1
|
The association of glycemic control and fall risk in diabetic elderly: a cross-sectional study in Hong Kong. BMC PRIMARY CARE 2022; 23:192. [PMID: 35915395 PMCID: PMC9344708 DOI: 10.1186/s12875-022-01807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Many foreign studies investigated glycemic control and fall risk. However, there was insufficient study on this topic in Hong Kong. This study aims to find out the association of glycemic control and fall risk in the diabetic elderly in a general outpatient clinic in the North District of Hong Kong. Their frequency of falls and other associated risk factors of fall were also studied.
Methods
A cross-sectional questionnaire survey was conducted on 442 diabetic patients aged 65 years-old or above with regular follow-up in a general outpatient clinic. Main outcome measure was the number of falls in the past one year from the interview date. Recurrent falls was defined as two or more falls in the past one year from the interview date. Subjects were asked about experience of hypoglycemic symptoms. HbA1c level, chronic illness, retinopathy etc. were obtained through computerized medical record review. Chi square test and logistic regression were used to assess the association between outcomes and the explanatory variables.
Results
In the past one year, 23.3% participants experienced at least one fall and 8.6% had recurrent falls. Hypoglycemic symptoms, and lower visual acuity < 0.6 were significantly associated with fall (OR 2.42, p = 0.007 and OR 1.75, p = 0.038 respectively). Age 75–79 years-old had a higher likelihood of fall than the 65–69 age group (OR 2.23, p = 0.044). Patients with HbA1c 7.0–7.4% had a lower risk of recurrent falls when compared to those with intensive control (OR 0.32, p = 0.044). Other risk factors that increased risk of recurrent falls were hypoglycemic symptoms (OR 6.64, p < 0.001) and history of cerebral vascular accident (OR 4.24, p = 0.003).
Conclusions
Hypoglycemic symptoms had a very strong association with falls. Less stringent HbA1c control reduced the risk of recurrent falls. Healthcare professionals need to take a more proactive approach in enquiring about hypoglycemia. There should be individualized diabetic treatment target for the diabetic elderly.
Collapse
|
2
|
Clinical Intervention Effect of a Predictive Model Constructed Based on Risk Factors for Falls in Elderly Patients during Hospitalization. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4983254. [PMID: 36193201 PMCID: PMC9525773 DOI: 10.1155/2022/4983254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
Falls in elderly patients are an important cause of fractures, functional impairment, and mortality. In this paper, a questionnaire was used to collect information on fall history, balance function and sensory function from patients over 65 years of age. In the analysis, the presence or absence of falls was used as a factor, and a corresponding prediction model was constructed using methods such as univariate analysis and regression analysis. This survey found that in the past year, 60% of the patients had fallen, 16.67% had one fall, 33.33% had two falls, and 50% had three or more falls; model specificity is 61.54%, the sensitivity is 71.43%, and the misjudgment is 38.46%. The model has good specificity and sensitivity and a small misjudgment rate; so, the model is more reasonable. This paper selects several sensitivity indices that have a certain impact on the risk of falling and makes a satisfactory forecast, which can provide a theoretical basis for the prevention of the risk of falls in elderly patients during hospitalization.
Collapse
|
3
|
Ong WF, Kamaruzzaman SB, Tan MP. Falls in older persons with type 2 diabetes in the Malaysian Elders Longitudinal Research (MELoR) study. Int J Clin Pract 2021; 75:e14999. [PMID: 34714589 DOI: 10.1111/ijcp.14999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/19/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Older persons with diabetes are at an increased risk of falls leading to fractures, head injuries and disability. OBJECTIVE To evaluate the potential relationship between falls and diabetes in older persons and identify differences in risk factors of falls among older persons with and without diabetes using the first wave dataset of the Malaysian Elders Longitudinal Research (MELoR) study. METHODOLOGY Community dwelling adults aged ≥ 55 years were selected through stratified random sampling from three parliamentary constituencies in greater Kuala Lumpur. Baseline data was obtained through computer-assisted, home-based interviews. The presence of falls was established by enquiring about falls in the preceding 12 months. Diabetes was defined as self-reported, physician-diagnosed diabetes, diabetes medication use and an HbA1c of ≥ 6.3%. RESULTS Diabetes was present in 44.4% of the overall 1610 participants. The prevalence for fall among older diabetics was 25.6%. Recurrent falls (odds ratio (OR) 1.65; 95% confidence interval (CI) 1.06-2.57) was more common among diabetics. Following adjustment for potential confounders, osteoporosis (OR 2.58; 95% CI 1.31-5.08) and dizziness (OR 1.50; 95% CI 1.01-2.23) were independent risk factors for falls. Better instrumental activities of daily living scores were protective against falls (OR 0.75; 95% CI 0.58-0.97). CONCLUSION The presence of osteoporosis and dizziness was associated with an increased risk of falls among older diabetics. These findings will need to be confirmed in future prospective follow-up of this cohort.
Collapse
Affiliation(s)
- Wan Feng Ong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul B Kamaruzzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| |
Collapse
|
4
|
Bazargan M, Loeza M, Ekwegh T, Adinkrah EK, Kibe LW, Cobb S, Assari S, Bazargan-Hejazi S. Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7246. [PMID: 34299695 PMCID: PMC8306928 DOI: 10.3390/ijerph18147246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. METHODS We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. RESULTS Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. DISCUSSION Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.
Collapse
Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Margarita Loeza
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Tavonia Ekwegh
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | | | - Lucy W. Kibe
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
| | - Sharon Cobb
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, UCLA, Los Angeles, CA 90095, USA
- Department of Psychiatry, CDU, Los Angeles, CA 90059, USA
| |
Collapse
|
5
|
Sairafian K, Towe CW, Crandall M, Brown LR, Haut ER, Ho VP. Sociodemographic Patterns of Outpatient Falls: Do Minority Patients Fall Less Frequently? J Surg Res 2019; 243:332-339. [PMID: 31255933 DOI: 10.1016/j.jss.2019.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/30/2019] [Accepted: 05/08/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Falls are the most common cause of injury in the elderly, resulting in $50 billion of annual spending. Social and demographic factors associated with falling are not well understood. We hypothesized minority groups (minority race, lower income, and lower education levels) would experience similar rates of falling to majority groups after adjustment for medical factors. MATERIAL AND METHODS We used the 2013 Medicare Current Beneficiary Survey Public Use File, a representatively sampled cross-sectional survey of Medicare outpatients. Fall was defined as at least one self-reported fall in the previous year. Logistic regression was performed to determine sociodemographic factors (age, sex, race, ethnicity, income, education level, and marital status) associated with fall. Health factors, physical limitations, and cognitive limitations were included as possible confounders. Data are presented as extrapolated weighted population proportions (±SE). RESULTS 13,924 Medicare beneficiaries, representing 47 million people, were included. 26.6% (±0.4) reported falling. In adjusted logistic regression, black and Hispanic patients had significantly fewer self-reported falls than white patients, after adjustment for medical conditions, physical limitations, and cognitive limitations. DISCUSSION Black and Hispanic Medicare patients are significantly less likely to have reported a fall than non-Hispanic whites. This finding differs from other health-related disparities in which minorities most commonly experience higher risk or more severe diseases. These data may also represent differences in self-reporting, indicating disparities in self-reported data in these cohorts. Further studies on social factors related to falling are needed in this population.
