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Roytman S, Paalanen R, Carli G, Marusic U, Kanel P, van Laar T, Bohnen NI. Multisensory mechanisms of gait and balance in Parkinson's disease: an integrative review. Neural Regen Res 2025; 20:82-92. [PMID: 38767478 DOI: 10.4103/nrr.nrr-d-23-01484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/18/2024] [Indexed: 05/22/2024] Open
Abstract
Understanding the neural underpinning of human gait and balance is one of the most pertinent challenges for 21st-century translational neuroscience due to the profound impact that falls and mobility disturbances have on our aging population. Posture and gait control does not happen automatically, as previously believed, but rather requires continuous involvement of central nervous mechanisms. To effectively exert control over the body, the brain must integrate multiple streams of sensory information, including visual, vestibular, and somatosensory signals. The mechanisms which underpin the integration of these multisensory signals are the principal topic of the present work. Existing multisensory integration theories focus on how failure of cognitive processes thought to be involved in multisensory integration leads to falls in older adults. Insufficient emphasis, however, has been placed on specific contributions of individual sensory modalities to multisensory integration processes and cross-modal interactions that occur between the sensory modalities in relation to gait and balance. In the present work, we review the contributions of somatosensory, visual, and vestibular modalities, along with their multisensory intersections to gait and balance in older adults and patients with Parkinson's disease. We also review evidence of vestibular contributions to multisensory temporal binding windows, previously shown to be highly pertinent to fall risk in older adults. Lastly, we relate multisensory vestibular mechanisms to potential neural substrates, both at the level of neurobiology (concerning positron emission tomography imaging) and at the level of electrophysiology (concerning electroencephalography). We hope that this integrative review, drawing influence across multiple subdisciplines of neuroscience, paves the way for novel research directions and therapeutic neuromodulatory approaches, to improve the lives of older adults and patients with neurodegenerative diseases.
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Affiliation(s)
- Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Paalanen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Giulia Carli
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
- Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
- Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Gioia A, Libera T, Burks G, Arena S, Hamel RN, Zukowski LA. The effect of virtual reality treadmill training on obstacle crossing parameters in older adults. Hum Mov Sci 2024; 96:103247. [PMID: 38901163 DOI: 10.1016/j.humov.2024.103247] [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: 12/20/2023] [Revised: 04/29/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
With increased age, walking without tripping requires greater cognitive demand. Therefore, it may be beneficial for training interventions to address and incorporate aspects of cognitive load. The purpose of this study was to compare a semi-immersive virtual reality treadmill training (VRTT) and conventional treadmill training (CTT) on obstacle clearance and trip hazard in older adults. Obstacle clearance parameters were measured with foot-mounted inertial measurement units (IMUs) and a Zeno pressure walkway. All data were processed and analyzed through custom Matlab scripts. Obstacle step height mean decreased (p = .003) in the lead limb following both training interventions. Additional significant changes were found in pre- and post-obstacle distance mean following both training interventions. Furthermore, significant correlations were found between demographic, cognitive, and functional mobility assessments and changes in dependent measures. The findings suggest that both the VRTT and CTT interventions may provide a reduction in trip risk in older adults, although through different methods.
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Affiliation(s)
- Alexander Gioia
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Theresa Libera
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Garret Burks
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Sara Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Renee N Hamel
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Lisa A Zukowski
- Department of Physical Therapy, High Point University, High Point, NC, USA.
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Bégin D, Janecek M, Macedo LG, Richardson J, Wojkowski S. The relationship between fear of falling and functional ability following a multi-component fall prevention program: an analysis of clinical data. Physiother Theory Pract 2024; 40:1121-1132. [PMID: 36305706 DOI: 10.1080/09593985.2022.2137384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The first objective was to evaluate clinical data from a multi-component fall prevention program. The second objective was to explore the relationship between physical function and fear of falling (FoF). METHODS Adults (N = 287, mean age = 76 years) who participated in the Building Balance Program between 2011-2020 were assessed with five physical function measures and two FoF measures. Repeated measures ANOVA controlling for age and sex were performed to assess change from baseline. Linear regressions were conducted to evaluate how physical function explained variations in FoF. RESULTS There were significant improvements between pre and post-program Berg Balance Scale (BBS) scores (p < .001), Timed-Up and Go (TUG) times (p < .001), 30 second Chair-Stand (30 CST repetitions) (p < .001), Functional Reach (FR) distance (p < .001), gait speed (p < .001), single item-FoF score (p < .001), and short Falls Efficacy Scale-International (FES-I score) (p < .001). After controlling for sex on all regression analyses, age, and pre-program gait speed explained variations in pre-program short FES-I scores (Adjusted R2 = 0.19). Age, pre-program BBS and 30 CST repetitions explained variations in pre-program level of FoF (Adjusted R2 = 0.25). Variations in post-program short FES-I scores (Adjusted R2 = 0.17) were explained by age, post-program TUG times and FR distance after controlling for age and sex. Robust regressions indicated variations in post-program level of FoF explained by age, post-program TUG and FR distance with a two-way interaction between age and FR. CONCLUSION A multi-component fall prevention program improved physical function and decreased FoF. A small association between physical function and FoF similar between pre- and post-program conditions was identified.
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Affiliation(s)
- Diane Bégin
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Marci Janecek
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
| | - Sarah Wojkowski
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada
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Dams J, Gottschalk S, Schwenk M, Nerz C, Becker C, Klenk J, Jansen CP, König HH. Budget impact analysis of a Lifestyle-integrated Functional Exercise (LiFE) program for older people in Germany: a Markov model based on data from the LiFE-is-LiFE trial. BMC Geriatr 2024; 24:186. [PMID: 38395743 PMCID: PMC10893703 DOI: 10.1186/s12877-024-04802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Fall prevention is important for healthy ageing, but the economic impact of fall prevention are scarcely investigated. A recent cost-effectiveness analysis compared a group-delivered Lifestyle-integrated Functional Exercise Program (gLiFE) with an individually-delivered program (LiFE) in community-dwelling people (aged ≥ 70 years) at risk of falling. In addition, the current study aimed to analyze the budget impact of LiFE and gLiFE, compared with standard care in Germany. METHODS A Markov model was developed to reflect falls and associated care needs for community-dwelling persons over 5 years. The intervention effects of LiFE and gLiFE were shown to be equivalent in a non-inferiority trial, although the costs differed. Outpatient, inpatient, and intervention costs were assessed from a payer's perspective. The effect of parameter uncertainty was assessed in sensitivity analyses. RESULTS The budget impact due to intervention costs was €510 million for LiFE and €186 million for gLiFE. Over five years, health care expenditures were €35,008 million for those receiving standard care, €35,416 million for those receiving LiFE, and €35,091 million for persons receiving gLiFE. Thereby, LiFE and gLiFE could prevent 2700 deaths and 648,000 falls over 5 years. Parameter uncertainties in the risk of falling, uptake of an intervention offer, and in the intervention effects had a major influence; thus cost savings for LiFE and gLiFE compared with standard care could be achieved for individuals with a high risk of falling. CONCLUSIONS The results revealed that cost savings for LiFE and gLiFE compared with standard care could only be achieved for individuals at high risk of falling, with gLiFE being superior to LiFE. Future research should consider benefits and aspects of fall prevention beyond falls (e.g., physical activity, social aspects, and personal preferences of participants). TRIAL REGISTRATION The study was preregistered under underclinicaltrials.gov (identifier: NCT03462654) on 12th March 2018; https://clinicaltrials.gov/ct2/show/NCT03462654 .
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Michael Schwenk
- Department of Sport Science, Human Performance Research Centre, University of Konstanz, Constance, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Center for Geriatric Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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Spangler J, Mitjans M, Collimore A, Gomes-Pires A, Levine DM, Tron R, Awad LN. Automation of Functional Mobility Assessments at Home Using a Multimodal Sensor System Integrating Inertial Measurement Units and Computer Vision (IMU-Vision). Phys Ther 2024; 104:pzad184. [PMID: 38159106 PMCID: PMC10851845 DOI: 10.1093/ptj/pzad184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Functional movement assessments are routinely used to evaluate and track changes in mobility. The objective of this study was to evaluate a multimodal movement monitoring system developed for autonomous, home-based, functional movement assessment. METHODS Fifty frail and prefrail adults were recruited from the Brigham and Women's Hospital at Home program to evaluate the feasibility and accuracy of applying the multimodal movement monitoring system to autonomously recognize and score functional activities collected in the home. Study subjects completed sit-to-stand, standing balance (Romberg, semitandem, and tandem), and walking test activities in likeness to the Short Physical Performance Battery. Test activities were identified and scored manually and by the multimodal movement monitoring system's activity recognition and scoring algorithms, which were previously trained on lab-based biomechanical data to integrate wearable inertial measurement unit (IMU) and external red-blue-green-depth vision data. Feasibility was quantified as the proportion of completed tests that were analyzable. Accuracy was quantified as the degree of agreement between the actual and system-identified activities. In an exploratory analysis of a subset of functional activity data, the accuracy of a preliminary activity-scoring algorithm was also evaluated. RESULTS Activity recognition by the IMU-vision system had good feasibility and high accuracy. Of 271 test activities collected in the home, 217 (80%) were analyzable by the activity-recognition algorithm, which overall correctly identified 206 (95%) of the analyzable activities: 100% of walking, 97% of balance, and 82% of sit-to-stand activities (χ2(2) = 19.9). In the subset of 152 tests suitable for activity scoring, automatic and manual scores showed substantial agreement (Kw = 0.76 [0.69, 0.83]). CONCLUSIONS Autonomous recognition and scoring of home-based functional activities is enabled by a multimodal movement monitoring system that integrates inertial measurement unit and vision data. Further algorithm training with ecologically valid data and a kitted system that is independently usable by patients are needed before fully autonomous, functional movement assessment is realizable. IMPACT Functional movement assessments that can be administered in the home without a clinician present have the potential to democratize these evaluations and improve care access.
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Affiliation(s)
- Johanna Spangler
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Marc Mitjans
- Department of Mechanical Engineering, College of Engineering, Boston University, Boston, Massachusetts, USA
| | - Ashley Collimore
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Aysha Gomes-Pires
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David M Levine
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Roberto Tron
- Department of Mechanical Engineering, College of Engineering, Boston University, Boston, Massachusetts, USA
| | - Louis N Awad
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
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Melo-Alonso M, Murillo-Garcia A, Leon-Llamas JL, Villafaina S, Gomez-Alvaro MC, Morcillo-Parras FA, Gusi N. Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review. J Clin Med 2024; 13:635. [PMID: 38276141 PMCID: PMC10816706 DOI: 10.3390/jcm13020635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. OBJECTIVES (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. METHODS The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O'Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. RESULTS A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. CONCLUSIONS There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step.
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Affiliation(s)
- Maria Melo-Alonso
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Juan Luis Leon-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Mari Carmen Gomez-Alvaro
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Felipe Alejandro Morcillo-Parras
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
- International Institute for Innovation in Aging, Universidad de Extremadura, 10003 Caceres, Spain
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Adam CE, Fitzpatrick AL, Leary CS, Ilango SD, Phelan EA, Semmens EO. The impact of falls on activities of daily living in older adults: A retrospective cohort analysis. PLoS One 2024; 19:e0294017. [PMID: 38170712 PMCID: PMC10763967 DOI: 10.1371/journal.pone.0294017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment. METHOD Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall. RESULTS Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall. CONCLUSIONS Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.
