Incidence and prevalence of falls in adults with intellectual disability living in the community: a systematic review

How does the SARS-CoV-2 reinfection rate change over time? The global evidence from systematic review and meta-analysis

BACKGROUND

There is a significant increase in the number of SARS-CoV-2 reinfection reports in various countries. However, the trend of reinfection rate over time is not clear.

METHODS

We searched PubMed, Web of Science, Medline, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang for cohort studies, case-control studies, and cross-sectional studies up to March 16, 2023, to conduct a meta-analysis of global SARS-CoV-2 reinfection rate. Subgroup analyses were performed for age, country, study type, and study population, and time-varying reinfection rates of SARS-CoV-2 were estimated using meta-regression. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute critical appraisal tool.

RESULT

A total of 55 studies involving 111,846 cases of SARS-CoV-2 reinfection were included. The pooled SARS-CoV-2 reinfection rate was 0.94% (95% CI: 0.65 -1.35%). In the subgroup analyses, there were statistically significant differences in the pooled reinfection rates by reinfection variant, and study type (P < 0.05). Based on meta-regression, the reinfection rate fluctuated with time.

CONCLUSION

Meta-regression analysis found that the overall reinfection rate increased and then decreased over time, followed by a period of plateauing and then a trend of increasing and then decreasing, but the peak of the second wave of reinfection rate was lower than the first wave. SARS-CoV-2 is at risk of reinfection and the Omicron variant has a higher reinfection rate than other currently known variants. The results of this study could help guide public health measures and vaccination strategies in response to the Coronavirus Disease 2019 (COVID-19) pandemic.

Prevalence of health risk behaviours related to non-communicable diseases amongst South African university students: a systematic review

BACKGROUND

Engagement in risk behaviours adopted during university continues after graduation, increasing the risk of non-communicable diseases (NCDs). This systematic review aimed to investigate the prevalence of NCD risk behaviours amongst South African university students.

METHODS

PubMed and Scopus databases were searched (January 1990-April 2022) for studies investigating alcohol consumption, cigarette smoking, inadequate consumption of fruits and vegetables and physical inactivity. Study qualities were assessed with the Joanna Briggs Institute critical appraisal and levels of evidence checklists. An overall prevalence percentage was obtained for each risk behaviour.

RESULTS

A total of 50 studies (n = 26 624 students) were included. A range of 44.8-75.0% of students consumed inadequate servings of fruits and vegetables. Just over 54% consumed alcohol (95% confidence intervals [95%CI]:54.0-55.5%). A significantly higher percentage of males (44.2%) than females (25.8%) drank heavily (P < 0.001). Approximately one-third (34.8%, 95%CI:33.4-36.3%) were sedentary and 39.0% (95%CI:37.5-40.4%) were insufficiently active. Almost one-fifth (17.9%, 95%CI:17.3-18.5%) smoked cigarettes, being significantly more prevalent amongst males (21.8%) than females (13.5%) (P < 0.001). A total of 10% smoked 1-10 cigarettes/day and 1.2% smoked >10 cigarettes/day.

CONCLUSION

High percentages of South African students eat inadequate servings of fruits and vegetables, consume alcohol are physically inactive and smoke cigarettes. South African universities should implement screening measures and health campaigns.

Interventions to reduce falls in community-dwelling adults with intellectual disability: a systematic review

BACKGROUND

People with intellectual disability have a high risk of falls and falls-related injuries. Although people with intellectual disability are at increased risk of falls, there is a need to better understand the efficacy of interventions that can help reduce falls and address risk factors in this population. This systematic review aimed to evaluate the type, nature and effectiveness of interventions undertaken to reduce falls with community-dwelling adults with intellectual disability and the quality of this evidence.

