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Lu H, Dong XX, Li DL, Wu Q, Nie XY, Xu Y, Wang P, Pan CW. Prevalent falls, fall frequencies and health-related quality of life among community-dwelling older Chinese adults. Qual Life Res 2023; 32:3279-3289. [PMID: 37395987 DOI: 10.1007/s11136-023-03474-2] [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] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Fall is a serious health hazard to older adults. The aim of our study was to investigate the relationship between falls and health-related quality of life (HRQOL) in mainland China. METHODS Data from 4579 Chinese community-dwelling older adults was analyzed. Data of falls was self-reported by participants, the HRQOL of older adults was measured by the 3-Level EQ-5D (EQ-5D-3L, 3L). Regression models were built to explore the associations of falls (experience and frequency) with the 3L data (index score, EQ-VAS score and health problems). The potential interaction effects between falls and gender on HRQOL were assessed using a likelihood ratio test, sex-stratified analysis was also performed to separately investigate the associations in men and women. RESULTS A total of 368 (8.0%) participants had the experience of fall during the last year. Falls (experience and frequency) were significantly related to EQ-5D-3L index and EQ-VAS scores, fall experience contributed to pain/discomfort and anxiety/depression problems, while fall frequency was associated with physical-related problems and pain/discomfort. Significant interactions between falls and sex in several EQ-5D measures were also observed, and men had lager magnitude of associations than women. CONCLUSION Falls were negative associated with overall HRQOL as well as separate HRQOL dimensions among older adults. It also appears that the HRQOL influence on older men is more evident than older women.
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Affiliation(s)
- Heng Lu
- School of Public Health, Medical College of Soochow University, Ren Ai Road, Suzhou, 215123, China
| | - Xing-Xuan Dong
- School of Public Health, Medical College of Soochow University, Ren Ai Road, Suzhou, 215123, China
| | - Dan-Lin Li
- School of Public Health, Medical College of Soochow University, Ren Ai Road, Suzhou, 215123, China
| | - Qian Wu
- School of Public Health, Medical College of Soochow University, Ren Ai Road, Suzhou, 215123, China
| | - Xin-Yi Nie
- School of Public Health, Medical College of Soochow University, Ren Ai Road, Suzhou, 215123, China
| | - Yong Xu
- School of Public Health, Medical College of Soochow University, Ren Ai Road, Suzhou, 215123, China
| | - Pei Wang
- School of Public Health, Fudan University, Dong An Road, Shanghai, 200032, China.
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China.
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Ren Ai Road, Suzhou, 215123, China.
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Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia. Zdr Varst 2023. [DOI: 10.2478/sjph-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
ABSTRACT
Introduction
Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it.
Methods
We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants’ homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk.
Results
The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: [22.9, 26.8]) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001).
Conclusion
Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders’ health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.
