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Menz HB, Bergin SM, McClelland JA, Munteanu SE. Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data. Gerontology 2024; 70:611-619. [PMID: 38626742 DOI: 10.1159/000538731] [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: 12/18/2023] [Accepted: 03/31/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate. METHODS Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and fall characteristics (proposed mechanism and fall direction). RESULTS There were 300 falls experienced by 118 older adults aged 58 years-98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%), and wearing shoes (7/99 falls, 7%). CONCLUSION Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.
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Affiliation(s)
- Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shan M Bergin
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jodie A McClelland
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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2
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Ullrich P, Werner C, Schönstein A, Bongartz M, Eckert T, Beurskens R, Abel B, Bauer JM, Lamb SE, Hauer K. Effects of a Home-Based Physical Training and Activity Promotion Program in Community-Dwelling Older Persons with Cognitive Impairment after Discharge from Rehabilitation: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2022; 77:2435-2444. [PMID: 35022728 DOI: 10.1093/gerona/glac005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status. METHODS Patients with mild to moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance, and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time). RESULTS Among 118 randomized participants (82.3 ± 6.0 years) with CI (MMSE: 23.3 ± 2.4) and high levels of multimorbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95% CI: 1.0-2.8; p < .001), with persistent benefits over the follow-up (1.3 points; 95% CI: 0.4-2.2; p < .001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term. CONCLUSIONS The results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multimorbid population. CLINICAL TRIAL REGISTRATION ISRCTN82378327.
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Affiliation(s)
- Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Christian Werner
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Anton Schönstein
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Martin Bongartz
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Tobias Eckert
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Rainer Beurskens
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany.,FHM Bielefeld, University of Applied Sciences, Bielefeld, Germany
| | - Bastian Abel
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Jürgen M Bauer
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
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3
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Hildebrand A, Jacobs PG, Folsom JG, Mosquera-Lopez C, Wan E, Cameron MH. Comparing fall detection methods in people with multiple sclerosis: A prospective observational cohort study. Mult Scler Relat Disord 2021; 56:103270. [PMID: 34562766 DOI: 10.1016/j.msard.2021.103270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
Abstract
Background Falls occur across the population but are more common, and have more negative sequelae, in people with multiple sclerosis (MS). Given the prevalence and impact of falls, accurate measures of fall frequency are needed. This study compares the sensitivity and false discovery rates of three methods of fall detection: the current gold standard, prospective paper fall calendars, real-time self-reporting and automated detection, the latter two from a novel body-worn device. Methods Falls in twenty-five people with MS were recorded for eight weeks with prospective fall calendars, real-time body-worn self-report, and an automated body-worn detector concurrently. Eligible individuals were adults with MS enrolled in a randomized controlled trial of a fall prevention intervention. Entry criteria were at least two falls or near-falls in the previous two months, Expanded Disability Status Scale ≤ 6.0, community dwelling, and no MS relapse in the previous month. The sensitivity (proportion of true falls detected) and false discovery rates (proportion of false reports generated) of the fall detection methods were compared. A true fall was a fall reported by at least two methods. A false report was a fall reported by only one method. The trial is registered on ClinicalTrials.gov (NCT02583386) and is closed. Results In the 1,276 person-days of fall counting with all three methods in use simultaneously there were 1344 unique fall events. Of these, 8.5% (114) were true falls and 91.5% (1230) were false reports. Fall calendars had the lowest sensitivity (0.614) and the lowest false discovery rate (0.067). The automated detector had the highest sensitivity (0.921) and the highest false discovery rate (0.919). All methods generated under one false report per day. There were no fall detection-related adverse events. Conclusion Fall calendars likely underestimate fall frequency by around 40%. The automated detector evaluated here misses very few falls but likely overestimates the number of falls by around one fall per day. Additional research is needed to produce an ideal fall detection and counting method for use in clinical and research applications. Funding United States Department of Veterans Affairs, Rehabilitations Research and Development Service.
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Affiliation(s)
- Andrea Hildebrand
- Department of Neurology, VA Portland Health Care System, Oregon Health and Science University, 3710 SW US Veterans Hospital Rd., Mail Code P3MSCOE, Portland, OR 97239, United States.
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code CH13B, Portland, OR 97239, United States
| | - Jonathon G Folsom
- Department of Biomedical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code CH13B, Portland, OR 97239, United States
| | - Clara Mosquera-Lopez
- Department of Biomedical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code CH13B, Portland, OR 97239, United States
| | - Eric Wan
- Department of Electrical and Computer Engineering, Portland State University, 1900 SW 4th Avenue, Portland, OR 97201, United States
| | - Michelle H Cameron
- Department of Neurology, VA Portland Health Care System, Oregon Health and Science University, 3710 SW US Veterans Hospital Rd., Mail Code P-3-NEU, Portland, OR 97239, United States
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4
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Harari Y, Shawen N, Mummidisetty CK, Albert MV, Kording KP, Jayaraman A. A smartphone-based online system for fall detection with alert notifications and contextual information of real-life falls. J Neuroeng Rehabil 2021; 18:124. [PMID: 34376199 PMCID: PMC8353784 DOI: 10.1186/s12984-021-00918-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/28/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls are a leading cause of accidental deaths and injuries worldwide. The risk of falling is especially high for individuals suffering from balance impairments. Retrospective surveys and studies of simulated falling in lab conditions are frequently used and are informative, but prospective information about real-life falls remains sparse. Such data are essential to address fall risks and develop fall detection and alert systems. Here we present the results of a prospective study investigating a proof-of-concept, smartphone-based, online system for fall detection and notification. METHODS The system uses the smartphone's accelerometer and gyroscope to monitor the participants' motion, and falls are detected using a regularized logistic regression. Data on falls and near-fall events (i.e., stumbles) is stored in a cloud server and fall-related variables are logged onto a web portal developed for data exploration, including the event time and weather, fall probability, and the faller's location and activity before the fall. RESULTS In total, 23 individuals with an elevated risk of falling carried the phones for 2070 days in which the model classified 14,904,000 events. The system detected 27 of the 37 falls that occurred (sensitivity = 73.0 %) and resulted in one false alarm every 46 days (specificity > 99.9 %, precision = 37.5 %). 42.2 % of the events falsely classified as falls were validated as stumbles. CONCLUSIONS The system's performance shows the potential of using smartphones for fall detection and notification in real-life. Apart from functioning as a practical fall monitoring instrument, this system may serve as a valuable research tool, enable future studies to scale their ability to capture fall-related data, and help researchers and clinicians to investigate real-falls.