METHOD

Four electronic databases were searched: Ovid MEDLINE, PsycINFO, CINAHL Plus and the Cochrane Library. Studies were included if they involved people aged 18 years or over, at least 50% of study participants had intellectual disability, participants were community-dwelling, and the study evaluated any interventions aiming to reduce falls. Study quality was assessed using the National Institutes of Health study quality assessment tools. Reporting of the review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Seven studies were eligible for review, with a total of 286 participants and mean age of 50.4 years. As only one randomised trial was identified, a narrative synthesis of results was undertaken. Five studies evaluated exercise interventions, one evaluated a falls clinic programme, and one evaluated stretch fabric splinting garments. Methodological quality varied (two studies rated as good, four as fair, and one as poor). Exercise interventions varied in terms of exercise type and dosage, frequency and intensity, and most did not align with recommendations for successful falls prevention exercise interventions reported for older people. While the majority of studies reported reduced falls, they differed in methods of reporting falls, and most did not utilise statistical analyses to evaluate outcomes.

CONCLUSION

This review identified a small number of falls prevention intervention studies for people with intellectual disability. Although several studies reported improvements in fall outcomes, ability to draw conclusions about intervention effectiveness is limited by small sample sizes and few studies. Further large-scale research is required to implement and evaluate falls prevention interventions specifically for adults with intellectual disability.

Pain Management in the Most Vulnerable Intellectual Disability: A Review

This review is made up of two parts; the first part discussing intellectual disability (ID) in general, while the second part covers the pain associated with intellectual disability and the challenges and practical tips for the management of pain associated with (ID). Intellectual disability is characterized by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. ID is a disorder with no definite cause but has multiple risk factors, including genetic, medical, and acquired. Vulnerable populations such as individuals with intellectual disability may experience more pain than the general population due to additional comorbidities and secondary conditions, or at least the same frequency of pain as in the general population. Pain in patients with ID remains largely unrecognized and untreated due to barriers to verbal and non-verbal communication. It is important to identify patients at risk to promptly prevent or minimize those risk factors. As pain is multifactorial, thus, a multimodal approach using both pharmacotherapy and non-pharmacological management is often the most beneficial. Parents and caregivers should be oriented to this disorder, given adequate training and education, and be actively involved with the treatment program. Significant work to create new pain assessment tools to improve pain practices for individuals with ID has taken place, including neuroimaging and electrophysiological studies. Recent advances in technology-based interventions such as virtual reality and artificial intelligence are rapidly growing to help give patients with ID promising results to develop pain coping skills with effective reduction of pain and anxiety. Therefore, this narrative review highlights the different aspects regarding the current status of the pain associated with intellectual disability, with more emphasis on the recent pieces of evidence for the assessment and management of pain among populations with intellectual disability.

Efficacy of OK-432 sclerotherapy for different types of lymphangiomas: a review and meta-analysis

OBJECTIVE

This study aims to perform a meta-analysis to figure out the efficacy of OK-432 sclerotherapy between Macrocystic (MAC) lymphangiomas and Microcystic (MIC) lymphangiomas.

METHODS

We conducted a systematic review and meta-analysis to clarify the relationship between OK-432 and lymphangiomas. PubMed and ISI Web of Science were searched from inception to May 2022. Joanna Briggs Institute (JBI) manual was used to evaluate the risk of bias. We calculated pooled Relative Risks (RR) and 95% Confidence Interval (95% CI) using random effects model to evaluate the relations between OK-432 and lymphangiomas.

RESULTS

A total of 11 studies (including 352 cases) about OK-432 sclerotherapy for lymphangioma were included in the current meta-analyses. The results suggested that the efficacy of OK-432 was significantly in MAC lesions than in MIC (RR=1.51, 95% CI 1.298-1.764), with significant moderate degrees of heterogeneity among 11 studies (I2=51.2%, p=0.025). Subgroup analyses suggested that there was significant association in both retrospective studies (RR=1.26, 95% CI 1.03-1.53) and classification (by 1 cm) (RR=1.37, 95% CI 1.04-1.80) were associated with the efficacy of OK-432.

CONCLUSION

To our knowledge, our study represents the first meta-analysis examining the efficacy of OK-432 in the treatment of different types of LMs. However, the regional differences and the age differences of the subjects are the main limitations of this study and should be avoided in further research. Our results suggested that OK-432 sclerotherapy for macrocystic lymphangiomas was more effective.