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Roberts HJ, Johnson KM, Sullivan JE, Hoppes CW. Balance Confidence and Balance Performance, But Not Fall History Are Associated With Quality of Life in Community-Dwelling Older Adults: A Cross Sectional Study. J Geriatr Phys Ther 2023; 46:82-89. [PMID: 35471965 DOI: 10.1519/jpt.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Fear of falling (FoF) is highly prevalent in community-dwelling older adults and is associated with low health-related quality of life (QoL). Low QoL is associated with increased health care utilization and is a predictor of future falls, but few studies have examined the relationship between high-level balance and dynamic gait performance and QoL in community-dwelling older adults. The purpose of this cross-sectional study was to determine whether there is a relationship between FoF avoidance behaviors, balance confidence, performance on measures of high-level mobility, and QoL in community-dwelling older adults. The secondary purpose was to determine whether older adults who fall have a different QoL than older adults who have not fallen in the past year. METHODS Eighty-nine community-dwelling older adults (76.33 ± 6.84 years, 54 female, 34 fallers) completed the World Health Organization Quality of Life-BREF (WHOQOL-BREF), Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), Functional Gait Assessment (FGA), and Community Balance and Mobility Scale (CB&M). Correlation and multiple regression analyses were calculated to determine the relationship between the outcome measures and domains on the WHOQOL-BREF. RESULTS AND DISCUSSION Significant correlations were observed between the WHOQOL-BREF physical health domain and the ABC, FFABQ, FGA, and CB&M (ρ= 0.524, -0.509, 0.348, and r = 0.423, respectively), the WHOQOL-BREF psychological domain and the ABC (ρ= 0.284) and FFABQ (ρ=-0.384), and the WHOQOL-BREF environment domain and the ABC (ρ= 0.343) and FFABQ (ρ=-0.406). No correlations were found between WHOQOL-BREF domain scores and a history of falls. CONCLUSIONS Performance-based outcome measures that measure high-level mobility such as the CB&M and FGA, and patient-reported outcome measures for balance confidence and FoF avoidance behavior such as the ABC and FFABQ, are correlated with the physical health QoL domain on the WHOQOL-BREF. The ABC and FFABQ are correlated with psychological and environment QoL. Fall history was not correlated with QoL. Interventions to decrease FoF or improve high-level mobility may improve QoL in community-dwelling older adults.
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Affiliation(s)
- Holly J Roberts
- Rocky Mountain University of Health Professions, Provo, Utah
- University of Puget Sound School of Physical Therapy, Tacoma, Washington
| | - Kristen M Johnson
- Rocky Mountain University of Health Professions, Provo, Utah
- Hawaii Pacific University, Honolulu, Hawaii
| | - Jane E Sullivan
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carrie W Hoppes
- Army-Baylor Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, Texas
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Trajectories of mobility difficulty and falls in community-dwelling adults aged 50 + in Taiwan from 2003 to 2015. BMC Geriatr 2022; 22:902. [PMID: 36434511 PMCID: PMC9700940 DOI: 10.1186/s12877-022-03613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND A decline in mobility leads to fall occurrence and poorer performance in instrumental activities of daily living, which are widely proved to be associated with older adults' health-related quality of life. To inform potential predicaments faced by older adults at different age levels, predictors of this mobility change and falls along with the ageing process need to be further evaluated. Therefore, this study examined the risk factors associated with the longitudinal course of mobility difficulty and falls among community-dwelling middle-aged and older adults in the Taiwanese community. METHODS We evaluated data for the period between 2003 and 2015 from the Taiwan Longitudinal Study on Aging; the data cover 5267 community-based middle-aged and older adults with approximately 12 years of follow-up. In terms of mobility, the participants self-reported difficulties in mobility tasks (eg, ambulation) and whether they used a walking device. We employed linear mixed-effects regression models and cumulative logit models to examine whether personal characteristics are associated with mobility difficulty and falls. RESULTS Mobility difficulty significantly increased over time for the participants aged ≥ 60 years. Perceived difficulties in standing, walking, squatting, and running became apparent from a younger age than limitations with hand function. The probability of repeated falls increased significantly with older age at 70 (p = .002), higher level of mobility difficulty (p < .0001), lower cognitive status (p = .001), living alone (p = .001), higher number of comorbid illnesses (p < .001), walking device use (p = .003), longer time in physical activities (p < .011), and elevated depressive symptoms (p = .006). Although walking aid use increased the probability of falls, individuals with mobility difficulty had a reduced probability of repeated falls when using a walking device (p = .02). CONCLUSION Community-dwelling Taiwanese adults face an earlier mobility difficulty starting in 60 years old. Individuals with more leisure and physical activities in daily life were more likely to maintain mobility and walking safety. Long-term, regular, social, and physical activity could be a referral option for falls prevention program. The use of a walking device and safety precautions are warranted, particularly for individuals with walking difficulties.
