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Keast S, Broatch JR, Chung S, Dixon R, Dongol R, Emerson L, Hayes A, Iuliano S, Levinger I, Lin X, McKnight E, Moore K, Nagano H, Parker AG, Said CM, Sales M, Thomas R, White C, Zanker J, Gilmartin-Thomas J. Best practice in dementia health care: Key clinical practice pointers from a national conference and innovative opportunities for pharmacy practice. Res Social Adm Pharm 2024:S1551-7411(24)00230-4. [PMID: 39122588 DOI: 10.1016/j.sapharm.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/24/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Sub-optimal care of people living with dementia has serious consequences for older populations. The 2021 Australian Royal Commission noted that a large proportion of older adults in aged care live with dementia, yet there are limitations in the knowledge and understanding of staff who care for them. In the pursuit of educating pharmacists, physicians, allied health care professionals, researchers, academics, people living with dementia and their carers, and the public, who are facing the challenges of dementia management, the 'Best Practice in Dementia Health Care' conference was held on November 10, 2022 at Western Health (Sunshine Hospital, Melbourne, Australia). METHODS Sixteen experts presented on the current practice and challenges associated with delivering best practice dementia health care to older Australians, often highlighting how medication-related challenges impacted on their area of practice. RESULTS Presenters highlighted the importance of individualised medication management plans, considerations of culture and Indigenous communities, the role of technology, and the impact of exercise and the physical environment on care of people living with dementia. Key clinical practice messages from each expert presenter fit into four main topics: 'navigating complexities of medication management'; 'enhancing wellbeing'; 'supportive settings and environments'; and 'programs and services improving care'. CONCLUSIONS Pharmacists are crucial members of allied health care teams. They have the necessary medication and comorbidity expertise to review medication regimens, liaise with all health care providers, and provide holistic, pharmacological and non-pharmacological patient education. Towards providing best practice dementia health care, pharmacists can contribute in several ways, such as providing health practitioner education to increase understanding about medications and how they can impact on allied health practice, to ensure that medications are prescribed appropriately and safely. Further, pharmacists can make available resources to ensure people living with dementia receive culturally safe and appropriate care, while advocating for greater understanding of the history and experiences of people living with dementia to ensure care aligns with their day-to-day routines. Finally, pharmacists can provide peer-support to other health care professionals and care staff to ensure optimal management of behavioural and psychological symptoms of dementia. The information and insights shared at the conference can serve as a valuable resource for pharmacists and other health care professionals and researchers working to improve the lives of those living with dementia.
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Affiliation(s)
- Sam Keast
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - James R Broatch
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | | | | | - Roshna Dongol
- Doutta Galla Aged Care Services, Melbourne, Australia.
| | - Leanne Emerson
- Dementia Australia, Melbourne, Australia; Audiology Australia, Victoria, Australia.
| | - Alan Hayes
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia; Department of Medicine, Western Health (University of Melbourne), Melbourne, Australia.
| | | | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia.
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | - Kirsten Moore
- National Ageing Research Institute, Parkville, Australia; Department of Medicine, Royal Melbourne Hospital (University of Melbourne), Parkville, Victoria, Australia.
| | - Hanatsu Nagano
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Alexandra G Parker
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Catherine M Said
- Western Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia.
| | - Myrla Sales
- Western Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia.
| | - Rees Thomas
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | | | - Jesse Zanker
- Western Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital (University of Melbourne), Parkville, Victoria, Australia.
| | - Julia Gilmartin-Thomas
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia; Department of Medicine, Western Health (University of Melbourne), Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia; Allied Health Department, Alfred Health, Victoria, Australia.
