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Simo-Tabue N, Letchimy L, Mounsamy L, Rinaldo L, Vainqueur L, Ntsama-Essomba MJ, Mallet G, Boucaud-Maitre D, Tabue Teguo M. Association between Polypharmacy and Hospitalization among Older Adults Admitted to Emergency Departments for Falls in Guadeloupe: A Retrospective Cohort Study. Healthcare (Basel) 2024; 12:1471. [PMID: 39120174 PMCID: PMC11311858 DOI: 10.3390/healthcare12151471] [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: 05/31/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction: Falls are a common geriatric syndrome in older people. Falls are associated with adverse health events such as dependency, unplanned emergency admissions and death. This study aimed to identify the factors associated with fall severity, such as diabetes, hypertension, heart disease, cognitive decline and polypharmacy, as well as sociodemographic characteristics in patients aged 70 years and over admitted to the emergency department in Guadeloupe. Method: A single-center, observational, retrospective study of patients aged 70 years and over admitted to the emergency department (ED) of the University Hospital of Guadeloupe for a fall between 1 May 2018 and 30 April 2019 was conducted. Fall severity was defined as the need for hospitalization. Bivariate analysis was used to determine the associations between fall severity and sociodemographic characteristics, comorbidities, history of falls and polypharmacy (defined as the daily use of at least five drugs). Polypharmacy was analyzed as a binary variable (>5 drugs daily; yes or no) in categories (0-3 (ref.), 4-6, 7-9 and ≥10 drugs). Results: During the study period, 625 patients who attended the ED for a fall were included. The mean age was 82.6 ± 7.6 years, and 51.2% were women. Of these, 277 patients (44.3%) were admitted to the hospital, and 3 patients (0.5%) died. In the bivariate analysis, only polypharmacy was associated with hospitalization for a fall (OR: 1.63 [95% CI: 1.33-2.02]). The odds ratios for the polypharmacy categories were 1.46 [95% CI 0.99-2.14], 1.65 [1.09-2.50] and 1.48 [0.76-2.85] for 4-6, 7-9 and ≥10 drugs, respectively. Conclusions: Polypharmacy was associated with hospitalization as a proxy for fall severity. A regular review of drug prescriptions is essential to reduce polypharmacy in older adults.
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Affiliation(s)
- Nadine Simo-Tabue
- Unité de Recherche EpiCliV, Université des Antilles, 97233 Fort-de-France, France
- Service de Gériatrie, CHU de Martinique, 97261 Fort-de-France, France
| | - Laurys Letchimy
- Pôle Gériatrie-Gérontologie, Université des Antilles, 97233 Fort-de-France, France
- CHU de Martinique, 97261 Fort-de-France, France
| | - Ludwig Mounsamy
- CHU Pointe à Pitre, Université des Antilles, 97233 Fort-de-France, France; (L.M.)
| | - Leila Rinaldo
- CHU Pointe à Pitre, Université des Antilles, 97233 Fort-de-France, France; (L.M.)
| | - Larissa Vainqueur
- CHU Pointe à Pitre, Université des Antilles, 97233 Fort-de-France, France; (L.M.)
| | | | - Guillaume Mallet
- CHU Pointe à Pitre, Université des Antilles, 97233 Fort-de-France, France; (L.M.)
| | - Denis Boucaud-Maitre
- Centre Hospitalier le Vinatier, 69500 Bron, France
- Epidémiologie Clinique et Vieillissement (EpiCliV), Université des Antilles, 97233 Fort-de-France, France
| | - Maturín Tabue Teguo
- Unité de Recherche EpiCliV, Université des Antilles, 97233 Fort-de-France, France
- Département de Recherche Clinique et Innovation, CHU de Martinique, 97261 Fort-de-France, France
- Equipe ACTIVE, Université de Bordeaux, 33405 Talence, France
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Kim GS, Kim N, Won CW, Shim MS, Park MK, Kim M, Lee S. Cross-Lagged Panel Analysis between Physical Frailty, Cognitive Function, and Falls by Sex. J Am Med Dir Assoc 2023; 24:1541-1548.e1. [PMID: 37579927 DOI: 10.1016/j.jamda.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/10/2023] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later. DESIGN Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS). SETTING AND PARTICIPANTS A total of 2318 community-dwelling older adults aged 70-84 years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men. METHODS PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used. RESULTS The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β) = 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β = 0.041, 95% CI 0.006-0.076; P = .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β = 0.063, 95% CI 0.012-0.114; P = .015). CONCLUSIONS AND IMPLICATIONS Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement and maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea.
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Min Kyung Park
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seoyoon Lee
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
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Kurt M, Savaş D, Şimşek TT, Yiş U. Factors associated with balance ability in Duchenne and Becker muscular dystrophies. Gait Posture 2023; 99:139-145. [PMID: 36435068 DOI: 10.1016/j.gaitpost.2022.11.008] [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] [Received: 06/19/2022] [Revised: 10/08/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Problems such as progressive muscle function loss, postural deteriorations, and contractures seen in patients with Duchenne and Becker muscular dystrophies (D/BMD) may affect children's balance ability, and impaired balance ability may lead to limitations in children's functional level. RESEARCH QUESTION What factors are associated with balance ability in children with D/BMD? METHODS Twenty participants with D/BMD were included in the study. Participants' ages were asked; height, body weight, and body mass index (BMI) were recorded. Children's functional level was assessed with the Motor Function Measurement-32 (MFM-32), Brooke and Vignos Scales. Muscle strength of hip flexion and extension, knee flexion and extension, and ankle dorsiflexion was measured with a handheld dynamometer. Balance measurements were performed using the Balance Master System. The relationship between balance and continuous independent variables was determined using Spearman's test. RESULTS The mean age of the participants was 8.57 ± 3.27 years. The balance abilities of children with BMD were better than those of children with DMD (p < 0.05). The balance diminished with age (p < 0.05), while there was a positive correlation between balance and weight, height, BMI (p < 0.05). There was a positive correlation between the balance and the MFM-32 total and subsection scores. Muscle strength was positively related to balance (p < 0.05). SIGNIFICANCE The results showed the balance ability in children with D/BMD was affected by age, height, weight, BMI, functional level, and muscle strength. Based on the results of this study, balance and strength training should be an integral part of the rehabilitation of children with D/BMD.
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Affiliation(s)
- Merve Kurt
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey; Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Dilan Savaş
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Tülay Tarsuslu Şimşek
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.
| | - Uluç Yiş
- Dokuz Eylül University Department of Pediatrics, Pediatric Neurology, İzmir, Turkey.
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Detecting differences in gait initiation between older adult fallers and non-fallers through multivariate functional principal component analysis. J Biomech 2022; 144:111342. [DOI: 10.1016/j.jbiomech.2022.111342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/15/2022] [Accepted: 10/03/2022] [Indexed: 11/20/2022]
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Altan O, Ekşioğlu E, Öztürk EA, Hakan Demirhan T, Kaya Z, Aytaç Eyüpoğlu S, Koşan Çulha V, Gürlek Gökçebay D, Özbek NY. Clinical Evaluation of Balance in Children With Hemophilic Arthropathy. Indian J Hematol Blood Transfus 2022; 38:698-702. [PMID: 36258722 PMCID: PMC9569260 DOI: 10.1007/s12288-022-01526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/10/2022] [Indexed: 10/18/2022] Open
Abstract
Purpose Hemophilia is a hereditary coagulation disorder characterized by acute hemorrhages into the musculoskeletal system, leading eventually to arthropathy and disability. Chronic inflammation of the synovial membrane arises as a result of frequent joint hemorrhage. Proteolytic enzymes in the blood and cartilage cause deterioration after that, and joint space narrows. Chronic hemophilic arthropathy develops as a result of these unfavorable developments, which occur more quickly, especially in the target joints. Balance is a process that allows us to maintain our orientation in three-dimensional space while also regulating our body posture to avoid falling. After the central nervous system evaluates deep stimuli from sensory, visual, and auditory receptors, movement of the corresponding muscle groups is delivered. Methods The goal of this study was to investigate how impairment to deep sensory receptors (proprioception) in the arthropathic joint structure affected hemophiliacs' balance. The study comprised 34 patients with hemophilic arthropathy, and 34 age and weight matched healthy volunteers. Results When balance tests of patients with hemophilic arthropathy were compared to healthy controls, hemophiliacs had a greater risk of falling. As the degree of arthropathy increased, so did the risk of falling and balance test values in individuals with hemophilic arthropathy. Conclusions Treatment and coagulation factor prophylaxis to prevent the onset of arthropathy will improve patients' quality of life and reduce morbidity associated with frequent falls and bleeding. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-022-01526-0.
