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Manirajan P, Sivanandy P, Ingle PV. Enhancing knowledge, attitude, and perceptions towards fall prevention among older adults: a pharmacist-led intervention in a primary healthcare clinic, Gemas, Malaysia. BMC Geriatr 2024; 24:309. [PMID: 38566052 PMCID: PMC10988811 DOI: 10.1186/s12877-024-04930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Falls and fall-related injuries are very common among older adults, and the risk of falls increases with the aging process. The lack of awareness of falls and fall-related injuries among older adults can contribute to an increasing risk of falls. Hence, a study was carried out to improve the knowledge, attitude, and perception of falls and fractures among older adults in a primary care setting in Gemas, a rural area of the Selangor state of Malaysia. METHOD A structured educational intervention was provided to older adults who visited the primary care setting in Gemas and provided written informed consent to participate in the study. A total of 310 older adult patients was included in the study using a convenience sampling technique. RESULTS Before the intervention, 74.84% of the respondents (n = 232) agreed that falls and related fractures are the leading causes of hospital admission among older adults. In post-intervention, the number of respondents who agreed with this statement increased to 257 (82.91%). At baseline, 28 respondents (9.03%) had poor knowledge, 160 respondents (51.61%) had average knowledge levels, and 122 respondents (39.35%) had good knowledge. In post-intervention, respondents with poor and average knowledge reduced to 1.93% (n = 6) and 29.35% (n = 91) respectively. A majority of respondents' knowledge levels improved significantly after the intervention (n = 213; 68.71%). About eight respondents (2.58%) had a negative perception of falls. In post-intervention, the percentage reduced to 0.65% as only two respondents had a negative perception. A total of 32 types of fall-risk-increasing drugs (FRIDs) have been prescribed to the respondents. A strong correlation (r = 0.89) between pre- and post-intervention knowledge was shown among the respondents. Paired t-test analysis showed a statistically significant difference. CONCLUSION The pharmacist-led educational intervention significantly improved the knowledge, attitude, and perception of falls among older adults. More structured and periodical intervention programmes are warranted to reduce the risk of falls and fractures among older adults.
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Affiliation(s)
- Priya Manirajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, 57000, Kuala Lumpur, Malaysia
| | - Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, 57000, Kuala Lumpur, Malaysia.
| | - Pravinkumar Vishwanath Ingle
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, 57000, Kuala Lumpur, Malaysia
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The association of glycemic control and fall risk in diabetic elderly: a cross-sectional study in Hong Kong. BMC PRIMARY CARE 2022; 23:192. [PMID: 35915395 PMCID: PMC9344708 DOI: 10.1186/s12875-022-01807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Many foreign studies investigated glycemic control and fall risk. However, there was insufficient study on this topic in Hong Kong. This study aims to find out the association of glycemic control and fall risk in the diabetic elderly in a general outpatient clinic in the North District of Hong Kong. Their frequency of falls and other associated risk factors of fall were also studied.
Methods
A cross-sectional questionnaire survey was conducted on 442 diabetic patients aged 65 years-old or above with regular follow-up in a general outpatient clinic. Main outcome measure was the number of falls in the past one year from the interview date. Recurrent falls was defined as two or more falls in the past one year from the interview date. Subjects were asked about experience of hypoglycemic symptoms. HbA1c level, chronic illness, retinopathy etc. were obtained through computerized medical record review. Chi square test and logistic regression were used to assess the association between outcomes and the explanatory variables.
Results
In the past one year, 23.3% participants experienced at least one fall and 8.6% had recurrent falls. Hypoglycemic symptoms, and lower visual acuity < 0.6 were significantly associated with fall (OR 2.42, p = 0.007 and OR 1.75, p = 0.038 respectively). Age 75–79 years-old had a higher likelihood of fall than the 65–69 age group (OR 2.23, p = 0.044). Patients with HbA1c 7.0–7.4% had a lower risk of recurrent falls when compared to those with intensive control (OR 0.32, p = 0.044). Other risk factors that increased risk of recurrent falls were hypoglycemic symptoms (OR 6.64, p < 0.001) and history of cerebral vascular accident (OR 4.24, p = 0.003).
Conclusions
Hypoglycemic symptoms had a very strong association with falls. Less stringent HbA1c control reduced the risk of recurrent falls. Healthcare professionals need to take a more proactive approach in enquiring about hypoglycemia. There should be individualized diabetic treatment target for the diabetic elderly.
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Juhani WSA, Alanazi AM, Aldusari RS. Epidemiological characteristics of traumatic musculoskeletal injuries during the COVID-19 pandemic at a single tertiary hospital. J Family Med Prim Care 2021; 10:3882-3887. [PMID: 34934696 PMCID: PMC8653492 DOI: 10.4103/jfmpc.jfmpc_2463_20] [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: 12/15/2020] [Revised: 02/28/2021] [Accepted: 05/03/2021] [Indexed: 11/04/2022] Open
Abstract
Background Musculoskeletal (MSK) injuries are common but can lead to devastating outcomes. During the COVID-19 pandemic in Saudi Arabia, it is thought that the burden of traumatic MSK injuries is minimized. Objective This study aimed to assess the epidemiological characteristics of traumatic MSK injuries during the lockdown period in Saudi Arabia. Materials and Methods This retrospective descriptive study included all patients who were admitted to the orthopedic department at a single tertiary hospital level 1 trauma center due to traumatic injuries from March 23 to June 21, 2020. Results The study included 92 patients. The majority were male (68.5%). The most common comorbidity was hypertension (30.4%). Falls were the most common mechanism of injury (47%). The most common sites to be fractured were the proximal femur (22.8%) followed by the distal tibia/fibula (14%). Skull fractures (12%), rib fractures (6.5%), and pneumothorax (6.5%) were the most common associated injuries. Age and the number of injuries were significant predictors of increased length of hospital stay. Conclusions Major considerations for primary prevention must be taken into account during long periods of time with no direct patient interaction. Patient education is important to help avoid any burden that might be caused by otherwise preventable injuries. Further studies should be conducted to assess this phenomenon more in depth and to establish the appropriate method of educating patients on primary prevention.