Collapse
Affiliation(s)
- Kevin Sairafian
- Division of Trauma, Department of Surgery, Critical Care, Burns, Emergency General Surgery. MetroHealth Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine- Jacksonville, Jacksonville, Florida
| | - Laura R Brown
- Division of Trauma, Department of Surgery, Critical Care, Burns, Emergency General Surgery. MetroHealth Medical Center, Cleveland, Ohio
| | - Elliott R Haut
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vanessa P Ho
- Division of Trauma, Department of Surgery, Critical Care, Burns, Emergency General Surgery. MetroHealth Medical Center, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.
| |
Collapse
|
6
|
Bazargan M, Smith JL, King EO. Potentially inappropriate medication use among hypertensive older African-American adults. BMC Geriatr 2018; 18:238. [PMID: 30290768 PMCID: PMC6173851 DOI: 10.1186/s12877-018-0926-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background Inappropriate use of medications, particularly among minority older adults with co-morbidity, remains a major public health concern. The American Geriatrics Society (AGS) reports that Potentially Inappropriate Medication (PIM) continues to be prescribed for older adults, despite evidence of poor outcomes. The main objective of this study was to examine the prevalence of PIM use among underserved non-institutionalized hypertensive older African-American adults. Furthermore, this study examines potential correlations between PIM use and the number and type of chronic conditions. Methods This cross-sectional study is comprised of a convenience sample of 193 hypertensive non-institutionalized African-American adults, aged 65 years and older recruited from several senior housing units located in underserved areas of South Los Angeles. The updated 2015 AGS Beers Criteria was used to identify participants using PIMs. Results Almost one out of two participants had inappropriate medication use. While the average number of PIMs taken was 0.87 drugs, the range was from one to seven medications. Almost 23% of PIMs were due to drugs with potential drug-drug interactions. The most common PIM was the use of proton pump inhibitors (PPI) and Central Nervous System (CNS) active agents. Nearly 56% of PIMs potentially increased the risk of falls and fall-associated bone fractures. The use of PIMs was significantly higher among participants who reported a higher number of chronic conditions. Nearly 70% of participants with PIM use reported suffering from chronic pain. Conclusions The major reason for high levels of polypharmacy, PIMs, and drug interactions is that patients suffer from multiple chronic conditions. But it may not be possible or necessary to treat all chronic conditions. Therefore, the goals of care should be explicitly reviewed with the patient in order to determine which of the many chronic conditions has the greatest impact on the life goals and/or functional priorities of the patient. Those drugs that have a limited impact on the patient’s functional priorities and that may cause harmful drug-drug interactions can be reduced or eliminated, while the remaining medications can focus on the most important functional priorities of the patient.
Collapse
Affiliation(s)
- Mohsen Bazargan
- Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA. .,University of California, Los Angeles, USA.
| | - James L Smith
- Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA
| | - Ebony O King
- Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA.,University of California, Los Angeles, USA
| |
Collapse
|
7
|
Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M, Wermelink AMAT, van der Velde N. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others. J Am Med Dir Assoc 2018; 19:372.e1-372.e8. [PMID: 29402646 DOI: 10.1016/j.jamda.2017.12.099] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications. METHODS AND DESIGN A systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately. RESULTS In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association). CONCLUSION Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations.
Collapse
Affiliation(s)
- Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Esther M M van de Glind
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Joost G Daams
- Medical library, Academic Medical Center, Amsterdam, the Netherlands
| | - Kimberley J Ploegmakers
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Max de Vries
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Anne M A T Wermelink
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | | |
Collapse
|
8
|
Lee PY, Tsai YJ, Liao YT, Yang YC, Lu FH, Lin SI. Reactive balance control in older adults with diabetes. Gait Posture 2018; 61:67-72. [PMID: 29306146 DOI: 10.1016/j.gaitpost.2017.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 02/02/2023]
Abstract
Diabetes mellitus is a major health problem for older adults worldwide and could be associated with impaired ability to recover balance after postural disturbances. This study compared reactive balance control in three groups of adults, young (YA), healthy non-diabetes older (nonDM-OA) and diabetes older (DM-OA). Twenty participants in each group completed a series of vision, plantar cutaneous sensitivity, grip power and lower limb strength tests. In the reactive balance test, participants stood on a force platform and used the dominant hand to pull the handle of a cord that could be suddenly released to create an imbalancing force. The anteroposterior (AP) and mediolateral (ML) motion of the center of pressure (COP) immediately after the sudden release was calculated to represent the level of imbalance experienced by the participants. Regression analysis entering big toe plantar sensitivity and grip power as independent variable was conducted for COP range for the three groups separately. The results showed that, except for the knee extensor, DM-OA had significantly poorer muscle strength and plantar sensitivity, and greater COP ML motion than YA and nonDM-OA. DM-OA also had significantly greater COP AP motion than YA. Grip power alone and together with plantar sensitivity explained a significant amount of variance in the AP and ML COP motion respectively (r2 = 0.334 and 0.582, respectively) for DM-OA. These findings indicated that diabetes in older adults was associated with declines in reactive balance control, and these changes may be related to muscle weakness and plantar insensitivity.
Collapse
Affiliation(s)
- Pei-Yun Lee
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ting Liao
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fen-Hwa Lu
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sang-I Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
9
|
Shanbhogue VV, Hansen S, Frost M, Brixen K, Hermann AP. Bone disease in diabetes: another manifestation of microvascular disease? Lancet Diabetes Endocrinol 2017; 5:827-838. [PMID: 28546096 DOI: 10.1016/s2213-8587(17)30134-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/27/2017] [Accepted: 03/28/2017] [Indexed: 12/24/2022]
Abstract
Type 1 and type 2 diabetes are generally accepted to be associated with increased bone fracture risk. However, the pathophysiological mechanisms of diabetic bone disease are poorly understood, and whether the associated increased skeletal fragility is a comorbidity or a complication of diabetes remains under debate. Although there is some indication of a direct deleterious effect of microangiopathy on bone, the evidence is open to question, and whether diabetic osteopathy can be classified as a chronic, microvascular complication of diabetes remains uncertain. Here, we review the current knowledge of potential contributory factors to diabetic bone disease, particularly the association between diabetic microangiopathy and bone mineral density, bone structure, and bone turnover. Additionally, we discuss and propose a pathophysiological model of the effects of diabetic microvascular disease on bone, and examine the progression of bone disease alongside the evolution of diabetes.
Collapse
Affiliation(s)
| | - Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Morten Frost
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Anne P Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
10
|
Lukaszyk C, Coombes J, Turner NJ, Hillmann E, Keay L, Tiedemann A, Sherrington C, Ivers R. Yarning about fall prevention: community consultation to discuss falls and appropriate approaches to fall prevention with older Aboriginal and Torres Strait Islander people. BMC Public Health 2017; 18:77. [PMID: 28764677 PMCID: PMC5540430 DOI: 10.1186/s12889-017-4628-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Fall related injury is an emerging issue for older Indigenous people worldwide, yet few targeted fall prevention programs are currently available for Indigenous populations. In order to inform the development of a new Aboriginal-specific fall prevention program in Australia, we conducted community consultation with older Aboriginal people to identify perceptions and beliefs about falls, and to identify desired program elements. Methods Yarning Circles were held with Aboriginal and Torres Strait Islander people aged 45 years and over. Each Yarning Circle was facilitated by an Aboriginal researcher who incorporated six indicative questions into each discussion. Questions explored the impact of falls on Yarning Circle participants, their current use of fall prevention services and investigated Yarning Circle participant’s preferences regarding the design and mode of delivery of a fall prevention program. Results A total of 76 older Aboriginal people participated in ten Yarning Circles across six sites in the state of New South Wales. Participants associated falls with physical disability, a loss of emotional well-being and loss of connection to family and community. Many participants did not use existing fall prevention services due to a lack of availability in their area, having no referral provided by their GP and/or being unaware of fall prevention programs in general. Program elements identified as important by participants were that it be Aboriginal-specific, group-based, and on-going, with the flexibility to be tailored to specific communities, with free transport provided to and from the program. Conclusions Older Aboriginal people reported falls to be a priority health issue, with a significant impact on their health and well-being. Few older Aboriginal people accessed prevention programs, suggesting there is an important need for targeted Aboriginal-specific programs. A number of important program elements were identified which if incorporated into prevention programs, may help to address the rising burden of falls.