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Affiliation(s)
- Orcan Altan
- Pediatric Hematology/Oncology, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, University of Health Sciences, Ziraat Mah. Irfan Bastug Cd. Kurtdereli Sk. No: 10, 06110 Ankara, Turkey
| | - Emel Ekşioğlu
- Physical Therapy and Rehabilitation, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Erhan Arif Öztürk
- Physical Therapy and Rehabilitation, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tülin Hakan Demirhan
- Pediatric Radiology, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Zühre Kaya
- Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Vildan Koşan Çulha
- Pediatric Hematology/Oncology, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, University of Health Sciences, Ziraat Mah. Irfan Bastug Cd. Kurtdereli Sk. No: 10, 06110 Ankara, Turkey
| | - Dilek Gürlek Gökçebay
- Pediatric Hematology/Oncology, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, University of Health Sciences, Ziraat Mah. Irfan Bastug Cd. Kurtdereli Sk. No: 10, 06110 Ankara, Turkey
| | - Namık Yaşar Özbek
- Pediatric Hematology/Oncology, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, University of Health Sciences, Ziraat Mah. Irfan Bastug Cd. Kurtdereli Sk. No: 10, 06110 Ankara, Turkey
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Characteristics of transitional locomotor tasks performed by patients with dementia. Exp Brain Res 2022; 240:1605-1616. [PMID: 35362724 DOI: 10.1007/s00221-022-06355-1] [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: 09/29/2021] [Accepted: 03/21/2022] [Indexed: 11/04/2022]
Abstract
Elderly individuals may be at increased risk of falls than their peers. Early identification of balance disorders and their appropriate intervention are crucial for patients with dementia. The aim of this study was to identify postural instability in patients from mild to moderate dementia while performing transitional locomotor tasks under different conditions. Fifty-four patients with dementia and 30 healthy controls voluntarily participated in the study. The transitional locomotor task was performed on two force platforms under four conditions: unimpeded transition, obstacle clearance, step-up and step-down trials. The recording of center of foot pressure displacements was divided into three distinct phases: 1st phase-quiet standing before the transitional locomotor task, 2nd phase-forward stepping, 3rd phase-quiet standing after the transitional locomotor task. Patients with dementia were characterized by a longer transitional locomotor task time than the control group under all conditions (P < 0.03). Significant differences in quiet standing before the transitional locomotor task were observed between patients with dementia and the control group, but only in unimpeded transition and obstacle clearance trials (P < 0.02). No significant differences in quiet standing after step transition were observed between patients with dementia and the control group (P > 0.05). Postural control research in patients with dementia should focus on the functional motor task rather than on a simple motor task (quiet standing). Because even patients with mild dementia have impaired dynamic balance, the assessment of transitional locomotor tasks performed by patients with dementia might provide an indicator of an early diagnosis of dementia and might lead to better individualized physiotherapy.
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Kimijanová J, Bzdúšková D, Hirjaková Z, Hlavačka F. Age-Related Changes of the Anticipatory Postural Adjustments During Gait Initiation Preceded by Vibration of Lower Leg Muscles. Front Hum Neurosci 2021; 15:771446. [PMID: 34744671 PMCID: PMC8566353 DOI: 10.3389/fnhum.2021.771446] [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: 09/06/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Gait initiation (GI) challenges the balance control system, especially in the elderly. To date, however, there is no consensus about the age effect on the anticipatory postural adjustments (APAs). There is also a lack of research on APAs in older adults after proprioceptive perturbation in the sagittal plane. This study aimed to compare the ability of young and older participants to generate APAs in response to the vibratory-induced perturbation delivered immediately before GI. Twenty-two young and 22 older adults performed a series of GI trials: (1) without previous vibration; (2) preceded by the vibration of triceps surae muscles; and (3) preceded by the vibration of tibialis anterior muscles. The APAs magnitude, velocity, time-to-peak, and duration were extracted from the center of pressure displacement in the sagittal plane. Young participants significantly modified their APAs during GI, whereas older adults did not markedly change their APAs when the body vertical was shifted neither backward nor forward. Significant age-related declines in APAs were observed also regardless of the altered proprioception.The results show that young adults actively responded to the altered proprioception from lower leg muscles and sensitively scaled APAs according to the actual position of the body verticality. Contrary, older adults were unable to adjust their postural responses indicating that the challenging transition from standing to walking probably requires higher reliance on the visual input. The understanding of age-related differences in APAs may help to design training programs for the elderly specifically targeted to improve balance control in different sensory conditions, particularly during gait initiation.
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Affiliation(s)
- Jana Kimijanová
- Department of Behavioral Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Diana Bzdúšková
- Department of Behavioral Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Zuzana Hirjaková
- Department of Behavioral Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - František Hlavačka
- Department of Behavioral Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
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Kao PC, Pierro MA, Wu T, Gonzalez DM, Seeley R. Association between functional physical capacity and cognitive performance under destabilizing walking conditions in older adults. Exp Gerontol 2021; 155:111582. [PMID: 34637948 DOI: 10.1016/j.exger.2021.111582] [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: 08/10/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive decline increases the risk of falls in older adults. Understanding the association between cognitive function, functional physical capacity, and falls may help identify targets for fall screening and intervention. This study examined (1) cognitive and functional physical capacity in community-dwelling older adults with and without a history of falls or the presence of brain-derived neurotrophic factor (BDNF) gene Val66Met polymorphism (Val/Met), and (2) the association between their cognitive and functional physical capacity, focusing on the cognitive performance during dual-task, challenging walking conditions. METHODS Twenty-nine healthy, community-dwelling older adults attended two testing sessions for (1) functional assessments of physical capacity and global cognitive status, and (2) performing four cognitive tasks (visual and auditory Stroop tasks, Clock task, and Paced Auditory Serial Addition Test) during standing and while walking on the treadmill with and without medio-lateral treadmill platform sways. RESULTS Participants with a fall history had reduced functional reach distance whereas individuals with Val/Met had reduced functional gait assessment (FGA) score compared to their controls. In addition, participants with a fall history or Val/Met showed reduced Clock task performance under dual-task conditions. Among all cognitive tasks, visual-Stroop performance, especially during the perturbed walking conditions, was significantly correlated with more physical capacity items. The performance of the other three cognitive tasks provided complementary information on those items not correlated with visual-Stroop performance. CONCLUSIONS Clock task performance can distinguish fallers from non-fallers as well as older adults with and without the BDNF gene polymorphism. Administering different types of cognitive tasks and under more challenging walking conditions can better reveal the association between cognitive and functional physical capacity in older adults. Fall screening and prevention intervention should integrate cognitive tasks into the functional physical capacity assessment and training regime, and progress to a more challenging condition such as introducing gait or balance perturbations during the assessment or training.
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Affiliation(s)
- Pei-Chun Kao
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States; New England Robotics Validation and Experimentation (NERVE) Center, University of Massachusetts Lowell, Lowell, MA, United States.
| | - Michaela A Pierro
- Biomedical Engineering and Biotechnology Program, University of Massachusetts Lowell, Lowell, MA, United States
| | - Tong Wu
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Daniela M Gonzalez
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, United States
| | - Rachel Seeley
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
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Kurt M, Tatlici E, Tarsuslu Simsek T. Anthropometric and demographic properties affect balance in healthy adults: an observational study. J Sports Med Phys Fitness 2021; 61:818-828. [PMID: 34110120 DOI: 10.23736/s0022-4707.20.11422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Anthropometric and demographic properties may affect balance, but there is no consensus on this subject; so, there is a need for studies that explore it. This study aimed to assess the relationship between balance and anthropometric as well as demographic properties; and to determine the effect of anthropometric and demographic properties on balance in healthy adults. METHODS Sixty healthy adults were included in this study. The ages of the participants were questioned; height, body weight, Body Mass Index, head circumference, upper extremity, lower extremity, and foot length were evaluated, and shoe numbers were recorded. Balance assessments were performed with the Balance Master System device. RESULTS The mean age of the participants was 23.50±1.97 years. The balance developed with age (P<0.05), while there was a negative correlation between height and balance (P<0.05). Weight gain affected balance negatively (P<0.05). The increase in head circumference, extremity, and foot length was associated with a deterioration in balance (P<0.05). CONCLUSIONS The results of the current study were showed that anthropometric and demographic properties affect balance. The increase in some of the anthropometric and demographic properties including height, weight, head circumference, extremity, and foot length harms the balance. During balance assessments, anthropometric and demographic characteristics should be considered as a factor that affects balance.
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Affiliation(s)
| | - Ezgi Tatlici
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkey
| | - Tulay Tarsuslu Simsek
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Gait variability is affected more by peripheral artery disease than by vascular occlusion. PLoS One 2021; 16:e0241727. [PMID: 33788839 PMCID: PMC8011739 DOI: 10.1371/journal.pone.0241727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Patients with peripheral artery disease with intermittent claudication (PAD-IC) have altered gait variability from the first step they take, well before the onset of claudication pain. The mechanisms underlying these gait alterations are poorly understood. Aims To determine the effect of reduced blood flow on gait variability by comparing healthy older controls and patients with PAD-IC. We also determined the diagnostic value of gait variability parameters to identify the presence of PAD. Methods A cross-sectional cohort design was used. Thirty healthy older controls and thirty patients with PAD-IC walked on a treadmill at their self-selected speed in pain free walking (normal walking for healthy older controls; prior to claudication onset for PAD) and reduced blood flow (post vascular occlusion with thigh tourniquet for healthy older controls; pain for PAD) conditions. Gait variability was assessed using the largest Lyapunov exponent, approximate entropy, standard deviation, and coefficient of variation of ankle, knee, and hip joints range of motion. Receiver operating characteristics curve analyses of the pain free walking condition were performed to determine the optimal cut-off values for separating individuals with PAD-IC from those without PAD-IC. Results and discussion Patients with PAD-IC have increased amount of variability for knee and hip ranges of motion compared with the healthy older control group. Regarding the main effect of condition, reduced blood flow demonstrated increased amount of variability compared with pain free walking. Significant interactions between group and condition at the ankle show increased values for temporal structure of variability, but a similar amount of variability in the reduced blood flow condition. This demonstrates subtle interactions in the movement patterns remain distinct between PAD-IC versus healthy older controls during the reduced blood flow condition. A combination of gait variability parameters correctly identifies PAD-IC disease 70% of the time or more. Conclusions Gait variability is affected both by PAD and by the mechanical induction of reduced blood flow. Gait variability parameters have potential diagnostic ability, as some measures had 90.0% probability of correctly identifying patients with PAD-IC.