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Affiliation(s)
- Yaar Harari
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan Ability Lab, IL, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Nicholas Shawen
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan Ability Lab, IL, Chicago, USA
- Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, USA
| | - Konrad P Kording
- Departments of Bioengineering and Neuroscience, University of Pennsylvania, Philadelphia, PA, USA
| | - Arun Jayaraman
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan Ability Lab, IL, Chicago, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
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5
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Del Din S, Galna B, Lord S, Nieuwboer A, Bekkers EMJ, Pelosin E, Avanzino L, Bloem BR, Olde Rikkert MGM, Nieuwhof F, Cereatti A, Della Croce U, Mirelman A, Hausdorff JM, Rochester L. Falls Risk in Relation to Activity Exposure in High-Risk Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:1198-1205. [PMID: 31942969 PMCID: PMC7243591 DOI: 10.1093/gerona/glaa007] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 11/27/2022] Open
Abstract
Background Physical activity is linked to many positive health outcomes, stimulating the development of exercise programs. However, many falls occur while walking and so promoting activity might paradoxically increase fall rates, causing injuries, and worse quality of life. The relationship between activity exposure and fall rates remains unclear. We investigated the relationship between walking activity (exposure to risk) and fall rates before and after an exercise program (V-TIME). Methods One hundred and nine older fallers, 38 fallers with mild cognitive impairment (MCI), and 128 fallers with Parkinson’s disease (PD) were randomly assigned to one of two active interventions: treadmill training only or treadmill training combined with a virtual reality component. Participants were tested before and after the interventions. Free-living walking activity was characterized by volume, pattern, and variability of ambulatory bouts using an accelerometer positioned on the lower back for 1 week. To evaluate that relationship between fall risk and activity, a normalized index was determined expressing fall rates relative to activity exposure (FRA index), with higher scores indicating a higher risk of falls per steps taken. Results At baseline, the FRA index was higher for fallers with PD compared to those with MCI and older fallers. Walking activity did not change after the intervention for the groups but the FRA index decreased significantly for all groups (p ≤ .035). Conclusions This work showed that V-TIME interventions reduced falls risk without concurrent change in walking activity. We recommend using the FRA index in future fall prevention studies to better understand the nature of intervention programs.
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Affiliation(s)
- Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sue Lord
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Belgium
| | - Esther M J Bekkers
- KU Leuven, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Belgium
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genova, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Italy
| | - Bastiaan R Bloem
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Freek Nieuwhof
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Radboud University Medical Center, Department of Geriatric Medicine, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Andrea Cereatti
- Department of Biomedical Sciences, Bioengineering Unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- Department of Biomedical Sciences, Bioengineering Unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Jeffrey M Hausdorff
- Laboratory for Early Markers of Neurodegeneration, Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel.,Department of Physical Therapy, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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6
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Hauer K, Schwenk M, Englert S, Zijlstra R, Tuerner S, Dutzi I. Mismatch of Subjective and Objective Risk of Falling in Patients with Dementia. J Alzheimers Dis 2020; 78:557-572. [PMID: 33016908 DOI: 10.3233/jad-200572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. OBJECTIVE To analyze mismatch of objective and subjective fall risk and associated factors in PwD. METHOD Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti's Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables. RESULTS In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less concerns about falling due to previous falls (OR 0.25), and higher quality of life (OR 1.10), while overestimation (28.9%) was determined by higher rate of support seeking strategies (OR 50.3), activity avoidance (OR 15.2), better executive (OR 21.0) and memory functions (OR 21.5), and lower quality of life (OR.75) in multivariate logistic regression. CONCLUSION The majority of patients showed a mismatch between objective and subjective falls risk. Underestimation as well as overestimation of fall risk was associated with specific profiles based on cognitive- and psychological status, falls and fall-related behavioral consequences which should be included in the comprehensive assessment of fall risk, and planning of individualized fall prevention programs for this population.
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Affiliation(s)
- Klaus Hauer
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Michael Schwenk
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Stefan Englert
- Institute of Medical Biometry und Informatics; Department of Medical Biometry at the University of Heidelberg, Heidelberg, Germany
| | - Rixt Zijlstra
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, Netherlands
| | - Sabine Tuerner
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Ilona Dutzi
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
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Hauer K, Dutzi I, Gordt K, Schwenk M. Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5385. [PMID: 32962248 PMCID: PMC7570858 DOI: 10.3390/s20185385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann-Whitney-U tests, and Chi-square tests between patients with ("in-hospital fallers") and without an in-hospital fall ("in-hospital non-fallers"), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.
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Affiliation(s)
- Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Centre at the Heidelberg University, 69126 Heidelberg, Germany; (K.H.); (I.D.)
| | - Ilona Dutzi
- Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Centre at the Heidelberg University, 69126 Heidelberg, Germany; (K.H.); (I.D.)
| | - Katharina Gordt
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany;
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, 69115 Heidelberg, Germany
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8
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Feasibility and Accuracy of Different Methods for Collecting Data on Falls Among Older People With Dementia. Alzheimer Dis Assoc Disord 2019; 34:362-365. [PMID: 31789633 PMCID: PMC7116406 DOI: 10.1097/wad.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. This study compared different methods for collecting data on falls among people with dementia to identify which is most feasible and accurate. Eighty-three dyads, comprised of a community-dwelling person with dementia and their informal carer, participated in the TAi ChI for people with demenTia (TACIT) trial. Falls were collected prospectively over 6 months using monthly calendars, weekly and monthly telephone interviews, and 3-monthly telephone interviews with the carer. Unique falls identified across the reporting methods were combined, and this total was compared against each reporting method in isolation and combinations. A higher frequency of falls indicated greater accuracy. Falls data collection was most feasible with weekly telephone interviews (84%), and most accurate with the combination of weekly telephone interviews with monthly calendars (96%). For the greatest completeness and accuracy of falls data with community-dwelling people with dementia, researchers should use both weekly telephone interviews and monthly calendars.