Effects of Virtual Reality-Based Exercise on Physical Fitness in People with Intellectual Disability: A Systematic Review of Randomized Controlled Trials

It is unclear whether virtual reality (VR)-based exercise can improve physical fitness in people with intellectual disability (ID). This systematic review therefore aimed to synthesize existing evidence regarding the efficacy of VR-based exercise on physical fitness in people with ID. Eligible articles were searched through six major electronic databases from inception until August 15, 2022. Returned studies were screened through predefined inclusion and exclusion criteria. Data from the included studies were then extracted and synthesized. A total of 13 randomized controlled trials were included and 12 of them were found to have good research quality. Different physical fitness outcomes were evaluated: (1) muscular fitness (d = 0.05-2.12; proportion of effect = 5/6), (2) cardiorespiratory fitness (d = 0.12-0.67; proportion of effect = 5/5), (3) flexibility (d = 0.81; proportion of effect = 1/2), (4) body composition (d = 0.10; proportion of effect = 2/3), (5) balance (d = 0.23-1.65; proportion of effect = 6/7), (6) coordination (d = 0.19-0.48; proportion of effect = 2/3), (7) speed and agility (d = 0.13-0.46; proportion of effect = 4/4), and (8) overall motor proficiency (d = 0.02-1.08; proportion of effect = 1/3). While there was some preliminary evidence showing that VR-based exercise could improve muscular fitness, cardiorespiratory fitness, balance, and speed and agility in individuals with ID, other outcomes showed less conclusive or limited positive evidence. Overall, additional studies are needed to understand the benefits of VR-based exercise on physical fitness in people with ID.

Eight-week virtual reality training improves lower extremity muscle strength but not balance in adolescents with intellectual disability: A randomized controlled trial

Purpose: This study aims to assess the effects of 8-week virtual reality (VR) training on balance and lower extremity muscle strength in adolescents with intellectual disability (ID).

Methods: Thirty adolescents with intellectual disability were randomly divided into the virtual reality group and control group. The participants in the virtual reality group and the control group received the virtual reality training and the physical education (PE) course, respectively, for 8 weeks. The Berg Balance Scale (BBS), Timed Up and Go (TUG) test and lower extremity muscle strength were measured before and after the training.

Results: The between-group results showed that the participants in the virtual reality group increased the muscle strength of hip flexors (p &lt; 0.001), hip extensors (p = 0.002), hip abductors (p &lt; 0.001), knee flexors (p &lt; 0.001), knee extensors (p = 0.002) and ankle plantar flexors (p = 0.042) significantly after training, compared to the control group. However, no significant improvement was found in the berg balance scale and timed up and go scores between the virtual reality group and control group after training (p &gt; 0.05). The within-group results showed that the strength of all the muscle groups significantly increased after training in the virtual reality group (p &lt; 0.05) compared to the baseline. However, no significant difference was found in the muscle strength in the control group before and after training. The within-group berg balance scale and timed up and go scores showed no significant improvements in both groups.

Conclusion: Virtual reality training intervention might be effective in improving the lower extremity muscle strength, but no significant improvement was found on balance ability in adolescents with intellectual disability.

Athletes with intellectual disability: The effects of cognitive deficits and sports practice on bipedal standing balance

BACKGROUND

Athletes with intellectual disability represent a unique population who experiences the contrasting effects of cognitive deficits and benefits of sports on balance. This study investigated the combined impact of intellectual disability and sport practice on balance.

METHOD

Center-of-pressure excursion in bipedal stance of 2 disability (with and without intellectual disability) × 2 sport practice (athlete and novice) participant groups was measured in several balance conditions.

RESULTS

Sport practice exerted no significant effect on any of the center-of-pressure measures used. In contrast, intellectual disability's effects on balance, which were most apparent in challenging balance conditions, were significant (p < .05) and had large effect sizes (η_p ²  > 0.13).

CONCLUSION

The negative effects of cognitive deficits on the balance of young adults with intellectual disability underscore the need for effective interventions. Although findings did not support sports' balance-remediating potential, the value of sport participation for individuals with intellectual disability cannot be fully dismissed just yet.