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Affiliation(s)
- Wazzan S Al Juhani
- Department of Surgery, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Alanazi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rakan S Aldusari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Ong WF, Kamaruzzaman SB, Tan MP. Falls in older persons with type 2 diabetes in the Malaysian Elders Longitudinal Research (MELoR) study. Int J Clin Pract 2021; 75:e14999. [PMID: 34714589 DOI: 10.1111/ijcp.14999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/19/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Older persons with diabetes are at an increased risk of falls leading to fractures, head injuries and disability. OBJECTIVE To evaluate the potential relationship between falls and diabetes in older persons and identify differences in risk factors of falls among older persons with and without diabetes using the first wave dataset of the Malaysian Elders Longitudinal Research (MELoR) study. METHODOLOGY Community dwelling adults aged ≥ 55 years were selected through stratified random sampling from three parliamentary constituencies in greater Kuala Lumpur. Baseline data was obtained through computer-assisted, home-based interviews. The presence of falls was established by enquiring about falls in the preceding 12 months. Diabetes was defined as self-reported, physician-diagnosed diabetes, diabetes medication use and an HbA1c of ≥ 6.3%. RESULTS Diabetes was present in 44.4% of the overall 1610 participants. The prevalence for fall among older diabetics was 25.6%. Recurrent falls (odds ratio (OR) 1.65; 95% confidence interval (CI) 1.06-2.57) was more common among diabetics. Following adjustment for potential confounders, osteoporosis (OR 2.58; 95% CI 1.31-5.08) and dizziness (OR 1.50; 95% CI 1.01-2.23) were independent risk factors for falls. Better instrumental activities of daily living scores were protective against falls (OR 0.75; 95% CI 0.58-0.97). CONCLUSION The presence of osteoporosis and dizziness was associated with an increased risk of falls among older diabetics. These findings will need to be confirmed in future prospective follow-up of this cohort.
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Affiliation(s)
- Wan Feng Ong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul B Kamaruzzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
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Older Adults with Hypertension: Prevalence of Falls and Their Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168257. [PMID: 34444005 PMCID: PMC8392439 DOI: 10.3390/ijerph18168257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023]
Abstract
Falls are prominent health issues among older adults. Among hypertensive older adults, falls may have a detrimental effect on their health and wellbeing. The purpose of this study is to determine the prevalence of falls among hypertensive older adults and to identify the associated factors that contribute to their falls. This was a cross-sectional study conducted among two hundred and sixty-nine hypertensive older adults who were selected via systematic random sampling in two primary health clinics in Kuala Terengganu, Malaysia. Data on their socio-demographic details, their history of falls, medication history and clinical characteristics were collected. Balance and gait were assessed using the Performance Oriented Mobility Assessment (POMA). It was found that 32.2% of participants reported falls within a year. Polypharmacy (adjusted OR 2.513, 95% CI 1.339, 4.718) and diuretics (adjusted OR 2.803, 95% CI 1.418, 5.544) were associated with an increased risk of falls. Meanwhile, a higher POMA score (adjusted OR 0.940, 95% CI 0.886, 0.996) and the number of antihypertensives (adjusted OR 0.473, 95% CI 0.319, 0.700) were associated with a low incidence of falling among hypertensive older adults. Falls are common among hypertensive older adults. Older adults who are taking diuretics and have a polypharmacy treatment plan have a higher incidence of falls. However, older adults taking a higher number of anti-hypertensive medications specifically were not associated with an increased prevalence of falls.
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Makhtar A, Syed Elias SM, Azizi A. The relationship between painful diabetic peripheral neuropathy and functional status of older people in Kuantan, Pahang. ENFERMERIA CLINICA 2021. [PMID: 33849146 DOI: 10.1016/j.enfcli.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study aimed to determine the relationship between painful diabetic peripheral neuropathy and functional status among older people in Kuantan, Pahang. A cross-sectional study was performed by using an interviewer-administered questionnaire among 300 participants recruited from selective Primary Health Centres and endocrine clinics, Hospital Tengku Ampuan Afzan in Kuantan, Pahang. The data were analyzed by using SPSS version 22. The findings indicated that most participants reported neuropathic pain experience. The severity of pain was found to be significantly related to patients who had been diagnosed over 10 years ago, Indians patients and those who were treating their diabetes with insulin alone. No significant relationship was found between pain severity and functional status. The severity of pain and the associated factors suggest the need for a multidisciplinary approach to provide effective treatment to patients with painful diabetic peripheral neuropathy.
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Affiliation(s)
- Aniawanis Makhtar
- Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Kuantan, Malaysia
| | | | - Athirah Azizi
- Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Kuantan, Malaysia
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Chang CT, Ang JY, Islam MA, Chan HK, Cheah WK, Gan SH. Prevalence of Drug-Related Problems and Complementary and Alternative Medicine Use in Malaysia: A Systematic Review and Meta-Analysis of 37,249 Older Adults. Pharmaceuticals (Basel) 2021; 14:ph14030187. [PMID: 33669084 PMCID: PMC7996557 DOI: 10.3390/ph14030187] [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: 01/20/2021] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 01/18/2023] Open
Abstract
Drug-related problems (DRPs) in the elderly include polypharmacy, potentially inappropriate medications, nonadherence, and drug-related falls. In this systematic review and meta-analysis, the prevalence of DRPs and complementary and alternative medicine (CAM) use among the Malaysian elderly was estimated. PubMed, Scopus, Web of Science, and Google Scholar databases were searched to identify studies published since their inception up to 24 August 2020. A random-effects model was used to generate the pooled prevalence of DRPs along with its corresponding 95% confidence interval (CI). The heterogeneity of the results was estimated using the I2 statistics, and Cochran’s Q test and sensitivity analyses were performed to confirm the robustness of the results. We identified 526 studies, 23 of which were included in the meta-analysis. (n = 29,342). The pooled prevalence of DRPs among Malaysian elderly was as follows: (1) polypharmacy: 49.5% [95% CI: 20.5–78.6], (2) potentially inappropriate medications: 28.9% [95% CI: 25.4–32.3], (3) nonadherence to medications: 60.6% [95% CI: 50.2–70.9], and (4) medication-related falls 39.3% [95% CI: 0.0–80.8]. Approximately one in two Malaysian elderly used CAM. The prevalence of polypharmacy and potentially inappropriate medications among the Malaysian elderly population was high, calling for measures and evidence-based guidelines to ensure the safe medication use.
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Affiliation(s)
- Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh 30400, Perak, Malaysia;
- Correspondence: (C.-T.C.); or (M.A.I.)
| | - Ju-Ying Ang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh 30400, Perak, Malaysia;
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (C.-T.C.); or (M.A.I.)