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9
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Benzinger P. [What should we do with fallers?]. MMW Fortschr Med 2019; 161:42-45. [PMID: 31828632 DOI: 10.1007/s15006-019-1235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Petra Benzinger
- Geriatrisches Zentrum am Bethanien, Krankenhaus Heidelberg, Universität Heidelberg, Rohrbacher Str. 149, D-69126, Heidelberg, Deutschland.
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Nyman SR, Ingram W, Sanders J, Thomas PW, Thomas S, Vassallo M, Raftery J, Bibi I, Barrado-Martín Y. Randomised Controlled Trial Of The Effect Of Tai Chi On Postural Balance Of People With Dementia. Clin Interv Aging 2019; 14:2017-2029. [PMID: 31819385 PMCID: PMC6875562 DOI: 10.2147/cia.s228931] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/26/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose To investigate the effect of Tai Chi exercise on postural balance among people with dementia (PWD) and the feasibility of a definitive trial on falls prevention. Patients and methods Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus weekly Tai Chi classes and home practice for 20 weeks (n=42). The primary outcome was the timed up and go test. All outcomes for PWD and their carers were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period. Results For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = -2.17, 3.81). At follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, standardised effect size [ES] = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi. Conclusion With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD [Trial registration: NCT02864056].
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Affiliation(s)
- Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Plymouth, Devon PL4 8AA, UK
| | - Jeanette Sanders
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Plymouth, Devon PL4 8AA, UK
| | - Peter W Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK
| | - Sarah Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK
| | - Michael Vassallo
- Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK
| | - James Raftery
- Faculty of Medicine, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Iram Bibi
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK
| | - Yolanda Barrado-Martín
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK
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Dautel A, Eckert T, Gross M, Hauer K, Schäufele M, Lacroix A, Hendlmeier I, Abel B, Pomiersky R, Gugenhan J, Büchele G, Reber KC, Becker C, Pfeiffer K. Multifactorial intervention for hip and pelvic fracture patients with mild to moderate cognitive impairment: study protocol of a dual-centre randomised controlled trial (OF-CARE). BMC Geriatr 2019; 19:125. [PMID: 31039754 PMCID: PMC6492424 DOI: 10.1186/s12877-019-1133-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background A hip or pelvic fracture is a major fall-related injury which often causes a decline in mobility performance and physical activity. Over 40% of patients with hip fracture have cognitive impairment or dementia and poorer rehabilitation outcomes than those without cognitive impairment. In this subgroup, there is a lack of evidence on the best practices supporting recovery. The main aim of this study is to investigate the effects of a transitional care intervention after inpatient rehabilitation on physical activity and functional performance in this group of cognitively impaired patients. Methods/design This dual-centre, randomised controlled trial compares a multifactorial intervention with usual care as control condition. Two hundred and forty community-dwellers (≥ 65 years) with a hip or pelvic fracture and mild to moderate cognitive impairment (MMSE 17–26) are recruited at the end of inpatient rehabilitation. The four-month intervention consists of (a) an individually tailored, progressive home exercise program and physical activity promotion delivered by professional instructors and lay instructors (two home visits per week) and (b) a long-term care counselling approach addressing unmet care needs, pleasurable activities, and caregiver issues if needed. Primary outcome parameters are physical activity, measured as daily walking duration with an accelerometer-based activity monitor (activPAL™) over 72 h, and functional performance, assessed with Short Physical Performance Battery sum scores. Secondary outcome parameters are fear of falling, fall related self-efficacy, falls, quality of life, depression and activity of daily living. Data are collected at the end of rehabilitation, before the intervention at the patient’s home (baseline), after four months (post-intervention), and seven months (follow-up). In addition to completer and intent-to-treat analyses of outcomes, economic data and incremental cost-effectiveness are analysed. Discussion Existing service models of volunteer services and legal counselling provided by care counsellors were considered when developing the intervention protocol. Therefore, it should be feasible to translate and deliver the intervention into real-world practice if it has been demonstrated to be effective. Trial registration German Clinical Trials Register, DRKS00008863 (Accessed 17 Apr 2019), ISRCTN registry, ISRCTN69957256 (Accessed 17 Apr 2019).
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Affiliation(s)
- Anja Dautel
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | | | - Michaela Gross
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Martina Schäufele
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | | | - Ingrid Hendlmeier
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Bastian Abel
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Rebekka Pomiersky
- Agaplesion Bethanien Hospital, Heidelberg, Germany.,Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Katrin C Reber
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg, Hamburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany.
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12
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Ullrich P, Eckert T, Bongartz M, Werner C, Kiss R, Bauer JM, Hauer K. Life-space mobility in older persons with cognitive impairment after discharge from geriatric rehabilitation. Arch Gerontol Geriatr 2018; 81:192-200. [PMID: 30605862 DOI: 10.1016/j.archger.2018.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/11/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation. METHODS A cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17-26) following geriatric rehabilitation was conducted. Life-space mobility (LSM) was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI). Bivariate analyses and multivariate regression analyses were used to investigate associations between LSM and physical, cognitive, psychosocial, environmental, financial and demographic characteristics, and physical activity behavior. RESULTS LSM in 118 older, multimorbid participants (age: 82.3 ± 6.0 years) with cognitive impairment (MMSE score: 23.3 ± 2.4 points) was substantially limited, depending on availability of personal support and equipment. More than 30% of participants were confined to the neighborhood and half of all patients could not leave the bedroom without equipment or assistance. Motor performance, social activities, physical activity, and gender were identified as independent determinants of LSM and explained 42.4% (adjusted R²) of the LSA-CI variance in the regression model. CONCLUSION The study documents the highly restricted LSM in older persons with CI following geriatric rehabilitation. The identified modifiable determinants of LSM show potential for future interventions to increase LSM in such a vulnerable population at high risk for restrictions in LSM by targeting motor performance, social activities, and physical activity. A gender-specific approach may help to address more advanced restrictions in women.
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Affiliation(s)
- Phoebe Ullrich
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Tobias Eckert
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Martin Bongartz
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Christian Werner
- Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Rainer Kiss
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany; Department of Health and Social Affairs, FHM Bielefeld, University of Applied Science, Ravensberger Str. 10G, 33602 Bielefeld, Germany
| | - Jürgen M Bauer
- Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Klaus Hauer
- Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany.