Collapse
Affiliation(s)
- Caroline Lukaszyk
- The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia. .,Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Julieann Coombes
- The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Norma Jean Turner
- Illawarra Shoalhaven Local Health District, Suite 2 Level 2, 67-71 King Street, Warrawong, NSW, 2502, Australia
| | - Elizabeth Hillmann
- Mingaletta Aboriginal and Torres Strait Islander Corporation, 6 Sydney Avenue, Umina, NSW, 2257, Australia
| | - Lisa Keay
- The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anne Tiedemann
- The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Cathie Sherrington
- The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.,School of Nursing and Midwifery, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| |
Collapse
|
11
|
Differences in Fall Risk Factors Between Adults With Diabetes and Those Without Who Are Homebound. TOPICS IN GERIATRIC REHABILITATION 2017. [DOI: 10.1097/tgr.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Rodrigues AM, Gregório MJ, Gein P, Eusébio M, Santos MJ, de Sousa RD, Coelho PS, Mendes JM, Graça P, Oliveira P, Branco JC, Canhão H. Home-Based Intervention Program to Reduce Food Insecurity in Elderly Populations Using a TV App: Study Protocol of the Randomized Controlled Trial Saúde.Come Senior. JMIR Res Protoc 2017; 6:e40. [PMID: 28288956 PMCID: PMC5368350 DOI: 10.2196/resprot.6626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/27/2017] [Accepted: 02/08/2017] [Indexed: 11/23/2022] Open
Abstract
Background The limited or uncertain access to adequate food in elderly people includes not only economic restrictions but also inability of food utilization due to functional or cognitive impairment, health problems, and illiteracy. Objective The aim of this work is to present the protocol of the randomized controlled trial Saúde.Come Senior, an educational and motivational television (TV)-based intervention to promote healthy lifestyles and decrease food insecurity in elderly people. Methods A randomized controlled study will be conducted in subjects aged 60 years and older with food insecurity, identified at 17 primary care centers in the Lisboa e Vale do Tejo health region in Lisbon, Portugal. The primary outcome will be the changes in participants’ food insecurity score (evaluated by the Household Food Insecurity Scale) at 3 months. Change in other outcomes will be assessed (dietary habits, nutritional status, physical activity, health status, and clinical outcomes). Subjects will be followed over 6 months; the intervention will last 3 months. Data collection will be performed at 3 different time points (baseline, end of intervention at 3 months, and follow-up at 6 months). The intervention is based on an interactive TV app with an educational and motivational program specifically developed for the elderly that has weekly themes and includes daily content in video format: (1) nutrition and diet tips for healthy eating, (2) healthy, easy to cook and low-cost recipes, and (3) physical exercise programs. Furthermore, brief reminders on health behaviors will also be broadcasted through the TV app. The total duration of the study will be 6 months. The intervention is considered to be effective and meaningful if 50% of the individuals in the experimental group have a decrease of 1 point in the food insecurity score, all the remaining being unchanged. We expect to include and randomize 282 (141 experimental and 141 control) elderly with food insecurity. We will recruit a total of 1,128 subjects considering that 50% of the target individuals are food insecure (based on INFOFAMÍLIA Survey) (567) and about 50% of those will adhere to the study (282). Results The randomized controlled trial with the 12-week home-based intervention with a comprehensive program on healthy eating and physical activity delivery is planned to start recruiting participants at the end of 2017. Conclusions This study will assess the efficacy of this innovative tool (Saúde.Come Senior) for disseminating relevant health information, modifying behaviors, and decreasing food insecurity in an easy, low-cost, and massive way.
Collapse
Affiliation(s)
- Ana Maria Rodrigues
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.,Instituto de Medicina Molecular, Rheumatology Research Unit, Lisboa, Portugal
| | - Maria João Gregório
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Pierre Gein
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Maria José Santos
- Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.,Instituto de Medicina Molecular, Rheumatology Research Unit, Lisboa, Portugal.,Hospital Garcia de Orta, Almada, Portugal
| | - Rute Dinis de Sousa
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Pedro S Coelho
- NOVA Information Management School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jorge M Mendes
- NOVA Information Management School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Pedro Graça
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisboa, Portugal
| | - Pedro Oliveira
- Católica-Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Jaime C Branco
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Serviço de Reumatologia do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Helena Canhão
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
| |
Collapse
|
13
|
Hong X, Chen X, Chu J, Shen S, Chai Q, Lou G, Chen L. Multiple diabetic complications, as well as impaired physical and mental function, are associated with declining balance function in older persons with diabetes mellitus. Clin Interv Aging 2017; 12:189-195. [PMID: 28182146 PMCID: PMC5279842 DOI: 10.2147/cia.s123985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate whether there is a difference in balance function between older persons with and without diabetes mellitus (DM), and to identify whether mediating factors, such as diabetic complications, Instrumental Activities of Daily Living (IADL) score, Mini-Mental State Examination (MMSE) score, as well as hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL), are associated with balance function in older persons with DM. METHODS In this cross-sectional study, a total of 208 older persons were divided into a DM group (n=80) and a control group who did not have DM (n=128). Balance function was evaluated with the Tinetti performance-oriented mobility assessment (POMA), which includes balance and gait subscales. Activities of daily living (ADL), IADL, and the MMSE were also measured. Fall incidents in last 12 months, the use of walking aids, fear of falling, comorbidities, and polypharmacy were recorded. Diabetic complications were recorded, and HbA1c, FPG, TC, TG, and LDL were measured in the patients of the DM group. RESULTS Fall incidents in last 12 months were higher in the DM group than in the control group (P<0.01). POMA score as well as ADL and IADL scores were lower in the diabetic group than the control group (P<0.05). Within the diabetic group, the POMA score was positively related to the ADL score (odds ratio [OR], 11.7; 95% confidence interval [CI], 3.076-44.497; P<0.01), IADL score (OR, 16.286; 95% CI, 4.793-55.333; P<0.01), and MMSE score (OR, 10.524; 95% CI, 2.764-40.074; P<0.01), but was negatively related to age (OR, 7.707; 95% CI, 2.035-29.185; P<0.01) and diabetic complication (OR, 6.667; 95% CI, 2.279-19.504; P<0.01). Also, within the DM group, the decreased POMA score was associated with multiple diabetic complications (OR, 5.977; 95% CI, 1.378-25.926; P<0.05), decreased IADL score (OR, 10.288; 95% CI, 2.410-43.915; P<0.01), and MMSE score (OR, 13.757; 95% CI, 2.556-74.048; P<0.01). CONCLUSION Multiple diabetic complications, lower MMSE, ADL, and IADL scores were associated with declining balance function in the older persons with DM. These findings can alert physicians to detect and intervene earlier on declining balance in older persons with DM.