Unique Pain Responses in Different Etiological Subgroups of Intellectual and Developmental Disabilities

We studied whether there exist variations in pain responses between different intellectual and developmental disability (IDD) etiologies. Self-reports and facial expressions (Facial Action Coding System = FACS) were recorded during experimental pressure stimuli and compared among 31 individuals with IDD-13 with cerebral palsy (CP), nine with Down syndrome (DS), nine with unspecified origin (UIDD)-and among 15 typically developing controls (TDCs). The CP and DS groups had higher pain ratings and FACS scores compared to the UIDD and TDC groups, and steeper stimulus-response functions. The DS group exhibited the most diverse facial expressions. There were variations in the foci of facial expressions between groups. It appears that different IDD etiologies display distinct pain responses.

Prevalence of diabetic macular edema based on optical coherence tomography in people with diabetes: A systematic review and meta-analysis

Diabetic macular edema (DME) is a leading cause of vision loss among people with diabetes. Optical coherence tomography (OCT) allows for accurate assessment and early detection of DME. Meta-analyses on DME prevalence diagnosed with OCT are lacking. We performed a meta-analysis to assess the global prevalence of OCT-diagnosed DME. We searched five electronic databases (EMBASE, CINAHL, Web of Science, Scopus, and MEDLINE) on May 29, 2020 and updated the search on March 19 and June 22, 2021. The quality of retrieved studies was evaluated using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects model was used to pool prevalence estimates. Countries were classified into low-to-middle-income and high-income countries using World Bank data for subgroup analyses. Seven studies were included in this meta-analysis. The pooled prevalence of DME was 5.47% (95% CI: 3.66%-7.62%) overall, 5.81% (95% CI: 0.07%-18.51%) in low-to-middle-income countries and 5.14% (95% CI: 3.44%-7.15%) in high-income countries. We reported approximately 5.5% of people with diabetes have DME, with a statistically non-significantly lower prevalence in high-income countries versus low-to-middle-income countries. Given the global pandemic of diabetes, there is a need to inform physicians and educate people with diabetes regarding early detection and treatment of DME using OCT.

Cognitive-motor multitasking in athletes with and without intellectual impairment

PURPOSE

We investigated cognitive-motor multitasking in 29 top athletes with intellectual impairment (II) recruited during the European Championship Games organized by Virtus (World Intellectual Impairment Sports) and 29 control (CT) athletes matched for age, sex, sports practiced, and lifetime accumulated practice hours.

METHODS

Participants performed a cognitive task that required recognizing previously displayed visual objects among distractors. The motor task required maintaining a stable upright posture balancing on a rocking board placed atop a force plate which assessed center-of-pressure (COP) movement. Both tasks were performed separately (with participants seated for the cognitive single task) and concurrently under dual-task conditions, wherein participants memorized objects while balancing. We analyzed recognition accuracy, COP path length, and sample entropy of the COP trajectory as a measure for automaticity of postural control.

RESULTS

As expected, CT-athletes outperformed II-athletes in the cognitive task but the two groups have comparable performance in the postural task under single- and dual-task conditions. When multitasking, CT-athletes switched to more automatic postural control and maintained their postural sway at single-task levels. II-athletes prioritized balance thereby successfully keeping COP excursion comparable to single-task conditions. However, this came with pronounced costs for memory performance, which was unaffected by multitasking in CT-athletes.

CONCLUSION

The adaptive capacity observed in control athletes was not at the disposal of II-athletes who revealed pronounced sensitivities to multitasking interference. This sensitivity obviously was not compensated for by either athletic competence or potential transfer of athletic skill to domain-general cognitive functions.