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13
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Nyman SR, Hayward C, Ingram W, Thomas P, Thomas S, Vassallo M, Raftery J, Allen H, Barrado-Martín Y. A randomised controlled trial comparing the effectiveness of tai chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: protocol for the TACIT trial (TAi ChI for people with demenTia). BMC Geriatr 2018; 18:263. [PMID: 30390620 PMCID: PMC6215631 DOI: 10.1186/s12877-018-0935-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/03/2018] [Indexed: 02/01/2023] Open
Abstract
Background Falls are a public health issue for the older adult population and more so for people with dementia (PWD). Compared with their cognitively intact peers, PWD are at higher risk of falls and injurious falls. This randomised controlled trial aims to test the clinical and cost effectiveness of Tai Chi to improve postural balance among community-dwelling PWD and to assess the feasibility of conducting a larger definitive trial to reduce the incidence of falls among PWD. Methods A 3-centre parallel group randomised controlled trial with embedded process evaluation. One hundred and fifty community-dwelling dyads of a person with dementia and their informal carer will be recruited and assessed at baseline and at six-month follow-up. Dyads will be randomised in a 1:1 ratio to either usual care or usual care plus a Tai Chi intervention for 20 weeks. The Tai Chi intervention will consist of weekly classes (45 min’ Tai Chi plus up to 45 min for informal discussion, with up to 10 dyads per class) and home-based exercises (20 min per day to be facilitated by the carer). Home practice of Tai Chi will be supported by the use of behaviour change techniques with the Tai Chi instructor at a home visit in week 3–4 of the intervention (action planning, coping planning, self-monitoring, and alarm clock reminder) and at the end of each class (feedback on home practice). The primary outcome is dynamic balance measured using the Timed Up and Go test, coinciding with the end of the 20-week intervention phase for participants in the Tai Chi arm. Secondary outcomes for PWD include functional balance, static balance, fear of falling, global cognitive functioning, visual-spatial cognitive functioning, quality of life, and falls. Secondary outcomes for carers include dynamic balance, static balance, quality of life, costs, and carer burden. Discussion This trial is the first in the UK to test the effectiveness of Tai Chi to improve balance among PWD. The trial will inform a future study that will be the first in the world to use Tai Chi in a trial to prevent falls among PWD. Trial registration NCT02864056.
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Affiliation(s)
- Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science & Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset, BH12 5BB, UK.
| | - Christopher Hayward
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Peter Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Sarah Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Michael Vassallo
- Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - James Raftery
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Helen Allen
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Yolanda Barrado-Martín
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science & Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset, BH12 5BB, UK
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Falls and Physical Activity in Persons With Mild to Moderate Dementia Participating in an Intensive Motor Training: Randomized Controlled Trial. Alzheimer Dis Assoc Disord 2018. [PMID: 28628488 DOI: 10.1097/wad.0000000000000201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Physical activity is beneficial in people with dementia. As physical activity increases risk exposure for falls, safety concerns arise. Prior exercise trials in people with dementia have not measured physical activity. Falls in relation to exposure time rather than person-years as outcome measure has been promoted but not investigated in people with dementia. METHODS Patients with mild to moderate dementia (n=110) were randomized to an intensive, progressive strength and functional training intervention or to a low-intensity group training for 12 weeks each. Physical activity was measured with a standardized questionnaire. Falls were documented prospectively by calendars for 12 months. RESULTS During the intervention, physical activity was significantly higher in the intervention group (P<0.001) without an increased fall rate (intervention group vs. CONTROL GROUP 2.89 vs. 1.94; incidence rate ratio, 1.49; 95% confidence interval, 0.66-3.36; P=0.333). In the subgroup of multiple fallers, the number of falls per 1000 hours of activity was significantly lower in the intervention group (8.85 vs. 18.67; P=0.017). CONCLUSIONS Increased physical activity during exercise intervention was safe in people with mild to moderate dementia. Fall rate adjusted for physical activity is a useful and sensitive outcome measure in addition to fall rate per person-years.
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15
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Harwood RH, van der Wardt V, Goldberg SE, Kearney F, Logan P, Hood-Moore V, Booth V, Hancox JE, Masud T, Hoare Z, Brand A, Edwards RT, Jones C, das Nair R, Pollock K, Godfrey M, Gladman JRF, Vedhara K, Smith H, Orrell M. A development study and randomised feasibility trial of a tailored intervention to improve activity and reduce falls in older adults with mild cognitive impairment and mild dementia. Pilot Feasibility Stud 2018; 4:49. [PMID: 29468084 PMCID: PMC5816352 DOI: 10.1186/s40814-018-0239-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND People with dementia progressively lose abilities and are prone to falling. Exercise- and activity-based interventions hold the prospect of increasing abilities, reducing falls, and slowing decline in cognition. Current falls prevention approaches are poorly suited to people with dementia, however, and are of uncertain effectiveness. We used multiple sources, and a co-production approach, to develop a new intervention, which we will evaluate in a feasibility randomised controlled trial (RCT), with embedded adherence, process and economic analyses. METHODS We will recruit people with mild cognitive impairment or mild dementia from memory assessment clinics, and a family member or carer. We will randomise participants between a therapy programme with high intensity supervision over 12 months, a therapy programme with moderate intensity supervision over 3 months, and brief falls assessment and advice as a control intervention. The therapy programmes will be delivered at home by mental health specialist therapists and therapy assistants. We will measure activities of daily living, falls and a battery of intermediate and distal health status outcomes, including activity, balance, cognition, mood and quality of life. The main aim is to test recruitment and retention, intervention delivery, data collection and other trial processes in advance of a planned definitive RCT. We will also study motivation and adherence, and conduct a process evaluation to help understand why results occurred using mixed methods, including a qualitative interview study and scales measuring psychological, motivation and communication variables. We will undertake an economic study, including modelling of future impact and cost to end-of-life, and a social return on investment analysis. DISCUSSION In this study, we aim to better understand the practicalities of both intervention and research delivery, and to generate substantial new knowledge on motivation, adherence and the approach to economic analysis. This will enable us to refine a novel intervention to promote activity and safety after a diagnosis of dementia, which will be evaluated in a definitive randomised controlled trial. TRIAL REGISTRATION ClinicalTrials.gov: NCT02874300; ISRCTN 10550694.