Collapse
Affiliation(s)
- Xiufang Hong
- Zhejiang Chinese Medical University; Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Jiaojiao Chu
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Shanshan Shen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Qichen Chai
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Gaobo Lou
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Lingyan Chen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| |
Collapse
|
14
|
Lukaszyk C, Harvey L, Sherrington C, Keay L, Tiedemann A, Coombes J, Clemson L, Ivers R. Risk factors, incidence, consequences and prevention strategies for falls and fall-injury within older indigenous populations: a systematic review. Aust N Z J Public Health 2016; 40:564-568. [PMID: 27774702 DOI: 10.1111/1753-6405.12585] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/01/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the risk factors, incidence, consequences and existing prevention strategies for falls and fall-related injury in older indigenous people. METHODS Relevant literature was identified through searching 14 electronic databases, a range of institutional websites, online search engines and government databases, using search terms pertaining to indigenous status, injury and ageing. RESULTS Thirteen studies from Australia, the United States, Central America and Canada were identified. Few studies reported on fall rates but two reported that around 30% of indigenous people aged 45 years and above experienced at least one fall during the past year. The most common hospitalised fall injuries among older indigenous people were hip fracture and head injury. Risk factors significantly associated with falls within indigenous populations included poor mobility, a history of stroke, epilepsy, head injury, poor hearing and urinary incontinence. No formally evaluated, indigenous-specific fall prevention interventions were identified. CONCLUSION Falls are a significant and growing health issue for older indigenous people worldwide that can lead to severe health consequences and even death. No fully-evaluated, indigenous-specific fall prevention programs were identified. Implications for Public Health: Research into fall patterns and fall-related injury among indigenous people is necessary for the development of appropriate fall prevention interventions.
Collapse
Affiliation(s)
- Caroline Lukaszyk
- Injury Division, The George Institute for Global Health, New South Wales
| | - Lara Harvey
- Falls and Injury Prevention Group, Neuroscience Research Australia, New South Wales
| | - Cathie Sherrington
- Musculoskeletal Division, The George Institute for Global Health, New South Wales
| | - Lisa Keay
- Injury Division, The George Institute for Global Health, New South Wales
| | - Anne Tiedemann
- Musculoskeletal Division, The George Institute for Global Health, New South Wales
| | - Julieann Coombes
- Injury Division, The George Institute for Global Health, New South Wales
| | - Lindy Clemson
- Ageing, Work & Health Research Unit, The University of Sydney, New South Wales
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, New South Wales
| |
Collapse
|
15
|
Increasing fall risk awareness using wearables: A fall risk awareness protocol. J Biomed Inform 2016; 63:184-194. [DOI: 10.1016/j.jbi.2016.08.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 11/19/2022]
|
16
|
Han BH, Ferris R, Blaum C. Exploring ethnic and racial differences in falls among older adults. J Community Health 2016; 39:1241-7. [PMID: 24585104 DOI: 10.1007/s10900-014-9852-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Falls are common events that threaten the independence and health of older adults. Studies have found a wide range of fall statistics in different ethnic and racial groups throughout the world. These studies suggest that fall rates may differ between different racial and ethnic groups. Studies also suggest that the location of falls, circumstances of falls, and particular behaviors may also be different by population. Also migration to new locations may alter an individual's fall risk. However, there are few studies that directly compare ethnic and racial differences in falls statistics or examine how known fall risk factors change based on race and ethnicity. This paper reviews the existing literature on how falls may differ between different racial and ethnic groups, highlights gaps in the literature, and explores directions for future research. The focus of this paper is community dwelling older adults and immigrant populations in the United States.
Collapse
Affiliation(s)
- Benjamin H Han
- Division of Geriatric Medicine and Palliative Care, New York University School of Medicine, 550 First Avenue, BCD612, New York, NY, 10016, USA,
| | | | | |
Collapse
|
17
|
Kalula SZ, Ferreira M, Swingler GH, Badri M. Risk factors for falls in older adults in a South African Urban Community. BMC Geriatr 2016; 16:51. [PMID: 26912129 PMCID: PMC4766747 DOI: 10.1186/s12877-016-0212-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/01/2016] [Indexed: 01/22/2023] Open
Abstract
Background Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries. Methods A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa. Logistic regression models were fitted to determine the association between (1) falls and (2) recurrent falls occurring during follow-up and their potential socio-demographic, self-reported medical conditions and physical assessment predictors. Results Prevalence rates of 26.4 % for falls and 11 % for recurrent falls at baseline and 21.9 % for falls and 6.3 % for recurrent falls during follow-up. In both prospective analyses of falls and recurrent falls, history of previous falls, dizziness/vertigo, ethnicity (white or mixed ancestry vs black African) were significant predictors. However, poor cognitive score was a significant predictor in the falls analysis, and marital status (unmarried vs married) and increased time to perform the timed Up and Go test in the recurrent fall analysis but not in both. Other than the timed Up and Go test in recurrent falls analysis, physical assessment test outcomes were not significant predictors of falls. Conclusion Our study provides simple criteria based on demographic characteristics, medical and physical assessments to identify older persons at increased risk of falls. History taking remains an important part of medical practice in the determination of a risk of falls in older patients. Physical assessment using tools validated in developed country populations may not produce results needed to predict a risk of falls in a different setting.
Collapse
Affiliation(s)
- Sebastiana Zimba Kalula
- Division of Geriatric Medicine, The Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, Cape Town, South Africa.
| | - Monica Ferreira
- International Longevity Centre South Africa, Institute of Ageing in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - George H Swingler
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Motasim Badri
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| |
Collapse
|
18
|
Johnson JK, Nápoles AM, Stewart AL, Max WB, Santoyo-Olsson J, Freyre R, Allison TA, Gregorich SE. Study protocol for a cluster randomized trial of the Community of Voices choir intervention to promote the health and well-being of diverse older adults. BMC Public Health 2015; 15:1049. [PMID: 26463176 PMCID: PMC4603966 DOI: 10.1186/s12889-015-2395-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/06/2015] [Indexed: 11/12/2022] Open
Abstract
Background Older adults are the fastest growing segment of the United States population. There is an immediate need to identify novel, cost-effective community-based approaches that promote health and well-being for older adults, particularly those from diverse racial/ethnic and socioeconomic backgrounds. Because choral singing is multi-modal (requires cognitive, physical, and psychosocial engagement), it has the potential to improve health outcomes across several dimensions to help older adults remain active and independent. The purpose of this study is to examine the effect of a community choir program (Community of Voices) on health and well-being and to examine its costs and cost-effectiveness in a large sample of diverse, community-dwelling older adults. Method/design In this cluster randomized controlled trial, diverse adults age 60 and older were enrolled at Administration on Aging-supported senior centers and completed baseline assessments. The senior centers were randomly assigned to either start the choir immediately (intervention group) or wait 6 months to start (control). Community of Voices is a culturally tailored choir program delivered at the senior centers by professional music conductors that reflects three components of engagement (cognitive, physical, and psychosocial). We describe the nature of the study including the cluster randomized trial study design, sampling frame, sample size calculation, methods of recruitment and assessment, and primary and secondary outcomes. Discussion The study involves conducting a randomized trial of an intervention as delivered in “real-world” settings. The choir program was designed using a novel translational approach that integrated evidence-based research on the benefits of singing for older adults, community best practices related to community choirs for older adults, and the perspective of the participating communities. The practicality and relatively low cost of the choir intervention means it can be incorporated into a variety of community settings and adapted to diverse cultures and languages. If successful, this program will be a practical and acceptable community-based approach for promoting health and well-being of older adults. Trial registration ClinicalTrials.gov NCT01869179 registered 9 January 2013.