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Affiliation(s)
- Claire E. Adam
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Annette L. Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Cindy S. Leary
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Sindana D. Ilango
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Elizabeth A. Phelan
- Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Erin O. Semmens
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
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Kim J, Foucher K. Fall experiences from the perspectives of people with osteoarthritis: in their own words. Disabil Rehabil 2024; 46:77-85. [PMID: 36519505 DOI: 10.1080/09638288.2022.2156629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To explore real-life experiences of people with osteoarthritis (OA) to increase understanding of how they perceive contributing factors to falls, circumstances at time of falls, and consequences of falls. MATERIALS AND METHODS Four focus groups of 3-7 people with OA from the Chicago, IL, USA, and neighboring areas were conducted remotely via web-based videoconferencing. Inclusion criteria included history of falls in previous 12 months and hip and/or knee OA. Focus group transcripts were coded and analyzed using a modified grounded theory approach to identify themes. RESULTS Focus group participants (n = 17) described experiences associated with fall-related events that resulted in the identification of four themes: (1) perception of falls and fall risks can be influenced by OA symptoms, (2) ability to remember circumstances of falls are influenced by consequences, (3) behaviors and attitudes that address OA symptoms and avoidance of falls are similar and (4) OA symptoms and falls have common psychological impacts on lives. CONCLUSION Our study highlights how people with OA define falls, perceive contributing factors to falls, and describe general and OA-related factors that contributed to their fall experiences. The shared experiences contributed to the creation of themes that represented various aspects of the circumstances and impact of falls. Consideration for the identified themes may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and prioritize research into the biopsychosocial effects of falls in people with OA.IMPLICATIONS FOR REHABILITATIONInformation about circumstances of a fall such as location, activity, and symptoms of osteoarthritis may be beneficial in creating tailored fall prevention training and education.Falls are a common problem for people with lower limb osteoarthritis that can lead to negative changes in activity and quality of life.The psychological impact of osteoarthritis symptoms may be contributing to fear of falling and decrease participation in daily activities.Awareness of the perceptions people with osteoarthritis have about their symptoms may provide educational and training opportunities to address the benefits of different therapeutic treatments.Awareness of perceptions people with osteoarthritis have about their risk of falling may provide educational and training opportunities to address the benefits of different therapeutic treatments.
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Affiliation(s)
- Janis Kim
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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Fernandes VDO, Moreira BDS, de Melo GASC, de Avelar NCP, Costa HS, Bastone ADC. Factors associated with fear of falling in older women with knee osteoarthritis: A cross-sectional study. Geriatr Nurs 2024; 55:333-338. [PMID: 38154414 DOI: 10.1016/j.gerinurse.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
Knee instability in patients with knee osteoarthritis (KOA) is associated with fear of falling (FoF). This study aimed to investigate the prevalence and the factors associated with FoF in older women with KOA. A cross-sectional study was conducted with 93 older women with KOA. Sociodemographic variables, medical conditions, handgrip strength, and anthropometric and body composition measurements were assessed. The Short Physical Performance Battery was used to measure functional performance. The Western Ontario and McMaster Universities Osteoarthritis Index was applied to assess pain, stiffness, and disability. FoF was assessed by the Falls Efficacy Scale-International. The prevalence of FoF was high (88.2 %). Disability, history of falls, handgrip strength, obesity, number of medications, and pain were independently associated with FoF. Our findings suggest that health professionals should investigate FoF when evaluating older women with KOA and address these risk factors when developing strategies to prevent or minimize FoF in this population.
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Affiliation(s)
- Vanessa de Oliveira Fernandes
- Department of Physical Therapy, Postgraduate Program in Rehabilitation and Functional Performance - Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Rodovia MGT 367, Km 583, Nº 5000, Bairro Alto da Jacuba, Diamantina, MG CEP 39100-000, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, Nº 190 - Santa Efigênia, Belo Horizonte, MG 30130-100, Brazil
| | - Gisele Aparecida Santos Correia de Melo
- Department of Physical Therapy, Postgraduate Program in Rehabilitation and Functional Performance - Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Rodovia MGT 367, Km 583, Nº 5000, Bairro Alto da Jacuba, Diamantina, MG CEP 39100-000, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, SC 88040-900, Brazil
| | - Henrique Silveira Costa
- Department of Physical Therapy, Postgraduate Program in Rehabilitation and Functional Performance - Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Rodovia MGT 367, Km 583, Nº 5000, Bairro Alto da Jacuba, Diamantina, MG CEP 39100-000, Brazil
| | - Alessandra de Carvalho Bastone
- Department of Physical Therapy, Postgraduate Program in Rehabilitation and Functional Performance - Universidade Federal dos Vales do Jequitinhonha e Mucuri/UFVJM, Campus JK, Rodovia MGT 367, Km 583, Nº 5000, Bairro Alto da Jacuba, Diamantina, MG CEP 39100-000, Brazil.
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Heo KN, Seok JY, Ah YM, Kim KI, Lee SB, Lee JY. Development and validation of a machine learning-based fall-related injury risk prediction model using nationwide claims database in Korean community-dwelling older population. BMC Geriatr 2023; 23:830. [PMID: 38082380 PMCID: PMC10712099 DOI: 10.1186/s12877-023-04523-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Falls impact over 25% of older adults annually, making fall prevention a critical public health focus. We aimed to develop and validate a machine learning-based prediction model for serious fall-related injuries (FRIs) among community-dwelling older adults, incorporating various medication factors. METHODS Utilizing annual national patient sample data, we segmented outpatient older adults without FRIs in the preceding three months into development and validation cohorts based on data from 2018 and 2019, respectively. The outcome of interest was serious FRIs, which we defined operationally as incidents necessitating an emergency department visit or hospital admission, identified by the diagnostic codes of injuries that are likely associated with falls. We developed four machine-learning models (light gradient boosting machine, Catboost, eXtreme Gradient Boosting, and Random forest), along with a logistic regression model as a reference. RESULTS In both cohorts, FRIs leading to hospitalization/emergency department visits occurred in approximately 2% of patients. After selecting features from initial set of 187, we retained 26, with 15 of them being medication-related. Catboost emerged as the top model, with area under the receiver operating characteristic of 0.700, along with sensitivity and specificity rates around 65%. The high-risk group showed more than threefold greater risk of FRIs than the low-risk group, and model interpretations aligned with clinical intuition. CONCLUSION We developed and validated an explainable machine-learning model for predicting serious FRIs in community-dwelling older adults. With prospective validation, this model could facilitate targeted fall prevention strategies in primary care or community-pharmacy settings.
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Affiliation(s)
- Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Jeong Yeon Seok
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan-si, 38541, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Seung-Bo Lee
- Department of Medical Informatics, Keimyung University School of Medicine, Dalgubeol-Daero 1095, Dalseo-Gu, Daegu, 42601, Republic of Korea.
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea.
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11
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Choi JH, Choi ES, Park D. In-hospital fall prediction using machine learning algorithms and the Morse fall scale in patients with acute stroke: a nested case-control study. BMC Med Inform Decis Mak 2023; 23:246. [PMID: 37915000 PMCID: PMC10619231 DOI: 10.1186/s12911-023-02330-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Falls are one of the most common accidents in medical institutions, which can threaten the safety of inpatients and negatively affect their prognosis. Herein, we developed a machine learning (ML) model for fall prediction in patients with acute stroke and compared its accuracy with that of the existing fall risk prediction tool, the Morse Fall Scale (MFS). METHODS This is a retrospective nested case-control study. The initial sample size was 8462 admitted to a single cerebrovascular specialty hospital with acute stroke. A total of 156 fall events occurred, and each fall case was randomly matched with six control cases. Six ML algorithms were used, namely, regularized logistic regression, support vector machine, naïve Bayes (NB), k-nearest neighbors, random forest, and extreme-gradient boosting (XGB). RESULTS We included 156 in the fall group and 934 in the non-fall group. The mean ages of the fall and non-fall groups were 68.3 (± 12.2) and 65.3 (± 12.9) years old, respectively. The MFS total score was significantly higher in the fall group (54.3 ± 18.3) than in the non-fall group (37.7 ± 14.7). The area under the receiver operating curve (AUROC) of the MFS in predicting falls was 0.76 (0.73-0.79). XGB had the highest AUROC of 0.85 (0.78-0.92), and XGB and NB had the highest F1 score of 0.44. CONCLUSIONS The AUROC values of all of ML algorithms were similar to those of the MFS in predicting fall risk in patients with acute stroke, allowing for accurate and efficient fall screening.
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Affiliation(s)
- Jun Hwa Choi
- College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
- Department of Quality Improvement, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Eun Suk Choi
- College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
- Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea.
| | - Dougho Park
- Medical Research Institute, Pohang Stroke and Spine Hospital, 352, Huimang-daero, Nam-gu, Pohang, 37659, Republic of Korea.
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Republic of Korea.
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Jensen-Battaglia M, Mohammed M, Loh KP, Wells M, Tylock R, Ramsdale E, Canin B, Geer J, O'Rourke MA, Liu JJ, Seplaki CL, Mohile SG, Wildes TM. Modifiable fall risk factors among older adults with advanced cancer: Secondary analysis of a cluster-randomized clinical trial. J Geriatr Oncol 2023; 14:101650. [PMID: 37897888 PMCID: PMC10872468 DOI: 10.1016/j.jgo.2023.101650] [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: 06/14/2023] [Revised: 08/28/2023] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Older adults with cancer have unique fall risk factors related to their disease and treatment such as polypharmacy and neurotoxic treatments. In this secondary analysis, we identified modifiable risk factors associated with future falls among older adults with advanced cancers. MATERIALS AND METHODS Data were from the COACH study (ClinicalTrials.gov: NCT02107443; PI: Mohile). Patients were age ≥ 70, had stage III/IV solid tumor or lymphoma, ≥1 geriatric assessment impairment, and were receiving palliative intent treatment. Falls were self-reported at baseline (in the past six months), four to six weeks, three months, and six months. We generated inverse probability weights to account for mortality-related loss to follow-up and applied these in generalized linear mixed models to estimate incidence rate ratios. RESULTS Of 541 patients (mean age: 77, standard deviation [SD]: 5.27), 140 (26%) reported prior falls at baseline, and 467 (86%) had falls data for ≥1 follow-up timepoint. Of those, 103 (22%) reported at least one fall during the follow-up period, and 112 (24%) had incomplete follow-up due to death. In fully adjusted models, prior falls and impaired Timed Up and Go score were associated with higher incidence of falls over 6 months. DISCUSSION We identified several potentially modifiable fall risk factors in older adults with advanced cancers. Future studies should consider ways to integrate fall risk assessment into ongoing cancer care and intervene to reduce falls in this population.
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Affiliation(s)
- Marielle Jensen-Battaglia
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Mostafa Mohammed
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Megan Wells
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Rachael Tylock
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Erika Ramsdale
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Beverly Canin
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, St. Louis Park, MN, USA.
| | - Mark A O'Rourke
- NCORP of the Carolinas (Prisma Health NCORP), Greenville, SC, USA.
| | | | - Christopher L Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Supriya G Mohile
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Tanya M Wildes
- University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA.
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Alzahrani MS, Vennu V. Metabolic syndrome is associated with an increased risk of falls in the elderly. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:370-373. [PMID: 38909297 DOI: 10.25259/nmji_944_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
Numerous studies have investigated the causes of falls in the elderly. However, there is little information about metabolic syndrome (MS) as a risk factor for falls in older adults. No evaluations have given a qualitative overview of studies examining the relationship between MS and falls in the elderly. We did a literature search in electronic databases to look for studies that assessed a link between MS and falls among people over the age of 55 years. We found three studies of high quality. These included 2774 people with an average age of 72 years. Even after controlling for other risk factors, two studies found that MS was significantly associated with an older adult's 1.3-2.5-fold increased risk of falling. We found that MS and its independent components were strongly linked with falls among the elderly, even after correcting for numerous variables.