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Affiliation(s)
- Rowan H. Harwood
- Health Care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH UK
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | | | - Sarah E. Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Fiona Kearney
- Health Care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Vicky Hood-Moore
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Vicky Booth
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Jennie E. Hancox
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Tahir Masud
- Health Care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH UK
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, Bangor University, Bangor, LL57 2PZ UK
| | - Andrew Brand
- NWORTH Clinical Trials Unit, Bangor University, Bangor, LL57 2PZ UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ UK
| | - Roshan das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, NG8 1BB UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Maureen Godfrey
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - John R. F. Gladman
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Kavita Vedhara
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD UK
| | - Helen Smith
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, NG6 9RD UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, NG8 1BB UK
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16
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Klenk J, Becker C, Palumbo P, Schwickert L, Rapp K, Helbostad JL, Todd C, Lord SR, Kerse N. Conceptualizing a Dynamic Fall Risk Model Including Intrinsic Risks and Exposures. J Am Med Dir Assoc 2017; 18:921-927. [DOI: 10.1016/j.jamda.2017.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
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Bayen E, Jacquemot J, Netscher G, Agrawal P, Tabb Noyce L, Bayen A. Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study. J Med Internet Res 2017; 19:e339. [PMID: 29042342 PMCID: PMC5663952 DOI: 10.2196/jmir.8095] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background Falls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool. Objective The objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care. Methods A pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24×7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents’ falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice. Results Over 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents. Conclusions Video monitoring offers high potential to support conventional care in memory care facilities.
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Affiliation(s)
- Eleonore Bayen
- Pitie-Salpetriere Hospital - Assistance Publique Hôpitaux de Paris (APHP) & University Pierre et Marie Curie, Department of Neuro-Rehabilitation, Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, Paris, France
| | - Julien Jacquemot
- SafelyYou Inc. at SkyDeck (Chief Technology Officer), Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, United States
| | - George Netscher
- SafelyYou Inc. at SkyDeck (Chief Technology Officer), Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, United States
| | - Pulkit Agrawal
- SafelyYou Inc. at SkyDeck (Chief Architect), Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, United States
| | | | - Alexandre Bayen
- Center for Information Technology Research in the Interest of Society and SafelyYou Inc. at SkyDeck (Chief Scientist), Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, United States
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18
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Hannou S, Voirol P, Pannatier A, Weibel ML, Sadeghipour F, von Gunten A, Mall JF, De Giorgi Salamun I. Pharmacist intervention acceptance for the reduction of potentially inappropriate drug prescribing in acute psychiatry. Int J Clin Pharm 2017; 39:1228-1236. [PMID: 28905171 DOI: 10.1007/s11096-017-0513-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/19/2017] [Indexed: 12/28/2022]
Abstract
Background Prescribing for the elderly is challenging. A previous observational study conducted in our geriatric psychiatry admission unit (GPAU) using STOPP/START criteria showed a high number of potentially inappropriate drug prescriptions (PIDPs). A clinical pharmacist was added to our GPAU as a strategy to reduce PIDPs. Objective The objective of the present study was to assess the impact of a clinical pharmacist on PIDPs by measuring acceptance rates of pharmacist interventions (PhIs). Setting This study was conducted at the GPAU of Lausanne University Hospital. Method The clinical pharmacist attended four GPAU meetings weekly. Complete medication reviews were performed daily. The clinical pharmacist conducted standard analyses based on clinical judgment and STOPP/START criteria assessment. A PhI was generated when a PIDP was detected. When a PhI was accepted, the PIDP was considered as eliminated. Acceptance rate of PhI was calculated (number of PhI accepted/total number of PhI). Main outcome measure PhIs acceptance rates. Results In a cohort of 102 patients seen between July 2013 and February 2014, a total of 697 PhIs (average 6.8/patient) were made based on standard evaluation (n = 479) and STOPP/START criteria (n = 243). The global acceptance rate was 68% (standard, 78%; STOPP/START, 47%). Conclusion Good PhIs acceptance rates demonstrated that a clinical pharmacist can reduce PIDPs in a GPAU. PhIs based on standard evaluation had a higher acceptance than those based on STOPP/START criteria, probably because they are better adapted to individual patients. However, these two evaluation approaches can be used in a complementary manner.
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Affiliation(s)
- Sophia Hannou
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Voirol
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | - André Pannatier
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | | | - Farshid Sadeghipour
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | - Armin von Gunten
- Geriatric Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Frédéric Mall
- Geriatric Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
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Bongartz M, Kiss R, Ullrich P, Eckert T, Bauer J, Hauer K. Development of a home-based training program for post-ward geriatric rehabilitation patients with cognitive impairment: study protocol of a randomized-controlled trail. BMC Geriatr 2017; 17:214. [PMID: 28899341 PMCID: PMC5596467 DOI: 10.1186/s12877-017-0615-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/07/2017] [Indexed: 01/31/2023] Open
Abstract
Background Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI. Methods A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness. Discussion Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI. Trial registration International Standard Randomized Controlled Trial (#ISRCTN82378327). Registered: August 10, 2015.