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Relationship between Associated Neuropsychological Factors and Fall Risk Factors in Community-Dwelling Elderly. Healthcare (Basel) 2022; 10:healthcare10040728. [PMID: 35455905 PMCID: PMC9025626 DOI: 10.3390/healthcare10040728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 12/10/2022] Open
Abstract
This study examined whether neuropsychological factors could affect fall risk factors in the community-dwelling elderly via correlation analysis. A total of 393 older adults (76.69 ± 6.01) participated in this study. Cognitive function, depression, fall efficacy, balance confidence, balance, gait, and muscle strength were evaluated, and the correlation between psychological factors and fall risk factors was analyzed. Additionally, a multiple regression analysis was conducted to determine whether or not there was a significant effect between psychological factors and fall risk factors. Analysis showed that the psychological factors examined were all significantly correlated with the fall risk factors. A correlation analysis between cognitive function and fall risk factors showed that the correlation coefficient of the 6-Meter Walk Test was highest; for depression and fall risk factors, the correlation coefficient of gait speed was highest; for fall efficacy and fall risk factors, the correlation coefficient of the 6-Meter Walk Test was highest; and for confidence in balancing and fall risk factors, the correlation coefficient of the 6-Meter Walk Test was highest. This study suggests that psychological factors affect fall risk factors in the community-dwelling elderly, and a multifaceted approach that includes psychological factors would be helpful in providing interventions for falls.
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Orcioli-Silva D, Islam A, Baker MR, Gobbi LTB, Rochester L, Pantall A. Bi-Anodal Transcranial Direct Current Stimulation Combined With Treadmill Walking Decreases Motor Cortical Activity in Young and Older Adults. Front Aging Neurosci 2021; 13:739998. [PMID: 34924993 PMCID: PMC8681021 DOI: 10.3389/fnagi.2021.739998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Walking in the "real world" involves motor and cognitive processes. In relation to this, declines in both motor function and cognition contribute to age-related gait dysfunction. Transcranial direct current stimulation (tDCS) and treadmill walking (STW) have potential to improve gait, particularly during dual-task walking (DTW); walking whilst performing a cognitive task. Our aims were to analyze effects of combined anodal tDCS + STW intervention on cortical activity and gait during DTW. Methods: Twenty-three young adults (YA) and 21 older adults (OA) were randomly allocated to active or sham tDCS stimulation groups. Participants performed 5-min of mixed treadmill walking (alternating 30 s bouts of STW and DTW) before and after a 20-min intervention of active or sham tDCS + STW. Anodal electrodes were placed over the left prefrontal cortex (PFC) and the vertex (Cz) using 9 cm2 electrodes at 0.6 mA. Cortical activity of the PFC, primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) bilaterally were recorded using a functional near-infrared spectroscopy (fNIRS) system. Oxygenated hemoglobin (HbO2) levels were analyzed as indicators of cortical activity. An accelerometer measured gait parameters. We calculated the difference between DTW and STW for HbO2 and gait parameters. We applied linear mixed effects models which included age group (YA vs. OA), stimulation condition (sham vs. active), and time (pre- vs. post-intervention) as fixed effects. Treadmill belt speed was a covariate. Partial correlation tests were also performed. Results: A main effect of age group was observed. OA displayed higher activity bilaterally in the PFC and M1, unilaterally in the right PMC and higher gait variability than YA. M1 activity decreased in both YA and OA following active tDCS + STW. There was no overall effect of tDCS + STW on PFC activity or gait parameters. However, negative correlations were observed between changes in left PFC and stride length variability following active tDCS + STW intervention. Conclusion: Increased activity in multiple cortical areas during DTW in OA may act as a compensatory mechanism. Reduction in M1 activity following active tDCS + STW with no observed gait changes suggests improved neural efficiency.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Aisha Islam
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annette Pantall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Kuo CT, Chen DR, Chen YM, Chen PY. Validation of the short falls efficacy scale-international for Taiwanese community-dwelling older adults: Associations with fall history, physical frailty, and quality of life. Geriatr Nurs 2021; 42:1012-1018. [PMID: 34256149 DOI: 10.1016/j.gerinurse.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/21/2023]
Abstract
The FES-I is widely used to measure the fear of falling. However, studies linking the Chinese version of the FES-I to frailty and quality of life among older adults are still limited. Thus, this study examined the association of the full 16-item FES-I and the 7-item short FES-I with fall history, physical frailty, and quality of life among older Taiwanese adults. A total of 751 community-dwelling older adults in Taipei City participated in this study. Data analyses included logistic and linear regression models. The 16-item and the short FES-I were strongly correlated (Spearman rho = 0.963), and both scales are reliable. The 7-item FES-I was positively associated with fall history and physical frailty and negatively associated with the physical (b = -0.65, p < 0.001) and mental (b = -0.59, p < 0.001) components of health-related quality of life, independent of physical frailty. Thus, the short FES-I can be used to increase the feasibility of health screenings of older adults in Chinese-speaking contexts.