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Affiliation(s)
- Majed Saeed Alzahrani
- Department of Preventive Medicine, Preventive and Public Health Joint Program, Taif 11454, Makkah, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, 10219 Riyadh 11433, ArRiyadh, Saudi Arabia
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14
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Terheyden JH, Gerhards J, Ost RAD, Wintergerst MWM, Holz FG, Finger RP. Patient-reported vision impairment in low luminance predicts multiple falls. BMC Geriatr 2023; 23:583. [PMID: 37735629 PMCID: PMC10515075 DOI: 10.1186/s12877-023-04317-y] [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: 03/20/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Visual impairment is an independent risk factor for falling. Whether this extends to patient-reported visual difficulties has not been assessed to date. We have evaluated whether patient-reported visual difficulties in low-contrast and low luminance situations are a risk factor for falls and concerns about falling. METHODS Baseline assessments in outpatients with varying degrees of visual impairment aged ≥ 60 years included the Vision Impairment in Low Luminance (VILL) questionnaire and socio-demographic data; prospective follow-up assessments included falls over 12 months, the Falls Efficacy Scale (FES-I) and the VILL. The VILL was scored using Rasch models, and the FES-I was categorized following published guidelines. Associations were investigated using logistic regression analysis, controlling for age, visual acuity and known risk factors of falling. RESULTS We included 112 participants (74 women, mean age 70 ± 7 years). Twenty-seven participants recalled any falls and eleven recalled multiple falls at follow-up. Higher VILL reading subscale and mobility subscale scores at baseline were significantly associated with reporting less multiple falls at follow-up (OR 0.559 [0.333-0.936], p = 0.027 and OR 0.595 [0.377-0.940], p = 0.026). VILL scores were significantly associated with concerns about falling (high versus low: p ≤ 0.004, reading, mobility and emotional subscales; high versus moderate: p = 0.004, emotional subscale). CONCLUSIONS Patient-reported visual difficulties under low illumination and in low-contrast conditions are predictive of multiple falls in the future, have an additional predictive value over established risk scores, and are associated with concerns to fall. Current fall risk assessments may benefit from the inclusion of such assessments, e.g. the VILL questionnaire.
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Affiliation(s)
- Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
| | - Johanna Gerhards
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Reglind A D Ost
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Maximilian W M Wintergerst
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
- Department of Ophthalmology, University Hospital Mannheim & Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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15
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Xiao X, Li L, Yang H, Peng L, Guo C, Cui W, Liu S, Yu R, Zhang X, Zhang M. Analysis of the incidence of falls and related factors in elderly patients based on comprehensive geriatric assessment. Aging Med (Milton) 2023; 6:245-253. [PMID: 37711258 PMCID: PMC10498826 DOI: 10.1002/agm2.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
Objective To investigate the incidence of falls in elderly aged 65 years and above among outpatients and inpatients, and to analyze its related factors and identify prevention strategies. Methods A retrospective analysis was conducted on 451 patients aged 65 years and above who received comprehensive geriatric assessment in outpatients and inpatients from the Department of Geriatrics in the Second Xiangya Hospital from March 2021 to March 2022. According to whether there had been at least one fall in the past year, the patients were divided into a fall group and a non-fall group. Data were collected from the We-Chat applet of comprehensive geriatric assessment. A t test and chi-square test were performed to compare the difference between the two groups. Logistic regression analysis was then conducted to identify factors associated with falls. Results (1) The incidence of falls among the outpatient and inpatient was 28.8%. (2) The rate of light, moderate, and heavy dependence on daily living ability and decreased mobile balance ability were higher in the fall group than those in the non-fall group. The average calf circumference in the fall group was significantly lower than that in the non-fall group. (3) The prevalence of diabetes and eye diseases in the fall group was significantly higher than that in the non-fall group. (4) The percentage of insomnia and suspicious insomnia cases in the fall group was higher than that in the non-fall group. The mean scores for dysphagia, frailty, and incontinence were higher and the mean malnutrition score was lower in the fall group than in the non-fall group. (5) Multiple logistic regression analysis showed that frailty, insomnia, and malnutrition were independent influencing factors of fall (OR = 1.955, 1.652, 10.719, P = 0.044, 0.041, 0.025, respectively). Conclusions The incidence of falls among outpatients and inpatients aged 65 years and above is high. Frailty, insomnia, and malnutrition are the main factors influencing falls in these patients.
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Affiliation(s)
- Xun Xiao
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Ling Li
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Huijuan Yang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Lei Peng
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Chunbo Guo
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Wei Cui
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Shunying Liu
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Renhe Yu
- College of Public HealthCentral South UniversityChangshaChina
| | - Xiangyu Zhang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
- Hunan Clinical Medical Research Center for Geriatric SyndromeChangshaChina
| | - Mengxi Zhang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
- Hunan Clinical Medical Research Center for Geriatric SyndromeChangshaChina
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Aloraini SM, Alothaim NK, Alsalamah NM, Aldaihan MM. Knowledge translation theories in fall prevention and balance control: A scoping review. PM R 2023; 15:1175-1193. [PMID: 35982513 DOI: 10.1002/pmrj.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/03/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022]
Abstract
Falls are a major problem all over the world. Falls may result in bone fractures, fear of falling, and reduced participation in activities of daily living and in social activities, thus, an increased cost of health care to the individual and the society. Falls occur as a result of compounding factors that combine and overwhelm an individual's ability to maintain or regain his or her balance. However, fall rates are often reported as high, suggesting the presence of a gap between clinical practices related to fall prevention and the knowledge of the best available evidence related to fall prevention. The science of knowledge translation (KT) offers a variety of theories that can facilitate the implementation of up-to-date knowledge among clinicians. Therefore, the aim of this study was to identify and review the use of knowledge translation theories, namely the Knowledge to Action Framework (KTA), Promoting Action on Research Implementation in Health Services framework (PARIHS), Consolidated Framework for Implementation Research (CFIR), and the Theoretical Domains Framework (TDF), in studies related to fall prevention and balance control. A scoping review was conducted to identify studies related to fall prevention and balance control that used one of these four KT theories. An extensive literature search was performed up to January 2021. Two independent reviewers conducted a study selection process followed by data extraction of the search results. Our results identified 16 studies that were related to the scope of our review, with three studies utilizing KTA, two studies using PARIHS, four studies using CFIR, and seven studies using the TDF. Overall, it appears that the use of KT theories is helpful to guide interventions for fall prevention and improve balance control. Future efforts are needed to facilitate the use of KT theories for guiding clinical practices related to fall prevention and balance control.
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Affiliation(s)
- Saleh M Aloraini
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Noot K Alothaim
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Norah M Alsalamah
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Mishal M Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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17
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Kim EK, Sienko N, Gardi A, Krauter R, Pasquesi L, Sharon JD. Visually enhanced vestibulo-ocular reflex gain in patients with vestibular disease. Laryngoscope Investig Otolaryngol 2023; 8:1061-1067. [PMID: 37621269 PMCID: PMC10446303 DOI: 10.1002/lio2.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Vestibular migraine (VM) is a diagnostic challenge. Visually enhanced vestibulo-ocular reflex (VVOR) gain, a measure of the visual-vestibular interaction, has been proposed as a tool for diagnosing VM. This study seeks to evaluate VVOR gain's diagnostic capability to predict VM and to compare the phenotypes of vestibular patients with elevated versus normal/low VVOR gain. Methods A retrospective review of consecutive adult patients at a dizziness clinic from October 2016 and December 2020 was conducted. VVOR gain's diagnostic performance was assessed with the area under the receiver operating characteristic (AUROC) analysis. Demographic factors and clinical presentations were compared between vestibular patients with elevated versus normal/low VVOR gain. Results One hundred forty patients (70 with VM) were analyzed. VVOR gain was elevated in 68.6% of patients with VM, compared to 52.9% of patients without VM (p = .057). The AUROC of VVOR gain was 0.5902 (95% confidence interval: 0.4958-0.6846). Vestibular patients with elevated VVOR gain were younger than those with normal/low VVOR gain (mean age 50 vs. 62, p < .0001). A higher proportion of subjects with elevated VVOR gain had symptoms triggered by certain foods (17.6% vs. 5.5%, p = .040) and experienced sound sensitivity (34.1% vs. 18.2%, p = .040) and motion sensitivity (23.5% vs. 9.1%, p = .041). A greater proportion of VM patients with elevated VVOR gain were triggered by certain foods (27.1% vs. 0%, p = .006). Conclusion VVOR gain alone has limited ability to discriminate VM from other vestibular conditions and must be interpreted carefully. VVOR gain elevation may be associated with food triggers and motion and sound sensitivity. Level of Evidence IV.
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Affiliation(s)
- Eric K. Kim
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Natalie Sienko
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Adam Gardi
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Roseanne Krauter
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of Family Health Care Nursing, School of NursingUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Lauren Pasquesi
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Jeffrey D. Sharon
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Kragh Ekstam A, Andersson P. Oral Health Status Using the Revised Oral Assessment Guide and Mortality in Older Orthopaedic Patients: A Cross-Sectional Study. Clin Interv Aging 2023; 18:1103-1113. [PMID: 37489127 PMCID: PMC10363347 DOI: 10.2147/cia.s410577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Purpose Orthogeriatric hospitalised patients with fractures of the lower limb constitute a vulnerable population with increased risk of morbidity, polypharmacy, and mortality as well as impaired oral health. The aim of this cross-sectional study was to investigate whether any relationship existed between oral health issues in older orthopaedic patients and mortality. Material and Methods The study population consisted of older orthopedic patients emergently admitted to a hospital in southern Sweden due to mainly fractures of the hip. Their oral health at admission was assessed by trained nurses using the revised oral assessment guide (ROAG), as well as examined by dental hygienists. Medical and demographic data were collected from medical records and mortality from the national population registry. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Data were analysed using foremost dichotomized data derived from mean values and then processed using multiple logistic regression adjusted for identified probable confounders. Results Of the 187 study patients (≥65 years) with a mean age of 81 (SD 7.9) years, 71% were women, mean CCI score was 6.7 and 90-days mortality 12.3%. Oral health issues (ROAG >8, 73%) consisted mainly of problems with teeth/dentures (41%), tongue (36%), lips (35%), and saliva (28%). In patients with any oral health impairment (ROAG >8) the 90-days mortality was significantly increased (p=0.040), using logistic regression analysis adjusted for age, gender, comorbidity, and use of ≥5 drugs. In patients with a ROAG score ≥10 (≥mean) the association remained at 90-days (p=0.029) and 180-days (p=0.013). Decayed teeth were present in 24% and was significantly associated with ROAG >8 (p=0.020). Conclusion The main finding of this study was a possible relationship between oral health impairment at admission and early mortality in orthogeriatric hospitalised patients. The opportunity to identify their oral health problems can help improving further care planning and care.
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Affiliation(s)
- Annika Kragh Ekstam
- Department of Orthopaedics, Region Skåne Office for Hospitals in North-Eastern Skåne, Kristianstad, SE-291 85, Sweden
| | - Pia Andersson
- Department of Health Sciences, Kristianstad University, Kristianstad, SE-291 88, Sweden
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Wang BY, Sherrington C, Fairhall N, Kwok WS, Michaleff ZA, Tiedemann A, Wallbank G, Pinheiro MB. Exercise for fall prevention in community-dwelling people aged 60+: more effective in trials with higher fall rates in control groups. J Clin Epidemiol 2023; 159:116-127. [PMID: 37156341 DOI: 10.1016/j.jclinepi.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Exercise is beneficial for fall prevention. Targeting interventions to people who fall more may lead to greater population impacts. As trials have used varying methods to assess participant risk level, prospectively-measured control group fall rates may provide a more accurate and poolable way to understand intervention effects in different subpopulations. We aimed to explore differences in effectiveness of fall prevention exercise according to prospectively-measured fall rate. METHODS Secondary analysis of a Cochrane review investigating exercise for fall prevention in peopled aged ≥60 years. Meta-analysis assessed the impact of exercise on fall rate. Studies were dichotomized according to the median control group fall rate (0.87, IQR 0.54-1.37 falls/person-year). Meta-regression explored the effects on falls in trials with higher and lower control group fall rates. RESULTS Exercise reduced the rate of falls in trials with higher (rate ratio 0.68, 95% CI 0.61-0.76, 31 studies) and lower control group fall rates (rate ratio 0.88, 95% CI 0.79-0.97, 31 studies, P = 0.006 for difference in effects). CONCLUSION Exercise prevents falls, moreso in trials with higher control group fall rates. As past falls strongly predict future falls, targeting interventions to those with more past falls may be more efficient than other falls risk screening methods.