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Affiliation(s)
- Martin Bongartz
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
| | - Rainer Kiss
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany
| | - Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany
| | - Tobias Eckert
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany
| | - Jürgen Bauer
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.,Department of Geriatrics, University of Heidelberg, 69117, Heidelberg, Germany
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany
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Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JCT. Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment. Am J Geriatr Psychiatry 2017; 25:397-406. [PMID: 28063853 DOI: 10.1016/j.jagp.2016.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the relationship between cognitive performance and falls in older people with mild to moderate cognitive impairment (CI) by investigating the mediational effects of medical, medication, neuropsychological, and physiological factors. DESIGN Secondary analysis, prospective cohort study. SETTING Community and low-level care. PARTICIPANTS 177 older people (aged 82 ± 7 years) with mild to moderate CI (MMSE 11-23; ACE-R < 83). MEASUREMENTS Global cognition and six neuropsychological domains (memory, language, visuospatial, processing speed, executive function [EF], and affect) were assessed. Participants also underwent sensorimotor and balance assessments. Falls were recorded prospectively for 12 months. RESULTS The EF domain was most strongly associated with multiple falls (relative risk [RR]: 1.50, 95% CI: 1.18-1.91). Global cognition was not associated with falls (RR: 1.09, 95% CI: 0.92-1.30). Additional analyses showed that participants with poorer EF (median cutpoint) were more likely to be taking centrally acting medications and were less physically active. They also had significantly worse vision, reaction time, knee extension strength, balance (postural sway, controlled leaning balance), and higher physiological fall risk scores. Participants with poorer EF were 1.5 times (RR: 1.50, 95% CI: 1.03-2.18) more likely to have multiple falls. Mediational analyses demonstrated that reaction time and postural sway reduced the relative risk of EF on multiple falls by 31% (RR: 1.19, 95% CI: 0.81-1.74). CONCLUSIONS Within this sample of older people with mild to moderate CI, poorer EF increased the risk of multiple falls. This relationship was mediated by reaction time and postural sway,suggesting cognitively impaired older people with poorer EF may benefit from fall prevention programs targeting these mediating factors.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; Cognitive Decline Partnership Centre, Sydney Medical School, University of Sydney, Australia; Department of Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Stephen R Lord
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; School of Public Health and Community Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; School of Public Health and Community Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Susan E Kurrle
- Cognitive Decline Partnership Centre, Sydney Medical School, University of Sydney, Australia
| | - A Stefanie Mikolaizak
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; Department of Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Klenk J, Schwickert L, Palmerini L, Mellone S, Bourke A, Ihlen EAF, Kerse N, Hauer K, Pijnappels M, Synofzik M, Srulijes K, Maetzler W, Helbostad JL, Zijlstra W, Aminian K, Todd C, Chiari L, Becker C. The FARSEEING real-world fall repository: a large-scale collaborative database to collect and share sensor signals from real-world falls. Eur Rev Aging Phys Act 2016; 13:8. [PMID: 27807468 PMCID: PMC5086409 DOI: 10.1186/s11556-016-0168-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/22/2016] [Indexed: 12/04/2022] Open
Abstract
Background Real-world fall events objectively measured by body-worn sensors can improve the understanding of fall events in older people. However, these events are rare and hence challenging to capture. Therefore, the FARSEEING (FAll Repository for the design of Smart and sElf-adaptive Environments prolonging Independent livinG) consortium and associated partners started to build up a meta-database of real-world falls. Results Between January 2012 and December 2015 more than 300 real-world fall events have been recorded. This is currently the largest collection of real-world fall data recorded with inertial sensors. A signal processing and fall verification procedure has been developed and applied to the data. Since the end of 2015, 208 verified real-world fall events are available for analyses. The fall events have been recorded within several studies, with different methods, and in different populations. All sensor signals include at least accelerometer measurements and 58 % additionally include gyroscope and magnetometer measurements. The collection of data is ongoing and open to further partners contributing with fall signals. The FARSEEING consortium also aims to share the collected real-world falls data with other researchers on request. Conclusions The FARSEEING meta-database will help to improve the understanding of falls and enable new approaches in fall risk assessment, fall prevention, and fall detection in both aging and disease. Electronic supplementary material The online version of this article (doi:10.1186/s11556-016-0168-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jochen Klenk
- Department of Clinical Gerontology, Robert Bosch Hospital, Auerbachstr. 110, Stuttgart, Germany ; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lars Schwickert
- Department of Clinical Gerontology, Robert Bosch Hospital, Auerbachstr. 110, Stuttgart, Germany
| | - Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy
| | - Sabato Mellone
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy
| | - Alan Bourke
- Department of Neuroscience, NTNU, Trondheim, Norway
| | | | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Klaus Hauer
- Department of Geriatric Research, Bethanien-Hospital/Geriatric Center at the University of Heidelberg, Heidelberg, Germany
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Karin Srulijes
- Department of Clinical Gerontology, Robert Bosch Hospital, Auerbachstr. 110, Stuttgart, Germany
| | - Walter Maetzler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ; German Research Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Christopher Todd
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Auerbachstr. 110, Stuttgart, Germany
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Klenk J, Kerse N, Rapp K, Nikolaus T, Becker C, Rothenbacher D, Peter R, Denkinger MD. Physical Activity and Different Concepts of Fall Risk Estimation in Older People--Results of the ActiFE-Ulm Study. PLoS One 2015; 10:e0129098. [PMID: 26058056 PMCID: PMC4461251 DOI: 10.1371/journal.pone.0129098] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches. DESIGN Prospective cohort study with one-year follow-up of falls using fall calendars. Physical activity was defined as walking duration and recorded at baseline over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Average daily physical activity was extracted from these data and categorized in low (0-59 min), medium (60-119 min) and high (120 min and more) activity. SETTING The ActiFE Ulm study located in Ulm and adjacent regions in Southern Germany. PARTICIPANTS 1,214 community-dwelling older people (≥65 years, 56.4% men). MEASUREMENTS Negative-binomial regression models were used to calculate fall rates and incidence rate ratios for each activity category each with using (1) person-years and (2) hours walked as denominators stratified by gender, age group, fall history, and walking speed. All analyses were adjusted either for gender, age, or both. RESULTS No statistically significant association was seen between falls per person-year and average daily physical activity. However, when looking at falls per 100 hours walked, those who were low active sustained more falls per hours walked. The highest incidence rates of falls were seen in low-active persons with slow walking speed (0.57 (95% confidence interval (95% CI): 0.33 to 0.98) falls per 100 hours walked) or history of falls (0.60 (95% CI: 0.36 to 0.99) falls per 100 hours walked). CONCLUSION Falls per hours walked is a relevant and sensitive outcome measure. It complements the concept of incidence per person years, and gives an additional perspective on falls in community-dwelling older people.
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Affiliation(s)
- Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Richard Peter
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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Yang Y, Feldman F, Leung PM, Scott V, Robinovitch SN. Agreement between video footage and fall incident reports on the circumstances of falls in long-term care. J Am Med Dir Assoc 2015; 16:388-94. [PMID: 25669670 DOI: 10.1016/j.jamda.2014.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Incident reports guide fall prevention efforts in long-term care (LTC) facilities, often based on descriptions of how falls occurred. The validity of these reports is poorly understood. We examined agreement on fall characteristics between fall incident reports and analysis of video footage of real-life falls in LTC. DESIGN/SETTING/PARTICIPANTS Video capture of 863 falls (by 309 individuals) over 6 years in common areas of 2 LTC facilities in British Columbia. MEASUREMENTS We reviewed each fall video with a previously validated questionnaire to determine the cause of imbalance leading to the fall, activity at the time of falling, and use of mobility aids. These data were compared with corresponding information recorded by staff on fall incident reports. RESULTS There was agreement between video analysis and incident reports on the cause of imbalance in 45.5% of falls (kappa = 0.25), on activity at time of falling in 45.1% of falls (kappa = 0.22), and on use of mobility aids in 79.5% of falls (kappa = 0.59). When compared with video analysis, incident reports overreported falls due to slips, and falling while rising and while using a wheelchair or walker. Incident reports also underreported falls due to hit/bump and loss-of-support, and falling while standing and sitting down. CONCLUSION In more than 50% of falls, we found discrepancies between fall incident reports and analysis of video footage on the cause of imbalance and activity while falling. Emerging technologies incorporating video capture or wearable sensors should improve our ability to understand the mechanisms and improve the prevention of falls in LTC.