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Taylor ME, Kerckhaert L, Close JCT, van Schooten KS, Lord SR. The Impact of Misaligned Perceived and Objective Fall Risk in Cognitively Impaired Older People. J Alzheimers Dis 2024:JAD240489. [PMID: 39031366 DOI: 10.3233/jad-240489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. Objective We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Methods Participants (n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). Results The anxious (IRR = 1.70, 95% CI = 1.02-2.84), unaware (IRR = 2.00, 95% CI = 1.22-3.26), and aware (IRR = 2.53, 95% CI = 1.67-3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Conclusions Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Luuk Kerckhaert
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
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3
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Guirguis-Blake JM, Perdue LA, Coppola EL, Bean SI. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2024; 332:58-69. [PMID: 38833257 DOI: 10.1001/jama.2024.4166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Importance Falls are the most common cause of injury-related morbidity and mortality in older adults. Objective To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults. Data Sources MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024. Study Selection Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older. Data Extraction and Synthesis Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment. Main Outcomes and Measures Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms. Results Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise. Conclusions and Relevance Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.
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Affiliation(s)
- Janelle M Guirguis-Blake
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
- Department of Family Medicine, University of Washington, Tacoma
| | - Leslie A Perdue
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Greene L, Barber R, Bingham A, Connors J, Conroy S, Elkhafer K, Fox C, Goodwin V, Gordon A, Hall AJ, Harwood RH, Hulme C, Jackson T, Litherland R, Morgan-Trimmer S, Pankiewicz S, Parry SW, Sharma A, Ukoumunne O, Whale B, Allan L. Maintaining independence in individuals with dementia at home after a fall: a protocol for the UK pilot cluster randomised controlled trial MAINTAIN. BMJ Open 2024; 14:e083494. [PMID: 38307534 PMCID: PMC10836345 DOI: 10.1136/bmjopen-2023-083494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Individuals with dementia face an increased risk of falls. Falls can cause a decline in the individual's overall functionality. All types of falls, including those that do not result in injury, can lead to psychosocial consequences, such as diminished confidence and a fear of falling. Projections indicate a rising trend in dementia diagnoses, implying an increase in fall incidents. Yet, there is a lack of evidence to support interventions for people living with dementia who have fallen. Our objective is to test the feasibility of a falls intervention trial for people with dementia. METHOD AND ANALYSIS This is a UK-based two-arm pilot cluster randomised controlled trial. In this study, six collaborating sites, which form the clusters, will be randomly allocated to either the intervention arm or the control arm (receiving treatment as usual) at a 1:1 ratio. During the 6 month recruitment phase, each cluster will enrol 10 dyads, comprising 10 individuals with dementia and their respective carers, leading to a total sample size of 60 dyads. The primary outcomes are the feasibility parameters for a full trial (ie, percentage consented, follow-up rate and cost framework). Secondary outcomes include activities of daily living, quality of life, fall efficacy, mobility, goal attainment, cognitive status, occurrence of falls, carer burden and healthcare service utilisation. Outcome measures will be collected at baseline and 28 weeks, with an additional assessment scheduled at 12 weeks for the healthcare service utilisation questionnaire. An embedded process evaluation, consisting of interviews and observations with participants and healthcare professionals, will explore how the intervention operates and the fidelity of study processes. ETHICS AND DISSEMINATION The study was approved by the NHS and local authority research governance and research ethics committees (NHS REC reference: 23/WA/0126). The results will be shared at meetings and conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN16413728.
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Affiliation(s)
- Leanne Greene
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Robert Barber
- Centre for Health of the Elderly, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison Bingham
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - James Connors
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences University of Exeter, University of Exeter, Exeter, UK
| | - Simon Conroy
- St Pancras Rehabilitation Unit, Central and North West London NHS Foundation Trust, London, UK
| | - Kamr Elkhafer
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Chris Fox
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Victoria Goodwin
- Department of Public Health and Sport Science, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Adam Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS) School of Medicine, University of Nottingham, Nottingham, UK
| | - Abigail J Hall
- Department of Public Health and Sports Science, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Claire Hulme
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - T Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Sarah Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sophie Pankiewicz
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Steve W Parry
- Population and Health Sciences Institute Newcastle University, Newcastle University, Newcastle upon Tyne, UK
| | - Ashima Sharma
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Obioha Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences University of Exeter, University of Exeter, Exeter, UK
| | - Bethany Whale
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Louise Allan
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Heller C, Haak M, Schmidt SM, Chiatti C, Ekstam L, Nilsson MH, Slaug B. The Relationship Between Physical Housing Characteristics, Housing Accessibility and Different Aspects of Health Among Community-Dwelling Older People: A Systematic Review. J Aging Health 2024; 36:120-132. [PMID: 37201208 PMCID: PMC10693737 DOI: 10.1177/08982643231175367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Objectives: To synthesize the evidence on the relationships between physical housing characteristics or housing accessibility and different aspects of health among community-dwelling people 60 years and older. Methods: A systematic review of recent evidence with a narrative synthesis was conducted. Results: We included 15 studies and found three themes covering physical housing characteristics or housing accessibility that are associated with aspects of health among community-dwelling older adults: (1) interventions by home modifications targeting housing features both at entrances and indoors; (2) non-interventions targeting indoor features; (3) non-interventions targeting entrance features, that is, the presence of an elevator or stairs at the entrance. The overall quality of evidence across studies was assessed as very low. Discussion: The findings highlight the need for studies with a stronger research design and higher methodological quality that address the physical housing environment in relation to health among older adults to strengthen the body of evidence.