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Affiliation(s)
- Chun-Tung Kuo
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Duan-Rung Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Peng-Yu Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
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Ito H, Toyone T, Nagai T, Ishikawa K, Kuroda T, Inagaki K. Relationship Between Muscle Mass of the Lower Limbs and Falls Caused by Spinal Misalignment in Women Aged 70 Years: A Retrospective Study. Clin Spine Surg 2021; 34:E19-E25. [PMID: 32453163 DOI: 10.1097/bsd.0000000000001009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This retrospective study was conducted from 2015 to 2016 at the osteoporosis outpatient clinic of Showa University School of Medicine. OBJECTIVE This study aimed to investigate the association between lower-limb muscle mass and spinal misalignment-related falls in elderly women. SUMMARY OF BACKGROUND DATA Poor spinal alignment affects gait and balance, reducing the quality of life. Negative correlations between age-associated skeletal muscle loss and spinal sagittal alignment have been reported. MATERIALS AND METHODS This study included 127 women with osteoporosis aged more than 70 years. The correlation between lower-limb skeletal muscle index (SMI) and sagittal vertical axis (SVA) was calculated using radiographic measurements. Spinopelvic parameters, including SVA, sacral slope, pelvic tilt (PT), pelvic incidence, and lumbar lordosis, were measured. Lower-limb SMI was measured using whole-body dual-energy x-ray absorptiometry and calculated as SMI=nonfat mass/height2. The balance function was evaluated using the single-leg stance test. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests; significance level was set at P<0.05. Bivariate and multivariate logistic regression analyses were used to determine correlations. RESULTS Participants were classified into the balance and mismatch groups on the basis of a threshold SVA value of 50 mm. The groups did not differ significantly in age, height, weight, pelvic incidence, or sacral slope. Lumbar lordosis significantly decreased and PT and lower-limb SMI significantly increased in the mismatch group compared with the balance group. Lower-limb SMI was significantly correlated with increased SVA in bivariate and multivariate regression analyses. Patients with PT ≥20 degrees and SVA ≥50 mm had significantly increased lower-limb SMI. CONCLUSIONS Increased SVA is associated with increased lower-limb SMI, which negatively affects standing balance. An increased lower-limb SMI may represent a novel compensatory mechanism for poor spinal alignment in elderly women with osteoporosis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hiroshi Ito
- Department of Orthopedic Surgery, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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Steckhan GMA, Fleig L, Schwarzer R, Warner LM. Perceived Physical Functioning and Gait Speed as Mediators in the Association Between Fear of Falling and Quality of Life in Old Age. J Appl Gerontol 2020; 41:421-429. [PMID: 33305984 DOI: 10.1177/0733464820979188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 (n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = -.27; 95% CI [-0.007, -0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = -.03; 95% CI [-0.06, -0.001]; R2 = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.