Collapse
Affiliation(s)
- Julene K Johnson
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. .,Center for Aging in Diverse Communities, University of California, San Francisco, USA.
| | - Anna M Nápoles
- Center for Aging in Diverse Communities, University of California, San Francisco, USA. .,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA.
| | - Anita L Stewart
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. .,Center for Aging in Diverse Communities, University of California, San Francisco, USA.
| | - Wendy B Max
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA.
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA.
| | - Rachel Freyre
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA.
| | - Theresa A Allison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA. .,Department of Family and Community Medicine, University of California, San Francisco, USA.
| | - Steven E Gregorich
- Center for Aging in Diverse Communities, University of California, San Francisco, USA. .,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA.
| |
Collapse
|
19
|
Lazkani A, Delespierre T, Bauduceau B, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Piedvache C, Becquemont L. Predicting falls in elderly patients with chronic pain and other chronic conditions. Aging Clin Exp Res 2015; 27:653-61. [PMID: 25637513 DOI: 10.1007/s40520-015-0319-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to identify fall predictors in elderly suffering from chronic pain (CP) and to test their applicability among patients with other chronic conditions. METHODS 1,379 non-institutionalized patients aged 65 years and older who were suffering from CP (S.AGE CP sub-cohort) were monitored every 6 months for 1 year. Socio-demographic, clinical and pain data and medication use were assessed at baseline for the association with falls in the following year. Falls were assessed retrospectively at each study visit. Logistic regression analyses were performed to identify fall predictors. The derived model was applied to two additional S.AGE sub-cohorts: atrial fibrillation (AF) (n = 1,072) and type-2 diabetes mellitus (T2DM) (n = 983). RESULTS Four factors predicted falls in the CP sub-cohort: fall history (OR: 4.03, 95 % CI 2.79-5.82), dependency in daily activities (OR: 1.81, 95 % CI 1.27-2.59), age ≥75 (OR: 1.53, 95 % CI 1.04-2.25) and living alone (OR: 1.73, 95 % CI 1.24-2.41) (Area Under the Curve: AUC = 0.71, 95 % CI 0.67-0.75). These factors were relevant in AF (AUC = 0.71, 95 % CI 0.66-0.75) and T2DM (AUC = 0.67, 95 % CI 0.59-0.73) sub-cohorts. Fall predicted probability in CP, AF and T2DM sub-cohorts increased from 7, 7 and 6 % in patients with no risk factors to 59, 66 and 45 % respectively, in those with the four predictors. Fall history was the strongest predictor in the three sub-cohorts. CONCLUSION Fall history, dependency in daily activities, age ≥75 and living alone are independent fall predictors in CP, AF and T2DM patients.
Collapse
Affiliation(s)
- Aida Lazkani
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France.
| | - Tiba Delespierre
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
| | | | | | - Philippe Bertin
- Rheumatology Department, Limoges University Hospital, Limoges, France
| | - Gilles Berrut
- Clinical Gerontology, Nantes University Hospital, Nantes, France
| | - Emmanuelle Corruble
- Paris-Sud Faculty of Medicine, Psychiatry Department, Bicêtre University Hospital, AP-HP, INSERM U 669, Paris-Sud University, Le Kremlin-Bicêtre, France
| | | | - Geneviève Derumeaux
- Cardiovascular Functional Exploration, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Jean Doucet
- Internal Medicine, Geriatrics and Therapeutics, Saint Julien University Hospital, Rouen University, Rouen, France
| | - Bruno Falissard
- Paris-Sud Faculty of Medicine, Biostatistics Department, AP-HP, Paul Brousse Hospital, INSERM U 669, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Francoise Forette
- National Gerontology Foundation, Paris Descartes University, Paris, France
| | - Olivier Hanon
- AP-HP, Broca Hospital, Geriatrics Department, Paris Descartes University, EA 4468, Paris, France
| | - Florence Pasquier
- Lille University Hospital, Lille Nord de France University, UDSL, EA 1046, Lille, France
| | - Michel Pinget
- Endocrinology, Diabetes and Nutrition-Related Diseases (NUDE Unit), Strasbourg University Hospital, and the European Centre for the Study of Diabetes (CeeD), Strasbourg University, Strasbourg, France
| | - Rissane Ourabah
- General Practice Department, Paris-Sud Faculty of Medicine, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Celine Piedvache
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
| | - Laurent Becquemont
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
| |
Collapse
|
20
|
Herrera-Rangel AB, Aranda-Moreno C, Mantilla-Ochoa T, Zainos-Saucedo L, Jáuregui-Renaud K. Influence of the body mass index on the occurrence of falls in patients with type 2 diabetes mellitus. Obes Res Clin Pract 2015; 9:522-6. [DOI: 10.1016/j.orcp.2015.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 11/11/2014] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
|
21
|
Abstract
Diabetes in ageing communities imposes a substantial personal and public health burden by virtue of its high prevalence, its capacity to cause disabling vascular complications, the emergence of new non-vascular complications, and the effects of frailty. In this Review, we examine the current state of knowledge about diabetes in older people (aged ≥ 75 years) and discuss how recognition of the effect of frailty and disability is beginning to lead to new management approaches. A multidimensional and multidisciplinary assessment process is essential to obtain information on medical, psychosocial, and functional capabilities, and also on how impairments of these functions could limit activities. Major aims of diabetes care include maintenance of independence, functional status, and quality of life by reduction of symptom and medicine burden, and active identification of risks. Linking of therapeutic targets to individual functional status is mandatory and very tight glucose control is often not necessary. Hypoglycaemia remains an important avoidable iatrogenic event. Quality diabetes care in older people remains an important challenge for health professionals.
Collapse
Affiliation(s)
- Alan Sinclair
- Diabetes Frail, Hampton Lovett, Droitwich, Worcestershire, UK.
| | - Trisha Dunning
- Centre for Nursing and Allied Health Research at Deakin University, VIC, Australia; Barwon Health, VIC, Australia
| | - Leocadio Rodriguez-Mañas
- Department of Geriatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain; School of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| |
Collapse
|
22
|
Waclawski E, Cherry N, Wagg A. The effect on fall rate of blood glucose testing at the time of falls in elderly diabetics. Diabetol Metab Syndr 2014; 6:65. [PMID: 24917889 PMCID: PMC4051385 DOI: 10.1186/1758-5996-6-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/19/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the pattern of blood sugar and HbA1c testing among supportive living residents with diabetes and whether, in those with diabetes, blood glucose measurement was done at the time of a fall. RESEARCH DESIGN AND METHODS The management of diabetes in relation to falls in the supportive living sector is unknown. A cross-sectional questionnaire study in Edmonton Alberta, Canada of Designated Supportive Living (DSL) homes have places funded by Alberta Health Services and other homes (SL) that have no funded places. A questionnaire was distributed to Directors of Care/managers of supportive living homes, with telephone interview follow-up if required. RESULTS Sixty responses from 61 of the 71 homes (86%) provided information. 21 were DSL and 39 were SL homes. DSL homes were significantly more likely than SL ones to report that residents with diabetes had blood glucose measurements as part of regular care, to be aware that glycosylated haemoglobin was measured, and to say that blood glucose was measured at the time of a fall. Regression analysis identified that facilities with a policy to measure blood glucose at the time of a fall had a lower rate of falls in residents with diabetes than facilities without such a policy (p < 0.05). No effect of this policy was seen in residents without diabetes. CONCLUSION Residents with diabetes were less likely to fall in homes that indicated that they had a policy to measure blood glucose at the time of a fall.