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Affiliation(s)
| | - Maria Haak
- Department of Nursing Education and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | | | - Lisa Ekstam
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Maria H. Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Björn Slaug
- Department of Health Sciences, Lund University, Lund, Sweden
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Santiago Martinez P, Lord SR, Close JCT, Taylor ME. Associations between psychotropic and anti-dementia medication use and falls in community-dwelling older adults with cognitive impairment. Arch Gerontol Geriatr 2023; 114:105105. [PMID: 37364485 DOI: 10.1016/j.archger.2023.105105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Evidence for effective fall prevention strategies is limited for people with cognitive impairment. Understanding what factors contribute to fall risk identifies potential intervention strategies. We aimed to determine if psychotropic and anti-dementia medication use are associated with falls in community-dwelling older people with mild-moderate cognitive impairment and dementia. DESIGN Secondary analysis of an RCT (i-FOCIS). PARTICIPANTS AND SETTING 309 community-dwelling people with mild to moderate cognitive impairment or dementia from Sydney, Australia. METHODS Demographic information, medical history, and medication use were collected at baseline and participants were followed up for 1-year for falls using monthly calendars and ancillary telephone falls. RESULTS Psychotropic medication use was associated with an increased rate of falls (IRR 1.41, 95%CI 1.03, 1.93) and slower gait speed, poor balance and reduced lower limb function when adjusting for age, sex, education and cognition, as well as RCT group allocation when examining prospective falls. Antidepressants use increased the rate of falls in a similarly adjusted model (IRR 1.54, 95%CI 1.10, 2.15), but when additionally adjusting for depressive symptoms, antidepressant use was no longer significantly associated with falls while depressive symptoms was. Anti-dementia medication use was not associated with rate of falls. CONCLUSIONS Psychotropic medication use increases fall risk, and anti-dementia medication does not reduce fall risk in older adults with cognitive impairment. Effective management of depressive symptoms, potentially with non-pharmacological approaches, is needed to prevent falls in this population. Research is also required to ascertain the risks/benefits of withdrawing psychotropic medications, particularly in relation to depressive symptoms.
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Affiliation(s)
| | - Stephen R Lord
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E Taylor
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.
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Palonen M, Turja T, Castano de la Rosa R, Ilomäki S, Kaasalainen T, Kivimäki Rantanen K, Pelsmakers S, Ruusuvuori J, Valtonen A, Kaunonen M. Learning from fall-related interventions for older people at home: A scoping review. Geriatr Nurs 2023; 54:76-82. [PMID: 37713947 DOI: 10.1016/j.gerinurse.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/17/2023]
Abstract
This scoping review aims to provide a better understanding about the fall-related interventions, and the conditions which stand out as effective in decreasing fall risks of older people at home. A total of 28 peer-reviewed papers were included when they reported interventions with an incidence of falls or fall-risk as a primary outcome for older people, focusing on the home environment, from 8 databases. Qualitative examination was complemented by quantitative risk ratio analysis where it was feasible. The interventions regarding incidence of falls had a mean risk rate of 0.75; moreover, interventions using multiple strategies were found relatively successful. The interventions regarding fall risk had a mean hazard rate of 0.66. A considerable number of no-effect ratios were evident. Combining education, home assessment or improvement, and use of technology with implementation by health service experts appears to be the most promising intervention strategy to reduce falls.