Pain Behavior of People with Intellectual and Developmental Disabilities Coded with the New PAIC-15 and Validation of Its Arabic Translation

Pain management necessitates assessment of pain; the gold standard being self-report. Among individuals with intellectual and developmental disabilities (IDD), self-report may be limited and therefore indirect methods for pain assessment are required. A new, internationally agreed upon and user-friendly observational tool was recently published—the Pain Assessment in Impaired Cognition (PAIC-15). The current study’s aims were: to test the use of the PAIC-15 in assessing pain among people with IDD and to translate the PAIC-15 into Arabic for dissemination among Arabic-speaking professionals. Pain behavior following experimental pressure stimuli was analyzed among 30 individuals with IDD and 15 typically developing controls (TDCs). Translation of the PAIC followed the forward–backward approach; and reliability between the two versions and between raters was calculated. Observational scores with the PAIC-15 exhibited a stimulus–response relationship with pressure stimulation. Those of the IDD group were greater than those of the TDC group. The overall agreement between the English and Arabic versions was high (ICC = 0.89); single items exhibited moderate to high agreement levels. Inter-rater reliability was high (ICC = 0.92). Both versions of the PAIC-15 are feasible and reliable tools to record pain behavior in individuals with IDD. Future studies using these tools in clinical settings are warranted.

Injuries and Illnesses Observed in Athletes from Beginner to Elite Levels at the 18th National Sports Festival for Persons with Disabilities in Japan

Objectives

: This study aimed to describe the injuries and illnesses that occurred at the 18th National Sports Festival for Persons with Disabilities in Japan, which was attended by more than 3000 athletes from beginner to elite levels.

Methods

: Records from medical stations set up at the venues for each sport were reviewed. The incidence rates (IRs) were calculated as the number of medical station visits per 1000 athlete-days. The backgrounds of injuries and illnesses were investigated.

Results

: In total, 3277 athletes attended the festival, and 134 eligible medical station visits were analyzed. Overall, 102 athletes complained of injuries. For the whole schedule of the festival, IRs were 15.5 for injuries and illnesses and 11.8 for injuries alone. For injuries and illnesses, high IRs were seen in soccer (39.8), basketball (25.6), and foot baseball (22.4); for injuries alone, high IRs were also seen in soccer (33.6), basketball (25.6), and foot baseball (16.8). The most frequent symptoms were internal symptoms (n=32), contusions (n=30), and wounds (n=24). Joint sprains occurred in various sports, whereas muscle strains happened mainly in disciplines demanding sprinting or high agility. Of the 55 cases that occurred during events or public rehearsals, 45 were traumatic, whereas the relation to sports activities was not described in 51 cases. Of participants with internal symptoms, 11 were suggested to have viral infections. We identified 21 injuries caused by falls.

Conclusions

: Minor trauma and viral infection were the most frequently observed symptoms among injuries and illnesses, respectively. Structured medical records and organized surveillance systems should be utilized to improve data collection and understand the onset of injury and illness.

A web-based prospective cohort study of home, leisure, school and sports injuries in France: a descriptive analysis

Background

Home and leisure injuries (HLIs) are a major public health problem. Cohort studies among general population are needed for targeted preventive actions but remain scarce. We quantify and qualify the HLIs collected prospectively in the MAVIE (Mutualists against Home and Leisure Injuries) observatory, a web-based cohort among volunteers of the French general population.

Methods

Participants reported HLIs from November 2014 to December 2019. We calculated crude and standardized incidence rates (SIRs) on the entire cohort, for each of the selected socio-demographic variables and each of the injury circumstances (place and activity), mechanisms, and injury severity levels. We also described other HLIs characteristics and consequences.

Results

Out of the 29,931 household members enrolled in the cohort, 12,419 participants completed the questionnaires. Among them, 8640 participants provided follow-up data, leading to a follow-up of 6302 persons for 5.2 years and 2483 HLIs were reported. We obtained a SIR of 85.0 HLIs per 1000 persons-years. Most reported injuries did not require emergency department attendance or hospitalization (64%). SIRs were higher in children (< 15 years of age) (109.1 HLIs per 1000 persons-years; 95% CI, 78.2–140.1) and adults aged 70 years and older (123.7 HLIs per 1000 persons-years; 95% CI, 79.2–168.3). Struck or hit by fall was the most frequent injury mechanism (52%) and also among the most severe injuries (73% of Struck or hit by fall HLIs ending with hospitalization). Sport (without contact with nature), and leisure and play activities were the injury circumstances with higher SIRs, 15.2 HLIs per 1000 persons-years (95% CI, 14.6–15.8) and 11.2 HLIs per 1000 persons-years (95% CI, 10.7–11.6), respectively. Outdoor sport activity (in contact with nature) was the circumstance with the highest proportion of hospitalizations (18% of outdoor sports HLIs ending with hospitalization).

