sleep quality, physical activity, environmental quality, age, ethnicity, sex differences, marital status, and educational level on the risk of falls in the elderly individuals with dementia. METHODOLOGY Data were derived from a group of 1210 Malaysian elderly individuals who were noninstitutionalized and demented. The multiple logistic regression model was applied to estimate the risk of falls in respondents. RESULTS Approximately the prevalence of falls was 17% among the individuals. The results of multiple logistic regression analysis revealed that age (odds ratio [OR] = 1.03), ethnicity (OR = 1.76), sleep quality (OR = 1.46), and environmental quality (OR = 0.62) significantly affected the risk of falls in individuals (P < .05). Furthermore, sex differences, marital status, educational level, and physical activity were not significant predictors of falls in samples (P > .05). CONCLUSION It was found that age, ethnic non-Malay, and sleep disruption increased the risk of falls in respondents, but high environmental quality reduced the risk of falls.
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Affiliation(s)
| | | | | | - Chan Yoke Mun
- Institute of Gerontology, Universiti Putra Malaysia, Selangor, Malaysia
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Hunter KF, Voaklander D, Hsu ZY, Moore KN. Lower urinary tract symptoms and falls risk among older women receiving home support: a prospective cohort study. BMC Geriatr 2013; 13:46. [PMID: 23672343 PMCID: PMC3658922 DOI: 10.1186/1471-2318-13-46] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/07/2013] [Indexed: 12/03/2022] Open
Abstract
Background Although lower urinary tract symptoms have been associated with falls, few studies have been undertaken to understand this relationship in vulnerable community dwelling older adults. The purpose of this study was to describe the relationship over time of falls risk and lower urinary tract symptoms among community based older women receiving home support services. Methods A prospective cohort study which took place in an urban setting in western Canada. Participants were 100 older women receiving home care or residing in assisted living with home support services and were followed for six months. Demographic characteristics were collected at baseline, with the Timed Up and Go (TUG), International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), and self-report of falls collected at baseline, 3 and 6 months. Descriptive statistics were used to summarize demographic data. Differences between the three visits were analyzed using the Friedman test with post hoc analysis and associations between variables by the Spearman Rank-Order Correlation Coefficient. Results One hundred women initially enrolled; 88 and 75 remained at three months and six months. Mean age = 84.3 years; 91% reported at least one urinary symptom at baseline and 35% reported falling in the six months prior to enrollment; 15.9% reported falling between the baseline and three months and 14.6% between three and six months. Mean TUG scores at each time point indicated falls risk (27.21, 29.18 and 27.76 seconds). Significant correlations between TUG and ICIQ-FLUTS (r = 0.33, p < .001; r = 0.39, p < .001) as well as TUG and overactive bladder scores (r = 0.25, p = .005; r = 0.28, p < .008) were found at baseline and three months, but not six months. Conclusions The association of lower urinary tract symptoms and falls risk in this group of vulnerable community dwelling older women at baseline and three months has potential clinical relevance. Lack of correlation at six months may be due loss of less robust participants, illuminating the difficulty in following frailer groups over time. Further studies are needed to understand the contribution of urinary symptoms to falls risk, and clinicians should incorporate continence assessment within falls risk assessment.
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Affiliation(s)
- Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada.
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Pereira AA, Ceolim MF, Neri AL. Associação entre sintomas de insônia, cochilo diurno e quedas em idosos da comunidade. CAD SAUDE PUBLICA 2013; 29:535-46. [DOI: 10.1590/s0102-311x2013000300011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/13/2012] [Indexed: 11/22/2022] Open
Abstract
Essa pesquisa investigou associações entre sintomas de insônia, cochilo diurno, e quedas em idosos da comunidade. Estudo transversal de base populacional e amostra probabilística envolvendo 689 idosos da comunidade. O protocolo continha variáveis de autorrelato e de desempenho físico. Foi utilizada a análise de regressão logística univariada e multivariada, e o nível de significância estatística adotado foi de p < 0,05. A prevalência de sintomas de insônia e cochilo diurno foi de 49,9% (n = 339) e 62,8% (n = 432), respectivamente. Quatorze vírgula quatro porcento relataram uma única queda e 11,9% relataram quedas recorrentes. A ocorrência de quedas associou-se com sexo feminino (OR = 7,73; IC95%: 3,03-19,72), idade > 80 anos (OR = 3,48; IC95%: 1,54-7,85), cochilo diurno (OR = 2,24; IC95%: 1,24-4,05) e sintomas depressivos (OR = 1,98; IC95%: 1,11-3,53). A associação entre cochilo diurno e quedas replicam dados de pesquisa internacional. Identificar fatores de risco modificáveis pode auxiliar programas de prevenção de quedas.