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Affiliation(s)
- Mira Palonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.
| | - Tuuli Turja
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | | | - Sakari Ilomäki
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Tapio Kaasalainen
- Faculty of Built Environment, Unit of Architecture, Tampere University, Tampere, Finland
| | | | - Sofie Pelsmakers
- Faculty of Built Environment, Unit of Architecture, Tampere University, Tampere, Finland
| | - Johanna Ruusuvuori
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Annika Valtonen
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; The Well-being Services County of Pirkanmaa, Hospital services, Tampere, Finland
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Tarbert R, Zhou J, Manor B. Potential Solutions for the Mitigation of Hip Injuries Caused by Falls in Older Adults: A Narrative Review. J Gerontol A Biol Sci Med Sci 2023; 78:853-860. [PMID: 36194471 PMCID: PMC10172985 DOI: 10.1093/gerona/glac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hip injuries caused by falling are common and often catastrophic for older adults. There is thus an urgent need to develop solutions designed to mitigate fall injuries to the hip by reducing the forces created on the body by ground impact. METHODS The goal of this narrative review was to synthesize published literature on available products developed with the expressed goal of reducing fall-related hip injuries. RESULTS Three categories were identified: passive wearables (eg, hip protectors), active wearables (eg, instrumented belts with deployable airbags), and compliant flooring. Laboratory studies indicate that each technology can reduce peak forces induced by simulated falls. Considerable preliminary data suggest that passive wearables and compliant flooring may reduce fall-related injuries within long-term care facilities. Controlled trials of specific types of these 2 technologies, however, have produced inconsistent results. While little is known about the effectiveness of active wearables, promising early data indicate the feasibility of an instrumented belt worn around the waist to effectively deploy an airbag to protect the hips prior to ground impact. Important challenges associated with one or more identified technologies included poor adherence to instructed wear as well as the potential for significant physical or time burden to caregivers or health care professionals. CONCLUSIONS Passive wearables, active wearables, and compliant flooring have shown promise in reducing fall-related hip injuries in older adults. Still, each type of product is accompanied by limited real-world data and/or significant challenges that must be overcome to maximize effectiveness and minimize unintended side effects.
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Affiliation(s)
- Rebecca J Tarbert
- ActiveProtective Technologies, Inc, Fort Washington, Pennsylvania, USA
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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9
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Leung KK, Carr FM, Kennedy M, Russell MJ, Sari Z, Triscott JA, Korownyk C. Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e069543. [PMID: 37085313 PMCID: PMC10124284 DOI: 10.1136/bmjopen-2022-069543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Falls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The COVID-19 pandemic has significantly increased the uptake of telehealth, but the effectiveness of virtual, home-based fall prevention programmes is not clearly known. We aim to synthesise the trials on telerehabilitation and home-based falls prevention programmes to determine their effectiveness in reducing falls and adverse outcomes, as well as to describe the safety risks associated with telerehabilitation. METHODS AND ANALYSIS This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Database searches from inception to August 2022 will be conducted without language restrictions of MEDLINE, EMBASE, Ovid HealthSTAR, CINAHL, SPORTDiscus, Physiotherapy EvidenceDatabase (PEDro) and the Cochrane Library. Grey literature including major geriatrics conference proceedings will be reviewed. Using Covidence software, two independent reviewers will in duplicate determine the eligibility of randomised controlled trials (RCTs). Eligible RCTs will compare telerehabilitation and home-based fall prevention programmes to usual care among community-dwelling older adults and will report at least one efficacy outcome: falls, fractures, hospitalisations, mortality or quality of life; or at least one safety outcome: pain, myalgias, dyspnoea, syncope or fatigue. Secondary outcomes include functional performance in activities of daily living, balance and endurance. Risk of bias will be assessed using the Cochrane Collaboration tool. DerSimonian-Laird random effects models will be used for the meta-analysis. Heterogeneity will be assessed using the I2 statistic and Cochran's Q statistic. We will assess publication bias using the Egger's test. Prespecified subgroup analyses and univariate meta-regression will be used. ETHICS AND DISSEMINATION Ethics approval is not required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022356759.