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Michalska J, Kamieniarz A, Sobota G, Stania M, Juras G, Słomka KJ. Age-related changes in postural control in older women: transitional tasks in step initiation. BMC Geriatr 2021; 21:17. [PMID: 33407197 PMCID: PMC7789726 DOI: 10.1186/s12877-020-01985-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Aging, being a natural process, involves many functional and structural changes within the body. Identifying the age-related postural changes will provide insight into the role of aging on postural control during locomotion. The aim of this study was to identify age-related postural changes during a transitional task under different conditions. Methods Sixty healthy females divided into three age groups: A (50-60 y/o), B (60-70 y/o), and C (70-80 y/o). The transitional task was measured by two force platforms. The procedure consisted of three phases: quiet standing, transfer onto a second platform, and quiet standing on the second platform. Four different conditions were applied: unperturbed transfer, obstacle crossing, step-up, and step-down. Double-support time, transit time, and stability time before and after the step task were analyzed. Results The transit time was longer by 30% for subjects over 70 y/o. The double-support time was longer by 11% among adults 60-70 y/o, while in people over 70 y/o it was longer by almost 50% compared to the 50-60 y/o subjects. The stability time before the transitional task was longer by 17% among adults over 60 y/o compared to middle-age subjects. The stability times before and after the transitional task were longer for adults in the 50-60 y/o category. Conclusion The proposed procedure is adequate for assessing age-related changes in postural control while undergoing a transitional task. An analysis of the double-support time and stability time before and after the step task enabled the detection of early signs of balance changes in middle-age adults. Independent of age, the transitional task parameters changed with the increasing difficulty of the tasks.
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Affiliation(s)
- Justyna Michalska
- Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Kamieniarz
- Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland.
| | - Grzegorz Sobota
- Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Kajetan J Słomka
- Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
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Laudani L, Rum L, Valle MS, Macaluso A, Vannozzi G, Casabona A. Age differences in anticipatory and executory mechanisms of gait initiation following unexpected balance perturbations. Eur J Appl Physiol 2020; 121:465-478. [PMID: 33106932 PMCID: PMC7862204 DOI: 10.1007/s00421-020-04531-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/12/2020] [Indexed: 01/14/2023]
Abstract
Purpose An age-related decline in anticipatory postural mechanisms has been reported during gait initiation; however, it is unclear whether such decline may jeopardize whole-body stability following unexpected balance perturbations. This study aimed to compare young and older individuals’ ability to generate postural responses and preserve stability in response to external waist perturbations delivered within gait initiation. Methods Ten young and ten older participants performed 10 gait initiation trials followed by 48 unperturbed and 12 perturbed trials in a random order. A stereophotogrammetric system and three force platforms were used to quantify mechanical parameters from the preparatory phase (e.g., timing and amplitude of postural adjustments) and from the stepping phase (e.g., step characteristics and dynamic stability). Activation patterns of lower leg muscles were determined by surface electromyography. Results Older participants responded to perturbation with lower increase in both magnitude (p < 0.001; η2p = 0.62) and duration (p = 0.001; η2p = 0.39) of preparatory parameters and soleus muscle activity (p < 0.001; η2p = 0.55), causing shorter (p < 0.001; η2p = 0.59) and lower (p < 0.001; η2p = 0.43) stepping, compared to young participants. Interestingly, young participants showed greater correlations between preparatory phase parameters and dynamic stability of the first step than older participants (average r of − 0.40 and − 0.06, respectively). Conclusion The results suggest that young participants took more time than older to adjust the anticipatory biomechanical response to perturbation attempting to preserve balance during stepping. In contrast, older adults were unable to modify their anticipatory adjustments in response to perturbation and mainly relied on compensatory mechanisms attempting to preserve stability via a more cautious stepping strategy.
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Affiliation(s)
- Luca Laudani
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
| | - Lorenzo Rum
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Maria Stella Valle
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Catania, Italy
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Antonino Casabona
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, Catania, Italy
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Bassement JNC, Shukla BK, Yadav SK, Vijay V, Mathur A, Hewson DJ. A Pilot Study to Detect Balance Impairment in Older Adults Using an Instrumented One-Leg Stance Test. J Biomech Eng 2020; 142:091001. [PMID: 32154835 DOI: 10.1115/1.4046636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 11/08/2022]
Abstract
The aim of this study was to investigate whether parameters from an instrumented one-leg stance (OLS) on a force plate could provide relevant information related to fall risk in older people. Forty-two community dwelling older people including 17 fallers and 25 nonfallers, and 25 young subjects performed a OLS while standing on a force plate, with parameters related to transferring weight onto one leg and postural sway in singe-leg stance evaluated. No differences were observed between older fallers and nonfallers and the younger participants for any of the weight transfer parameters. The younger participants were able to reduce their postural sway during the OLS test after the first 0-2 s period, unlike older participants who swayed the same amount throughout the test. The older fallers swayed significantly more than both nonfallers and younger participants throughout the 10-s of OLS evaluated. When the tests were used to classify older participants as fallers, the instrumented OLS achieved 100% accuracy, compared to 69.0% classification accuracy for the five times sit-to-stand test, 61.9% for the standard OLS, and 47.6% for the timed-up-and-go test. These findings suggest that the standard OLS test might not be suitable to detect fall risk. In contrast, an instrumented version of the OLS could provide valuable additional information that could identify older fallers. Future work will include a prospective study of the instrumented OLS in a larger population of older people.
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Affiliation(s)
| | - Brajesh K Shukla
- System Science, Indian Institute of Technology Jodhpur, Jodhpur 342037, India
| | - Sandeep K Yadav
- Department of Electrical Engineering, Indian Institute of Technology Jodhpur, Jodhpur 342037, India
| | - Vivek Vijay
- Department of Mathematics, Indian Institute of Technology Jodhpur, Jodhpur 342037, India
| | - Arvind Mathur
- Asian Centre for Medical Education, Research & Innovation, Jodhpur 342003, India
| | - David J Hewson
- Institute for Health Research, University of Bedfordshire, University Square, Luton, Bedfordshire LU1 3JU, UK
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Accuracy of the 4-Stage Balance Test and Sensor-Based Trunk Sway as Fall Risk Assessment Tools in the Emergency Department. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Cui C, Kulkarni A, Rietdyk S, Barbieri FA, Ambike S. Synergies in the ground reaction forces and moments during double support in curb negotiation in young and older adults. J Biomech 2020; 106:109837. [DOI: 10.1016/j.jbiomech.2020.109837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/21/2020] [Accepted: 05/02/2020] [Indexed: 12/28/2022]
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da Silva Soares F, Moreira VMPS, Alves LV, Dionisio VC. What is the influence of severity levels of knee osteoarthritis on gait initiation? Clin Biomech (Bristol, Avon) 2020; 74:51-57. [PMID: 32145669 DOI: 10.1016/j.clinbiomech.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The anticipatory postural adjustments required for gait initiation have not yet been investigated in older adults with different levels of severity of knee osteoarthritis. This study aimed to evaluate the anticipatory postural adjustments adopted by older adults with different severity levels of knee osteoarthritis during gait initiation. METHODS Sixty-seven older adults with knee osteoarthritis (mild, moderate, and severe levels) and 11 healthy older adults control were evaluated bilaterally with a force plate to analyze gait initiation. The center of pressure trajectory during gait initiation was divided into four phases: three anticipatory postural adjustments, and a locomotor phase. The length, duration, and velocity of each phase were calculated. FINDINGS The results showed that during the right and left limbs swing forward, the severe and moderate knee osteoarthritis groups presented a significant reduction in the length of anticipatory postural adjustment phases, locomotion, duration, and velocity (P < 0.05). The severe knee osteoarthritis group presented a significantly higher body mass index (P < 0.003) than the other groups. However, just the healthy group presented a correlation between body mass index and anticipatory postural adjustments. INTERPRETATION Our results demonstrated that older adults with severe and moderate levels of knee osteoarthritis adopt longer lasting and slower anticipatory postural adjustment phases, lower locomotion, and lower center of pressure displacement during gait initiation, suggesting that this population has adaptive strategy in performing gait initiation, which is significantly changed by the knee osteoarthritis severity level.