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, Bandar Alor Setar, Alor Setar 05460, Kedah, Malaysia;
| | - Wee-Kooi Cheah
- Clinical Research Centre, Hospital Taiping, Ministry of Health, Taiping 34000, Perak, Malaysia;
- Medical Department, Hospital Taiping, Ministry of Health, Taiping 34000, Perak, Malaysia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor, Malaysia;
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Abdul Rahman K, Ahmad SA, Che Soh A, Ashari A, Wada C, Gopalai AA. The Association of Falls with Instability: An Analysis of Perceptions and Expectations toward the Use of Fall Detection Devices Among Older Adults in Malaysia. Front Public Health 2021; 9:612538. [PMID: 33681130 PMCID: PMC7928312 DOI: 10.3389/fpubh.2021.612538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Falls are a significant incident among older adults affecting one in every three individuals aged 65 and over. Fall risk increases with age and other factors, namely instability. Recent studies on the use of fall detection devices in the Malaysian community are scarce, despite the necessity to use them. Therefore, this study aimed to investigate the association between the prevalence of falls with instability. This study also presents a survey that explores older adults' perceptions and expectations toward fall detection devices. Methods: A cross-sectional survey was conducted involving 336 community-dwelling older adults aged 50 years and older; based on randomly selected participants. Data were analyzed using quantitative descriptive analysis. Chi-square test was conducted to investigate the associations between self-reported falls with instability, demographic and walking characteristics. Additionally, older adults' perceptions and expectations concerning the use of fall detection devices in their daily lives were explored. Results: The prevalence of falls was 28.9%, where one-quarter of older adults fell at least once in the past 6 months. Participants aged 70 years and older have a higher fall percentage than other groups. The prevalence of falls was significantly associated with instability, age, and walking characteristics. Around 70% of the participants reported having instability issues, of which over half of them fell at least once within 6 months. Almost 65% of the participants have a definite interest in using a fall detection device. Survey results revealed that the most expected features for a fall detection device include: user-friendly, followed by affordably priced, and accurate. Conclusions: The prevalence of falls in community-dwelling older adults is significantly associated with instability. Positive perceptions and informative expectations will be used to develop an enhanced fall detection incorporating balance monitoring system. Our findings demonstrate the need to extend the fall detection device features aiming for fall prevention intervention.
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Affiliation(s)
- Kawthar Abdul Rahman
- Programme of Gerontechnology, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Anom Ahmad
- Programme of Gerontechnology, Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Malaysia
| | - Azura Che Soh
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Malaysia
| | - Asmidawati Ashari
- Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Malaysia
| | - Chikamune Wada
- Graduate School of Life Science and System Engineering, Kyushu Institute of Technology, Kitakyushu, Japan
| | - Alpha Agape Gopalai
- Advanced Engineering Platform, School of Engineering, Monash University Malaysia, Subang Jaya, Malaysia
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Sahril N, Shahein NA, Yoep N, Mahmud NA, Sooryanarayana R, Maw Pin T, Muhamad NA, Ismail H. Prevalence and factors associated with falls among older persons in Malaysia. Geriatr Gerontol Int 2020; 20 Suppl 2:33-37. [PMID: 33370863 DOI: 10.1111/ggi.13980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 11/29/2022]
Abstract
AIM Falls are a common problem among older people, leading to major morbidity and increased mortality. The study aimed to determine the prevalence of falls among older persons in Malaysia and its associated factors. METHODS Data were obtained from the National Health and Morbidity Survey 2018 (NHMS 2018), a cross-sectional study using stratified cluster sampling design. Older persons were defined as aged ≥60 years in this study. Descriptive and logistic regression analyses were conducted using SPSS version 25.0. RESULTS Overall, 14.1% (95% confidence interval [CI]: 12.46, 15.84) of older persons reported having experienced at least one fall during the past 12 months. Univariate analyses revealed an association between the history of falls with not being employed (odds ratio [OR]: 1.35 [95% CI: 1.03, 1.77]), diabetes mellitus (OR: 1.65 [95% CI: 1.33, 2.04]), limitation in activities of daily living (ADL) (OR: 1.90 [95% CI: 1.43, 2.54]) or instrumental ADL (OR: 1.47 [95% CI: 1.16, 1.84]). Multiple logistic regression revealed that falls were positively associated with those who had diabetes mellitus (OR: 1.55 [95% CI: 1.23, 1.94]) and limitation in ADL (OR: 1.56 [95% CI: 1.14, 2.15]); 43.9% of falls occurred outdoors. CONCLUSION One in six older Malaysian people experience at least one fall over a 12-month period. Diabetes mellitus and limitation in ADL were the factors associated with falls among older persons. A comprehensive and targeted program designed to reduce risk of falls is urgently needed. Future research should identify suitable programs for our setting to reduce the potential society burden of falls in older Malaysians. Geriatr Gerontol Int 2020; 20: 33-37.
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Affiliation(s)
- Norhafizah Sahril
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nik Adilah Shahein
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Norzawati Yoep
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nor Azna Mahmud
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Rajini Sooryanarayana
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.,Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Tan Maw Pin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Asiah Muhamad
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Hasimah Ismail
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
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Wettasinghe AH, Dissanayake DWN, Allet L, Katulanda P, Lord SR. Falls in older people with diabetes: Identification of simple screening measures and explanatory risk factors. Prim Care Diabetes 2020; 14:723-728. [PMID: 32473990 DOI: 10.1016/j.pcd.2020.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/11/2020] [Accepted: 05/17/2020] [Indexed: 11/21/2022]
Abstract
AIMS To identify risk factors for falls in older people with diabetes mellitus (DM) and to develop a low-cost fall risk screening tool. METHODS Older adults with DM (n = 103; age = 61.6 + 6.0 years) were recruited from diabetic clinics. Demographic, DM specific factors, lower limb strength and sensation, cognition, fear of falling, hand reaction time, balance, mobility and gait parameters were assessed using validated methods. Falls were prospectively recorded over six months. RESULTS Past falls and female gender were identified as significant predictors of falls: history of falls and female gender increased fall rates by 4.62 (95% CI = 2.31-9.27) and 2.40 (95% CI = 1.04-5.54) respectively. Fall rates were significantly associated with Diabetic Neuropathy scores, HbA1c level, contrast sensitivity, quadriceps strength, postural sway, tandem balance, stride length and Timed Up and Go Test times. A multi-variable fall risk tool derived using five measures, revealed that absolute risk for multiple falls increased from 0% in participants with zero or one factor to 83% in participants with all five risk factors. CONCLUSIONS Simple screening items for fall risk in people with DM were identified, with parsimonious explanatory risk factors. These findings help guide tailored interventions for preventing falls in DM.