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Affiliation(s)
- Karen K Leung
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Frances M Carr
- Department of Internal Medicine (Geriatrics), University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Megan Kennedy
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | | | - Zainab Sari
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Jean Ac Triscott
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Jehu DA, Davis JC, Gill J, Oke O, Liu-Ambrose T. The Effect of Exercise on Falls in People Living with Dementia: A Systematic Review. J Alzheimers Dis 2023; 92:1199-1217. [PMID: 36872779 DOI: 10.3233/jad-221038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
BACKGROUND People living with dementia (PWD) are at a heightened risk for falls. However, the effects of exercise on falls in PWD are unclear. OBJECTIVE To conduct a systematic review of randomized controlled trials (RCTs) examining the efficacy of exercise to reduce falls, recurrent falls, and injurious falls relative to usual care among PWD. METHODS We included peer-reviewed RCTs evaluating any exercise mode on falls and related injuries among medically diagnosed PWD aged ≥55years (international prospective register of systematic reviews (PROSPERO) ID:CRD42021254637). We excluded studies that did not solely involve PWD and were not the primary publication examining falls. We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register and grey literature on 08/19/2020 and 04/11/2022; topical categories included dementia, exercise, RCTs, and falls. We evaluated the risk of bias (ROB) using the Cochrane ROB Tool-2 and study quality using the Consolidated Standards of Reporting Trials. RESULTS Twelve studies were included (n = 1,827; age = 81.3±7.0 years; female = 59.3%; Mini-Mental State Examination = 20.1±4.3 points; intervention duration = 27.8±18.5 weeks; adherence = 75.5±16.2%; attrition = 21.0±12.4%). Exercise reduced falls in two studies [Incidence Rate Ratio (IRR) range = 0.16 to 0.66; fall rate range: intervention = 1.35-3.76 falls/year, control = 3.07-12.21 falls/year]; all other studies (n = 10) reported null findings. Exercise did not reduce recurrent falls (n = 0/2) or injurious falls (n = 0/5). The RoB assessment ranged from some concerns (n = 9) to high RoB (n = 3); no studies were powered for falls. The quality of reporting was good (78.8±11.4%). CONCLUSION There was insufficient evidence to suggest that exercise reduces falls, recurrent falls, or injurious falls among PWD. Well-designed studies powered for falls are needed.
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Affiliation(s)
- Deborah A Jehu
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer C Davis
- Applied Health Economics Laboratory, The University of British Columbia -Okanagan, Kelowna, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, BC, Canada
| | - Jessica Gill
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Olabamibo Oke
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Teresa Liu-Ambrose
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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11
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Felton N, Deave T. The Lived Experience of Healthcare Workers in Preventing Falls in Community Dwelling Individuals with Dementia. Geriatrics (Basel) 2022; 7:113. [PMID: 36286216 PMCID: PMC9601408 DOI: 10.3390/geriatrics7050113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Older adults living with dementia have at least twice the risk of falling compared to their peers living without cognitive impairment. There is evidence for the effectiveness of standard interventions in falls prevention in community dwellings, but they may not translate to individuals with Mild Cognitive Impairment (MCI) or dementia. A qualitative enquiry, adopting an interpretive research design underpinned by a phenomenological approach using semi-structured interviews with four healthcare workers from the field was adopted. Data were analysed using Interpretive Phenomenological Analysis to identify themes. Four major themes were developed: on-going assessment is important in guiding interventions and influencing change, knowledge and experience informs practice, individuals living with dementia have complex physical and cognitive needs, and teamwork is essential in falls prevention strategies, which highlighted falls prevention in this context being multifactorial and complex. The findings found that combining physical and cognitive strategies as part of falls prevention has potential benefits for this population, including reducing falls risks and maintaining function. Targeted training and awareness raising within a supportive multi-disciplinary team structure is required, underpinned by on-going, person-centred assessments.