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Affiliation(s)
- Fabiana da Silva Soares
- Doctor Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
| | | | - Luiza Vinhal Alves
- Physical Therapy Course, Federal University of Uberlandia, Uberlândia, Brazil
| | - Valdeci Carlos Dionisio
- Physical Therapy Course, Federal University of Uberlandia, Uberlândia, Brazil; Doctor Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
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Phelan EA, Rillamas-Sun E, Johnson L, LaMonte MJ, Buchner DM, LaCroix AZ, Anderson GL. Determinants, circumstances and consequences of injurious falls among older women living in the community. Inj Prev 2020; 27:34-41. [PMID: 31941756 DOI: 10.1136/injuryprev-2019-043499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify the risk factors of women who fell with injury relative to women who did not fall or fell without injury and to describe the circumstances and consequences of injurious and non-injurious falls. METHODS We analysed 5074 older women from the Objective Physical Activity and Cardiovascular Health Study who prospectively tracked their falls using a 13-month calendar. Women with a reported fall were phone interviewed about fall-related details, including injuries. Risk factors were identified from surveys and clinical home visits. Logistic regression models were used to calculate adjusted ORs and 95% CIs for injurious falls relative to not falling or falling without injury. Circumstances of injurious and non-injurious falls were compared. RESULTS At least one fall was experienced by 1481 (29%) participants. Of these, 1043 were phone interviewed, of whom 430 (41%) reported at least one injurious fall. Relative to not falling, the risk factor most strongly associated with experiencing an injurious fall was having fallen ≥2 times (OR 4.0, CI 2.7 to 5.8) in the past year. Being black was protective for fall-related injury (OR 0.6, CI 0.4 to 0.9). No strong associations in risk factors were observed for injurious relative to non-injurious falls. Injurious falls were more likely to occur away from and outside of the home (p<0.05). Over half of those who injured self-managed their injury. CONCLUSION Falling repeatedly is a powerful risk factor for injurious falls. Those who have fallen more than once should be prioritised for interventions to mitigate the risk of an injurious fall.
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Affiliation(s)
- Elizabeth A Phelan
- Division of Gerontology and Geriatric Medicine and Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lisa Johnson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - David M Buchner
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Abstract
OBJECTIVES The aim of this study was to evaluate specific medications and patient characteristics as risk factors of falling in the hospital. METHODS This is a case-control study comparing demographic, health, mobility, and medication data for 228 patients who fell between June 29, 2007, and November 14, 2007, at a large tertiary care hospital and 690 randomly selected control patients. Logistic regression was used to identify fall risk factors. RESULTS Independent risk factors of falling included history of falls (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.8-4.2); needing an assistive device (OR, 3.2; 95% CI, 1.5-6.8) or person assistance (OR, 2.1; 95% CI, 1.3-3.3) to ambulate; being underweight (OR, 2.4; 95% CI, 1.2-4.7) or obese (OR, 1.6; 95% CI, 1.0-2.5); confusion (OR, 2.4; 95% CI, 1.5-4.0); dizziness (OR, 2.1; 95% CI, 1.1-4.3); incontinence (OR, 1.5; 95% CI, 1.0-2.3); and an order for a hydantoin (OR, 3.3; 95% CI, 1.3-8.0) or benzodiazepine anticonvulsant (OR, 2.2; 95% CI, 1.5-3.3), haloperidol (OR, 2.8; 95% CI, 1.2-6.8), tricyclic antidepressant (OR, 2.4; 95% CI, 1.2-4.9), or insulin (OR, 1.5; 95% CI, 1.0-2.1). Female sex (OR, 0.8; 95% CI, 0.6-1.0), proton pump inhibitors (OR, 0.6; 95% CI, 0.4-0.9), and muscle relaxants (OR, 0.4; 95% CI, 0.3-0.7) were associated with lower risk for falling. CONCLUSIONS This study identified medications and patient characteristics associated with increased risk for falling in the hospital. High-risk medications identified in this study may serve as targets for medication review or adjustment, which have been recommended as a component of multifaceted fall prevention programs.
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van Kooten D, Hettinga F, Duffy K, Jackson J, Taylor MJD. Are there associations with age and sex in walking stability in healthy older adults? Gait Posture 2018; 60:65-70. [PMID: 29161624 DOI: 10.1016/j.gaitpost.2017.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/06/2017] [Accepted: 11/10/2017] [Indexed: 02/02/2023]
Abstract
The variability of the centre of pressure (COP) during walking can provide information in relation to stability when walking. The aim of this study was to investigate if age and sex were associated with COP variability, COP excursions, and COP velocities during walking. One-hundred and fourteen older adults (age 65.1±5.5 yrs.) participated in the study. A Kistler force platform (1000Hz) recorded the ground reaction forces and COPs during walking at a self-selected walking speed. The stance phase was divided, using the vertical GRF, into four sub-phases: loading response (LR), mid-stance (MSt), terminal stance (TSt), and pre-swing (PSw). The standard deviations of the COP displacement (variability), the COP velocity, and COP excursion in the medial-lateral and anterior-posterior directions, as well as the resultant magnitude were assessed. When controlling for walking speed, a greater age was associated with a higher variability and excursion of the COP during LR only suggesting that stability is maintained during the majority of the stance phase. During LR lower COP velocity was significantly associated for females for anterior-posterior and total COP, which may be a strategy to facilitate stability before, and moving into, MSt and TSt.
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Affiliation(s)
- Daan van Kooten
- School of Sport, Exercise, and Rehabilitation Sciences, University of Essex, Colchester, UK
| | - Florentina Hettinga
- School of Sport, Exercise, and Rehabilitation Sciences, University of Essex, Colchester, UK
| | - Kim Duffy
- School of Sport, Exercise, and Rehabilitation Sciences, University of Essex, Colchester, UK
| | - Jo Jackson
- School of Sport, Exercise, and Rehabilitation Sciences, University of Essex, Colchester, UK
| | - Matthew J D Taylor
- School of Sport, Exercise, and Rehabilitation Sciences, University of Essex, Colchester, UK.
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20
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Castel C, Lescure P, Loggia G, Morello R, De Mil R, Saint-Lorant G. [Elderly hospitalised people and walking capacities]. SOINS. GÉRONTOLOGIE 2017; 22:16-20. [PMID: 29132658 DOI: 10.1016/j.sger.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Falls in the elderly are frequent. A study carried out over 6 months in a university hospital's acute geriatric unit highlighted the real walking capacities of hospitalised elderly people. It also changed the perception of caregivers, doctors and nurses with regard to the real physical aptitudes of these patients enabling the risk of falls to be reduced in preparation for their return home or to a residential care home.
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Affiliation(s)
- Camille Castel
- Service de pharmacie, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France.
| | - Pascale Lescure
- Service de médecine gériatrique aiguë, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - Gilles Loggia
- Service de médecine gériatrique aiguë, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - Rémi Morello
- Unité de biostatistique et de recherche clinique, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - Rémi De Mil
- Unité de biostatistique et de recherche clinique, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
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Taylor-Piliae RE, Peterson R, Mohler MJ. Clinical and Community Strategies to Prevent Falls and Fall-Related Injuries Among Community-Dwelling Older Adults. Nurs Clin North Am 2017; 52:489-497. [PMID: 28779828 DOI: 10.1016/j.cnur.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Falls in older adults are the result of several risk factors across biological and behavioral aspects of the person, along with environmental factors. Falls can trigger a downward spiral in activities of daily living, independence, and overall health outcomes. Clinicians who care for older adults should screen them annually for falls. A multifactorial comprehensive clinical fall assessment coupled with tailored interventions can result in a dramatic public health impact, while improving older adult quality of life. For community-dwelling older adults, effective fall prevention has the potential to reduce serious fall-related injuries, emergency room visits, hospitalizations, institutionalization, and functional decline.
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Affiliation(s)
- Ruth E Taylor-Piliae
- College of Nursing, University of Arizona, 1305 North Martin Avenue, PO Box 210203, Tucson, AZ 85721-0203, USA.
| | - Rachel Peterson
- Arizona Center on Aging, College of Medicine, University of Arizona, 1807 East Elm Street, Tucson, AZ 85719, USA
| | - Martha Jane Mohler
- Arizona Center on Aging, College of Medicine, University of Arizona, 1807 East Elm Street, Tucson, AZ 85719, USA; Division of Geriatrics, General Internal Medicine, and Palliative Medicine, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA; Mel and Enid Zuckerman College of Public Health, University of Arizona, 295 N. Martin Avenue, Tucson, AZ 85724, USA
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Vafaei A, Pickett W, Zunzunegui MV, Alvarado BE. Relationships Between Neighborhood Social Capital and The Occurrence of Outdoor Falls in Canadian Older Adults: A Multilevel Analysis. J Aging Health 2017; 30:1108-1135. [PMID: 28553821 DOI: 10.1177/0898264317706236] [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: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether neighborhood-level social capital is a risk factor for falls outside of the home in older adults. METHODS Health questionnaires were completed by community-dwelling Canadians aged +65 years living in Kingston (Ontario) and St-Hyacinthe (Quebec), supplemented by neighborhood-level census data. Multilevel logistic regression models with random intercepts were fit. Variations in the occurrence of falls across neighborhoods were quantified by median odds ratio and 80% interval odds ratio. RESULTS Between-neighborhood differences explained 7% of the variance in the occurrence of falls; this variance decreased to 2% after adjustment for neighborhood-level variables. In the fully adjusted models, higher levels of social capital increased the odds of falls by almost 2 times: (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.19, 3.71]). DISCUSSION Living in neighborhoods with higher levels of social capital was associated with higher risk of falling in older adults, possibly through more involvement in social activities.