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Bloch F, Thibaud M, Tournoux-Facon C, Brèque C, Rigaud AS, Dugué B, Kemoun G. Estimation of the risk factors for falls in the elderly: Can meta-analysis provide a valid answer? Geriatr Gerontol Int 2012. [DOI: 10.1111/j.1447-0594.2012.00965.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Caroline Tournoux-Facon
- Department of Epidemiology and Biostatistics. Inserm CIC P802; University of Poitiers; Poitiers; France
| | - Cyril Brèque
- P'Institute UPR 3346; University of Poitiers; Poitiers; France
| | | | - Benoit Dugué
- Laboratory «Mobilité, Vieillissement, Exercice» (MOVE), EA 6314; University of Poitiers; Poitiers; France
| | - Gilles Kemoun
- Laboratory «Mobilité, Vieillissement, Exercice» (MOVE), EA 6314; University of Poitiers; Poitiers; France
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Johnson EG, Meltzer JD. Effect of sitting pause times on postural stability after supine-to-standing transfer in dimly lit environments. J Geriatr Phys Ther 2012; 35:15-9. [PMID: 22189950 DOI: 10.1519/jpt.0b013e31821cb0ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Falls are common and often take place in the home. Risk of fall increases if the environment is dimly lit. Longer sitting pause times, before standing, might improve postural stability after standing from a supine position. The purpose of this investigation was to measure the effects of sitting pause times on postural sway velocity immediately following a supine-to-standing transfer in a dimly lit room in older and younger adult women. METHODS Five women aged 65 to 70 years and 5 aged 23 to 30 years participated in the study. On each of 2 consecutive days, study participants lay on a mat table with their eyes closed for 45 minutes before performing a supine-to-standing transfer in a dimly lit room. Sitting pause times of 2 seconds and 30 seconds preceded the transfers. RESULTS Mean postural sway velocity for the whole sample and for younger and older groups was less after a 30-second pause time than that after a 2-second pause time (sample, P = .001; young, P = .019; old, P = .021). No significant difference in mean postural sway velocity was observed between the 2 groups (P > .05). CONCLUSIONS Total mean postural sway velocity was less when study participants performed a sitting pause of 30 seconds before standing in a dimly lit room. These results suggest that longer sitting pause times may provide improved adaptability to dimly lit environments contributing to improved postural stability.
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Affiliation(s)
- Eric G Johnson
- Department of Physical Therapy, Loma Linda University, California 92350, USA.
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Mesas AE, López-García E, Rodríguez-Artalejo F. Self-reported sleep duration and falls in older adults. J Sleep Res 2011; 20:21-7. [PMID: 20626611 DOI: 10.1111/j.1365-2869.2010.00867.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Whether the association between sleep duration and accidental falls is independent of sleep quality is uncertain. It is also unclear if this association varies with age and sex among older adults. Data were collected through telephone interviews of 1542 community-dwelling individuals aged ≥68 years in Spain. Analyses were performed with logistic regression and adjusted for the main confounders, including lifestyle, health status, comorbidity and sleep quality, as measured by nighttime and daytime sleep complaints. Analyses were also stratified by age and sex. In total, 449 (29.1%) participants fell in the previous year; of these, 57.7% had one fall and 42.3% had recurrent (≥2) falls. As compared with those who usually slept 7-8 h, those sleeping ≥11 h were more likely to suffer recurrent falls [odds ratios (OR) 2.75; 95% confidence intervals (CI) 1.32-5.62]. In the stratified analysis, there was no association between sleep duration and falls in those aged ≤75 years and in men. In contrast, among those aged >75 years, the percentage of individuals with ≥1 falls was higher in those sleeping ≤5 h (OR 2.15; 95% CI 1.20-3.87) and ≥11 h (OR 2.34; 95% CI 1.17-4.68) than in those sleeping 7-8 h; also, women who slept ≥11 h were more likely to fall ≥1 times (OR 3.89; 95% CI 1.74-8.69). In conclusion, long sleep duration was associated with higher frequency of falls in older adults, even after adjustment for a wide range of sleep quality indicators. The association is clearer in women and the oldest adults. Assessment of sleep duration can help identify older adults who might benefit from interventions aimed at fall prevention.
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Affiliation(s)
- Arthur Eumann Mesas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ-CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Pereira AA, Ceolim MF. Relação entre problemas do sono, desempenho funcional e ocorrência de quedas em idosos da comunidade. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2011. [DOI: 10.1590/s1809-98232011000400016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Esta revisão objetivou sistematizar estudos que avaliam a relação entre problemas do sono, desempenho funcional e ocorrência de quedas em idosos da comunidade. MÉTODO: Realizou-se revisão bibliográfica entre 21 e 30 de setembro de 2009, no idioma Inglês, com as seguintes palavras-chave: "sleep" AND "falls" AND "functional performance" AND "elderly". Foram utilizadas as bases de dados PubMed, Ageline e Scielo. Foram critérios de inclusão: artigos publicados de janeiro de 2006 a setembro de 2009; artigos completos; estudos transversais, retrospectivos, prospectivos; estudos realizados com idosos da comunidade. RESULTADOS: Foram encontrados 52 estudos, dos quais foram avaliados dez que preencheram os critérios de inclusão. CONCLUSÕES: Os estudos mostraram que os distúrbios do sono podem piorar o desempenho funcional, além de representarem fator de risco independente para quedas em idosos.
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