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Affiliation(s)
- Belinda Y Wang
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Nicola Fairhall
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Wing S Kwok
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Zoe A Michaleff
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia; Northern NSW Local Health District, Lismore, New South Wales, Australia; Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Anne Tiedemann
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Geraldine Wallbank
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Marina B Pinheiro
- Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia.
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Leung KHM, Brandis S. The smart-home study: A feasibility study to pilot the use of smartphone technology to identify environmental falls risk factors in the home. Hong Kong J Occup Ther 2023; 36:3-12. [PMID: 37332299 PMCID: PMC10273796 DOI: 10.1177/15691861231155994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/24/2023] [Indexed: 09/20/2023] Open
Abstract
Introduction While occupational therapy home assessments are effective to identify environmental falls risk factors, patients may not receive these services due to workforce distribution and geographical distances. Technology may offer a new way for occupational therapists to conduct home assessments to identify environmental fall risks. Objectives To (i) explore the feasability of identifying environmental risk factors using smartphone technology, (ii) develop and pilot a suite of procedures for taking smartphone images and (iii) examine the inter-rater reliability and content validity between occupational therapists when assessing smartphone images using a standardised assessment tool. Method Following ethical approval a procedure was developed and participants recruited to submit smartphone images of their bedroom, bathroom and toilet. Two independent occupational therapists then assessed these images using a home safety checklist. Findings were analysed using inferential and descriptive statistics. Results Of 100 volunteers screened, 20 individuals participated. A guideline for instructing patients to take home images was developed and tested. Participants averaged 9.00 minutes (SD 4.401) to complete the task, whilst occupational therapists took approximately 8 minutes to review the images. The inter-rater reliability between the two therapists was 0.740 (95% CI: 0.452-0.888). Conclusion The study found that use of smartphones was to a large extent feasible and conclude that the use of smartphone technologies is a potential complimentary service to traditional home visits. The effective prescription of equipment in this trial was identified as a challenge. The impact on costs and potential falls incidents remains uncertain and more research is warranted in representative populations.
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Affiliation(s)
- Ka Ho Marco Leung
- Department of Occupational Therapy, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Susan Brandis
- Department of Occupational Therapy, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
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21
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Lustosa LG, Rudoler D, Theou O, Dogra S. Leisure Sedentary Time is Associated with Self-Reported Falls in Middle-aged and Older Females and Males: an Analysis of the CLSA. Can Geriatr J 2023; 26:239-246. [PMID: 37265982 PMCID: PMC10198681 DOI: 10.5770/cgj.26.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Aim The purpose of this analysis was to report the prevalence of falls and falls-related injuries among those reporting different volumes of weekly sedentary time, and to understand the association of sedentary time and falls, accounting for functional fitness. Methods Baseline and first follow-up data from the Canadian Longitudinal Study on Aging (CSLA) were analyzed (n=22,942). Participants self-reported whether they had a fall in the past 12 months (at baseline) and whether they had an injury that was a result of a fall (follow-up). In-home interviews collected self-reported leisure sedentary time using the Physical Activity Scale for Elderly. Functional fitness was assessed using grip strength, timed-up-and-go, and chair rise tests during clinic visits. Results The prevalence of falls was higher among those who reported higher sedentary time. For example, among males aged 65 and older who reported lower sedentary time (<1,080 min/week), the prevalence of falls in the past 12 months (at baseline) was 7.8% compared to 9.8% in those reporting higher sedentary time. The odds of reporting a fall (at baseline) was 21% higher in those who reported higher sedentary time (OR: 1.21; 95%CI: 1.11-1.33) in adjusted models. No associations were found between sedentary time and injuries due to a fall. Conclusions Reporting high volumes of sedentary time may increase the risk of falls. Future research using device-based estimates of total sedentary time and breaks in sedentary time is needed to further elucidate this association.
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Affiliation(s)
- Lúcio G. Lustosa
- Faculty of Health Sciences (Kinesiology), Ontario Tech University, Oshawa, ON
| | - David Rudoler
- Faculty of Health Sciences (Kinesiology), Ontario Tech University, Oshawa, ON
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, NS
| | - Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), Ontario Tech University, Oshawa, ON
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22
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Adam CE, Fitzpatrick AL, Leary CS, Hajat A, Ilango SD, Park C, Phelan EA, Semmens EO. Change in gait speed and fall risk among community-dwelling older adults with and without mild cognitive impairment: a retrospective cohort analysis. BMC Geriatr 2023; 23:328. [PMID: 37231344 PMCID: PMC10214622 DOI: 10.1186/s12877-023-03890-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/14/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Although slow gait speed is an established risk factor for falls, few studies have evaluated change in gait speed as a predictor of falls or considered variability in effects by cognitive status. Change in gait speed may be a more useful metric because of its potential to identify decline in function. In addition, older adults with mild cognitive impairment are at an elevated risk of falls. The purpose of this research was to quantify the association between 12-month change in gait speed and falls in the subsequent 6 months among older adults with and without mild cognitive impairment. METHODS Falls were self-reported every six months, and gait speed was ascertained annually among 2,776 participants in the Ginkgo Evaluation of Memory Study (2000-2008). Adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for fall risk relative to a 12-month change in gait speed. RESULTS Slowing gait speed over 12 months was associated with increased risk of one or more falls (HR:1.13; 95% CI: 1.02 to 1.25) and multiple falls (HR:1.44; 95% CI: 1.18 to 1.75). Quickening gait speed was not associated with risk of one or more falls (HR 0.97; 95% CI: 0.87 to 1.08) or multiple falls (HR 1.04; 95% CI: 0.84 to 1.28), relative to those with a less than 0.10 m/s change in gait speed. Associations did not vary by cognitive status (pinteraction = 0.95 all falls, 0.25 multiple falls). CONCLUSIONS Decline in gait speed over 12 months is associated with an increased likelihood of falls among community-dwelling older adults, regardless of cognitive status. Routine checks of gait speed at outpatient visits may be warranted as a means to focus fall risk reduction efforts.
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Affiliation(s)
- Claire E Adam
- School of Public and Community Health Sciences, University of Montana, Missoula, USA.
- Center for Population Health Research, University of Montana, Missoula, USA.
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Cindy S Leary
- School of Public and Community Health Sciences, University of Montana, Missoula, USA
- Center for Population Health Research, University of Montana, Missoula, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Sindana D Ilango
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Christina Park
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Elizabeth A Phelan
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Erin O Semmens
- School of Public and Community Health Sciences, University of Montana, Missoula, USA
- Center for Population Health Research, University of Montana, Missoula, USA
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23
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Kirk B, French C, Gebauer M, Vogrin S, Zanker J, Sales M, Duque G. Diagnostic power of relative sit-to-stand muscle power, grip strength, and gait speed for identifying a history of recurrent falls and fractures in older adults. Eur Geriatr Med 2023:10.1007/s41999-023-00778-x. [PMID: 37058233 DOI: 10.1007/s41999-023-00778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To compare the diagnostic value of relative sit-to-stand muscle power with grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. METHODS Data from an outpatient clinic included anthropometry (height/weight), bone density, 5 times sit-to-stand time (stopwatch and standardized chair), grip strength (hydraulic dynamometer), and gait speed (4 m). Relative sit-to-stand muscle power (W.kg-1, normalised to body mass) was calculated using a validated equation. Outcomes of falls (past 1 year) and fractures (past 5 years) were self-reported and verified by medical records wherever possible. Binary logistic regression considering for potential confounders (age, sex, BMI, Charlson comorbidity index, femoral neck bone density) and receiver operating characteristics (ROC) curves were used in statistical analysis. RESULTS 508 community-dwelling older adults (median age: 78 years, interquartile range: 72, 83, 75.2% women) were included. Compared to greater relative sit-to-stand muscle power (1.62-3.78W.kg-1 for women; 2.03-3.90W.kg-1 for men), those with extremely low relative sit-to-stand muscle power were 2.35 (95% CI 1.54, 3.60, p < 0.001) and 2.41 (95% CI 1.25, 4.65, p = 0.009) times more likely to experience recurrent falls and fractures, respectively, in fully adjusted model. Compared to grip strength or gait speed, relative sit-to-stand muscle power showed the highest area under the ROC curve for identifying recurrent falls (AUC: 0.64) and fractures (AUC: 0.62). All tests showed low diagnostic power (AUC: < 0.7). CONCLUSION Relative sit-to-stand muscle power performed slightly (but not statistically) better than grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. However, all tests showed low diagnostic power.
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Affiliation(s)
- Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Chloe French
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Maria Gebauer
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- University Hospital of Guadalajara, Guadalajara, Spain
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Myrla Sales
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia.
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia.
- Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada.
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
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24
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Mozafaripour E, Sadati SKM, Najafi L, Zoghi M. The Effect of Motor Imaginary Combined with Transcranial Direct Current Stimulation (tDCS) on Balance in Middle-Aged Women with High Fall Risk: A Double-Blind Randomized Controlled Trial. Neural Plast 2023; 2023:9680371. [PMID: 37035217 PMCID: PMC10081897 DOI: 10.1155/2023/9680371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction. The risk of falling and its subsequent injuries increases with aging. Impaired balance and gait are important contributing factors to the increased risk of falling. A wide range of methods was examined to improve balance, but these interventions might produce small effects or be inapplicable for this population. The current study aimed at investigating the effect of motor imaginary (MI) training combined with transcranial direct current stimulation (tDCS) over the cerebellum on balance in middle-aged women with high fall risk. Methods. Thirty subjects aged 40-65 years old were divided into two groups including intervention (
) and sham control (
). The participants completed a 4-week program 3 times per week. The intervention group performed MI training combined with tDCS over the cerebellum, and the control group performed MI training combined with sham tDCS over the cerebellum. Static and dynamic balance were measured at baseline and after completing the 4-week program using balance error scoring system (BESS) and Y balance testing, respectively. Result. A one-way analysis of covariance and paired
-tests were used to analyze the data. Significant improvement was observed in both balance tests in the intervention group after the implementation of the 4-week intervention program compared to the control group. The within-group analysis showed that both static and dynamic balance improved significantly from the baseline values only in the intervention group (
) and not in the control group (
). Conclusion. The results of the study indicate that MI training combined with tDCS over the cerebellum can lead to balance improvement in middle-aged women with high fall risk.
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Affiliation(s)
- Esmaeil Mozafaripour
- Department of Health and Sports Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Seyed Kazem Mousavi Sadati
- Department of Physical Education and Sport Science, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Leila Najafi
- Department of Physical Education and Sport Science, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Maryam Zoghi
- Discipline of Physiotherapy, Institute of Health and Wellbeing, Federation University Australia, Victoria, Australia
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Konarzewski P, Konarzewska U, Kuryliszyn-Moskal A, Terlikowski R, Pauk J, Daunoraviciene K, Pauk K, Dakowicz A, Wojciuk M, Dzięcioł J, Dziecioł-Anikiej Z. What Influences Proprioceptive Impairments in Patients with Rheumatic Diseases? Analysis of Different Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3698. [PMID: 36834394 PMCID: PMC9965454 DOI: 10.3390/ijerph20043698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Rheumatic diseases lead to postural problems, which increase the risk of falls and lead to greater disability. The aim of the present work is to evaluate posture disorders in patients with osteoarthritis (OA) and rheumatoid arthritis (RA), as well as to evaluate the influence of other factors. A total of 71 subjects were enrolled in this study. Joint position sense (JPS) and the functional assessment of proprioception on a balance platform for both lower limbs were examined. The Average Trace Error (ATE), test time (t), and Average Platform Force Variation (AFV) were calculated. Additionally, an equilibrium test was carried out in the one-legged standing position (Single Leg Stance-SLS). The results were compared in several ways and revealed the following: (1) A JPS of 10° plantar flexion in RA obtained significantly worse results when repeating the movement than OA; the ATEs were significantly lower in RA; and RA needed more support during SLS assessment. (2) RA patients with higher DAS28 had statistically significantly higher values in JPS, with 5° plantar flexion and 10° dorsal flexion, SLS assessment, and stabilometric rates. A statistically significant correlation between DAS28 and RA was found in a JPS of 10° plantar flexion. The VAS ruler demonstrated a significant moderate correlation with t. (3) Patients who experienced at least one fall demonstrated higher JPS and t. Our study shows that proprioception is the most influenced by the nature of the disease and the level of disease activity. We can see that the stability and balance functions are also greatly influenced by the patient's falling experience and the level of pain. These findings may be useful in designing an optimal proprioception-enhancing movement training plan.