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Affiliation(s)
- Yijian Yang
- Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | - Fabio Feldman
- Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; Seniors Fall and Injury Prevention, Older Adult Program, Fraser Health Authority, Surrey, BC, Canada
| | - Pet Ming Leung
- Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; Seniors Fall and Injury Prevention, Older Adult Program, Fraser Health Authority, Surrey, BC, Canada
| | - Vicky Scott
- BC Injury Research and Prevention Unit and BC Ministry of Health, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephen N Robinovitch
- Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
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Rapp K, Freiberger E, Todd C, Klenk J, Becker C, Denkinger M, Scheidt-Nave C, Fuchs J. Fall incidence in Germany: results of two population-based studies, and comparison of retrospective and prospective falls data collection methods. BMC Geriatr 2014; 14:105. [PMID: 25241278 PMCID: PMC4179843 DOI: 10.1186/1471-2318-14-105] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Fall incidence differs considerably between studies and countries. Reasons may be differences between study samples or different assessment methods. The aim was to derive estimates of fall incidence from two population-based studies among older community-living people in Germany and compare retrospective and prospective falls data collection methods. Methods Data were derived from the 2008–11 wave of the German health interview and examination survey for adults (DEGS1), and the Activity and Function of the Elderly in Ulm study (ActiFE-Ulm). Data collection took place in community facilities (DEGS1) or participants’ homes (ActiFE-Ulm). Participation rates were 42% (newly recruited) and 64% (panel component) in DEGS1 and 19.8% in ActiFE-Ulm. Self-report retrospective fall data covering the previous 12 month period in DEGS1 and ActiFE-Ulm were collected, but only ActiFE-Ulm used prospective 12 month fall calendars. The incidence of ‘any fall’ and ‘recurrent falls’ were calculated for both methods. Results Fall rates increased with age in men but not women. The ActiFE-Ulm prospectively assessed incidence (95% confidence interval) in women and men aged 65- < 90 years were 38.7 (36.9-40.5) and 29.7 (28.1-31.3) fallers/year and 13.7 (12.5-14.9) and 10.9 (9.9-12.0) recurrent fallers/year, respectively. Retrospective and prospective fall incidence in ActiFE-Ulm did not differ.The retrospectively assessed incidence of ‘any fall’ among persons 65- < 80 years were significantly lower in DEGS1 than ActiFE-Ulm (women: 25.7% (22.4-29.2) versus 37.4% (34.8-39.9); men: 16.3% (13.6-19.3) versus 28.9% (26.6-31.1). Retrospective incidence estimates of recurrent falls were similar in both studies for women (10.4% (8.3-12.9) versus 10.2% (8.5-11.8)) and men (6.1% (4.3-8.5) versus 8.4% (7.1-9.8)). Conclusion Both studies were population-based, but retrospective self-reported fall incidence differed between studies. Study design influences retrospective reported fall incidence considerably. Costly collection of prospective data gives similar rates to the cheaper retrospective report method.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
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25
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Stubbs B, Schofield P, Binnekade T, Patchay S, Sepehry A, Eggermont L. Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis. PAIN MEDICINE 2014; 15:1115-28. [PMID: 24837341 DOI: 10.1111/pme.12462] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain and recurrent falls are highly problematic in community-dwelling older adults, yet the association remains elusive. OBJECTIVE The objective of this study was to investigate the association between pain and recurrent falls in community-dwelling older adults. DESIGN Two independent reviewers conducted searches of major electronic databases, completed methodological assessment, and extracted the data of all included articles. Articles that were included are those that (1) involved community-dwelling older adults; (2) recorded recurrent falls; and (3) assessed pain. Articles that were excluded are those that included participants with dementia, any neurological conditions, or those with orthopedic trauma/surgery in the past 6 months. RESULTS Out of a potential of 71 articles, 11 met the inclusion criteria and 7 (N = 9,581) were eligible for the meta-analysis. The annual prevalence of recurrent falls in those reporting pain (12.9%) was higher than the pain-free control group (7.2%, P < 0.001). A global meta-analysis established that pain was associated with recurrent falls (odds ratio [OR]: 2.04, confidence interval [CI]: 1.75-2.39; N = 3,950 with pain and N = 5,631 controls), and this was decreased in a subgroup meta-analysis utilizing prospective studies only (OR: 1.79, CI: 1.44-2.21, P < 0.001, I2 = 0%; N = 3, N = 2,646). A subgroup analysis comparing recurrent fallers vs. non-fallers only (OR: 2.18, CI: 1.82-2.60, N = 6,320, I2 = 0%) established the odds were particularly higher than single fallers vs. non-fallers (OR:1.44, CI: 1.26-1.64, N = 6,903, (I2) = 0%). CONCLUSION Older adults with pain are at particularly increased risk of recurrent falls. Clinicians working with recurrent fallers should routinely assess pain while pain specialists should inquire about older adults' falls history.