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Affiliation(s)
| | | | - Ralf Schwarzer
- Freie Universität Berlin, Germany.,SWPS University of Social Sciences and Humanities, Warsaw, Poland
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10
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Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:781-801. [PMID: 31512086 DOI: 10.1007/s40258-019-00512-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
- Healthy Ageing Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Association of the built environments and health-related quality of life in community-dwelling older adults: a cross-sectional study. Qual Life Res 2019; 28:2393-2407. [PMID: 31073818 DOI: 10.1007/s11136-019-02199-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE The relationship between built environments and the quality of life (QoL) of the elderly has gained great attention in recent years. However, most QoL studies have been conducted in western countries; thus, limited research was found in Asia, in which the population density, urban forms, narrow roadways, and land use patterns are more compact and highly mixed in terms of use. Therefore, the purpose of this study was an interdisciplinary analysis of two national datasets, the National Land Use Investigation and the National Health Interview Survey, to explore the relationship between built environments and the health-related quality of life of older adults in Taiwan. METHODS Eight types of built environments at the township level were calculated, and 1222 nationally representative older adults aged 65 and older were recruited. The outcome variable was health-related QoL as measured using the EQ-5D, including utility score and the EQ-VAS. Statistical methods included descriptive analysis, bivariate analysis, and mixed-effects logistic regression analysis, which were conducted using SAS 9.4 software. RESULTS The results showed that a significant relationship exists between cultural and historical facilities and low EQ-VAS; none of the built environments were found to be related to the EQ-5D. Individual factors are the main determinants of the EQ-5D of older adults in Taiwan. Positive relationships were found if older adults were engaging in physical activities and social participation. CONCLUSIONS We suggest that building a supportive environment in which elderly people could consistently engage in physical activities and social participation is another potential approach that might contribute to active aging.
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Massa RE, Rosso A, Metti AL, Sparto PJ, Aizenstein H, Ferrucci L, Divecha A, Rosano C. Neuroimaging correlates of lateral postural control in older ambulatory adults. Aging Clin Exp Res 2019; 31:611-619. [PMID: 30168099 DOI: 10.1007/s40520-018-1028-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In older adults, impaired postural control contributes to falls, a major source of morbidity. Understanding central mechanisms may help identify individuals at risk for impaired postural control. AIMS To determine the relationship between gray matter volume (GMV), white matter hyperintensities (WMH), mean diffusivity (MD), and fractional anisotropy (FA) with lateral postural control. METHODS Neuroimaging and postural control were assessed in 193 community-dwelling older adults (mean age 82, 55.4% female, 44.6% black). GMV, WMH, and diffusion tensor-derived markers of microstructure (MD and FA) were quantified for total brain and regions of interest. Lateral postural control was defined as the root mean square error (RMSE) of lateral sway during a visual feedback test. Associations were assessed with linear regression, adjusted for total brain atrophy and risk factors for impaired postural control. RESULTS RMSE was higher for women than men (p < 0.001) and inversely correlated with gait speed (r = - 0.20, p = 0.01), modified mini-mental state (r = - 0.27, p < 0.001), digit symbol substitution test (r = - 0.20, p = 0.01) and quadriceps strength (r = - 0.18, p = 0.01). RMSE was inversely associated with GMV of bilateral precuneus (r = - 0.26, p = 0.01) and FA of corpus callosum and selected tracts in the right hemisphere (anterior thalamic radiation, cingulum, inferior longitudinal and fronto-occipital fasciculi), independent of covariates (r = - 0.34 to - 0.18, p ≤ 0.04). DISCUSSION Lower GMV and microstructural white matter integrity in selected networks can explain worse lateral postural control in older ambulatory adults without neurologic diseases. CONCLUSION Neuroimaging markers of poor postural control in healthy aging may help identify increased fall risk and design preventative fall strategies.
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Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls? Clin Interv Aging 2019; 14:701-719. [PMID: 31190764 PMCID: PMC6514257 DOI: 10.2147/cia.s197857] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/17/2019] [Indexed: 11/03/2022] Open
Abstract
Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.