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Affiliation(s)
- Asha H Wettasinghe
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | | | - Lara Allet
- Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland; Department of Physiotherapy, School for Health Sciences, HES-SO, University of Applied Sciences & Arts of Western Switzerland, Geneva, Switzerland
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW, Randwick, Sydney, Australia
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Mol A, Bui Hoang PTS, Sharmin S, Reijnierse EM, van Wezel RJA, Meskers CGM, Maier AB. Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2019; 20:589-597.e5. [PMID: 30583909 DOI: 10.1016/j.jamda.2018.11.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Orthostatic hypotension is a potential risk factor for falls in older adults, but existing evidence on this relationship is inconclusive. This study addresses the association between orthostatic hypotension and falls. DESIGN Systematic review and meta-analysis of the cross-sectional and longitudinal studies assessing the association between orthostatic hypotension and falls, as preregistered in the PROSPERO database (CRD42017060134). SETTING AND PARTICIPANTS A literature search was performed on February 20, 2017, in MEDLINE (from 1946), PubMed (from 1966), and EMBASE (from 1947) using the terms orthostatic hypotension, postural hypotension, and falls. References of included studies were screened for other eligible studies. Study selection was performed independently by 2 reviewers using the following inclusion criteria: published in English; mean/median age of the population ≥65 years; blood pressure measurement before and after postural change; and assessment of the association of orthostatic hypotension with falls. The following studies were excluded: conference abstracts, case reports, reviews, and editorials. Data extraction was performed independently by 2 reviewers. MEASURES Unadjusted odds ratios of the association between orthostatic hypotension and falls were used for pooling using a random effects model. Studies were rated as high, moderate, or low quality using the Newcastle-Ottawa Scale. RESULTS Out of 5646 studies, 63 studies (51,800 individuals) were included in the systematic review and 50 studies (49,164 individuals) in the meta-analysis. Out of 63 studies, 39 were cross-sectional and 24 were longitudinal. Orthostatic hypotension was positively associated with falls (odds ratio 1.73, 95% confidence interval 1.50-1.99). The result was independent of study population, study design, study quality, orthostatic hypotension definition, and blood pressure measurement method. CONCLUSIONS AND IMPLICATIONS Orthostatic hypotension is significantly positively associated with falls in older adults, underpinning the clinical relevance to test for an orthostatic blood pressure drop and highlighting the need to investigate orthostatic hypotension treatment to potentially reduce falls.
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Affiliation(s)
- Arjen Mol
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Faculty of Science, Nijmegen, the Netherlands
| | - Phuong Thanh Silvie Bui Hoang
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, City Campus, Parkville, Melbourne, Victoria, Australia
| | - Sifat Sharmin
- Melbourne Academic Centre for Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, City Campus, Parkville, Melbourne, Victoria, Australia
| | - Richard J A van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Faculty of Science, Nijmegen, the Netherlands; Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Zuidhorst Building, Enschede, the Netherlands
| | - Carel G M Meskers
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, City Campus, Parkville, Melbourne, Victoria, Australia.
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Pérez-Lloret S, Quarracino C, Otero-Losada M, Rascol O. Droxidopa for the treatment of neurogenic orthostatic hypotension in neurodegenerative diseases. Expert Opin Pharmacother 2019; 20:635-645. [PMID: 30730771 DOI: 10.1080/14656566.2019.1574746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION L-threo-3,4-dihydroxyphenylserine (droxidopa), a pro-drug metabolized to norepinephrine in nerve endings and other tissues, has been commercially available in Japan since 1989 for treating orthostatic hypotension symptoms in Parkinson's disease (PD) patients with a Hoehn & Yahr stage III rating, as well as patients with Multiple System Atrophy (MSA), familial amyloid polyneuropathy, and hemodialysis. Recently, the FDA has approved its use in symptomatic neurogenic orthostatic hypotension (NOH). Areas covered: The authors review the effects of droxidopa in NOH with a focus on the neurodegenerative diseases PD, MSA, and pure autonomic failure (PAF). Expert opinion: A few small and short placebo-controlled clinical trials in NOH showed significant reductions in the manometric drop in blood pressure (BP) after posture changes or meals. Larger Phase III studies showed conflicting results, with two out of four trials meeting their primary outcome and thus suggesting a positive yet short-lasting effect of the drug on OH Questionnaire composite score, light-headedness/dizziness score, and standing BP during the first two treatment-weeks. Results appear essentially similar in PD, MSA, and PAF. The FDA granted droxidopa approval in the frame of an 'accelerated approval program' provided further studies are conducted to assess its long-term effects on OH symptoms.
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Affiliation(s)
- Santiago Pérez-Lloret
- a Instituto de Investigaciones Cardiológicas , University of Buenos Aires, National Research Council (ININCA-UBA-CONICET) , Buenos Aires , Argentina.,b Department of Physiology , School of Medicine, University of Buenos Aires (UBA) , Buenos Aires , Argentina
| | - Cecilia Quarracino
- a Instituto de Investigaciones Cardiológicas , University of Buenos Aires, National Research Council (ININCA-UBA-CONICET) , Buenos Aires , Argentina
| | - Matilde Otero-Losada
- a Instituto de Investigaciones Cardiológicas , University of Buenos Aires, National Research Council (ININCA-UBA-CONICET) , Buenos Aires , Argentina
| | - Olivier Rascol
- c Services de Pharmacologie Clinique et Neurosciences, Centre d'Investigation Clinique CIC 1436, NS-Park/FCRIN Network, NeuroToul COEN Center , Université de Toulouse UPS, CHU de Toulouse, INSERM , Toulouse , France
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Oxley J, O'Hern S, Burtt D, Rossiter B. Falling while walking: A hidden contributor to pedestrian injury. ACCIDENT; ANALYSIS AND PREVENTION 2018; 114:77-82. [PMID: 28187874 DOI: 10.1016/j.aap.2017.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/06/2017] [Accepted: 01/17/2017] [Indexed: 06/06/2023]
Abstract
Walking is a sustainable mode of transportation which is beneficial to both individuals and to the broader community, however, there are risks and it is essential that road design and operation provides safe conditions for walking. In Victoria, pedestrians represent one of the most vulnerable road user groups, accounting for approximately 12% of all road fatalities and serious injuries. These figures largely represent injuries where the pedestrian has been struck by a vehicle with the extent of pedestrian-only injuries largely un-reported. Falling while walking may be a significant contributor to pedestrian only injuries. Indeed, the World Health Organisation has identified falls generally as the second leading cause of unintentional injury death in older populations. Despite the prevalence of fall-related injuries, there has been relatively little research undertaken to address the issues surrounding falls that occur while walking for transport and in public spaces. This study, therefore, aimed to address this gap in our knowledge. Analyses of various data sources were undertaken to enhance our understanding of fall-related injuries while walking in Victoria. Two sources of data were accessed: Only 85 fall-related incidents were reported in the crash-based data, however, pedestrian falls while walking in the road environment accounted for an average of 1680 hospital admissions and 3545 emergency department presentations each year, and this number is rising. The findings in this study show clearly that Police data is of little use when attempting to understand issues of safe travel for pedestrians other than vehicle-pedestrian incidents. However, analysis of hospital data provides a more realistic indication of the extent of pedestrian fall-related injuries and highlights the significant number of pedestrian fall-related injuries that occur each year. Moreover, the findings identified that older pedestrians are significantly over-represented amongst fall-related injuries that require hospital admission, while also having the highest rate of emergency department presentations when adjusting for age and exposure based on estimates of aggregate walking distances. The study also highlighted that the most common injury sustained from a fall were fractures. The implications of these findings and identification of 'best-practice' within a Safe System context are discussed in terms of enhancements to the physical environment (particularly footpath, kerb and ramp construction and maintenance), implementation of fall hazard assessment and management strategies, and educational programs to highlight the risks for falls and recommend preventative strategies, and overall enhancements of general fall interventions to include falls while walking outside (including exercise interventions). In addition, a number of research and data needs, particularly collection of in-depth data to identify contributory factors and injury outcomes related to falls while walking incidents.