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Timsina LR, Willetts JL, Brennan MJ, Marucci-Wellman H, Lombardi DA, Courtney TK, Verma SK. Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States. PLoS One 2017; 12:e0176561. [PMID: 28472065 PMCID: PMC5417511 DOI: 10.1371/journal.pone.0176561] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 04/12/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Falls are the leading cause of injury in almost all age-strata in the U.S. However, fall-related injuries (FI) and their circumstances are under-studied at the population level, particularly among young and middle-aged adults. This study examined the circumstances of FI among community-dwelling U.S. adults, by age and gender. METHODS Narrative texts of FI from the National Health Interview Survey (1997-2010) were coded using a customized taxonomy to assess place, activity, initiating event, hazards, contributing factors, fall height, and work-relatedness of FI. Weighted proportions and incidence rates of FI were calculated across six age-gender groups (18-44, 45-64, 65+ years; women, men). RESULTS The proportion of FI occurring indoors increased with age in both genders (22%, 30%, and 48% among men, and 40%, 49% and 62% among women for 18-44, 45-64, 65+ age-groups, respectively). In each age group the proportion of indoor FI was higher among women as compared to men. Among women, using the stairs was the second leading activity (after walking) at the time of FI (19%, 14% and 10% for women in 18-44, 45-64, 65+ age groups, respectively). FI associated with tripping increased with age among both genders, and women were more likely to trip than men in every age group. Of all age-gender groups, the rate of FI while using ladders was the highest among middle-aged men (3.3 per 1000 person-year, 95% CI 2.0, 4.5). Large objects, stairs and steps, and surface contamination were the three most common hazards noted for 15%, 14% and 13% of fall-related injuries, respectively. CONCLUSIONS The rate and the circumstances of FI differ by age and gender. Understanding these differences and obtaining information about circumstances could be vital for developing effective interventions to prevent falls and FI.
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Affiliation(s)
- Lava R. Timsina
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
- College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
| | - Joanna L. Willetts
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
| | - Melanye J. Brennan
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
| | - Helen Marucci-Wellman
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
| | - David A. Lombardi
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Theodore K. Courtney
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Santosh K. Verma
- Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Falls among frail older people in residential care. Scand J Public Health 2016. [DOI: 10.1177/14034948020300011201] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: A prospective study was carried out to investigate the incidence, circumstances, and injuries from falls among frail older people living in three different types of Swedish residential care settings. Methods: The settings were senior citizens' apartments, an old people's home, and a group dwelling for people with dementia. The falls were registered during the three-year study period on a semi-structured fall report, and injurious falls were categorized according to severity. Results: In total 428 falls occurred among 121 residents. The incidence rate of falls at the group dwelling was twice the rates of the old people's home and senior citizens' apartments (4282 compared with 1709 and 2114 falls per 1000 person-years respectively). Some 27% of the falls occurred during the night (2100 h to 0600 h) and 28% were related to a visit to the lavatory. The presence of acute disease at the time of a fall was diagnosed in 23% of the falls. Some type of injury occurred in 118 falls (28%) and 36 of these (8%) led to moderate or serious injuries. In total 48 fractures were diagnosed. Conclusions: In a preventive programme for falls and injuries in residential care settings, areas of particular interest should include falls after mealtimes and falls at night, conditions of acute diseases, rising up from sitting, walking, and activities in progress, especially visits to the lavatory.
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Affiliation(s)
- Jane Jensen
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden, , Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden, Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden
| | - Lars Nyberg
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden
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Robson LS, Single E, Xie X, Rehm J. The cost of alcohol-attributable injuries and poisonings in Canada, 1992. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145099802500302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alcohol-related injuries and poisonings are estimated to have caused 1.7% (3,359) of all deaths, 4.0% (123,119) of all corresponding potential years of life lost, 1.1% (38,687) of all hospitalizations, and 1.3% (533,895) of hospital days in Canada in 1992. The cost of these injuries is estimated to have been $3.9 billion, using a societal point of view and the human capital method of valuing forgone productivity. Leading causes of these human and economic costs are motor vehicle accidents, falls, self-inflicted injury and assault. Injuries and poisonings comprise a large portion of alcohol-related mortality (50% of deaths; 66% of potential years of life lost), morbidity (45% of hospitalizations) and economic costs (51%). Policy implications of these results are discussed.
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Affiliation(s)
- Lynda S. Robson
- Institute for Work and Health, 250 Bloor Street East, 7thfloor, Toronto, Ontario M4W 1E6, Canada
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Vafaei A, Pickett W, Zunzunegui MV, Alvarado BE. Neighbourhood social and built environment factors and falls in community-dwelling canadian older adults: A validation study and exploration of structural confounding. SSM Popul Health 2016; 2:468-475. [PMID: 29349162 PMCID: PMC5757896 DOI: 10.1016/j.ssmph.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 06/08/2016] [Accepted: 06/16/2016] [Indexed: 10/26/2022] Open
Abstract
Older persons are vulnerable to the ill effects of their social and built environment due to age-related limitations in mobility and bio-psychological vulnerability. Falls are common in older adults and result from complex interactions between individual, social, and contextual determinants. We addressed two methodological issues of neighbourhood-health and social epidemiological studies in this analysis: (1) validity of measures of neighbourhood contexts, and (2) structural confounding resulting from social sorting mechanisms. Baseline data from International Mobility in Aging Study were used. Samples included community-dwelling Canadians older than 65 living in Kingston (Ontario) and St-Hyacinthe (Quebec). We performed factor analysis and ecometric analysis to assess the validity of measures of neighbourhood social capital, socioeconomic status, and the built environment and stratified tabular analyses to explore structural confounding. The scales all demonstrated good psychometric and ecometric properties. There was an evidence of the existence of structural confounding in this sample of Canadian older adults as some combinations of strata for the three neighbourhood measures had no population. This limits causal inference in studying relationships between neighbourhood factors and falls and should be taken into account in aetiological aging research.
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Affiliation(s)
- Afshin Vafaei
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - William Pickett
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Beatriz E Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Overcrowding in Psychiatric Wards is Associated With Increased Risk of Adverse Incidents. Med Care 2016; 54:296-302. [DOI: 10.1097/mlr.0000000000000501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Renz E, Hackney M, Hall C. Foot clearance and variability in mono- and multifocal intraocular lens users during stair navigation. ACTA ACUST UNITED AC 2016; 53:933-944. [DOI: 10.1682/jrrd.2015.02.0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 12/15/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Erik Renz
- Georgia Institute of Technology, Atlanta, GA
| | - Madeleine Hackney
- Atlanta Department of Veterans Affairs (VA) Medical Center, Rehabilitation Research and Development Center, Decatur, GA; Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center, Decatur, GA; Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA
| | - Courtney Hall
- Auditory and Vestibular Dysfunction Research Enhancement Award Program, James H. Quillen VA Medical Center, Mountain Home, TN; Department of Physical Therapy, East Tennessee State University, Johnson City, TN
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Sheehan RC, Beltran EJ, Dingwell JB, Wilken JM. Mediolateral angular momentum changes in persons with amputation during perturbed walking. Gait Posture 2015; 41:795-800. [PMID: 25797789 PMCID: PMC4408235 DOI: 10.1016/j.gaitpost.2015.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/02/2015] [Accepted: 02/21/2015] [Indexed: 02/02/2023]
Abstract
Over 50% of individuals with lower limb amputation fall at least once each year. These individuals also exhibit reduced ability to effectively respond to challenges to frontal plane stability. The range of whole body angular momentum has been correlated with stability and fall risk. This study determined how lateral walking surface perturbations affected the regulation of whole body and individual leg angular momentum in able-bodied controls and individuals with unilateral transtibial amputation. Participants walked at fixed speed in a Computer Assisted Rehabilitation Environment with no perturbations and continuous, pseudo-random, mediolateral platform oscillations. Both the ranges and variability of angular momentum for both the whole body and both legs were significantly greater (p<0.001) during platform oscillations. There were no significant differences between groups in whole body angular momentum range or variability during unperturbed walking. The range of frontal plane angular momentum was significantly greater for those with amputation than for controls for all segments (p<0.05). For the whole body and intact leg, angular momentum ranges were greater for patients with amputation. However, for the prosthetic leg, angular momentum ranges were less for patients than controls. Patients with amputation were significantly more affected by the perturbations. Though patients with amputation were able to maintain similar patterns of whole body angular momentum during unperturbed walking, they were more highly destabilized by the walking surface perturbations. Individuals with transtibial amputation appear to predominantly use altered motion of the intact limb to maintain mediolateral stability.