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Affiliation(s)
| | | | - Anna Kuryliszyn-Moskal
- Department of Rehabilitation, Faculty of Health Sciences, Medical University of Białystok, Skłodowskiej-Curie 7A Str., 15-096 Białystok, Poland
| | - Robert Terlikowski
- Department of Rehabilitation, Faculty of Health Sciences, Medical University of Białystok, Skłodowskiej-Curie 7A Str., 15-096 Białystok, Poland
| | - Jolanta Pauk
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Wiejska 45C, 15-352 Białystok, Poland
| | - Kristina Daunoraviciene
- Department of Biomechanical Engineering, Faculty of Mechanics, Vilnius Gediminas Technical University, Plytinės g. 25, LT-10105 Vilnius, Lithuania
| | - Konrad Pauk
- Warsaw Medical University, Zwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Agnieszka Dakowicz
- Department of Rehabilitation, Faculty of Health Sciences, Medical University of Białystok, Skłodowskiej-Curie 7A Str., 15-096 Białystok, Poland
| | - Mariusz Wojciuk
- Department of Rehabilitation, Faculty of Health Sciences, Medical University of Białystok, Skłodowskiej-Curie 7A Str., 15-096 Białystok, Poland
| | - Janusz Dzięcioł
- Department of Human Anatomy, Faculty of Medicine, Medical University of Bialystok, Mickiewicza 2A Str., 15-230 Bialystok, Poland
| | - Zofia Dziecioł-Anikiej
- Department of Rehabilitation, Faculty of Health Sciences, Medical University of Białystok, Skłodowskiej-Curie 7A Str., 15-096 Białystok, Poland
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Dubbeldam R, Lee YY, Pennone J, Mochizuki L, Le Mouel C. Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks. Eur Rev Aging Phys Act 2023; 20:2. [PMID: 36765288 PMCID: PMC9921041 DOI: 10.1186/s11556-023-00312-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant larger step length variability, larger step time variability, and prolonged anticipatory postural adjustments in obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had a larger angular momentum than those who did not fall. Lastly, in an obstacle course, reduced gait flexibility (i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.
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Affiliation(s)
- Rosemary Dubbeldam
- Department of Movement Science, Institute of Sport and Exercise Science, University of Münster, Münster, Germany.
| | - Yu Yuan Lee
- grid.5949.10000 0001 2172 9288Department of Movement Science, Institute of Sport and Exercise Science, University of Münster, Münster, Germany
| | - Juliana Pennone
- grid.11899.380000 0004 1937 0722School of Arts, Sciences, and Humanities, University of São Paulo and School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Luis Mochizuki
- grid.11899.380000 0004 1937 0722School of Arts, Sciences, and Humanities, University of São Paulo and School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Charlotte Le Mouel
- Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, CNRS, SSA, INSERM, Centre Borelli, Paris, France
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27
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Davis DL, Roberts A, Calderon R, Kim S, Ryan AS, Sanses TVD. Gluteal muscle fatty infiltration, fall risk, and mobility limitation in older women with urinary incontinence: a pilot study. Skeletal Radiol 2023; 52:47-55. [PMID: 35896734 PMCID: PMC10091062 DOI: 10.1007/s00256-022-04132-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Gluteal muscle quality influences risk of falling and mobility limitation. We sought (1) to compare gluteal muscle fatty infiltration (FI) between groups of older women with urinary incontinence (UI) at risk for falling (at-risk group) and not at risk for falling (not-at-risk group), and (2) to determine correlation of gluteal FI with Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) performance. MATERIALS AND METHODS Prospective pilot study of gluteal FI on pelvis MRI for 19 women with UI, aged ≥ 70 years. A musculoskeletal radiologist selected axial T1-weighted MR images; then, two blinded medical student research assistants analyzed gluteal FI by quantitative fuzzy C-means segmentation. TUG and SPPB tests were performed. TUG ≥ 12 s defined participants as at risk for falling. Descriptive, correlation, and reliability analyses were performed. RESULTS Mean age, 76.3 ± 4.8 years; no difference for age or body mass index (BMI) between the at-risk (n = 5) versus not-at-risk (n = 14) groups. SPPB score (p = 0.013) was lower for the at-risk group (6.4 ± 3.1) than for the not-at-risk group (10.2 ± 1.9). Fuzzy C-means FI-%-estimate differed between the at-risk group and the not-at-risk group for bilateral gluteus medius/minimus (33.2% ± 15.6% versus 19.5% ± 4.1%, p = 0.037) and bilateral gluteus maximus (33.6% ± 15.6% versus 19.7% ± 6.9%, p = 0.047). Fuzzy C-means FI-%-estimate for bilateral gluteus maximus had significant (p < 0.050) moderate correlation with age (rho = - 0.64), BMI (rho = 0.65), and TUG performance (rho = 0.52). Fuzzy C-means FI-%-estimates showed excellent inter-observer and intra-observer reliability (intraclass correlation coefficient, ≥ 0.892). CONCLUSION Older women with UI at risk for falling have greater levels of gluteal FI and mobility limitation as compared to those not at risk for falling.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
| | - Andrew Roberts
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Shihyun Kim
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC, USA
| | - Alice S Ryan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tatiana V D Sanses
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC, USA
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28
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Liu X, Abudukeremu A, Jiang Y, Cao Z, Wu M, Zheng K, Ma J, Sun R, Chen Z, Chen Y, Zhang Y, Wang J. Association of motor index scores with fall incidence among community-dwelling older people. BMC Geriatr 2022; 22:1008. [PMID: 36585625 PMCID: PMC9805168 DOI: 10.1186/s12877-022-03680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several kinds of motor dysfunction have been studied for predicting future fall risk in community-dwelling older individuals. However, no study has tested the ability of the fine motor index (FINEA) and gross motor index (GROSSA) to predict the risk of falling, as well as the specific fall type. OBJECTIVE We investigated the associations of FINEA/GROSSA scores with fall risk, explained falls, and unexplained falls. METHODS A total of 6267 community-dwelling adults aged ≥ 50 years from the Irish Longitudinal Study on Aging (TILDA) cohort were included. First, the associations of FINEA and GROSSA scores with the history of total falls, explained falls and unexplained falls were assessed in a cross-sectional study and further verified in a prospective cohort after 2 years of follow-up by Poisson regression analysis. RESULTS We found that high FINEA and GROSSA scores were positively associated with almost all fall histories (FINEA scores: total falls: adjusted prevalence ratio [aPR] = 1.28, P = 0.009; explained falls: aPR = 1.15, P = 0.231; unexplained falls: aPR = 1.88, P < 0.001; GROSSA scores: total falls: aPR = 1.39, P < 0.001; explained falls: aPR = 1.28, P = 0.012; unexplained falls: aPR = 2.18, P < 0.001) in a cross-sectional study. After 2 years of follow-up, high FINEA scores were associated with an increased incidence of total falls (adjusted rate ratio [aRR] = 1.42, P = 0.016) and explained falls (aRR = 1.51, P = 0.020) but not with unexplained falls (aRR = 1.41, P = 0.209). High GROSSA scores were associated with an increased incidence of unexplained falls (aRR = 1.57, P = 0.041) and were not associated with either total falls (aRR = 1.21, P = 0.129) or explained falls (aRR = 1.07, P = 0.656). Compared with individuals without limitations in either the FINEA or GROSSA, individuals with limitations in both indices had a higher risk of falls, including total falls (aRR = 1.35, P = 0.002), explained falls (aRR = 1.31, P = 0.033) and unexplained falls (aRR = 1.62, P = 0.004). CONCLUSION FINEA scores were positively associated with accidental falls, while GROSSA scores were positively associated with unexplained falls. The group for whom both measures were impaired showed a significantly higher risk of both explained and unexplained falls. FINEA or GROSSA scores should be investigated further as possible tools to screen for and identify community-dwelling adults at high risk of falling.
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Affiliation(s)
- Xiao Liu
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ayiguli Abudukeremu
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuan Jiang
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhengyu Cao
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Maoxiong Wu
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Zheng
- Medical Care Strategic Customer Department, China Merchants Bank Shenzhen Branch, Shenzhen, China
| | - Jianyong Ma
- grid.24827.3b0000 0001 2179 9593Department of Pharmacology and Systems Physiology University of Cincinnati College of Medicine, Cincinnati, USA
| | - Runlu Sun
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiteng Chen
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yangxin Chen
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuling Zhang
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jingfeng Wang
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Revised indications for head CT in elderly patients with minor traumatic injuries: A retrospective analysis. J Neuroradiol 2022; 50:377-381. [PMID: 36402287 DOI: 10.1016/j.neurad.2022.11.006] [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: 10/30/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to assess the performance of a decision-tree for head-CT indication in elderly patients presenting minor traumatic injuries MATERIALS AND METHODS: A single-centre retrospective study was performed and analyses were based on emergency CT scans of all patients aged 65 and over who experienced minor head trauma due to falls. The primary judgement criteria was the diagnosis of a traumatic intracranial haemorrhagic lesion (tICH) depicted on the CT scan. Focal neurological deficit and history of tICH on a previous CT scan were used to create the decision-tree. RESULTS A total of 1001 patients were included. Ninety-five (9.5%) had tICH on the CT scan. Of these patients, 42 (46.1%) had an abnormal Glasgow Coma Scale, 30 (31.6%) a focal neurological deficit and 13 (13.7%) a history of tICH on a previous CT scan. The presence of at least one of these 3 risk factors was associated with the occurrence of tICH (p <0.001). The decision-tree developed from these risk factors allowed the appropriate classification of 63 of 95 patients (66.3%) with tICH. Undetected haemorrhagic lesions in patients with no clinical severity criteria evolved favourably. The decision-tree correctly identified 97% of patients without any tICH on the CT. CONCLUSION Systematic head CT for elderly patients presenting minor head trauma could be irrelevant. A decision-tree based on objective clinical severity criteria for the indication of head CT could detect the majority of tICH requiring surgical intervention. Prospective randomized studies are mandatory to confirm these hypotheses.