Collapse
Affiliation(s)
- Eugene Waclawski
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8303-112 St NW, Edmonton, AB T6G 2 T4, Canada
| | - Nicola Cherry
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8303-112 St NW, Edmonton, AB T6G 2 T4, Canada
| | - Adrian Wagg
- Department of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
23
|
Yau RK, Strotmeyer ES, Resnick HE, Sellmeyer DE, Feingold KR, Cauley JA, Vittinghoff E, De Rekeneire N, Harris TB, Nevitt MC, Cummings SR, Shorr RI, Schwartz AV. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care 2013; 36:3985-91. [PMID: 24130352 PMCID: PMC3836123 DOI: 10.2337/dc13-0429] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization. RESEARCH DESIGN AND METHODS The longitudinal Health, Aging, and Body Composition Study included 3,075 adults aged 70-79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models. RESULTS At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio [HR] 1.48 [95% CI 1.12-1.95]) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78-5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05-1.88]) and insulin-treated diabetes (2.24 [1.24-4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization. CONCLUSIONS Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall.
Collapse
|
24
|
Brown J, Kurichi JE, Xie D, Pan Q, Stineman MG. Instrumental activities of daily living staging as a possible clinical tool for falls risk assessment in physical medicine and rehabilitation. PM R 2013; 6:316-23; quiz 323. [PMID: 24140738 DOI: 10.1016/j.pmrj.2013.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 09/19/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether instrumental activity of daily living (IADL) limitation stages can distinguish among elderly, community-dwelling persons with high likelihoods to have fallen once and more than once. DESIGN A cross-sectional survey. SETTING A nationally representative sample from the Second Longitudinal Study of Aging (LSOA II). PARTICIPANTS Included were 7401 community-dwelling persons 70 years of age and older. METHODS The association of falling once and more than once within the past 12 months and 5 stages of increasing IADL limitation were explored by using a multinomial logistic regression model that controlled for demographics, education, perceived lack of home accessibility features, and health conditions. Sample proportions were weighted to reflect the prevalence in the U.S. population of 1994. MAIN OUTCOME MEASUREMENTS Subject recall of fall history. There were 3 categories for this variable: no fall, falling once, and falling more than once in the past 12 months. RESULTS Compared with IADL stage 0, the adjusted relative risk ratio of falling once peaked in individuals at IADL stage II at 2.0 (95% confidence interval [CI], 1.5-2.6), and those at IADL stage III had a relative risk ratio of 1.8 (95% CI, 1.3-2.6). The relative risk ratio of falling more than once was 2.1 (95% CI, 1.7-2.6), 4.0 (95% CI, 3.0-5.3), 3.7 (95% CI, 2.8-5.0), and 2.7 (95% CI, 1.5-4.9) for IADL stages I, II, III, and IV, respectively, when treating IADL stage 0 as reference. CONCLUSIONS IADL limitation stages could represent a powerful and practical tool for screening patients in the U.S. elderly population according to fall risk. Clinical implementation and prospective testing for validation as a screening tool would be necessary.
Collapse
Affiliation(s)
- Janice Brown
- Department of Physical Medicine and Rehabilitation, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(∗)
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, PA(†)
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, PA(‡)
| | - Qiang Pan
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, PA(§)
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, 423 Guardian Drive, 904 Blockley Hall, Philadelphia, PA 19104-6021(‖).
| |
Collapse
|
25
|
Bloch F, Thibaud M, Tournoux-Facon C, Brèque C, Rigaud AS, Dugué B, Kemoun G. Estimation of the risk factors for falls in the elderly: Can meta-analysis provide a valid answer? Geriatr Gerontol Int 2012. [DOI: 10.1111/j.1447-0594.2012.00965.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Caroline Tournoux-Facon
- Department of Epidemiology and Biostatistics. Inserm CIC P802; University of Poitiers; Poitiers; France
| | - Cyril Brèque
- P'Institute UPR 3346; University of Poitiers; Poitiers; France
| | | | - Benoit Dugué
- Laboratory «Mobilité, Vieillissement, Exercice» (MOVE), EA 6314; University of Poitiers; Poitiers; France
| | - Gilles Kemoun
- Laboratory «Mobilité, Vieillissement, Exercice» (MOVE), EA 6314; University of Poitiers; Poitiers; France
| |
Collapse
|
26
|
Prevalence of Falls and Its Associated Factors among Elderly Diabetes in a Tertiary Center, Malaysia. Curr Gerontol Geriatr Res 2012; 2012:539073. [PMID: 22693496 PMCID: PMC3369479 DOI: 10.1155/2012/539073] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 04/05/2012] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel's index). The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, P < 0.05), age group more than 75 (OR: 2.97, P < 0.05), retinopathy (OR: 2.19, P < 0.05), and orthostatic hypotension (OR: 2.87, P < 0.05) were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, P < 0.05). In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score.
Collapse
|
27
|
Pijpers E, Ferreira I, de Jongh RT, Deeg DJ, Lips P, Stehouwer CDA, Nieuwenhuijzen Kruseman AC. Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam. Age Ageing 2012; 41:358-65. [PMID: 22156559 DOI: 10.1093/ageing/afr145] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES to compare the incidence of recurrent falls in older people with and without diabetes, and to examine diabetes- and fall-related risk factors explaining the increased risk of recurrent falls associated with diabetes. METHODS population-based cohort study of 1,145 (85 with diabetes) community-dwelling participants, aged ≥65 years, from The Longitudinal Aging Study Amsterdam (LASA). Falls were assessed prospectively (every 3 months) during a 3-year follow-up period. Incidence of recurrent falls was estimated with Poisson regression analyses. The associations between diabetes and time to recurrent falls, defined as at least two falls occurring within a 6-month period, and the potential explanatory role of several risk factors herein, were analysed with the use of Cox-regression models. RESULTS during a mean follow-up of 139 weeks, 30.6% of the individuals with and 19.4% of the individuals without diabetes fell recurrently [incidence rate of 129.7 versus 77.4 per 1,000 persons-years, respectively, HR = 1.67 (95% CI: 1.11-2.51)]. Adjustments for potential confounders did not change the increased risk associated with diabetes [HR = 1.63 (1.06-2.52)]. Factors that partly explained this increased risk were: greater number of medication, higher levels of pain, poorer self-perceived health, lower physical activity and grip strength, more limitations in ADLs, lower-extremity physical performance and cognitive impairment. Altogether, these variables accounted for 47% of the increased risk of recurrent falls associated with diabetes [adjusted HR = 1.30 (0.79-2.11)]. CONCLUSION fall prevention efforts targeting the factors identified above may need to be incorporated into the care and treatment of older individuals with diabetes.