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Affiliation(s)
- Jennifer Oxley
- Monash University Accident Research Centre, Monash University, Clayton, Australia.
| | - Steve O'Hern
- Monash University Accident Research Centre, Monash University, Clayton, Australia
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Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Tan MP. Standing beat-to-beat blood pressure variability is reduced among fallers in the Malaysian Elders Longitudinal Study. Medicine (Baltimore) 2017; 96:e8193. [PMID: 29049203 PMCID: PMC5662369 DOI: 10.1097/md.0000000000008193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine the relationship between falls and beat-to-beat blood pressure (BP) variability.Continuous noninvasive BP measurement is as accurate as invasive techniques. We evaluated beat-to-beat supine and standing BP variability (BPV) using time and frequency domain analysis from noninvasive continuous BP recordings.A total of 1218 older adults were selected. Continuous BP recordings obtained were analyzed to determine standard deviation (SD) and root mean square of real variability (RMSRV) for time domain BPV and fast-Fourier transform low frequency (LF), high frequency (HF), total power spectral density (PSD), and LF:HF ratio for frequency domain BPV.Comparisons were performed between 256 (21%) individuals with at least 1 fall in the past 12 months and nonfallers. Fallers were significantly older (P = .007), more likely to be female (P = .006), and required a longer time to complete the Timed-Up and Go test (TUG) and frailty walk test (P ≤ .001). Standing systolic BPV (SBPV) was significantly lower in fallers compared to nonfallers (SBPV-SD, P = .016; SBPV-RMSRV, P = .033; SBPV-LF, P = .003; SBPV-total PSD, P = .012). Nonfallers had significantly higher supine to standing ratio (SSR) for SBPV-SD, SBPV-RMSRV, and SBPV-total PSD (P = .017, P = .013, and P = .009). In multivariate analyses, standing BPV remained significantly lower in fallers compared to nonfallers after adjustment for age, sex, diabetes, frailty walk, and supine systolic BP. The reduction in frequency-domain SSR among fallers was attenuated by supine systolic BP, TUG, and frailty walk.In conclusion, reduced beat-to-beat BPV while standing is independently associated with increased risk of falls. Changes between supine and standing BPV are confounded by supine BP and walking speed.
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Affiliation(s)
- Choon-Hian Goh
- Department of Biomedical Engineering, Faculty of Engineering
- Ageing and Age-Associated Disorders Research Group
- Department of Medicine, Faculty of Medicine
| | - Siew-Cheok Ng
- Department of Biomedical Engineering, Faculty of Engineering
| | | | - Ai-Vyrn Chin
- Ageing and Age-Associated Disorders Research Group
- Department of Medicine, Faculty of Medicine
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group
- Department of Medicine, Faculty of Medicine
- Centre for Innovations in Medical Engineering, University of Malaya, Kuala Lumpur, Malaysia
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15
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Zhou Y, Ke SJ, Qiu XP, Liu LB. Prevalence, risk factors, and prognosis of orthostatic hypotension in diabetic patients: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e8004. [PMID: 28885363 PMCID: PMC6392609 DOI: 10.1097/md.0000000000008004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is a major clinical sign of cardiovascular autonomic dysfunction in diabetic patients. Our aim was to quantitatively evaluate the prevalence and risk factors of OH in patients with diabetes mellitus (DM) and assess its prognosis. METHODS A comprehensive search of the PubMed, Embase, China National Knowledge Infrastructure, VIP Chinese Journal, Wanfang, and SINOMED databases was conducted for related published work up to September 25, 2016, and manually searched eligible studies from the references in accordance with the inclusion criteria. RESULTS We included 21 studies in the analysis, with a total sample size of 13,772. The pooled prevalence of OH in DM was 24% (95% confidence interval [CI]: 19-28%). Potential risk factors, that is, glycosylated hemoglobin A (HbA1c) (odds ratio [OR], 1.13, 95% CI, 1.07-1.20), hypertension (OR, 1.02, 95% CI, 1.01-1.02), and diabetic nephropathy (OR, 2.37, 95% CI, 1.76-3.19), were significantly associated with OH in DM. In addition, the prognosis of OH in DM was associated with higher risk of total mortality and cardiovascular events. CONCLUSION The pooled prevalence of OH in DM appears high. HbA1c, hypertension, and diabetic nephropathy are risk factors for OH in DM. OH indicates poor prognosis in diabetic patients. Attention should be focused on diabetic patients with the stated risk factors to prevent OH.