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Seo JH, Han JS, Lee Y, Myong JP, Ha US. Fall risk related to subtype-specific alpha-antagonists for benign prostatic hyperplasia: a nationwide Korean population-based cohort study. World J Urol 2022; 40:3043-3048. [DOI: 10.1007/s00345-022-04195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/14/2022] [Indexed: 12/05/2022] Open
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de Smet L, Carpels A, Creten L, De Pauw L, Van Eldere L, Desplenter F, De Hert M. Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital. Front Public Health 2022; 10:1020975. [PMID: 36388388 PMCID: PMC9651969 DOI: 10.3389/fpubh.2022.1020975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/13/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Falls in elderly patients treated in general hospitals have already been the focus of several studies. Research within psychiatric settings, however, remains limited, despite the fact that this population has a number of characteristics that could increase the fall risk. The aim of this retrospective study was to estimate the prevalence of falling in patients with a psychiatric hospital setting. Methods A retrospective descriptive chart review of falls registered in the period July 1, 2013 until June 30, 2019 in a Belgian University Psychiatric Hospital was conducted. Data were collected from the "patient related incident report and management system" (PiMS) of the hospital. All registered falls of all hospitalized patients were included in the study. Results During the 6-year study period an incidence of 4.4 falls per 1,000 patient days was found. Only 0.5% of the falls resulted in severe injury and none of these falls were fatal. Eighty percent of falls involved a patient over the age of 65. Only 25.0% of the elderly patients suffered physical consequences, while injuries were present in 31.4% of adults and 68.2% of young patients. The two most common causes of a fall were the health status (63.3%) and the behavior (55.1%) of the patient. Conclusion The estimated prevalence of falls in our study was generally in line with the rates found in literature on falls in psychiatric settings. Falls in psychiatric settings occur both in younger and older patients, suggesting that all age categories deserve sufficient attention in fall prevention policies. However, more research is necessary to improve fall prevention policies.
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Affiliation(s)
- Lynn de Smet
- University Psychiatric Center, KU Leuven, Leuven, Belgium,*Correspondence: Lynn de Smet
| | - Arnout Carpels
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Public Psychiatric Care Center Rekem, Rekem, Belgium
| | - Lotte Creten
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Louise De Pauw
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Franciska Desplenter
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marc De Hert
- University Psychiatric Center, KU Leuven, Leuven, Belgium,Center for Clinical Psychiatry, Department of Biomedical Sciences, KU Leuven, Leuven, Belgium,Antwerp Health Law and Ethics Chair, Universiteit Antwerpen, Antwerp, Belgium
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Cao YT, Wang JJ, Yang YT, Zhu SJ, Zheng LD, Lu WW, Zhu R, Wu T. Effect of home-based exercise programs with e-devices on falls among community-dwelling older adults: a meta-analysis. J Comp Eff Res 2022; 11:1201-1217. [PMID: 36148921 DOI: 10.2217/cer-2022-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore the effectiveness of home-based exercise programs with e-devices (HEPEs) on falls among community-dwelling older adults. Methods: Twelve randomized controlled trials were included in the meta-analysis considering four fall-related outcomes. Results: HEPEs significantly reduced the rate of falls (risk ratio: 0.82; 95% CI: 0.72-0.95; p = 0.006) and improved lower extremity strength (mean difference: -0.94; 95% CI: -1.71 to -0.47; p < 0.001). There was a significant improvement favoring HEPEs on balance if the participants were aged >75 years (mean difference: -0.55; 95% CI: -1.05 to -0.05; p = 0.03), or the intervention duration was at least 16 weeks (mean difference: -0.81; 95% CI: -1.58 to -0.05; p = 0.04). Conclusion: HEPEs demonstrated an overall positive effect on falls among community-dwelling older adults.
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Affiliation(s)
- Yu-Ting Cao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Jian-Jie Wang
- Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yi-Ting Yang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Shi-Jie Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Liang-Dong Zheng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Wei-Wei Lu
- Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Rui Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Tao Wu
- Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
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Flannery C, Dennehy R, Riordan F, Cronin F, Moriarty E, Turvey S, O'Connor K, Barry P, Jonsson A, Duggan E, O'Sullivan L, O'Reilly É, Sinnott SJ, McHugh S. Enhancing referral processes within an integrated fall prevention pathway for older people: a mixed-methods study. BMJ Open 2022; 12:e056182. [PMID: 35985777 PMCID: PMC9396121 DOI: 10.1136/bmjopen-2021-056182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Multifactorial interventions, which involve assessing an individual's risk of falling and providing treatment or onward referral, require coordination across settings. Using a mixed-methods design, we aimed to develop a process map to examine onward referral pathways following falls risk assessment in primary care. SETTING Primary care fall risk assessment clinics in the South of Ireland. PARTICIPANTS Focus groups using participatory mapping techniques with primary care staff (public health nurses (PHNs), physiotherapists (PT),and occupational therapists (OT)) were conducted to plot the processes and onward referral pathways at each clinic (n=5). METHODS Focus groups were analysed in NVivo V.12 using inductive thematic analysis. Routine administrative data from January to March 2018 included details of client referrals, assessments and demographics sourced from referral and assessment forms. Data were analysed in Stata V.12 to estimate the number, origin and focus of onward referrals and whether older adults received follow-up interventions. Quantitative and qualitative data were analysed separately and integrated to produce a map of the service. RESULTS Nine staff participated in three focus groups and one interview (PHN n=2; OT n=4; PT n=3). 85 assessments were completed at five clinics (female n=69, 81.2%, average age 77). The average number of risk factors was 5.4 out of a maximum of 10. Following assessment, clients received an average of three onward referrals. Only one-third of referrals (n=135/201, 33%) had data available on intervention receipt. Primary care staff identified variations in how formally onward referrals were managed and barriers, including a lack of client information, inappropriate referral and a lack of data management support. CONCLUSION Challenges to onward referral manifest early in an integrated care pathway, such as clients with multiple risk factors sent for initial assessment and the lack of an integrated IT system to share information across settings.
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Affiliation(s)
- Caragh Flannery
- School of Public Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- School of Public Health, University College Cork, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Finola Cronin
- Corks Falls Prevention Service, Health Service Executive, Naas, Ireland
| | - Eileen Moriarty
- School of Public Health, University College Cork, Cork, Ireland
- National Services for Older Persons Team, Health Service Executive, Naas, Ireland
| | - Spencer Turvey
- Cork Kerry Community Healthcare, Health Service Executive, Naas, Ireland
| | - Kieran O'Connor
- Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Patrick Barry
- Acute Medicine and Geriatric Medicine, Cork University Hospital Group, Cork, Ireland
| | | | - Eoin Duggan
- Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Mercers Institute for Successful Ageing, Saint James's Hospital, Dublin, Ireland
| | - Liz O'Sullivan
- Cork Kerry Community Healthcare HSE South, Health Service Executive, Dublin, Ireland
| | - Éilis O'Reilly
- School of Public Health, University College Cork, Cork, Ireland
| | - Sarah-Jo Sinnott
- Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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Falling Short: The Contribution of Central Insulin Receptors to Gait Dysregulation in Brain Aging. Biomedicines 2022; 10:biomedicines10081923. [PMID: 36009470 PMCID: PMC9405648 DOI: 10.3390/biomedicines10081923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Insulin resistance, which manifests as a reduction of insulin receptor signaling, is known to correlate with pathological changes in peripheral tissues as well as in the brain. Central insulin resistance has been associated with impaired cognitive performance, decreased neuronal health, and reduced brain metabolism; however, the mechanisms underlying central insulin resistance and its impact on brain regions outside of those associated with cognition remain unclear. Falls are a leading cause of both fatal and non-fatal injuries in the older population. Despite this, there is a paucity of work focused on age-dependent alterations in brain regions associated with ambulatory control or potential therapeutic approaches to target these processes. Here, we discuss age-dependent alterations in central modalities that may contribute to gait dysregulation, summarize current data supporting the role of insulin signaling in the brain, and highlight key findings that suggest insulin receptor sensitivity may be preserved in the aged brain. Finally, we present novel results showing that administration of insulin to the somatosensory cortex of aged animals can alter neuronal communication, cerebral blood flow, and the motivation to ambulate, emphasizing the need for further investigations of intranasal insulin as a clinical management strategy in the older population.
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Krieger J, Frackowiak M, Berger M, Heneka MT, Jacobs AH. Falls at advanced age - The importance to search for benign paroxysmal positional vertigo (BPPV). Exp Gerontol 2022; 165:111868. [PMID: 35700849 DOI: 10.1016/j.exger.2022.111868] [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: 04/16/2021] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION One of the most important geriatric syndromes is dizziness in conjunction with gait disorder and consequent falls. There are various differential diagnoses for dizziness, one of them is benign paroxysmal positional vertigo (BPPV). OBJECTIVES A targeted diagnostic work-up and treatment of BPPV can prevent subsequent falls and a decline in the patients' quality of life, prolonged hospitalization with unnecessary examinations and medication. DESIGN Prospective examination of patients with a positive medical history of BPPV. SETTING AND PARTICIPANTS All patients treated within the Department of Geriatrics between 05/2015 and 03/2018 were included. A total of n = 5166 patients were screened (n = 2651 geriatrics; n = 2515 controls). METHODS All patients from other wards subjected to a neurological examination due to vertigo served as controls. Patients with typical hints in the medical history for a BPPV were subjected to the diagnostic Dix-Hallpike maneuver and, if positive, subsequent canalith repositioning maneuvers. The percentage of successful positional treatments was determined in both groups. RESULTS N = 254 patients (4.9 %) had indications in the medical history for a BPPV. For 71 of n = 254 patients (28 %; in total 1.4 %; mean age: 78.4 ± 12.3 years) the diagnosis of BPPV was proven by a positive Dix-Hallpike maneuver. N = 39 (54.9 %) patients belong to the geriatric group (mean age 82 years) and n = 32 (45.1 %) to the control group (mean age 73.9 years). The frequency of BPPV was similar in both groups (1.3-1.5 %). In 91.9 % of patients the BPPV was localized in the posterior semicircular canal. Up to 93 % were asymptomatic after one or repeated canalith repositioning maneuvers. CONCLUSIONS AND IMPLICATIONS The BPPV should be considered as an important differential diagnosis for geriatric patients with dizziness and falls. After therapeutic repositioning maneuvers most of the patients are asymptomatic. Therefore, targeted screening and therapy ("theragnostic") of BPPV at an advanced age increases diagnostic accuracy and prevents unnecessary examinations, medications and future falls.
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Affiliation(s)
- Jasmin Krieger
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Monika Frackowiak
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Moritz Berger
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Michael T Heneka
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Andreas H Jacobs
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany.
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Frank A, Bendig J, Finkbeiner S, Hähnel T, Schnalke N, Feige T, Reichmann H, Falkenburger BH. Development and Validation of a Fall Questionnaire for Patients with Parkinson's Disease. Mov Disord Clin Pract 2022; 9:900-908. [PMID: 36247908 PMCID: PMC9547135 DOI: 10.1002/mdc3.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background In Parkinson's disease, postural instability and falls are of particular socioeconomic relevance. Although effective fall prevention and the prophylaxis of fall‐related injuries depend on low‐threshold symptom monitoring, validated instruments are lacking. Objectives To develop a self‐report questionnaire for the assessment of falls, near falls, fear of falling, fall‐related injuries, and causes of falls for patients with Parkinson's disease (PwPD). Methods A pool of potential items was generated from a literature review and by discussion in an expert panel. The first version of the Dresden Fall Questionnaire (DREFAQ) was tested in a group of German‐speaking movement disorder specialists as well as PwPD. The resulting 5‐item questionnaire was assessed in a validation cohort of 36 PwPD who documented fall events and near‐fall events in a calendar for 3 months and completed the DREFAQ at the end of the study. The questionnaire was subsequently used in a separate cohort of 46 PwPD to determine test–retest reliability and confirm the factor structure. Results The DREFAQ showed good internal consistency (Cronbach's α = 0.84) and good test–retest reliability (intraclass correlation coefficient, 0.76; 95% confidence interval, 0.60–0.86). The total DREFAQ score showed good concurrent validity with fall events (Spearman's ρ = 0.82) and near‐fall events (Spearman's ρ = 0.78) as determined by fall and near‐fall diaries. Factor analysis revealed a 2‐factor structure composed of near falls with fear of falling and severe falls with injuries. Conclusions The DREFAQ is a reliable and valid 5‐item questionnaire for determining the incidence of falls, near falls, fear of falling, fall‐related injuries, and causes of falls in PwPD.