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Affiliation(s)
- Nansi Felton
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK
- School for Health and Social Well-Being, University of the West of England, Bristol BS16 1DD, UK
| | - Toity Deave
- School for Health and Social Well-Being, University of the West of England, Bristol BS16 1DD, UK
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12
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López-García A, Sánchez-Ruíz ME. Feasible Intervention through Simple Exercise for Risk of Falls in Dementia Patients: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11854. [PMID: 36231155 PMCID: PMC9565761 DOI: 10.3390/ijerph191911854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
Physical exercise can help older people maintain capacities such as muscle strength, balance, postural control, bone mass, and functionality in ADL that usually decline with age. Dementia patients can attend day care centers where they participate in activities such as cognitive training, music and art therapy, and physical exercise sessions. This research aimed to determine the effectiveness of simple lower limb strength and single leg stance training, feasible in the facilities of day care centers, to reduce the risk of falls in the elderly with dementia. Twenty patients with dementia were divided into intervention and control groups. They participated in mobility, strength, coordination, and balance exercise sessions for 45-50 min on weekdays for 5 weeks. In addition, the intervention group patients performed simple lower limb strength (sit-to-stands) and single leg stance exercises in every session. Risk of falls was assessed with the Tinetti test and the SPPB. Comparisons of post- and pre-intervention scores for the Tinetti test and SPPB were statistically increased (0.8 ± 0.7, p = 0.03; 1.5 ± 1.3 points, p = 0.02) in intervention patients. Simple lower limb strength and single leg stance exercises feasible to be done in day care facilities are effective tools for reducing the risk of falls in the elderly with dementia.
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13
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Denfeld QE, Turrise S, MacLaughlin EJ, Chang PS, Clair WK, Lewis EF, Forman DE, Goodlin SJ. Preventing and Managing Falls in Adults With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2022; 15:e000108. [PMID: 35587567 DOI: 10.1161/hcq.0000000000000108] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Falls and fear of falling are a major health issue and associated with high injury rates, high medical care costs, and significant negative impact on quality of life. Adults with cardiovascular disease are at high risk of falling. However, the prevalence and specific risks for falls among adults with cardiovascular disease are not well understood, and falls are likely underestimated in clinical practice. Data from surveys of patient-reported and medical record-based analyses identify falls or risks for falling in 40% to 60% of adults with cardiovascular disease. Increased fall risk is associated with medications, structural heart disease, orthostatic hypotension, and arrhythmias, as well as with abnormal gait and balance, physical frailty, sensory impairment, and environmental hazards. These risks are particularly important among the growing population of older adults with cardiovascular disease. All clinicians who care for patients with cardiovascular disease have the opportunity to recognize falls and to mitigate risks for falling. This scientific statement provides consensus on the interdisciplinary evaluation, prevention, and management of falls among adults with cardiac disease and the management of cardiovascular care when patients are at risk of falling. We outline research that is needed to clarify prevalence and factors associated with falls and to identify interventions that will prevent falls among adults with cardiovascular disease.
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14
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Khoo I, Close JCT, Lord SR, Delbaere K, Taylor ME. Relationship between Depressive Symptoms and Cognitive, Psychological, and Physical Performance in Community-Dwelling Older People with Cognitive Impairment. Dement Geriatr Cogn Disord 2022; 50:482-490. [PMID: 34937036 DOI: 10.1159/000520853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Dementia and depression often coexist. Understanding how concomitant comorbidities affect function can improve assessment and management strategies. We examined the relationship between cognitive, psychological, and physical function and depressive symptoms in people with cognitive impairment. METHODS Cross-sectional study using baseline data from the iFOCIS randomized controlled trial involving 309 participants with mild-moderate cognitive impairment. The association between cognitive (Addenbrooke's Cognitive Examination-III [ACE-III], Frontal Assessment Battery), psychological (Goldberg Anxiety Scale; Iconographical Falls Efficacy Scale), and physical (Physiological Profile Assessment; Short Physical Performance Battery [SPPB]) function, and quality of life (QoL), physical activity levels and activities of daily living, and depressive symptoms (15-item Geriatric Depression Scale [GDS]) were assessed (adjusted for age, sex, education, and ACE-III as appropriate). RESULTS Participants with depressive symptoms (GDS ≥4) had significantly more falls in the previous year and a higher number of comorbidities than people without depressive symptoms (GDS <4). Each point increase in the GDS was associated with better memory, higher levels of anxiety and concern about falling, poorer balance, slower gait speed, and reduced QoL. The relationship between the GDS and poor balance and QoL withstood additional adjustment for comorbidity tertiles. The relationship between GDS and concern about falls withstood additional adjustment for previous falls (12 months) and SPPB scores. CONCLUSIONS Depressive symptomatology is associated with poorer physical and psychological function and reduced QoL in people with cognitive impairment. These factors should be considered when assessing and intervening in this group. Future research could examine these relationships longitudinally to establish causality and examine intervention efficacy in this group.