Collapse
Affiliation(s)
- Evelien Pijpers
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
28
|
Grzywacz JG, Arcury TA, Saldana S, Kirk JK, Bell RA, Ip E, Quandt SA. Social control in older adults' diabetes self management and well-being. Behav Med 2012; 38:115-20. [PMID: 23121208 PMCID: PMC3648584 DOI: 10.1080/08964289.2012.693976] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The "dual effects" hypothesis argues that social control can be effective in promoting positive health-related behavior change, but it can also jeopardize the targeted individual's well-being. This hypothesis is tested using hemoglobin A1C as an objective indicator of behavioral compliance with diabetes self-management behavior and depressive symptoms. Differences in the effects of social control on A1C and depressive symptoms by sex and ethnicity are tested. Cross-sectional data were obtained from a multi-ethnic sample of older adults with diabetes (N = 593). Greater social control was associated with poorer rather than better odds of achieving glucose control, and with greater depressive symptoms. There was no evidence that social control has differential effects on either glucose control or depressive symptoms by sex or ethnicity. Active use of social control attempts by family members and friends, especially if they are coercive or punitive in nature, are likely counterproductive for maintaining the physical and mental health of older adults with diabetes.
Collapse
Affiliation(s)
- Joseph G. Grzywacz
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of Medicine
| | - Julienne K. Kirk
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Ronny A. Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine
| |
Collapse
|
29
|
Grzywacz JG, Arcury TA, Ip EH, Nguyen HT, Saldana S, Reynolds T, Bell RA, Kirk JK, Quandt SA. Cultural basis for diabetes-related beliefs among low- and high-education African American, American Indian, and white older adults. Ethn Dis 2012; 22:466-472. [PMID: 23140078 PMCID: PMC3510461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES Racial and ethnic disparities in diabetes and subsequent complications are often attributed to culture; however, previous diabetes disparities research is restricted to in-depth ethnic-specific samples or to comparative study designs with limited belief assessment. The goal of our study was to improve understanding of the cultural basis for variation in diabetes beliefs. DESIGN Cross-sectional. SETTING Rural North Carolina. PARTICIPANTS Older adults (aged 60+) with diabetes, equally divided by ethnicity (White, African American, American Indian) and sex (N=593). INTERVENTIONS Guided by Explanatory Models of Illness and Cultural Consensus research traditions, trained interviewers collected data using 38 items in four diabetes belief domains: causes, symptoms, consequences, and medical management. Items were obtained from the Common Sense Model of Diabetes Inventory (CSMDI). MAIN OUTCOME Beliefs about diabetes. Response options for each diabetes belief item were "agree," "disagree" and "don't know." Collected data were analyzed using Anthropac (version 4.98) and Latent Gold (version 4.5) programs. RESULTS There is substantial similarity in diabetes beliefs among African Americans, American Indians and Whites. Diabetes beliefs were most similar in the symptoms and consequences domains compared to beliefs pertaining to causes and medical management. Although some discrete beliefs differed by ethnicity, systematic differences by ethnicity were observed for specific educational groups. CONCLUSIONS Socioeconomic conditions influence diabetes beliefs rather than ethnicity per se.
Collapse
Affiliation(s)
- Joseph G Grzywacz
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kadir AA, Hasim H. Prevalence of falls in elderly men with diabetes in Diabetic Clinic Universiti Sains Malaysia Hospital, Malaysia. JOURNAL OF MENS HEALTH 2011. [DOI: 10.1016/s1875-6867(11)60032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
31
|
Lai PC, Wong WC, Low CT, Wong M, Chan MH. A small-area study of environmental risk assessment of outdoor falls. J Med Syst 2010; 35:1543-52. [PMID: 20703763 DOI: 10.1007/s10916-010-9431-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 01/11/2010] [Indexed: 12/14/2022]
Abstract
Falls in public places are an issue of great health concern especially for the elderly. Falls among the elderly is also a major health burden in many countries. This study describes a spatial approach to assess environmental causes of outdoor falls using a small urban community in Hong Kong as an example. The method involves collecting data on fall occurrences and mapping their geographic positions to examine circumstances and environmental evidence that contribute to falls. High risk locations or hot spots of falls are identified on the bases of spatial proximity and concentration of falls within a threshold distance by means of kernel smoothing and standard deviational ellipses. This method of geographic aggregation of individual fall incidents for a small-area study yields hot spots of manageable sizes. The spatial clustering approach is effective in two ways. Firstly, it allows visualisation and isolation of fall hot spots to draw focus. Secondly and especially under conditions of resource decline, policy makers are able to target specific locations to examine the underlying causal mechanisms and strategise effective response and preventive measures based on the types of environmental risk factors identified.
Collapse
Affiliation(s)
- Poh-Chin Lai
- Department of Geography, The University of Hong Kong, Hong Kong.
| | | | | | | | | |
Collapse
|
32
|
Bloch F, Thibaud M, Dugué B, Brèque C, Rigaud AS, Kemoun G. Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics. Clinics (Sao Paulo) 2010; 65:895-903. [PMID: 21049218 PMCID: PMC2954741 DOI: 10.1590/s1807-59322010000900013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 05/21/2010] [Accepted: 05/31/2010] [Indexed: 11/21/2022] Open
Abstract
CONTEXT The multifactorial nature of falls among elderly people is well-known. Identifying the social-demographic characteristics of elderly people who fall would enable us to define the typical profile of the elderly who are at risk of falling. OBJECTIVE We aimed to isolate studies in which the social-demographic risk factors for falls among the elderly have been evaluated and to carry out a meta-analysis by combining the results of all of these selected studies. METHOD We did a systematic literature review using the key words "accidental fall / numerical data" and "risk factors." Inclusion criteria entailed the selection of articles with the following characteristics: population of subjects aged 60 years or over, falls that took place in everyday life, and social-demographic risk factors for falls. RESULTS 3,747 indexed articles published between 1981 and 2007 were identified, and 177 studies with available data were included, of which 129 had data on social-demographic risk factors for falls. Difficulties in activities of daily living (ADL) or in instrumental activities of daily living (IADL) double the risk of falling: The OR and 95% Cl were 2.26 (2.09, 2.45) for disturbance ADL and 2.10 (1.68, 2.64) for IADL. The OR and 95% Cl for Caucasians were 1.68 (0.98 - 2.88) and 0.64 (0.51 - 0.80) for Hispanics. In the subgroup of patients older than eighty, being married protected people from falling with an OR and 95% Cl =0.68 (0.53 - 0.87). CONCLUSION Defining factors that create a risk of falling and protect elderly people from falls using social-demographic characteristics lets us focus on an "at risk" population for which a specific program could be developed.
Collapse
Affiliation(s)
- F Bloch
- Department of Gerontology, Hôpital Broca, Paris, France.
| | | | | | | | | | | |
Collapse
|
33
|
Ramirez D, Wood RC, Becho J, Owings K, Markides K, Espino DV. Mini-mental state exam domains predict falls in an elderly population: follow-up from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) study. Ethn Dis 2010; 20:48-52. [PMID: 20178182 PMCID: PMC3027488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES Assessment of the predictive ability of the Mini-Mental Status Exam (MMSE) domains (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction) for falls in Mexican American elders tested the hypothesis that low MMSE domain scores are related to an increased number of falls. DESIGN Data were obtained from the 1998-99 re-survey (Wave 3) Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE), a population-based study of older Mexican Americans residing in the southwestern United States. METHODOLOGY We used a retrospective case control study design; 926 subjects who were aged > or = 77 years at Wave 3 were examined. MMSE scores were utilized to predict falls two years later. Measurements included sociodemographic characteristics, MMSE scores, activities of daily living (ADL), instrumental activities of daily living (IADL), and fall rates. MAIN OUTCOME MEASURES Relationships between MMSE domain scores and falls. RESULTS Of the 681 subjects examined two years later, 35.7% experienced at least one fall. Subjects with errors on orientation to place (OR = 2.01) and visual construction (OR = 1.9) were most likely to fall. CONCLUSIONS MMSE domains with poor scores and most predictive of falls in Mexican Americans elders were orientation to place and visual construction. Further evaluation for confusion level and visual ability in elders presenting with dysfunction on these domains may lead to a reduction of falls in this ethnic group.