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Affiliation(s)
- Anika Frank
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
- German Center for Neurodegenerative Diseases (DZNE) 01307 Dresden Germany
| | - Jonas Bendig
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
| | - Sophia Finkbeiner
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
| | - Tom Hähnel
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
| | - Nils Schnalke
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
| | - Tim Feige
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
| | - Heinz Reichmann
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
| | - Björn H. Falkenburger
- Department of Neurology University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden 01307 Dresden Germany
- German Center for Neurodegenerative Diseases (DZNE) 01307 Dresden Germany
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Gallo da Silva TT, Melo Filho J, Biesek S, Vojciechowski AS, Borba VZC, Gomes ARS. Accuracy of Tools to Differentiate Single From Recurrent Fallers Pre-Frail Older Women. Front Public Health 2022; 10:716851. [PMID: 35655457 PMCID: PMC9152280 DOI: 10.3389/fpubh.2022.716851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The objectives of this study were to analyze and compare musculoskeletal and functional performance and present cutoff points to differentiate pre-frail community-dwelling older women regarding their fall history: non fallers (0 falls), fallers (single fall), and recurrent fallers (≥2 falls). Method This is a cross-sectional, retrospective study on 90 pre-frail community-dwelling older women (71.2 ± 4.49 years) according to Fried criteria. We assessed peak torque (PT) (isokinetic dynamometer), muscle architecture/mass (ultrasound/dual-energy X-ray absorptometry), and the following functional performance: usual gait speed (UGS), fast gait speed (FGS), walking speed reserve (WSR), cadence and step length, and timed up and go. Results The recurrent fallers presented lower UGS (1.12 ± 0.18 vs. 1.29 ± 0.28 m/s; p = 0.05) and isometric PT of knee extensors than the fallers (89.88 ± 20.99 vs. 115.55 ± 23.09 Nm; p = 0.01), and lower FGS than the fallers (1.35 ± 0.26 vs. 1.5 ± 0.29 m/s; p = 0.03) and non-fallers (1.35 ± 0.26 vs. 1.52 ± 0.26 m/s; p = 0.01). The outcomes that differentiated the fallers from the non-fallers were both WSR calculated as a difference (WSRdiff) (≤0.26 m/s) and WSR calculated as a ratio (WSRratio) (≤1.25 m/s), while to differentiate the recurrent fallers from the non-fallers were FGS (≤1.44 m/s) and step length (≤73 cm). The following cutoff points might be used to differentiate recurrent fallers and fallers: UGS (≤1.12 m/s), FGS (≤1.34m/s), step length (≤73 cm), PT knee extension (≤114.2 Nm), PT knee flexion (≤46.3 Nm), and PT ankle dorsiflexion (≤22.1 Nm). Conclusion Recurrent fallers community-dwelling pre-frail older women presented a worse musculoskeletal and functional performance when compared to the non-fallers and fallers. Gait speed, step length, PT of both knee extension and flexion, and ankle dorsiflexion can be used to identify both single and recurrent fallers pre-frail older women, contributing to guide interventions and prevent falls and fractures.
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Affiliation(s)
| | - Jarbas Melo Filho
- Departament of Massage Under Graduation, Federal Institute of Paraná, Curitiba, Brazil
| | - Simone Biesek
- PhD Program in Physical Education, Federal University of Paraná, Curitiba, Brazil
| | | | - Victória Zeghbi Cochenski Borba
- Internal Medicine Department and Masters and PhD Programs, Endocrinology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Anna Raquel Silveira Gomes
- Masters and PhD Programs in Physical Education, Prevention and Rehabilitation in Physiotherapy Department, Federal University of Paraná, Curitiba, Brazil
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Tuvemo Johnson S, Anens E, Johansson AC, Hellström K. What Predicts Falls, and what are the Circumstances and Consequences of Falls in Community-Dwelling Older Adults Who Need Walking Aids or Home Help Service. Gerontol Geriatr Med 2022; 8:23337214221098900. [PMID: 35677675 PMCID: PMC9168864 DOI: 10.1177/23337214221098900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
The objective was to analyze predictive variables for falls in older community-dwelling
adults who needed walking aids or home help service, to describe the circumstances and
consequences of falls and fall injuries, and to describe the activities preceding falls,
n = 175, mean age 83 years. Falls were self-reported monthly in a fall
calendar and were followed up by a telephone interview. A logistic regression analysis was
performed to investigate predictive baseline variables for falls. Injuries were reported
in 82 of the 185 fall events. Previous falls and a high level of education had a
significant association with falls odds ratios 1.9 (95% CI 1.3–2.7), and 2.7 (95% CI
1.4–5.3). Activities preceding the falls were classified according to the International
Classification of Functioning (ICF). Falls and fall injuries were most common while moving
around within the home and rising from sitting to standing.
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Affiliation(s)
- Susanna Tuvemo Johnson
- Department of Women's and Childrens Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Elisabeth Anens
- Department of Women's and Childrens Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | | | - Karin Hellström
- Department of Women's and Childrens Health, Physiotherapy, Uppsala University, Uppsala, Sweden
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Falk J, Strandkvist V, Pauelsen M, Vikman I, Nyberg L, Röijezon U. Increased co-contraction reaction during a surface perturbation is associated with unsuccessful postural control among older adults. BMC Geriatr 2022; 22:438. [PMID: 35585517 PMCID: PMC9118814 DOI: 10.1186/s12877-022-03123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background As a strategy to maintain postural control, the stiffening strategy (agonist-antagonist co-contractions) is often considered dysfunctional and associated with poor physical capacity. The aim was to investigate whether increased stiffening is associated with unsuccessful postural control during an unpredictable surface perturbation, and which sensory and motor variables that explain postural stiffening. Methods A sample of 34 older adults, 75.8 ± 3.8 years, was subjected to an unpredicted surface perturbation with the postural task to keep a feet-in-place strategy. The participants also completed a thorough sensory- and motor test protocol. During the surface perturbation, electromyography was measured from tibialis anterior and gastrocnemius to further calculate a co-contraction index during the feed-forward and feedback period. A binary logistic regression was done with the nominal variable, if the participant succeeded in the postural task or not, set as dependent variable and the co-contraction indexes set as independent variables. Further, the variables from the sensory and motor testing were set as independent variables in two separate Orthogonal Projections of Latent Structures (OPLS)-models, one with the feed-forward- and the other with the feedback co-contraction index as dependent variable. Results Higher levels of ankle joint stiffening during the feedback, but not the feed-forward period was associated with postural task failure. Feedback stiffening was explained by having slow non-postural reaction times, poor leg muscle strength and being female whereas feed-forward stiffening was not explained by sensory and motor variables. Conclusions When subjected to an unpredicted surface perturbation, individuals with higher feedback stiffening had poorer postural control outcome, which was explained by poorer physical capacity. The level of feed-forward stiffening prior the perturbation was not associated with postural control outcome nor the investigated sensory and motor variables. The intricate causal relationships between physical capacity, stiffening and postural task success remains subject for future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03123-2.
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Affiliation(s)
- Jimmy Falk
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden.
| | - Viktor Strandkvist
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Mascha Pauelsen
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Irene Vikman
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Lars Nyberg
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Ulrik Röijezon
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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Jiang J, Guo W, Wang B. Effects of exergaming on executive function of older adults: a systematic review and meta-analysis. PeerJ 2022; 10:e13194. [PMID: 35433124 PMCID: PMC9009327 DOI: 10.7717/peerj.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 01/12/2023] Open
Abstract
Background Executive function (EF) involves a series of high-level processes, such as inhibition, switching, and updating. Aging-related cognitive decline has been shown to be strongly associated with EF worsening. The aims of this study were to perform a meta-analysis to evaluate the effects of exergaming, an emerging intervention, on EF performance in older adults and to conduct a moderator analysis of exergaming effects on EF. Methods Randomized controlled trials examining exergaming influences on EF in older adults were collated by searching the Web of Science, Elsevier Science, PubMed, and Google Scholar databases. Statistical data were quantified in Comprehensive Meta-analysis software. Overall EF and EF domains (inhibition, switching, and updating) were analyzed separately. Results A total of 15 studies were included. The meta-analysis results indicated that exergaming had a significant influence on overall EF in the older adult (standardized mean difference (SMD) = 0.349, 95% confidence interval (CI) [0.191-0.506], p < 0.001). The same effects were also found in EF domains of inhibition (SMD = 0.415, 95% CI [0.102-0.729], p = 0.009), switching (SMD = 0.243, 95% CI [0.071-0.415], p = 0.005), and updating (SMD = 0.366, 95% CI [0.140-0.592], p = 0.002). The effects of exergaming on overall EF were found to be moderated by the frequency of the intervention (Q(1) = 3.537, p = 0.06). Conclusion Exergaming was confirmed to improve overall EF, as well as in older adults, and the effect of exergaming on EF was shown to be moderated by intervention frequency.
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Affiliation(s)
- Jiahui Jiang
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Wei Guo
- College of Physical Education, Yangzhou University, Yangzhou, China,Institute of Sports, Exercise and Brain, Yangzhou University, Yangzhou, China
| | - Biye Wang
- College of Physical Education, Yangzhou University, Yangzhou, China,Institute of Sports, Exercise and Brain, Yangzhou University, Yangzhou, China
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Acosta DJ, Rinfret A, Plant J, Hsu AT. Using Patient Simulation to Promote Best Practices in Fall Prevention and Postfall Assessment in Nursing Homes. J Nurs Care Qual 2022; 37:117-122. [PMID: 34593738 PMCID: PMC8860205 DOI: 10.1097/ncq.0000000000000599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fall-related injuries rise with age and are of particular concern for frail populations living in nursing homes. LOCAL PROBLEM The Perley and Rideau Veterans' Health Centre is a large nursing home in Ontario, Canada. In 2019, we conducted internal audits of our Falls Prevention Program and identified notable variations in staff's response to a resident fall. INTERVENTIONS We developed an in situ patient simulation program of a resident fall. METHODS This was a mixed-methods evaluation of participants' perspectives of a simulation-based interprofessional education program for fall prevention. RESULTS Participants indicated high-level support for simulation-based learning, with more than 80% of the participants expressing that they will apply these skills in the future when caring for a resident who falls. CONCLUSIONS Our findings indicate that simulation-based training is well received by frontline workers in a nursing home setting and can be conducted as part of a typical shift with minimal disruption to resident care.
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Affiliation(s)
- Daniela J. Acosta
- Centre of Excellence in Frailty-Informed Care, The Perley and Rideau Veterans' Health Centre, Ottawa, Ontario, Canada (Mss Acosta, Rinfret, and Plant and Dr Hsu); and Bruyère Research Institute, Ottawa, Ontario, Canada (Dr Hsu)
| | - Amber Rinfret
- Centre of Excellence in Frailty-Informed Care, The Perley and Rideau Veterans' Health Centre, Ottawa, Ontario, Canada (Mss Acosta, Rinfret, and Plant and Dr Hsu); and Bruyère Research Institute, Ottawa, Ontario, Canada (Dr Hsu)
| | - Jennifer Plant
- Centre of Excellence in Frailty-Informed Care, The Perley and Rideau Veterans' Health Centre, Ottawa, Ontario, Canada (Mss Acosta, Rinfret, and Plant and Dr Hsu); and Bruyère Research Institute, Ottawa, Ontario, Canada (Dr Hsu)
| | - Amy T. Hsu
- Centre of Excellence in Frailty-Informed Care, The Perley and Rideau Veterans' Health Centre, Ottawa, Ontario, Canada (Mss Acosta, Rinfret, and Plant and Dr Hsu); and Bruyère Research Institute, Ottawa, Ontario, Canada (Dr Hsu)
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Chimeno-Hernández A, Querol-Giner F, Pérez-Alenda S, Núñez-Cortés R, Cruz-Montecinos C, Carrasco JJ, Aguilar-Rodríguez M. Effectiveness of physical exercise on postural balance in patients with haemophilia: A systematic review. Haemophilia 2022; 28:409-421. [PMID: 35363925 PMCID: PMC9325530 DOI: 10.1111/hae.14556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Balance training is important to improve balance and to decrease the risk of falls in patients with haemophilia (PWH). AIM To analyse the current knowledge about the effectiveness of physical exercise on postural balance in PWH. METHODS A systematic search for clinical trials, published before November 2021, was conducted using the following electronic databases: PubMed/MEDLINE, Web of Science, Embase, Wiley Online Library and the Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers extracted the data and assessed the risk of bias. The certainty of the evidence was analyzed using GRADE. RESULTS A total of ten studies involving 304 patients were included. The studies performed strength and balance exercises, and some included flexibility, mobilization, and/or aerobic exercises in their training programs. Postural balance was evaluated using a force platform and the one leg stand test was the most frequently used. Only five exercise programs achieved a significant increase in balance (pre-post) with a strength, postural balance, flexibility, and aerobic intervention. In general, the quality rate of the risk of bias was fair but the overall quality of the evidence across the studies was very low. CONCLUSION Five studies showed that there is a positive change in balance after the intervention. However, there is currently an unclear demonstration of evidence for the use of physical exercises to improve postural balance in people with haemophilia. Further studies with a higher methodological quality are needed.