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Affiliation(s)
- Riley C. Sheehan
- Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA,Military Performance Lab, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Ft. Sam Houston, TX 78234, USA,Please address all correspondence to: Riley C. Sheehan, Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX, 78712, Phone: 210-916-9160,
| | - Eduardo J. Beltran
- Military Performance Lab, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Ft. Sam Houston, TX 78234, USA
| | - Jonathan B. Dingwell
- Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA
| | - Jason M. Wilken
- Military Performance Lab, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Ft. Sam Houston, TX 78234, USA,DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE)
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Tai Chi Intervention Improves Dynamic Postural Control During Gait Initiation in Older Adults: A Pilot Study. J Appl Biomech 2014; 30:697-706. [DOI: 10.1123/jab.2013-0256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tai Chi intervention has been shown to be beneficial for balance improvement. The current study examined the effectiveness of Tai Chi to improve the dynamic postural control among older adults with mobility disability. Six sedentary older adults with mobility disability participated in a 16-week Tai Chi intervention consisting of one hour sessions three times a week. Dynamic postural control was assessed pre- and post intervention as participants initiated gait in four stepping conditions: forward; 45° medially, with the stepping leg crossing over the other leg; 45° and 90° laterally. The center of pressure (CoP) displacement, velocity, and its maximum separation distance from the center of mass in the anteroposterior, mediolateral, and resultant directions were analyzed. Results showed that in the postural phase, Tai Chi increased the CoP mediolateral excursions in the medial (13%) and forward (28%) conditions, and resultant CoP center of mass distance in the medial (9%) and forward (19%) conditions. In the locomotion phase, the CoP mediolateral displacement and velocity significantly increased after the Tai Chi intervention (both by > 100% in the two lateral conditions). These results suggest that through alteration in CoP movement characteristics, Tai Chi intervention might improve the dynamic postural control during gait initiation among older adults.
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Barbieri FA, Gobbi LTB, Lee YJ, Pijnappels M, van Dieën JH. Effect of triceps surae and quadriceps muscle fatigue on the mechanics of landing in stepping down in ongoing gait. ERGONOMICS 2014; 57:934-942. [PMID: 24697241 DOI: 10.1080/00140139.2014.903302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to evaluate the effects of muscle fatigue of triceps surae and quadriceps muscles in stepping down in ongoing gait. We expected that the subjects would compensate for muscle fatigue to prevent potential loss of balance in stepping down. A total of 10 young participants walked over a walkway at a self-selected velocity to step down a height difference of 10-cm halfway. Five trials were performed before and after a muscle fatigue protocol. Participants performed two fatigue protocols: one for ankle muscle fatigue and another for knee muscle fatigue. Kinematics of and ground reaction forces on the leading leg were recorded. Fatigue did not cause a change in the frequency of heel or toe landing. Our results indicate that in stepping down fatigue effects are compensated by redistributing work to unfatigued muscle groups and by gait changes aimed at enhancing balance control, which was however only partially successful.
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Affiliation(s)
- F A Barbieri
- a Department of Physical Education, Laboratório de Estudos da Postura e da Locomoção , São Paulo State University , Rio Claro , Brazil
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Boripuntakul S, Lord SR, Brodie MAD, Smith ST, Methapatara P, Wongpakaran N, Sungkarat S. Spatial variability during gait initiation while dual tasking is increased in individuals with mild cognitive impairment. J Nutr Health Aging 2014; 18:307-12. [PMID: 24626760 DOI: 10.1007/s12603-013-0390-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gait initiation (GI) is a complex transition phase of gait that can induce postural instability. Gait impairment has been well documented in people with Alzheimer's disease, but it is still inconclusive in individuals with Mild Cognitive Impairment (MCI). Previous studies have usually investigated gait performance of cognitive impaired persons under steady state walking. OBJECTIVE This study aimed to examine spatiotemporal variability during GI under single- and dual-task conditions in people with and without MCI. METHODS Spatiotemporal stepping characteristics and variability under single- and dual-task conditions (counting backwards by 3s) were assessed in 30 older adults with MCI and 30 cognitively intact controls. Mean and coefficients of variation (COV) of swing time, step time, step length and step width were compared between the two groups. RESULTS Mixed-model repeated measures ANOVA revealed a significant Group x Walking condition interaction for COV of step length and step width (P<0.05). Post-hoc analysis revealed that variability for these measures were significantly larger in the MCI group compared with the control group under the dual-task condition (P<0.05). CONCLUSIONS Step length and step width variability is increased in people with MCI during GI, particularly in a condition involving a secondary cognitive task. These findings suggest that individuals with MCI have reduced balance control when undertaking a challenging walking task such as gait initiation, and this is exacerbated with an added cognitive task. Future studies should prospectively investigate the relationship between GI variability and fall risk in this population.
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Affiliation(s)
- S Boripuntakul
- Somporn Sungkarat, PhD, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand,
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Mitchell RJ, Stanford R, McVeigh C, Bell D, Close JCT. Incidence, circumstances, treatment and outcome of high-level cervical spinal fracture without associated spinal cord injury in New South Wales, Australia over a 12 year period. Injury 2014; 45:217-22. [PMID: 23570702 DOI: 10.1016/j.injury.2013.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/31/2013] [Accepted: 02/22/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND No Australian population-based studies have examined temporal trends in the incidence of fracture of the first or second cervical vertebra (C1 or C2 fractures), their aetiology, treatment and outcome for younger (15-64 years) compared to older (65+ years) individuals. The aim of this research is to examine the circumstances, treatment and outcomes including mortality for C1 or C2 fractures without associated spinal cord injury by age group in New South Wales (NSW), Australia. METHOD A retrospective review of C1 or C2 vertebra fractures in individuals aged 15 years and over in the NSW Admitted Patient Data Collection from 1 July 1998 to 30 June 2010. Direct age standardised admission rates were calculated by cervical fracture type and by age group. Negative binomial regression was used to examine the statistical significance of changes in trend over time of hospitalised cervical fractures by age group. RESULTS The annual rate of hospitalised C1 and C2 fractures without associated spinal cord injury for individuals aged 15 years and over in NSW was 2.3 per 100,000 population, with the rate estimated to increase by 5.3% each year. Those aged 85+ years had the highest rates of hospitalisation. For those aged 15-64 years, road trauma was the most common mechanism of injury, while for those aged 65+ years, a fall was the dominant mechanism of injury. The in-hospital mortality for individuals aged 65+ years was 11.8% compared to 0.7% for those aged 15-64 years. CONCLUSIONS This study identified an estimated increasing trend in C1 and C2 fractures over time, particularly for older individuals. While younger individuals are commonly injured in road traffic accidents, older individuals are predominantly injured following a fall. Injury prevention strategies should be targeted to the different age groups and injury mechanisms. Implementation of effective falls prevention strategies is likely to reduce these injuries in older people whilst road and vehicle safety including vehicle rollover protection standards may improve rates in younger people.
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Affiliation(s)
- Rebecca J Mitchell
- Falls and Injury Prevention Group, Neuroscience Research Australia,, Australia.
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Beltran EJ, Dingwell JB, Wilken JM. Margins of stability in young adults with traumatic transtibial amputation walking in destabilizing environments. J Biomech 2013; 47:1138-43. [PMID: 24444777 DOI: 10.1016/j.jbiomech.2013.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/04/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
Understanding how lower-limb amputation affects walking stability, specifically in destabilizing environments, is essential for developing effective interventions to prevent falls. This study quantified mediolateral margins of stability (MOS) and MOS sub-components in young individuals with traumatic unilateral transtibial amputation (TTA) and young able-bodied individuals (AB). Thirteen AB and nine TTA completed five 3-min walking trials in a Computer Assisted Rehabilitation ENvironment (CAREN) system under each of three test conditions: no perturbations, pseudo-random mediolateral translations of the platform, and pseudo-random mediolateral translations of the visual field. Compared to the unperturbed trials, TTA exhibited increased mean MOS and MOS variability during platform and visual field perturbations (p<0.010). AB exhibited increased mean MOS during visual field perturbations and increased MOS variability during both platform and visual field perturbations (p<0.050). During platform perturbations, TTA exhibited significantly greater values than AB for mean MOS (p<0.050) and MOS variability (p<0.050); variability of the lateral distance between the center of mass (COM) and base of support at initial contact (p<0.005); mean and variability of the range of COM motion (p<0.010); and variability of COM peak velocity (p<0.050). As determined by mean MOS and MOS variability, young and otherwise healthy individuals with transtibial amputation achieved lateral stability similar to that of their able-bodied counterparts during unperturbed and visually-perturbed walking. However, based on mean and variability of MOS, unilateral transtibial amputation was shown to have affected lateral walking stability during platform perturbations.
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Affiliation(s)
- Eduardo J Beltran
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA
| | - Jonathan B Dingwell
- Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA
| | - Jason M Wilken
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.