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Low ST, Balaraman T. Physical activity level and fall risk among community-dwelling older adults. J Phys Ther Sci 2017; 29:1121-1124. [PMID: 28744029 PMCID: PMC5509573 DOI: 10.1589/jpts.29.1121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022] Open
Abstract
[Purpose] To find the physical activity level and fall risk among the community-dwelling
Malaysian older adults and determine the correlation between them. [Subjects and Methods]
A cross-sectional study was conducted in which, the physical activity level was evaluated
using the Rapid Assessment of Physical Activity questionnaire and fall risk with Fall Risk
Assessment Tool. Subjects recruited were 132 community-dwelling Malaysian older adults
using the convenience sampling method. [Results] The majority of the participants were
under the category of under-active regular light-activities and most of them reported low
fall risk. The statistical analysis using Fisher’s exact test did not show a significant
correlation between physical activity level and fall risk. [Conclusion] The majority of
community-dwelling Malaysian older adults are performing some form of physical activity
and in low fall risk category. But this study did not find any significant correlation
between physical activity level and fall risk among community-dwelling older adults in
Malaysia.
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Affiliation(s)
- Sok Teng Low
- Physiotherapy program, Faculty of Health and Life Sciences, INTI International University, Malaysia
| | - Thirumalaya Balaraman
- Physiotherapy program, Faculty of Health and Life Sciences, INTI International University, Malaysia
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Juraschek SP, Daya N, Appel LJ, Miller ER, Windham BG, Pompeii L, Griswold ME, Kucharska-Newton A, Selvin E. Orthostatic Hypotension in Middle-Age and Risk of Falls. Am J Hypertens 2017; 30:188-195. [PMID: 27638848 DOI: 10.1093/ajh/hpw108] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/08/2016] [Accepted: 08/16/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent. METHODS We conducted a prospective study of the association between baseline OH (1987-1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data. OH was defined as a drop in systolic blood pressure (SBP) ≥20mm Hg or diastolic blood pressure (DBP) ≥10mm Hg within 2 minutes of moving from the supine to standing position. Changes in SBP or DBP during OH assessments were also examined as continuous variables. RESULTS During a median follow-up of 23 years, there were 2,384 falls among 12,661 participants (mean age 54 years, 55% women, 26% black). OH was associated with risk of falls even after adjustment for demographic characteristics and other risk factors (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.10, 1.54; P = 0.002). Postural change in DBP was more significantly associated with risk of falls (HR 1.09 per -5mm Hg change in DBP; 95% CI: 1.05, 1.13; P < 0.001) than postural change in SBP (HR 1.03 per -5mm Hg change in SBP; 95% CI: 1.01, 1.05; P = 0.002). CONCLUSIONS In a community-based, middle-aged population, OH, and in particular, postural change in DBP, were independent risk factors for falls over 2 decades of follow-up. Future studies are needed to examine OH thresholds associated with increased risk of falls.
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Affiliation(s)
- Stephen P Juraschek
- The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Natalie Daya
- The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lawrence J Appel
- The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Edgar R Miller
- The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Beverly Gwen Windham
- University of Mississippi Medical Center Department of Medicine and Center of Biostatistics, Jackson, Mississippi, USA
| | - Lisa Pompeii
- University of Texas School of Public Health, Health Science Center at Houston, Houston, Texas, USA
| | - Michael E Griswold
- University of Mississippi Medical Center Department of Medicine and Center of Biostatistics, Jackson, Mississippi, USA
| | - Anna Kucharska-Newton
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Elizabeth Selvin
- The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA;
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Romli MH, Tan MP, Mackenzie L, Lovarini M, Suttanon P, Clemson L. Falls amongst older people in Southeast Asia: a scoping review. Public Health 2017; 145:96-112. [PMID: 28359399 DOI: 10.1016/j.puhe.2016.12.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/07/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The older population in the Southeast Asian region is accelerating and is expected to surpass the proportion of the ageing population in North America and Europe in the future. This study aims to identify the research literature related to falls among older people in Southeast Asia, to examine current practice and discuss the future direction on falls prevention and interventions in the region. STUDY DESIGN A scoping review design was used. METHODS A systematic literature search was conducted using the Medline, CINAHL, AMED, Ageline, PsycINFO, Web of Sciences, Scopus, Thai-Journal Citation Index, MyCite and trial registries databases. RESULTS Thirty-seven studies and six study protocols were included, from Thailand, Malaysia, Singapore, Vietnam, Indonesia and the Philippines. One-sixth of the studies involved interventions, while the remainder were observational studies. The observational studies mainly determined the falls risk factors. The intervention studies comprised multifactorial interventions and single interventions such as exercises, educational materials and visual correction. Many of the studies replicated international studies and may not have taken into account features unique to Southeast Asia. CONCLUSION Our review has revealed studies evaluating falls and management of falls in the Southeast Asian context. More research is required from all Southeast Asian countries to prepare for the future challenges of managing falls as the population ages.
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Affiliation(s)
- M H Romli
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia; Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - M P Tan
- Ageing and Age Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - L Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
| | - M Lovarini
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
| | - P Suttanon
- Faculty of Allied Health Sciences, Thammasat University, 99 Moo 18 Paholyothin Road, Klong Luang, Rangsit, Prathumthani 12120, Thailand.
| | - L Clemson
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
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Novel dynamic peak and distribution plantar pressure measures on diabetic patients during walking. Gait Posture 2017; 51:261-267. [PMID: 27838570 DOI: 10.1016/j.gaitpost.2016.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication leading to foot ulceration and amputation. Several kinematic, kinetic and plantar pressure measures have been proposed for DPN detection, however findings have been inconsistent. In this work, we present new shape features that capture variations in the plantar pressure using shape and entropy measures to the study of patients with retinopathy, DPN and nephropathy, and a control diabetic group with no complications. The change in the peak plantar pressure (PPP) position with each step for both feet was represented as a convex polygon, asymmetry index, area of the convex polygon, 2nd wavelet moment (WM2) and sample entropy (SamEn). WM2 and the SamEn were more sensitive in capturing variations due to presence of complications than the area and asymmetry measures. WM2 of the left heel (median: 1st IQ, 3rd IQ): 8.27 (4.6,14.8) and left forefoot: 9.2 (2.4,16) were significantly lower for the DPN group compared to the control (CONT) group (heel 11.9 (5.0,16.4); forefoot: 10.3 (4.4,21.3), p < 0.05). SamEn for the DPN group was significantly lower in the right foot compared to the left foot (1.3 (1.26, 1.37) and 1.33 (1.26,1.4), p < 0.01) compared to CONT (right foot: 1.37 (1.24,1.45) and left foot: 1.34 (1.25,1.42), P < 0.05). These new shape and regularity features have shown promising results in detecting diabetic peripheral neuropathy and warrant further investigation.