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Affiliation(s)
- Daniel Schoene
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Heller
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Yan N Aung
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
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15
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Buker N, Eraslan U, Kitis A, Kiter AE, Akkaya S, Sutcu G. Is quality of life related to risk of falling, fear of falling, and functional status in patients with hip arthroplasty? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1772. [PMID: 30892811 DOI: 10.1002/pri.1772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 02/01/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the relation between health-related quality of life and risk of falling, fear of falling, and functional status in patients with hip arthroplasty. METHODS In this cross-sectional study, 48 hips of 45 patients who aged between 33 and 79 (53.56 ± 12.50) years and had cementless total hip arthroplasty between 2010 and 2014 were evaluated. Twenty-seven of the patients participated in the study were female (60.0%) and 18 were male (40.0%). Health-related quality of life with Nottingham Health Profile, function of the hip joint with Harris Hip Score, risk of falling with Performance-Oriented Motion Assessment I, and fear of falling with Falls Efficacy Scale were assessed. In addition, chair stand test, 40-m walk test, stair-climb test, and single leg stance test were carried out. In analysing the relationships between these parameters, Pearson correlation analysis was employed. The level of significance was considered as p < 0.05. RESULTS Among the cases, who were evaluated 87.10 ± 45.22 (22.43-214.71) weeks after the operation, a significant correlation was found between health-related quality of life and risk of falling, function of hip joint, and functional tests (p < 0.05). CONCLUSION The evaluation of the factors related to health-related quality of life in hip arthroplasty patients may help identify patient needs and guide the rehabilitation process.
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Affiliation(s)
- Nihal Buker
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Umut Eraslan
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ali Kitis
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ahmet Esat Kiter
- Department of Orthopedics and Traumatology, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Semih Akkaya
- Department of Orthopedics and Traumatology, Denizli Cerrahi Hastanesi, Denizli, Turkey
| | - Gulsah Sutcu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Eagen TJ, Teshale SM, Herrera-Venson AP, Ordway A, Caldwell J. Participation in Two Evidence-Based Falls Prevention Programs by Adults Aging With a Long-Term Disability: Case-Control Study of Reach and Effectiveness. J Aging Health 2018; 31:39S-67S. [PMID: 30442042 DOI: 10.1177/0898264318808918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Adults aging with a long-term disability (LTD) are at an increased risk for falls. The Older Americans Act Title III-D and Prevention and Public Health Fund (PPHF) support several organizations to deliver falls prevention evidence-based programs designed to reduce risk factors; however, little is understood about the reach and effectiveness of these fall prevention programs for those with LTD compared to those without LTD. This study compared the reach and effectiveness of two evidence-based falls prevention programs between older adults with and without LTD. Method: Using a matched case-control design, 105 LTD older adults enrolled in A Matter of Balance (AMOB) or Stepping On were matched to 315 non-LTD older adults on age, sex, race, and education. Results: On average, LTD older adults attended a higher number of class sessions and were significantly more likely to complete the program compared with the matched-sample of non-LTD older adults. LTD older adults were equally likely as non-LTD older adults to report significant reductions in self-reported fear of falling, falls-related activity restriction, and improvement in falls self-efficacy following completion of the programs. Discussion: These findings provide preliminary evidence for the effectiveness of these evidence-based falls prevention programs for LTD older adults; however, more research is needed to extend these findings.