Conclusion

The incidences, causes, and consequences of HLI differ by age group and are mainly related to the performance of certain activities. Although the participants in the MAVIE cohort were not representative of the French population. Our study identified potential sub-populations and specific types of HLIs that should be targeted by future studies concerning risk factors and prevention programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-021-00343-9.

Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative

Background: Getting effective fall prevention into the homes of medically and physically vulnerable individuals is a critical public health challenge. Community paramedicine is emerging globally as a new model of care that allows emergency medical service units to evaluate and treat patients in non-emergency contexts for prevention efforts and chronic care management. The promise of community paramedicine as a delivery system for fall prevention that scales to community-level improvements in outcomes is compelling but untested.Objective: To study the impact of a community paramedic program's optimization of a fall prevention system entailing a clinical pathway and learning health system (called Community-FIT) on community-level fall-related emergency medical service utilization rates.Methods: We used an implementation science framework and quality improvement methods to design and optimize a fall prevention model of care that can be embedded within community paramedic operations. The model was implemented and optimized in an emergency medical service agency servicing a Midwestern city in the United States (∼35,000 residents). Primary outcome measures included relative risk reduction in the number of community-level fall-related 9-1-1 calls and fall-related hospital transports. Interrupted time series analysis was used to evaluate relative risk reduction from a 12-month baseline period (September 2016 - August 2017) to a 12-month post-implementation period (September 2018-August 2019).Results: Community paramedic home visits increased from 25 in 2017, to 236 in 2018, to 517 in 2019, indicating a large increase in the number of households that benefited from the efforts. A relative risk reduction of 0.66 (95% [CI] 0.53, 0.76) in the number of fall calls and 0.63 (95% [CI] 0.46, 0.75) in the number of fall-related calls resulting in transports to the hospital were observed.Conclusions: Community-FIT may offer a powerful mechanism for community paramedics to reduce fall-related 9-1-1 calls and transports to hospitals that can be implemented in emergency medical agencies across the country.

Specific Behavioral Responses Rather Than Autonomic Responses Can Indicate and Quantify Acute Pain among Individuals with Intellectual and Developmental Disabilities

Individuals with intellectual and developmental disabilities (IDD) are at a high risk of experiencing pain. Pain management requires assessment, a challenging mission considering the impaired communication skills in IDD. We analyzed subjective and objective responses following calibrated experimental stimuli to determine whether they can differentiate between painful and non-painful states, and adequately quantify pain among individuals with IDD. Eighteen adults with IDD and 21 healthy controls (HC) received experimental pressure stimuli (innocuous, mildly noxious, and moderately noxious). Facial expressions (analyzed with the Facial Action Coding System (FACS)) and autonomic function (heart rate, heart rate variability (HRV), pulse, and galvanic skin response (GSR)) were continuously monitored, and self-reports using a pyramid and a numeric scale were obtained. Significant stimulus-response relationships were observed for the FACS and pyramid scores (but not for the numeric scores), and specific action units could differentiate between the noxious levels among the IDD group. FACS scores of the IDD group were higher and steeper than those of HC. HRV was overall lower among the IDD group, and GSR increased during noxious stimulation in both groups. In conclusion, the facial expressions and self-reports seem to reliably detect and quantify pain among individuals with mild-moderate IDD; their enhanced responses may indicate increased pain sensitivity that requires careful clinical consideration.

Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients

Adult patients with hematologic malignancy and COVID-19 found a 34% risk of death, whereas pediatric patients had a 4% risk of death.

Patients on systemic anticancer therapy had a similar risk of death to patients on no treatment (RR, 1.17; 95% CI, 0.83-1.64).