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Affiliation(s)
- Brendon Stubbs
- School of Health and Social Care, University of Greenwich, London, UK
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26
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Sibley KM, Voth J, Munce SE, Straus SE, Jaglal SB. Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions. BMC Geriatr 2014; 14:22. [PMID: 24529293 PMCID: PMC3928582 DOI: 10.1186/1471-2318-14-22] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 02/11/2014] [Indexed: 12/01/2022] Open
Abstract
Background Falls and chronic disease are both important health issues in older adults. The objectives of this study were to quantify the prevalence of falls and multi-morbidity (≥2 chronic conditions) in Canadian older adults; examine associations between falls and number of chronic conditions; and explore whether certain patterns of chronic disease were associated with a greater risk of falling. Methods Data were derived from the Canadian Community Health Survey- Healthy Aging. Primary outcomes from 16,357 community-dwelling adults aged 65 years and over were self-reported falls in the previous 12 months and presence of 13 chronic conditions. Prevalence estimates were calculated with normalized sampling weights, and hierarchical cluster analysis was used to identify clusters based on chronic condition patterns, and tested for association to falls with logistic regression. Results Overall prevalence of falling and multi-morbidity were 19.8% and 62.0% respectively. Fall risk was significantly greater in individuals with one, two, four, five and six or more chronic conditions relative to those with none (all p < 0.05). A seven-cluster model was selected, including groups with low prevalence of chronic disease, or high prevalence of hypertension and arthritis, visual impairment, hypertension, chronic obstructive pulmonary disease (COPD), diabetes, or heart disease and hypertension. Only the hypertension cluster (Odds Ratio [OR] = 1.2) and COPD cluster (OR = 1.6) were significantly associated with increased falls relative to the low prevalence group. Conclusions Both the number and pattern of chronic conditions were related to falls. COPD emerged as a significant predictor of falls despite affecting a smaller proportion of respondents. Continued study is warranted to verify this association and determine how to incorporate consideration of chronic disease and multi-morbidity into fall risk assessments.
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Affiliation(s)
| | | | | | | | - Susan B Jaglal
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
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27
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Stubbs B, Binnekade T, Eggermont L, Sepehry AA, Patchay S, Schofield P. Pain and the Risk for Falls in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2014; 95:175-187.e9. [DOI: 10.1016/j.apmr.2013.08.241] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/14/2013] [Accepted: 08/24/2013] [Indexed: 12/16/2022]
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28
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Becker C, Schwickert L, Mellone S, Bagalà F, Chiari L, Helbostad JL, Zijlstra W, Aminian K, Bourke A, Todd C, Bandinelli S, Kerse N, Klenk J. Proposal for a multiphase fall model based on real-world fall recordings with body-fixed sensors. Z Gerontol Geriatr 2013. [PMID: 23184296 DOI: 10.1007/s00391-012-0403-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses.The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals.
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Affiliation(s)
- C Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany.
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29
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Yang Y, Schonnop R, Feldman F, Robinovitch SN. Development and validation of a questionnaire for analyzing real-life falls in long-term care captured on video. BMC Geriatr 2013; 13:40. [PMID: 23635343 PMCID: PMC3655003 DOI: 10.1186/1471-2318-13-40] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 04/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are the number one cause of injuries in older adults, and are particularly common in long-term care (LTC). Lack of objective evidence on the mechanisms of falls in this setting is a major barrier to prevention. Video capture of real-life falls can help to address this barrier, if valid tools are available for data analysis. To address this need, we developed a 24-item fall video analysis questionnaire (FVAQ) to probe key biomechanical, behavioural, situational, and environmental aspects of the initiation, descent, and impact stages of falls. We then tested the reliability of this tool using video footage of falls collected in LTC. METHODS Over three years, we video-captured 221 falls experienced by 130 individuals in common areas (e.g., dining rooms, hallways, and lounges) of two LTC facilities. The FVAQ was developed through literature review and an iterative process to ensure our responses captured the most common behaviours observed in preliminary review of fall videos. Inter-rater reliability was assessed by comparing responses from two teams, each having three members, who reviewed 15 randomly-selected videos. Intra-rater reliability was measured by comparing responses from one team at baseline and 12 months later. RESULTS In 17 of the 24 questions, the percentage of inter- and intra-rater agreement was over 80% and the Cohen's Kappa was greater than 0.60, reflecting good reliability. These included questions on the cause of imbalance, activity at the time of the fall, fall direction, stepping responses, and impact to specific body sites. Poorer agreement was observed for footwear, contribution of clutter, reach-to-grasp responses, and perceived site of injury risk. CONCLUSIONS Our results provide strong evidence of the reliability of the FVAQ for classifying biomechanical, behavioural, situational, and environmental aspects of falls captured on video in common areas in LTC. Application of this tool should reveal new and important strategies for the prevention and treatment of falls and fall-related injuries in this setting.
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Affiliation(s)
- Yijian Yang
- Technology for Injury Prevention in Seniors (TIPS) Program, Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Burnaby BC V5A 1S6, Canada.
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Robinovitch SN, Feldman F, Yang Y, Schonnop R, Leung PM, Sarraf T, Sims-Gould J, Loughin M. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet 2013; 381:47-54. [PMID: 23083889 PMCID: PMC3540102 DOI: 10.1016/s0140-6736(12)61263-x] [Citation(s) in RCA: 525] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Falls in elderly people are a major health burden, especially in the long-term care environment. Yet little objective evidence is available for how and why falls occur in this population. We aimed to provide such evidence by analysing real-life falls in long-term care captured on video. METHODS We did this observational study between April 20, 2007, and June 23, 2010, in two long-term care facilities in British Columbia, Canada. Digital video cameras were installed in common areas (dining rooms, lounges, hallways). When a fall occurred, facility staff completed an incident report and contacted our teams so that we could collect video footage. A team reviewed each fall video with a validated questionnaire that probed the cause of imbalance and activity at the time of falling. We then tested whether differences existed in the proportion of participants falling due to the various causes, and while engaging in various activities, with generalised linear models, repeated measures logistic regression, and log-linear Poisson regression. FINDINGS We captured 227 falls from 130 individuals (mean age 78 years, SD 10). The most frequent cause of falling was incorrect weight shifting, which accounted for 41% (93 of 227) of falls, followed by trip or stumble (48, 21%), hit or bump (25, 11%), loss of support (25, 11%), and collapse (24, 11%). Slipping accounted for only 3% (six) of falls. The three activities associated with the highest proportion of falls were forward walking (54 of 227 falls, 24%), standing quietly (29 falls, 13%), and sitting down (28 falls, 12%). Compared with previous reports from the long-term care setting, we identified a higher occurrence of falls during standing and transferring, a lower occurrence during walking, and a larger proportion due to centre-of-mass perturbations than base-of-support perturbations. INTERPRETATION By providing insight into the sequences of events that most commonly lead to falls, our results should lead to more valid and effective approaches for balance assessment and fall prevention in long-term care. FUNDING Canadian Institutes for Health Research.
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Affiliation(s)
- Stephen N Robinovitch
- Technology for Injury Prevention in Seniors Program, Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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