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Tsur A, Eluz D, Itah D, Segal Z, Shakeer N, Galin A. Clinical profile of fallers with femoral neck fractures. PM R 2013; 6:390-4. [PMID: 24252491 DOI: 10.1016/j.pmrj.2013.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the most common characteristics of elderly people who fell and fractured their femoral neck and who were admitted to our rehabilitation setting after surgery by an orthopedic surgeon. SETTING A rehabilitation department in a general regional hospital. PARTICIPANTS A cohort of 100 patients, 37 men and 63 women, hospitalized for rehabilitation after surgery for a fracture in the femoral neck. METHODS All the patients were interviewed by a physician from the rehabilitation department about the circumstances of their fall injuries, examined by an ophthalmologist for ocular problems, and evaluated by an occupational therapist for cognitive function. Data about background diseases were retrieved from the patients' medical records. MAIN OUTCOME MEASUREMENTS Age of the patients, place and time of the fall, the circumstances of the fall event, the footwear used at the time of the fall, ophthalmic problems, cognitive disorders, eyeglasses use, walking aids use, medication used that may affect the central nervous system, and the presence of diseases that may influence patients' equilibrium. RESULTS The mean age of the patients was 78 years, with a mean weight of 69 kg. Seventy-eight percent had 1-5 diseases that could influence their balance during weight bearing; 67% had an ophthalmic disease. For 70% of the patients, the cause of the fall appeared to be intrinsic (personal). Seventy-two percent wore socks or slippers, or were barefoot at the time of the fall. Sixty-four percent of the patients who used a walking aid did not use it during the fall event. Seventy-one percent of falls occurred indoors and 29% outdoors. Fifty-five percent of the patients were with another person when they fell. Fifty-one percent were taking tranquilizers or medications for sleep disorders. Sixty-eight percent fell during the daylight hours, between 6 AM and 6 PM. Of the patients who wore eyeglasses, 77.6% were not wearing them when they fell. Seventy percent had a short-term memory disorder, 57% had a concentration disorder, and 49% had an orientation disorder. CONCLUSIONS Characteristics common to patients who fell and fractured their femoral neck included age older than 78 years, cognitive impairment, nonuse of eyeglasses that were prescribed, and inappropriate footwear.
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Affiliation(s)
- Atzmon Tsur
- Department of Rehabilitation, Western Galilee Hospital, POB 21, Nahariya 22100, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(∗).
| | - Dana Eluz
- Occupational Therapy Institute, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(†)
| | - Dorit Itah
- Occupational Therapy Institute, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(‡)
| | - Zvi Segal
- Department of Ophthalmology, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(§)
| | - Nael Shakeer
- Department of Rehabilitation, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(‖)
| | - Arkady Galin
- Department of Rehabilitation, Western Galilee Hospital, Nahariya, Israel (Affiliated to the Faculty of Medicine in the Galilee, Bar-Ilan University, Israel)(¶)
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Chen Y, Mo F, Yi Q, Morrison H, Mao Y. Association between mental health and fall injury in Canadian immigrants and non-immigrants. ACCIDENT; ANALYSIS AND PREVENTION 2013; 59:221-6. [PMID: 23810953 DOI: 10.1016/j.aap.2013.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/30/2013] [Accepted: 06/04/2013] [Indexed: 05/15/2023]
Abstract
The study was to determine the association between mental health and the incidence of injury among Canadian immigrants and non-immigrants. We used data from 15,405 individuals aged 12 years or more, who were living in British Columbia, Canada, and participated in the 2007-2008 Canadian Community Health Survey (CCHS). We calculated a 12-month cumulative incidence of fall injury based on self-reporting. Logistic regression model was used to examine the association of the 12-month cumulative incidence of fall injury with immigration status and mental health before and after adjustment for covariates. The results show that self-reported mood and anxiety disorders were significantly associated with an increased incidence of fall injury. The adjusted odds ratios were 1.81 (95% CI: 1.37, 2.38) for mood disorder and 1.55 (95% CI: 1.12, 2.13) for anxiety disorder. Immigrant status was a significant effect modifier for the association between mental health and fall injury, with stronger associations in immigrants than in non-immigrants especially in elderly people. People with poor self perceived health were more likely to have a fall injury. Both mental health and general health were related to fall injury. There was a stronger association between mental health and fall injury in immigrants compared with non-immigrants in the elderly. More attention should be paid to mental health in immigrants associated with fall injury.
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Affiliation(s)
- Yue Chen
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5.
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Fernandez KM, Roemmich RT, Stegemöller EL, Amano S, Thompson A, Okun MS, Hass CJ. Gait initiation impairments in both Essential Tremor and Parkinson's disease. Gait Posture 2013; 38:956-61. [PMID: 23726428 PMCID: PMC3778167 DOI: 10.1016/j.gaitpost.2013.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/25/2013] [Accepted: 05/01/2013] [Indexed: 02/02/2023]
Abstract
Gait initiation is a transitional task involving a voluntary shift from a static, stable position to a relatively less-stable state of locomotion. During gait initiation, anticipatory postural adjustments precede stepping in order to generate forward momentum while balance is maintained. While deficits in gait initiation are frequently reported for persons with Parkinson's disease, there is a paucity of information regarding gait initiation performance in persons with Essential Tremor. We investigated anticipatory postural adjustments and spatiotemporal characteristics of gait initiation in persons with Essential Tremor and compared them to persons with Parkinson's disease as well as age-matched neurologically healthy adults. Twenty-four persons with Essential Tremor, 31 persons with Parkinson's disease, and 38 age-matched controls participated. We compared anterior-posterior and mediolateral center of pressure movements and spatiotemporal stepping characteristics during gait initiation among the three groups using Mann-Whitney U-tests with Bonferroni corrections for multiple comparisons and one-way ANOVAs. Persons with Parkinson's disease demonstrated significantly reduced displacement and velocity of the center of pressure during early phases of anticipatory postural adjustments relative to controls. Displacement of the center of pressure was also reduced in persons with Essential Tremor, although at a later stage of the gait initiation process. Persons with Parkinson's disease and Essential Tremor demonstrated similar reductions in step length during gait initiation when compared to controls. Persons with Parkinson's disease and Essential Tremor exhibit different deficits in gait initiation when compared to healthy older adults. Therefore, this study provides further evidence differentiating motor control features in these movement disorders.
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Affiliation(s)
- Kristina M. Fernandez
- Department of Applied Physiology and Kinesiology,Center for Movement Disorders and Neurorestoration
| | - Ryan T. Roemmich
- Department of Applied Physiology and Kinesiology,Center for Movement Disorders and Neurorestoration
| | - Elizabeth L. Stegemöller
- Department of Applied Physiology and Kinesiology,Center for Movement Disorders and Neurorestoration,Department of Neurology
| | - Shinichi Amano
- Department of Applied Physiology and Kinesiology,Center for Movement Disorders and Neurorestoration
| | - Amanda Thompson
- Center for Movement Disorders and Neurorestoration,Department of Neurology
| | - Michael S. Okun
- Center for Movement Disorders and Neurorestoration,Department of Neurology
| | - Chris J. Hass
- Department of Applied Physiology and Kinesiology,Center for Movement Disorders and Neurorestoration
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Bowling CB, Muntner P, Bradbury BD, Kilpatrick RD, Isitt JJ, Warriner AH, Curtis JR, Judd S, Brown CJ, Allman RM, Warnock DG, McClellan W. Low hemoglobin levels and recurrent falls in U.S. men and women: prospective findings from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Am J Med Sci 2013; 345:446-54. [PMID: 23328832 PMCID: PMC3640699 DOI: 10.1097/maj.0b013e3182638364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There are few data available on low hemoglobin and incident falls in the general U.S. population. METHODS Of 30,239 black and white U.S. adults ≥45 years in the population-based REasons for Geographic And Racial Differences in Stroke study, 16,782 had hemoglobin measured at baseline and follow-up data on falls. Hemoglobin was categorized by 1.0 g/dL increments relative to the World Health Organization anemia threshold (<13.0 g/dL for men, <12.0 g/dL for women). Recurrent falls (≥2 falls in the 6 months after baseline) were assessed during a telephone interview. RESULTS Recurrent falls occurred in 3.9% of men and 4.8% of women. Compared with those with a hemoglobin level 1 to 2 g/dL above the anemia cut-off, multivariable adjusted odds ratios (95% confidence intervals) for recurrent falls associated with hemoglobin levels ≥3, 2 to <3 and 0 to 1 g/dL above the cut-off point, and 0 to <1 and ≥1 g/dL below the cut-off point were 0.73 (0.45-1.19), 0.84 (0.57-1.24), 1.29 (0.88-1.90), 1.32 (0.0.80-1.2.18) and 2.12 (1.23-3.63), respectively, among men (linear trend P < 0.001), and 1.59 (1.10-2.3), 1.24 (0.95-1.62), 1.42(1.11-1.81), 1.28 (0.91-1.80) and 1.76 (1.13-2.74), respectively, among women (linear trend P = 0.45; quadratic trend P = 0.016). CONCLUSIONS Among men, lower hemoglobin levels were associated with an increased risk for recurrent falls. Although our findings suggest an increased risk for recurrent falls at both lower and higher hemoglobin levels among women, these findings should be confirmed in subsequent studies.
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Affiliation(s)
- C Barrett Bowling
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama 35233, USA.