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Affiliation(s)
- Isabella Khoo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Population Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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15
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Quick SM, Snowdon DA, Lawler K, McGinley JL, Soh SE, Callisaya ML. Physical Therapist and Physical Therapist Student Knowledge, Confidence, Attitudes, and Beliefs About Providing Care for People With Dementia: A Mixed-Methods Systematic Review. Phys Ther 2022; 102:6527603. [PMID: 35157773 PMCID: PMC9155993 DOI: 10.1093/ptj/pzac010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/11/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine physical therapists' and physical therapist students' attitudes and beliefs, knowledge, and confidence in working with people with dementia. METHODS This was a mixed-methods systematic review. Participants included physical therapists working in any clinical specialty and physical therapist students who had completed at least 1 clinical placement. Eleven databases were searched. The evidence was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were "qualitized" using thematic analysis and synthesized with qualitative data using thematic synthesis. RESULTS Fifteen studies were included (9 quantitative and 6 qualitative studies). Seven key themes evolved. Five related to the belief that (1) working with people with dementia is complex and challenging; (2) opportunities for education in dementia care are lacking; (3) working with people with dementia is a specialized area of practice; (4) there are unsupportive systems for working with people with dementia; and (5) people with dementia deserve rehabilitation, but their potential to improve is less certain. One theme related to knowledge (lack of knowledge in some areas of dementia care), and 1 theme related to confidence (lack of confidence in working with people with dementia). CONCLUSIONS Physical therapists and physical therapist students believe that working with people with dementia can be challenging. The low levels of knowledge and confidence in areas important to working with people who have dementia suggest that more education about dementia is needed. IMPACT This mixed-methods systematic review highlights that physical therapists and physical therapist students believe that working with people who have dementia is complex and challenging. Physical therapists want more training and support in this growing area of practice.
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Affiliation(s)
- Stephen M Quick
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia,Academic Unit, Peninsula Health, Melbourne, Australia,Address all correspondence to Mr Quick at:
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia,Academic Unit, Peninsula Health, Melbourne, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | | | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia,Academic Unit, Peninsula Health, Melbourne, Australia,Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
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16
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Zhang W, Low LF, Gwynn JD, Beveridge AH, Harper E, Mills N, Clemson L. A Safe Mobilisation Program to Improve Functional Mobility and Reduce Fall Risks in Cognitively Impaired Older Adults with Higher Level Gait Disorders: A Pilot Study. Dement Geriatr Cogn Disord 2021; 50:364-371. [PMID: 34569524 DOI: 10.1159/000519055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between gait and cognition, and their combined impact on postural stability may underlie the increased fall risk in older adults with dementia. However, there are few interventions to improve functional mobility and reduce fall risks in people with cognitive impairment. OBJECTIVES This study aims to investigate the feasibility and acceptability of a Safe Mobilisation Program for cognitively impaired older adults with higher level gait disorders. It also explores the potential effectiveness of the program on mobility and fall risks. METHODS Fifteen community-dwelling older adults participated in a 3-week pre-post intervention study. They were trained to take steady steps in transfers and mobilization using errorless learning and spaced retrieval teaching techniques. RESULTS The intervention program was feasible, all the participants completed the program and were able to mobilize safely. The program was acceptable and participants reported an increase in safety awareness, improvement in confidence while transferring and mobilising, and better quality of life. There was a trend of improvement in Falls Efficacy Scale-international (FES-I), 360° turn and Tinetti Performance Oriented Mobility Assessment (POMA), which may indicate improvement in balance and mobility. CONCLUSION The Safe Mobilisation Program was feasible and acceptable in older adults with cognitive impairment and gait disorders and warrants further evaluation.