Collapse
|
34
|
Poh-Chin L, Martin W, Ming-Houng C, Wing-Cheung W, Chien-Tat L. An ecological study of physical environmental risk factors for elderly falls in an urban setting of Hong Kong. THE SCIENCE OF THE TOTAL ENVIRONMENT 2009; 407:6157-6165. [PMID: 19775728 DOI: 10.1016/j.scitotenv.2009.08.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 08/20/2009] [Accepted: 08/25/2009] [Indexed: 05/28/2023]
Abstract
Elderly fall has become an issue of great public health concern and typically important to the aging population in Hong Kong because it carries a great burden to the individuals and the society. More accurate information about environmental risk factors to falls among the elderly could alleviate if not overcome the situation. Conventional approaches to elderly falls were mainly conducted using statistical methods and clinical tests on falls. This study employs ecological and associative analysis using the geographic information systems (GIS) technology to visualize spatial association of falls and environmental factors. The study identified eleven hot spots of elderly falls with unique environmental characteristics. Amongst various environmental attributes, busy streets and junctions, outdoor markets, and refuse collection points, exhibit a strong spatial relationship with the hot spots. The results have demonstrated that GIS can offer an excellent synergic platform to explore the role of space and pattern in fall occurrences.
Collapse
Affiliation(s)
- Lai Poh-Chin
- Department of Geography, The University of Hong Kong, Pokfulam Road, Hong Kong.
| | | | | | | | | |
Collapse
|
35
|
Lai PC, Low CT, Wong M, Wong WC, Chan MH. Spatial analysis of falls in an urban community of Hong Kong. Int J Health Geogr 2009; 8:14. [PMID: 19291326 PMCID: PMC2666650 DOI: 10.1186/1476-072x-8-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 03/17/2009] [Indexed: 11/30/2022] Open
Abstract
Background Falls are an issue of great public health concern. This study focuses on outdoor falls within an urban community in Hong Kong. Urban environmental hazards are often place-specific and dependent upon the built features, landscape characteristics, and habitual activities. Therefore, falls must be examined with respect to local situations. Results This paper uses spatial analysis methods to map fall occurrences and examine possible environmental attributes of falls in an urban community of Hong Kong. The Nearest neighbour hierarchical (Nnh) and Standard Deviational Ellipse (SDE) techniques can offer additional insights about the circumstances and environmental factors that contribute to falls. The results affirm the multi-factorial nature of falls at specific locations and for selected groups of the population. Conclusion The techniques to detect hot spots of falls yield meaningful results that enable the identification of high risk locations. The combined use of descriptive and spatial analyses can be beneficial to policy makers because different preventive measures can be devised based on the types of environmental risk factors identified. The analyses are also important preludes to establishing research hypotheses for more focused studies.
Collapse
Affiliation(s)
- Poh C Lai
- Department of Geography, The University of Hong Kong, Hong Kong.
| | | | | | | | | |
Collapse
|
36
|
Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, de Rekeneire N, Strotmeyer ES, Shorr RI, Vinik AI, Odden MC, Park SW, Faulkner KA, Harris TB. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care 2008; 31:391-6. [PMID: 18056893 PMCID: PMC2288549 DOI: 10.2337/dc07-1152] [Citation(s) in RCA: 308] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Older adults with type 2 diabetes are more likely to fall, but little is known about risk factors for falls in this population. We determined whether diabetes-related complications or treatments are associated with risk of falls in older diabetic adults. RESEARCH DESIGN AND METHODS In the Health, Aging, and Body Composition cohort of well-functioning older adults, participants reported falls in the previous year at annual visits. Odds ratios (ORs) for more frequent falls among 446 diabetic participants whose mean age was 73.6 years, with an average follow-up of 4.9 years, were estimated with continuation ratio models. RESULTS In the first year, 23[corrected]% reported falling; 22, 26, 30[corrected], and 31[corrected]% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR 1.50 -95% CI 1.07-2.12], worst quartile versus others); higher cystatin-C, a marker of reduced renal function (1.38 [1.11-1.71], for 1 SD increase); poorer contrast sensitivity (1.41 [0.97-2.04], worst quartile versus others); and low A1C in insulin users (4.36 [1.32-14.46], A1C <or=6 vs. >8%) were associated with risk of falls. In those using oral hypoglycemic medications but not insulin, low A1C was not associated with risk of falls (1.29 [0.65-2.54], A1C <or=6 vs. >8%). Adjustment for physical performance explained some, but not all, of these associations. CONCLUSIONS In older diabetic adults, reducing diabetes-related complications may prevent falls. Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C <or=6% increased risk of falls.
Collapse
Affiliation(s)
- Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94107-1762, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Recent studies have added to the evidence that type 1 and type 2 diabetes are associated with increased risk of hip fracture and other fractures. More frequent falls probably account for some of this increased risk, but reduced bone strength may also play a role. Although type 1 diabetes is associated with lower bone density, those with type 2 diabetes usually have elevated bone density. Yet for both types of diabetes, bone appears to be more fragile for a given density. Diabetes can affect bone through multiple pathways-some with contradictory effects-including obesity, insulin levels, hyperglycemia, and advanced glycation end products in collagen. Treatment with thiazolidinediones may increase fracture risk, at least in older women. Clinicians need to be aware of the increased fracture risk associated with diabetes. Additional research is needed to clarify the mechanisms underlying this increased risk and the best approaches to fracture prevention.
Collapse
Affiliation(s)
- Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107, USA.
| | | |
Collapse
|
38
|
Brotherton SS, Krause JS, Nietert PJ. A pilot study of factors associated with falls in individuals with incomplete spinal cord injury. J Spinal Cord Med 2007; 30:243-50. [PMID: 17684890 PMCID: PMC2031958 DOI: 10.1080/10790268.2007.11753932] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 01/03/2007] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI). STUDY DESIGN Cross-sectional mail survey. METHODS A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year. RESULTS After adjusting for covariates, having fallen in the past year was significantly (P < 0.05) associated with greater numbers of medical conditions (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.0-1.7), having arthritis (OR = 3.4, 95% CI = 1.2-9.6), experiencing dizziness (OR = 5.6, 95% Cl = 1.1-27.7), greater numbers of days with poor physical health (OR = 1.1; 95% Cl = 1.0-1.3), and the restriction of community activities because of fear of falling (OR = 1.5, 95% CI = 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR = 0.5; 95% Cl = 0.3-0.9), those with better perceived health compared to a year ago (OR = 0.4; 95% Cl = 0.2-0.8), individuals who exercised more frequently (OR = 0.2; 95% CI = 0.1-0.7), and those who used a walker (OR = 0.3; 95% CI = 0.1-0.9). CONCLUSIONS Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI.
Collapse
Affiliation(s)
- Sandra S Brotherton
- Department of Rehabilitation Sciences, Medical University of South Carolina, PO Box 250965, Charleston, SC 29425, USA.
| | | | | |
Collapse
|