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Mitchell RJ, Watson WL, Milat A, Chung AZQ, Lord S. Health and lifestyle risk factors for falls in a large population-based sample of older people in Australia. JOURNAL OF SAFETY RESEARCH 2013; 45:7-13. [PMID: 23708471 DOI: 10.1016/j.jsr.2012.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 09/19/2012] [Accepted: 11/29/2012] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Fall-related injuries among older people is a significant public health issue. METHOD To identify medical, general health and lifestyle factors associated with falls and multiple falls in older persons, a representative sample of people aged 65+ years living in the community in New South Wales (NSW) Australia were surveyed regarding their falls experience, lifestyle and general health. RESULTS One-quarter of respondents indicated they had fallen in the past 12 months. People who fell were more likely to be aged 85+ years, have cataracts, musculoskeletal system and connective tissue disorders, major diseases of the circulatory, respiratory and nervous systems, use four or more medications, use a mobility aid and be overweight than non-fallers. Individuals aged 85+ years and those who experienced circulatory diseases, used four or more medications and used mobility aids were more likely to experience multiple falls. DISCUSSION This representative population-based survey reinforces the multi-factorial nature of falls and the complex interaction of risk factors that increase the likelihood of individuals having a fall or multiple falls. Agencies focused on community-based fall prevention strategies should adopt a systematic, integrated approach to reduce the burden of fall injury at the population-level and should have mechanisms in place at the population-level to monitor the success of fall reduction strategies.
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Affiliation(s)
- Rebecca J Mitchell
- Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Australia.
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Barbieri FA, Lee YJ, Gobbi LTB, Pijnappels M, Van Dieën JH. The effect of muscle fatigue on the last stride before stepping down a curb. Gait Posture 2013; 37:542-6. [PMID: 23062731 DOI: 10.1016/j.gaitpost.2012.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/11/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
The stride before landing may be important during stepping down. The aim of this study was to analyze variability of the kinematics and muscle activity in the final stride before stepping down a curb, with and without ankle and knee muscle fatigue. Ten young participants walked at self-selected speed and stepped down a height difference (10-cm) in ongoing gait. Five trials were performed before and after a muscle fatigue protocol (one day: ankle muscle fatigue, another day: knee muscle fatigue). The analysis focused on the trailing leg during the last but one and the last step on the higher level. Kinematics and muscle activity were recorded. Fatigue increased variability of foot-step horizontal distance in the last step on the higher level of the trailing limb, as well as in the first steps on the lower level for both limbs. This appeared due to an increase in the range of motion of the knee joint after both fatigue protocols. Participants additionally showed an increased ankle and hip ROM and decreased knee ROM. Our results suggest a loss of control under fatigue reflected in a higher variability of trailing and leading limb-step horizontal distances, with compensatory changes to limit fatigue effects, such as a redistribution of movement over joints.
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Ward G, Holliday N, Fielden S, Williams S. Fall detectors: a review of the literature. ACTA ACUST UNITED AC 2012. [DOI: 10.1108/17549451211261326] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kearns WD, Fozard JL, Becker M, Jasiewicz JM, Craighead JD, Holtsclaw L, Dion C. Path Tortuosity in Everyday Movements of Elderly Persons Increases Fall Prediction Beyond Knowledge of Fall History, Medication Use, and Standardized Gait and Balance Assessments. J Am Med Dir Assoc 2012; 13:665.e7-665.e13. [DOI: 10.1016/j.jamda.2012.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/18/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
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Spatiotemporal variability during gait initiation in Parkinson's disease. Gait Posture 2012; 36:340-3. [PMID: 22543093 PMCID: PMC3407339 DOI: 10.1016/j.gaitpost.2012.01.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 01/12/2012] [Accepted: 01/21/2012] [Indexed: 02/02/2023]
Abstract
During gait initiation (GI), consistency of foot placement while stepping is important in making successful transitions from a state of stable static posture to an unstable state of dynamic locomotion. In populations characterized by gait dysfunction and postural instability, such as persons with Parkinson's disease (PD), the ability to generate a consistent stepping pattern during GI may be essential in the prevention of falls. However, little is known about GI variability in persons with PD as compared to their healthy elderly peers. Therefore, this study investigated spatiotemporal variability during the first two steps of GI in 46 persons with idiopathic PD and 49 healthy age-matched adults. Stepping characteristics, including the length, width, and time of the first two steps of GI as well as their coefficients of variation (CV) were compared between groups. Persons with PD initiated gait with significantly shorter steps (swing step length=.463 vs. .537 m, stance step length=.970 vs. 1.10 m) and higher variability in step length (swing step CV=8.82 vs. 5.45, stance step CV=6.76 vs. 3.61). Persons with PD also showed significantly higher variability in the time of the swing step (swing step CV=10.0 vs. 7.4). GI variability did not differ significantly between disease stages in persons with PD. Because greater variability in these measures during gait is related to an increased risk of falls, we propose that higher GI variability may play a considerable role in falls frequently observed during transitions from quiet standing in PD.
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Grundstrom AC, Guse CE, Layde PM. Risk factors for falls and fall-related injuries in adults 85 years of age and older. Arch Gerontol Geriatr 2012; 54:421-8. [PMID: 21862143 PMCID: PMC3236252 DOI: 10.1016/j.archger.2011.06.008] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/06/2011] [Accepted: 06/07/2011] [Indexed: 11/27/2022]
Abstract
Falls are a leading cause of morbidity and mortality in older adults. No previous studies on risk factors for falls have focused on adults 85 years and older, the most rapidly growing segment of adults. We examined demographic, health, and behavioral risk factors for falls and fall-related injuries in adults 65 years and older, with a particular focus on adults 85 years and older. We analyzed self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS) for 2008. Data was available for 120,923 people aged 65 or older and 12,684 people aged 85 or older. Of those aged 85 or older, 21.3% reported at least one fall in the past 3 months and 7.2% reported at least one fall related injury requiring medical care or limiting activity for a day or longer. Below average general health, male sex, perceived insufficient sleep, health problems requiring assistive devices, alcohol consumption, increasing body mass index and history of stroke were all independently associated with a greater risk of falls or fall related injuries. The greater risk of falling in those 85 years and older appeared to be due to the deterioration of overall health status with age; among those with excellent overall health status, there was no greater risk of falling in adults 85 years and older compared to those 65-84 years of age. Our results suggest that those with risk factors for falls and fall-related injuries may be appropriate targets for evidence-based fall prevention programs.
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Affiliation(s)
| | - Clare E. Guse
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Peter M. Layde
- Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
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Muir SW, Gopaul K, Montero Odasso MM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 2012; 41:299-308. [PMID: 22374645 DOI: 10.1093/ageing/afs012] [Citation(s) in RCA: 415] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND cognitive impairment is an established fall risk factor; however, it is unclear whether a disease-specific diagnosis (i.e. dementia), measures of global cognition or impairments in specific cognitive domains (i.e. executive function) have the greatest association with fall risk. Our objective was to evaluate the epidemiological evidence linking cognitive impairment and fall risk. METHODS studies were identified through systematic searches of the electronic databases of MEDLINE, EMBASE, PyschINFO (1988-2009). Bibliographies of retrieved articles were also searched. A fixed-effects meta-analysis was performed using an inverse-variance method. RESULTS twenty-seven studies met the inclusion criteria. Impairment on global measures of cognition was associated with any fall, serious injuries (summary estimate of OR = 2.13 (1.56, 2.90)) and distal radius fractures in community-dwelling older adults. Executive function impairment, even subtle deficits in healthy community-dwelling older adults, was associated with an increased risk for any fall (summary estimate of OR = 1.44 (1.20, 1.73)) and falls with serious injury. A diagnosis of dementia, without specification of dementia subtype or disease severity, was associated with risk for any fall but not serious fall injury in institution-dwelling older adults. CONCLUSION the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk. There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values. Executive function was also associated with increased risk, which supports its inclusion in fall risk assessment especially when global measures are within normal limits.
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Affiliation(s)
- Susan W Muir
- Division of Geriatric Medicine, The University of Western Ontario, 801 Commissioners Road East, London, Ontario, Canada
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Allen J, Koziak A, Buddingh S, Liang J, Buckingham J, Beaupre LA. Rehabilitation in patients with dementia following hip fracture: a systematic review. Physiother Can 2012; 64:190-201. [PMID: 23449813 DOI: 10.3138/ptc.2011-06bh] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. METHODS Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity. RESULTS A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. CONCLUSIONS People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings. Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle–Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.
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Fear of falling is associated with prolonged anticipatory postural adjustment during gait initiation under dual-task conditions in older adults. Gait Posture 2012; 35:282-6. [PMID: 22024142 DOI: 10.1016/j.gaitpost.2011.09.100] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 02/02/2023]
Abstract
Little is known about dynamic balance control under dual-task conditions in older adults with fear of falling (FoF). The purpose of this study was to examine the effect of FoF on anticipatory postural adjustment (APA) during gait initiation under dual-task conditions in older adults. Fifty-seven elderly volunteers (age, 79.2 [6.8] years) from the community participated in this study. Each participant was categorised into either the Fear (n=24) or No-fear (n=33) group on the basis of the presence or absence of FoF. Under single- and dual-task conditions, centre of pressure (COP) data were collected while the participants performed gait initiation trials from a starting position on a force platform. We also performed a 10-m walking test (WT), a timed up & go test (TUG), and a functional reach test (FR). The reaction and APA phases were measured from the COP data. The results showed that under the dual-task condition, the Fear group had significantly longer APA phases than the No-fear group, although no significant differences were observed between the 2 groups in the reaction and APA phases under the single-task condition and in any clinical measurements (WT, TUG, and FR). Our findings suggest that specific deficits in balance control occur in subjects with FoF during gait initiation while dual tasking, even if their physical functions are comparable to subjects without FoF.
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