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Affiliation(s)
- Weihong Zhang
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Occupational Therapy, Wolper Jewish Hospital, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Josephine Diana Gwynn
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Harry Beveridge
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Elizabeth Harper
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Nicholas Mills
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lindy Clemson
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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17
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Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis. Ageing Res Rev 2021; 71:101452. [PMID: 34450352 DOI: 10.1016/j.arr.2021.101452] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 08/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community. RESULTS A comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample's results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high. CONCLUSIONS In older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.
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18
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Li F, Harmer P, Eckstrom E, Ainsworth BE, Fitzgerald K, Voit J, Chou LS, Welker FL, Needham S. Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis. Age Ageing 2021; 50:1557-1568. [PMID: 34120175 PMCID: PMC8437077 DOI: 10.1093/ageing/afab110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 12/11/2022] Open
Abstract
Objective Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. Methods PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer’s disease and related dementias, mild cognitive impairment). Results We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90–1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. Conclusions The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice. PROSPERO Registration number: CRD42020202094.
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Affiliation(s)
- Fuzhong Li
- Oregon Research Institute, Eugene, OR 97403, USA
- Shanghai University of Sport, Shanghai, China
| | - Peter Harmer
- Willamette University, Department of Exercise and Health Science, Salem, OR 97301, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | | | | | - Jan Voit
- Voit Better Balance, Seattle, WA 98104, USA
| | - Li-Shan Chou
- Iowa State University, Department of Kinesiology, Ames, IA 50011, USA
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19
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Taylor ME, Toots A, Lord SR, Payne N, Close JCT. Cognitive Domain Associations with Balance Performance in Community-Dwelling Older People with Cognitive Impairment. J Alzheimers Dis 2021; 81:833-841. [PMID: 33814432 DOI: 10.3233/jad-201325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In older people with cognitive impairment (CI), executive function (EF) has been associated with motor performance including balance and gait. The literature examining and supporting a relationship between balance performance and other cognitive domains is limited. OBJECTIVE To investigate the relationship between global cognition and cognitive domain function and balance performance in older people with CI. METHODS The iFOCIS randomized controlled trial recruited 309 community-dwelling older people with CI. Baseline assessments completed before randomization were used for analyses including the Addenbrooke's Cognitive Examination-III (ACE-III; global cognition) and its individual cognitive domains (attention; memory; verbal fluency; language; visuospatial ability) and the Frontal Assessment Battery (FAB), a measure of EF. A composite balance score was derived from postural sway and leaning balance tests. RESULTS In linear regression analyses adjusted for covariates, global cognition and each cognitive domain were significantly associated with balance performance. EF (verbal fluency; β= -0.254, p < 0.001, adjusted R2 = 0.387) and visuospatial ability (β= -0.258, p < 0.001, adjusted R2 = 0.391) had the strongest associations with balance performance. In a comprehensively adjusted multivariable model including all of the ACE-III cognitive domains, visuospatial ability and EF (verbal fluency) were independently and significantly associated with balance performance. CONCLUSION Poorer global cognition and cognitive domain function were associated with poorer balance performance in this sample of people with CI. Visuospatial ability and EF were independently associated with balance, highlighting potential shared neural networks and the role higher-level cognitive processes and spatial perception/processing play in postural control.
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Affiliation(s)
- Morag E Taylor
- Neuroscience Research Australia, UNSW Sydney, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, Australia
| | - Annika Toots
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW Sydney, Randwick, NSW, Australia
| | - Narelle Payne
- Neuroscience Research Australia, UNSW Sydney, Randwick, NSW, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW Sydney, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, Australia
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