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Al-Momani M, Al-Momani F, Alghadir AH, Alharethy S, Gabr SA. Factors related to gait and balance deficits in older adults. Clin Interv Aging 2016; 11:1043-9. [PMID: 27570449 PMCID: PMC4986683 DOI: 10.2147/cia.s112282] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the effects of physical, mental, and cognitive disabilities on gait and balance deficits among nursing home residents with different diseases in Jordan and also to find the risk of fall associated with or without these diseases. METHODS A sample of 221 nursing home residents aged 18-100 years in Jordan was recruited for this study. All participants were assessed using the Arabic versions of the Tinetti assessment battery (TAB) for gait and balance, mini-mental state examination, and disability of arm, shoulder, and hand assessment test. RESULTS A total of 221 nursing home residents were included in this study. Different chronic diseases were medically reported in this study. Psychiatric disorders (45.7%) were shown to be the most prevalent disease seen among the participants, followed by hypertension and diabetes mellitus affecting 33.5% and 23.5% of the participants, respectively. However, the least prevalent diseases were stroke (17.2%), joint inflammation (17.2%), and arthritis (9.0%). Based on TAB scores, the participants were classified into three groups: high risk of falls (≤18; n=116), moderate risk of falls (19-23; n=25), and low risk of falls (≥24; n=80). The correlation between physical activity and mental health problems with risks of falls was reported in all participants. The data showed that participants with over 50% upper extremity disability, stroke, heart disease, arthritis, joint diseases, diabetes, and hypertension recorded higher risks of falls as measured by TAB test compared to those with low and moderate TAB scores. Also, impairment in cognitive abilities and psychiatric disorders was shown to be associated with gait and balance problems, with a higher risk of falls in 47.5% and 46.1% of the residents, respectively. CONCLUSION This study revealed a significant impact of upper limb disability, stroke, heart disease, arthritis, joint diseases, diabetes, and hypertension as well as psychiatric disorders and cognitive disabilities on gait and balance deficits among home-resident older adults.
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Affiliation(s)
- Murad Al-Momani
- Department of Otolaryngology – Head & Neck Surgery (ORL-HNS), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fidaa Al-Momani
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sami Alharethy
- Department of Otolaryngology – Head & Neck Surgery (ORL-HNS), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sami A Gabr
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Loganathan A, Ng CJ, Tan MP, Low WY. Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study. BMJ Open 2015; 5:e008460. [PMID: 26546140 PMCID: PMC4636608 DOI: 10.1136/bmjopen-2015-008460] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/26/2015] [Accepted: 09/02/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the barriers faced by healthcare professionals (HCPs) in managing falls among older people (aged above 60 years) who have a high risk of falling. RESEARCH DESIGN The study used a qualitative methodology, comprising 10 in-depth interviews and two focus group discussions. A semistructured topic guide was used to facilitate the interviews, which were audio recorded, transcribed verbatim and checked for accuracy. Data were analysed thematically using WeftQDA software. PARTICIPANTS 20 HCPs who managed falls in older people. SETTING This study was conducted at the Primary Care Clinic in the University Malaya Medical Centre (UMMC), Malaysia. RESULTS Four categories of barriers emerged-these were related to perceived barriers for older people, HCPs' barriers, lack of caregiver support and healthcare system barriers. HCPs perceived that older people normalised falls, felt stigmatised, were fatalistic, as well as in denial regarding falls-related advice. HCPs themselves trivialised falls and lacked the skills to manage falls. Rehabilitation was impeded by premature decisions to admit older people to nursing homes. Lastly, there was a lack of healthcare providers as well as a dearth of fall education and training on fall prevention for HCPs. CONCLUSIONS This study identified barriers that explain poor fall management in older people with a high risk of falls. The lack of structured fall prevention guidelines and insufficient training in fall management made HCPs unable to advise patients on how to prevent falls. The findings of this study warrant evidence-based structured fall prevention intervention targeted to patients as well as to HCPs.
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Affiliation(s)
- Annaletchumy Loganathan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wah Yun Low
- Faculty of Medicine, Dean's Office, University of Malaya, Kuala Lumpur, Malaysia
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Lazkani A, Delespierre T, Bauduceau B, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Piedvache C, Becquemont L. Predicting falls in elderly patients with chronic pain and other chronic conditions. Aging Clin Exp Res 2015; 27:653-61. [PMID: 25637513 DOI: 10.1007/s40520-015-0319-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to identify fall predictors in elderly suffering from chronic pain (CP) and to test their applicability among patients with other chronic conditions. METHODS 1,379 non-institutionalized patients aged 65 years and older who were suffering from CP (S.AGE CP sub-cohort) were monitored every 6 months for 1 year. Socio-demographic, clinical and pain data and medication use were assessed at baseline for the association with falls in the following year. Falls were assessed retrospectively at each study visit. Logistic regression analyses were performed to identify fall predictors. The derived model was applied to two additional S.AGE sub-cohorts: atrial fibrillation (AF) (n = 1,072) and type-2 diabetes mellitus (T2DM) (n = 983). RESULTS Four factors predicted falls in the CP sub-cohort: fall history (OR: 4.03, 95 % CI 2.79-5.82), dependency in daily activities (OR: 1.81, 95 % CI 1.27-2.59), age ≥75 (OR: 1.53, 95 % CI 1.04-2.25) and living alone (OR: 1.73, 95 % CI 1.24-2.41) (Area Under the Curve: AUC = 0.71, 95 % CI 0.67-0.75). These factors were relevant in AF (AUC = 0.71, 95 % CI 0.66-0.75) and T2DM (AUC = 0.67, 95 % CI 0.59-0.73) sub-cohorts. Fall predicted probability in CP, AF and T2DM sub-cohorts increased from 7, 7 and 6 % in patients with no risk factors to 59, 66 and 45 % respectively, in those with the four predictors. Fall history was the strongest predictor in the three sub-cohorts. CONCLUSION Fall history, dependency in daily activities, age ≥75 and living alone are independent fall predictors in CP, AF and T2DM patients.