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Affiliation(s)
- Ana Chimeno-Hernández
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Felipe Querol-Giner
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Juan J Carrasco
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
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Wabe N, Siette J, Seaman KL, Nguyen AD, Raban MZ, Close JCT, Lord SR, Westbrook JI. The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data. BMC Geriatr 2022; 22:271. [PMID: 35365078 PMCID: PMC8973529 DOI: 10.1186/s12877-022-02973-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents. METHODS A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score > 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivityEvent Rate(ER) and specificityER. RESULTS A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivityER 33.6%) and specificity of 88.8% (specificityER 82.0%). The follow-up PH-FRAT assessments increased sensitivityER values although the specificityER decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivityER 74.4%) and specificity of 55.2% (specificityER 45.6%). CONCLUSIONS Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia
| | - Karla L Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy D Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,St Vincent's Clinical School, UNSW Medicine, UNSW, Sydney, NSW, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Brew B, Faux SG, Blanchard E. Effectiveness of a Smartwatch App in Detecting Induced Falls: Observational Study. JMIR Form Res 2022; 6:e30121. [PMID: 35311686 PMCID: PMC8981002 DOI: 10.2196/30121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/23/2021] [Accepted: 12/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Older adults are at an increased risk of falls with the consequent impacts on the health of the individual and health expenditure for the population. Smartwatch apps have been developed to detect a fall, but their sensitivity and specificity have not been subjected to blinded assessment nor have the factors that influence the effectiveness of fall detection been fully identified. Objective This study aims to assess accuracy metrics for a novel fall detection smartwatch algorithm. Methods We performed a cross-sectional study of 22 healthy adults comparing the detection of induced forward, side (left and right), and backward falls and near falls provided by a smartwatch threshold-based algorithm, with a video record of induced falls serving as the gold standard; a blinded assessor compared the two. Three different smartwatches with two different operating systems were used. There were 226 falls: 64 were backward, 51 forward, 55 left sided, and 56 right sided. Results The overall smartwatch app sensitivity for falls was 77%, the specificity was 99%, the false-positive rate was 1.7%, and the false-negative rate was 16.4%. The positive and negative predictive values were 98% and 84%, respectively, while the accuracy was 89%. There were 249 near falls: the sensitivity was 89%, the specificity was 100%, there were no false positives, 11% were false negatives, the positive predictive value was 100%, the false-negative predictive value was 83%, and the accuracy was 93%. Conclusions Falls were more likely to be detected if the fall was on the same side as the wrist with the smartwatch. There was a trend toward some smartwatches and operating systems having superior sensitivity, but these did not reach statistical significance. The effectiveness data and modifying factors pertaining to this smartwatch app can serve as a reference point for other similar smartwatch apps.
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Affiliation(s)
- Bruce Brew
- Department of Neurology, St Vincent's Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Steven G Faux
- University of New South Wales, Sydney, Australia.,Sacred Heart Rehabilitation Service, St Vincent's Hospital, Sydney, Australia
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Using Machine Learning to Identify Feelings of Energy and Fatigue in Single-Task Walking Gait: An Exploratory Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12063083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The objective of this study was to use machine learning to identify feelings of energy and fatigue using single-task walking gait. Participants (n = 126) were recruited from a university community and completed a single protocol where current feelings of energy and fatigue were measured using the Profile of Moods Survey–Short Form approximately 2 min prior to participants completing a two-minute walk around a 6 m track wearing APDM mobility monitors. Gait parameters for upper and lower extremity, neck, lumbar and trunk movement were collected. Gradient boosting classifiers were the most accurate classifiers for both feelings of energy (74.3%) and fatigue (74.2%) and Random Forest Regressors were the most accurate regressors for both energy (0.005) and fatigue (0.007). ANCOVA analyses of gait parameters comparing individuals who were high or low energy or fatigue suggest that individuals who are low energy have significantly greater errors in walking gait compared to those who are high energy. Individuals who are high fatigue have more symmetrical gait patterns and have trouble turning when compared to their low fatigue counterparts. Furthermore, these findings support the need to assess energy and fatigue as two distinct unipolar moods as the signals used by the algorithms were unique to each mood.
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46
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Canever JB, de Souza Moreira B, Danielewicz AL, de Avelar NCP. Are multimorbidity patterns associated with fear of falling in community-dwelling older adults? BMC Geriatr 2022; 22:192. [PMID: 35272634 PMCID: PMC8915478 DOI: 10.1186/s12877-022-02889-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/02/2022] [Indexed: 01/09/2023] Open
Abstract
Background Multimorbidity is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in the same individual and can be grouped into different patterns based on the type of disease. These patterns are associated with poorer quality of life and premature death. It is believed that these patterns entail functional limitations, which may contribute to the fear of falling; however, this association remains unknown. Identifying this possible association is fundamental for developing individual and collective care approaches aimed at preventing the different patterns of chronic diseases in older adults in order to decrease the fear of falling. The objective of this study was to investigate the association between multimorbidity patterns and fear of falling in older adults. Methods This was a cross-sectional study including 308 older adults. The exposure variables were the presence of three multimorbidity patterns (cardiopulmonary, musculoskeletal, and vascular-metabolic) and pattern association assessed by self-report of two or more similar coexisting chronic diseases. The outcome was fear of falling assessed by the Brazilian version of Falls Efficacy Scale-International (cut-off point ≥ 23 points). Multivariable logistic regression was used to analyze the association between variables. Results Older adults with cardiopulmonary, musculoskeletal, vascular-metabolic patterns and pattern association had 3.49 (95%CI 1.13; 10.78), 2.03 (95%CI 1.13; 3.64), 2.14 (95%CI 1.20; 3.82), and 4.84 (95%CI 2.19; 10.68), respectively, greater chances of presenting fear of falling when compared to older adults without the patterns. Conclusions The presence of multimorbidity patterns is associated with higher chances of reporting fear of falling. It is emphasized that the introduction of public health programs aimed at preventing multimorbidity patterns is essential to reduce possible adverse health outcomes, including fear of falling and its negative consequences for older adult health.
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Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | | | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil.
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de Souza Moreira B, Cristina de Souza Andrade A, Xavier CC, Proietti FA, Braga LDS, Friche AADL, Teixeira Caiaffa W. Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:522-534. [PMID: 32568556 DOI: 10.1080/09603123.2020.1782354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.
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Affiliation(s)
- Bruno de Souza Moreira
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Luciana de Souza Braga
- Department of Preventive and Social Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amélia Augusta de Lima Friche
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Waleska Teixeira Caiaffa
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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48
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Effects of age and surface instability on the control of the center of mass. Hum Mov Sci 2022; 82:102930. [PMID: 35123153 DOI: 10.1016/j.humov.2022.102930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
During standing, posture can be controlled by accelerating the Center of Mass (CoM) through shifting the center of pressure (CoP) within the base of support by applying ankle moments ("CoP mechanism"), or through the "counter-rotation mechanism", i.e., changing the angular momentum of segments around the CoM to change the direction of the ground reaction force. Postural control develops over the lifespan; at both the beginning and the end of the lifespan adequate postural control appears more challenging. In this study, we aimed to assess mediolateral balance performance and the related use of the postural control mechanisms in children, older adults and younger adults when standing on different (unstable) surfaces. Sixteen pre-pubertal children (6-9y), 17 younger adults (18-24y) and eight older adults (65-80y) performed bipedal upright standing trials of 16 s on a rigid surface and on three balance boards that could freely move in the frontal plane, varying in height (15-19 cm) of the surface of the board above the point of contact with the floor. Full body kinematics (16 segments, 48 markers, using SIMI 3D-motion analysis system (GmbH) and DeepLabCut and Anipose) were retrieved. Performance related outcome measures, i.e., the number of trials with balance loss and the Root Mean Square (RMS) of the time series of the CoM acceleration, the contributions of the CoP mechanism and the counter-rotation mechanism to the CoM acceleration in the frontal plane and selected kinematic measures, i.e. the orientation of the board and the head and the Mean Power Frequency (MPF) of the balance board orientation and the CoM acceleration were determined. Balance loss only occurred when standing on the highest balance board, twice in one older adult once in one younger adult. In children and older adults, the RMS of the CoM accelerations were larger, corresponding to poorer balance performance. Across age groups and conditions, the contribution of the CoP mechanism to the total CoM acceleration was much larger than that of the counter-rotation mechanisms, ranging from 94% to 113% vs 23% to 38% (with totals higher than 100% indicating opposite effects of both mechanisms). Deviations in head orientation were small compared to deviations in balance board orientation. We suggest that the CoP mechanism is dominant, since the counter-rotation mechanism would conflict with stabilizing the orientation of the head in space.
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49
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Nualyong T, Siriphorn A. Accuracy of the figure of 8 walk test with and without dual-task to predict falls in older adults. J Bodyw Mov Ther 2022; 30:69-75. [DOI: 10.1016/j.jbmt.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022]
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Spanò B, Lombardi MG, De Tollis M, Szczepanska MA, Ricci C, Manzo A, Giuli S, Polidori L, Griffini IA, Adriano F, Caltagirone C, Annicchiarico R. Effect of Dual-Task Motor-Cognitive Training in Preventing Falls in Vulnerable Elderly Cerebrovascular Patients: A Pilot Study. Brain Sci 2022; 12:168. [PMID: 35203932 PMCID: PMC8869774 DOI: 10.3390/brainsci12020168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
Falling is a frequent and major clinical problem among older adults, as well as in patients with chronic cerebrovascular diseases (CVD). At present, sequential (mixed) and simultaneously (dual-task) motor-cognitive trainings are the best approaches to affording patients more autonomy in their everyday motor independence while reducing fall risks and consequences. The objective of this study was to evaluate the efficacy of an advanced and innovative dual-task motor-cognitive rehabilitation program on fall risks in vulnerable older persons with chronic CVD. To this purpose, 26 consecutive older fallers with chronic CVD were recruited, and completed a mixed motor-cognitive or a dual-task motor-cognitive training program. Each patient also underwent two test evaluations to assess balance, gait, fear of falling, and walking performance at pre-and post-intervention. We found that our experimental motor-cognitive dual-task rehabilitation program could be an effective method to improve walking balance, gait, walking speed, and fear of falling, while reducing the risk of falls in older people with chronic CVD. Furthermore, results show that the simultaneous motor-cognitive training is more effective than the sequential motor-cognitive training. Therefore, our study brings innovative data, which can contribute positively to the management of this population.
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Affiliation(s)
- Barbara Spanò
- Technology and Training Methods for Disability Care Laboratory, Department of Clinical and Behavioral Neurology, Santa Lucia Foundation IRCCS, 00179 Rome, Italy; (M.G.L.); (M.D.T.); (M.A.S.); (C.R.); (A.M.); (S.G.); (L.P.); (I.A.G.); (F.A.); (C.C.); (R.A.)
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