Outcomes for patients with hematologic malignancy infected with COVID-19 have not been aggregated. The objective of this study was to perform a systematic review and meta-analysis to estimate the risk of death and other important outcomes for these patients. We searched PubMed and EMBASE up to 20 August 2020 to identify reports of patients with hematologic malignancy and COVID-19. The primary outcome was a pooled mortality estimate, considering all patients and only hospitalized patients. Secondary outcomes included risk of intensive care unit admission and ventilation in hospitalized patients. Subgroup analyses included mortality stratified by age, treatment status, and malignancy subtype. Pooled prevalence, risk ratios (RRs), and 95% confidence intervals (CIs) were calculated using a random-effects model. Thirty-four adult and 5 pediatric studies (3377 patients) from Asia, Europe, and North America were included (14 of 34 adult studies included only hospitalized patients). Risk of death among adult patients was 34% (95% CI, 28-39; N = 3240) in this sample of predominantly hospitalized patients. Patients aged ≥60 years had a significantly higher risk of death than patients <60 years (RR, 1.82; 95% CI, 1.45-2.27; N = 1169). The risk of death in pediatric patients was 4% (95% CI, 1-9; N = 102). RR of death comparing patients with recent systemic anticancer therapy to no treatment was 1.17 (95% CI, 0.83-1.64; N = 736). Adult patients with hematologic malignancy and COVID-19, especially hospitalized patients, have a high risk of dying. Patients ≥60 years have significantly higher mortality; pediatric patients appear to be relatively spared. Recent cancer treatment does not appear to significantly increase the risk of death.

Exploring enablers and barriers to accessing health services after a fall among people with intellectual disability

BACKGROUND

Adults with intellectual disability experience high rates of falls making falls prevention an important health need. The purpose of the study was to seek perspectives of older adults with intellectual disability and their caregivers to (a) explore the experiences of older adults with intellectual disability when seeking healthcare services after a fall and (b) identify enablers and barriers when taking up evidence-based falls recommendations.

METHOD

A qualitative exploratory study was undertaken as part of a prospective observational cohort study. Semi-structured interviews were conducted with a purposeful sample. Data were analysed thematically using Colaizzi's method.

RESULTS

Seventeen interviews were conducted (n = 21). Emergent themes demonstrated that participants had limited knowledge about falls prevention. Enablers included individualizing falls prevention strategies. Barriers included not being offered access to established falls prevention pathways.

CONCLUSION

There is an urgent need to develop high-quality falls prevention services for older adults with intellectual disability.

Incidence and associated risk factors for falls in adults with intellectual disability

BACKGROUND

People with intellectual disability (ID) experience age-related changes earlier in life, and as such, falls among people with ID are of serious concern. Falls can cause injury and consequently reduce quality of life. Limited studies have investigated the incidence of falls among people with ID and the associated risk factors. The purpose of this study was to investigate the incidence of falls and risk factors for falling in people with ID living in the community.

METHODS

A prospective observational cohort (n = 78) of community-dwelling adults with ID. Characteristics measured at baseline included falls history, medication use, balance and mobility. Falls were reported for 6 months using monthly calendars and phone calls. Data were analysed using univariate and multivariate logistic regression to identify risk factors associated with falling.

RESULTS

Participants [median (interquartile range) age 49 (43-60) years, female n = 32 (41%)] experienced 296 falls, with 36 (46.2%) participants having one or more falls. The incidence of falls was 5.7 falls (injurious falls = 0.8) per person year (one outlier removed from analysis). A history of falls [adjusted odds ratio (OR): 6.37, 95% confidence interval (CI) (1.90-21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15-17.67)] were associated with a significantly increased risk of falling. Falls were significantly less frequent among participants taking more than four medications [adjusted OR: 0.22, 95% CI (0.06-0.83)] and participants who were continent [adjusted OR: 0.25, 95% CI (0.07-0.91)].

CONCLUSIONS

People with ID fall at a younger age compared with the broader community. The associated falls risk factors also differ to older community-dwelling adults. Health professionals should prioritise assessment and management of falls risk in this population.