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Affiliation(s)
- Thomas J Eagen
- University of Washington, Seattle, USA.,National Council on Aging, Arlington, VA, USA
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Vitorio R, Stuart S, Gobbi LTB, Rochester L, Alcock L, Pantall A. Reduced Gait Variability and Enhanced Brain Activity in Older Adults With Auditory Cues: A Functional Near-Infrared Spectroscopy Study. Neurorehabil Neural Repair 2018; 32:976-987. [DOI: 10.1177/1545968318805159] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rodrigo Vitorio
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, UK
- Sao Paulo State University (UNESP), Institute of Biosciences, Campus Rio Claro, Brazil
| | - Samuel Stuart
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, UK
| | - Lilian T. B. Gobbi
- Sao Paulo State University (UNESP), Institute of Biosciences, Campus Rio Claro, Brazil
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, UK
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lisa Alcock
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, UK
| | - Annette Pantall
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, UK
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Kim SY, Bang W, Kim MS, Park B, Kim JH, Choi HG. Nocturia Is Associated with Slipping and Falling. PLoS One 2017; 12:e0169690. [PMID: 28060916 PMCID: PMC5218404 DOI: 10.1371/journal.pone.0169690] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
Several reports have demonstrated associations between falls and nocturia in the elderly. However, little information is available regarding other age groups. This study evaluated the relationship between the frequency of nocturia and falls in men using a large, population-based survey in Korea, and the results were adjusted for various confounding factors. Data from a 2011 Korean community health survey (KCHS) were retrieved for 92,660 men aged 19 to 103 years. Information regarding the history of slips or falls in the past year was collected. The frequency of nocturia was classified as 0, 1, 2, 3, 4, and ≥ 5 instances a night. Walking during the day, education, income, body mass index (BMI), smoking, alcohol consumption, sleep time, stress level and medical histories of hypertension, diabetes mellitus, hyperlipidemia, cerebral stroke, angina or myocardial infarction, arthritis, and osteoporosis were adjusted using multiple logistic regression analysis with complex sampling. A subgroup analysis was conducted for young (19–30 years), middle-aged (31–60 years), and elderly individuals (61+ years). Approximately 14.6% of the men had a history of falls. Their mean age was 42.9 years, which was significantly higher than that of the non-faller group (P < 0.001). An increased frequency of nocturia was associated with increased adjusted odds ratio (AOR) for falls (AOR for 1 instance of nocturia/night = 1.41 [95% confidence interval, 1.33–1.50]; AOR for 2 instances = 1.41 [1.33–1.50]; AOR for 3 instances = 2.00 [1.75–2.28]; AOR for 4 instances = 2.12 [1.73–2.61]; AOR for ≥ 5 instances = 2.02 [1.74–2.36], P < 0.001). In the subgroup analysis, the AORs for falls significantly increased in all age groups as the frequency of nocturia increased.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Woojin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Jin-Hwan Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
- * E-mail:
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Chien T, Goddard M, Casey J, Devitt R, Filinski J. Evaluating Individualized Falls Prevention for Clients with Medically Complex Conditions. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2016. [DOI: 10.3109/02703181.2015.1136367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Teresa Chien
- Faculty of Medicine, Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Goddard
- Faculty of Medicine, Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Humphreys C, Moffatt C, Hood V. Risk of falling for people with venous leg ulcers: a literature review. Br J Community Nurs 2016; 21 Suppl 3:S34-8. [PMID: 26940732 DOI: 10.12968/bjcn.2016.21.sup3.s34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Little is known about the risk of falling for people with venous leg ulcers (VLUs), and this subject has not been considered in UK populations. Many problems associated with living with VLUs are also known risk factors for sustaining a fall. This literature review considered the question: 'Do community-dwelling older adults with VLUs have different outcomes in physical function measures used to assess the risk of falling compared with those without VLUs?' METHOD A review of quantitative literature relating to measures of physical function in people with and without VLUs was undertaken, the development of which was guided by the PRISMA guidelines. FINDINGS People with VLUs have poorer scores in measures of physical function than in people without. Reliability of studies included in the review was hampered by small sample sizes and threats to internal validity and generalisability. CONCLUSIONS People with VLUs may be at a greater risk of falling owing to limitations in balance and mobility. Improving physical function may result in ulcer healing and better quality of life. Reducing falls risk may also lead to improved patient safety and enhanced care outcomes. Further research is needed to better understand the problem.
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Affiliation(s)
- Catriona Humphreys
- Senior Physiotherapist, Nottingham University Hospitals NHS Trust, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, Faculty of Medicine and Health Sciences, University of Nottingham, England
| | - Victoria Hood
- Lecturer, Faculty of Medicine and Health Sciences, University of Nottingham, England
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