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Affiliation(s)
- Aida Lazkani
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France.
| | - Tiba Delespierre
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
| | | | | | - Philippe Bertin
- Rheumatology Department, Limoges University Hospital, Limoges, France
| | - Gilles Berrut
- Clinical Gerontology, Nantes University Hospital, Nantes, France
| | - Emmanuelle Corruble
- Paris-Sud Faculty of Medicine, Psychiatry Department, Bicêtre University Hospital, AP-HP, INSERM U 669, Paris-Sud University, Le Kremlin-Bicêtre, France
| | | | - Geneviève Derumeaux
- Cardiovascular Functional Exploration, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Jean Doucet
- Internal Medicine, Geriatrics and Therapeutics, Saint Julien University Hospital, Rouen University, Rouen, France
| | - Bruno Falissard
- Paris-Sud Faculty of Medicine, Biostatistics Department, AP-HP, Paul Brousse Hospital, INSERM U 669, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Francoise Forette
- National Gerontology Foundation, Paris Descartes University, Paris, France
| | - Olivier Hanon
- AP-HP, Broca Hospital, Geriatrics Department, Paris Descartes University, EA 4468, Paris, France
| | - Florence Pasquier
- Lille University Hospital, Lille Nord de France University, UDSL, EA 1046, Lille, France
| | - Michel Pinget
- Endocrinology, Diabetes and Nutrition-Related Diseases (NUDE Unit), Strasbourg University Hospital, and the European Centre for the Study of Diabetes (CeeD), Strasbourg University, Strasbourg, France
| | - Rissane Ourabah
- General Practice Department, Paris-Sud Faculty of Medicine, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Celine Piedvache
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
| | - Laurent Becquemont
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
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Park H, Satoh H, Miki A, Urushihara H, Sawada Y. Medications associated with falls in older people: systematic review of publications from a recent 5-year period. Eur J Clin Pharmacol 2015; 71:1429-40. [PMID: 26407688 DOI: 10.1007/s00228-015-1955-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/18/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Falls are an important public health problem in older people. Medication use is considered a risk factor for falls. This study systematically reviewed recent studies to determine the medications that might be associated with the risk of falling in older people. METHODS We conducted a systematic review of prospective and retrospective studies identified through the MEDLINE and CINAHL databases that quantitatively assessed the contribution of medications to falls risk in participants ≥60 years old published in English between May 2008 and April 2013. RESULTS The search identified 1,895 articles; 36 articles met the inclusion criteria. Of the 19 studies that investigated the effect of polypharmacy on the risk of falling, six studies reported that the risk of falling increased with polypharmacy. Data on the use of antihypertensive medications including calcium channel blockers, beta-blockers, and angiotensin system blocking medications were collected in 14 studies, with mixed results. Twenty-nine studies reported an association between the risk of falls and psychotropic medications including sedatives and hypnotics, antidepressants, and benzodiazepines. CONCLUSIONS The use of sedatives and hypnotics and antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors appears to be related with an increased risk of falls. It is not clear if the use of antihypertensive medications is associated with the risk of falls in older people.
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Affiliation(s)
- Hyerim Park
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Satoh
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akiko Miki
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hisashi Urushihara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, 1-5-30 Shiba-koen, Minato-ku, Tokyo, 105-8512, Japan
| | - Yasufumi Sawada
- Endowed Laboratory of Drug Lifetime Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Formiga F, Chivite D, Ruiz D, Navarro M, Perez Castejon JM, Duaso E, Montero A, Lopez-Soto A, Corbella X. Clinical evidence of diabetes mellitus end-organ damage as risk factor for falls complicated by hip fracture: A multi-center study of 1225 patients. Diabetes Res Clin Pract 2015; 109:233-7. [PMID: 26070216 DOI: 10.1016/j.diabres.2015.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/14/2015] [Accepted: 05/28/2015] [Indexed: 01/08/2023]
Abstract
AIMS To identify the differential characteristics of patients with type 2 diabetes mellitus (T2DM) complicated by end-organ damage who experience a fall-related hip fracture. METHODS We analyzed the socio-demographic data and index fall clinical characteristics of a group of patients with nephropathy, neuropathy or retinopathy related to T2DM consecutively admitted to six hospitals in Barcelona, Spain because of a fall-related hip fracture. RESULTS Out of 1225 patients admitted because of a fall-related hip fracture, 107 (8.7%) had clinical evidence of end-organ damage related to T2DM. Among this cohort the mean number of falls during the year prior to the index admission was 2.6±3.2; and 29 of them (27.1%) had already experienced three or more falls. Most falls leading to the index admission took place at the patients' home, from a standing position, and during daylight time. An intrinsic cause of falling was identified in all but one of these patients. Multiple stepwise logistic regression analysis showed that, compared to patients without this diagnosis, patients with complicated T2DM were younger (odds ratio 0.762), had less prevalence of dementia (odds ratio 0.078), but had experienced a higher number of falls in the previous year (odds 1.183). CONCLUSIONS A significant amount of patients with clinical evidence of end-organ damage due to T2DM who experience a fall-related hip fracture have a history of recurrent falling in the previous year. These patients should be identified and offered preventive actions aimed at reducing their risk of falling.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - David Chivite
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Domingo Ruiz
- Geriatric Unit, Internal Medicine Service, Hospital Sant Pau, IDIBAPS, Barcelona, Spain
| | - Margarita Navarro
- Geriatric Unit, Internal Medicine Service, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - J M Perez Castejon
- Geriatric Unit, Hospital Sociosanitari Isabel Roig (Centres Blauclinic), Barcelona, Spain
| | - Enric Duaso
- Geriatric Service, Hospital d'Igualada, Consorci Santiàri de l'Anoia, Barcelona, Spain
| | - Abelardo Montero
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alfonso Lopez-Soto
- Geriatric Unit, Internal Medicine Service, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Albert Jovell Institute for Public Health and Patients, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Wang IK, Chen HJ, Cheng YK, Wu YY, Lin SY, Chou CY, Chang CT, Yen TH, Chuang FR, Sung FC, Hsu CY. Subdural hematoma in diabetic patients. Eur J Neurol 2014; 22:99-105. [PMID: 25164261 DOI: 10.1111/ene.12538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Subdural hematoma (SDH) is associated with a high mortality rate. However, the risk of SDH in diabetic patients has not been well studied. The aim of the study was to examine the risk of SDH in incident diabetic patients. METHODS From a universal insurance claims database of Taiwan, a cohort of 28,045 incident diabetic patients from 2000 to 2005 and a control cohort of 56,090 subjects without diabetes were identified. The incidence and hazard ratio of SDH were measured by the end of 2010. RESULTS The mean follow-up years were 7.24 years in the diabetes cohort and 7.44 years in the non-diabetes cohort. The incidence of SDH was 1.57-fold higher in the diabetes cohort than in the non-diabetes cohort (2.04 vs. 1.30 per 1000 person-years), with an adjusted hazard ratio of 1.63 [95% confidence interval (CI) 1.43-1.85]. The stratified data showed that adjusted hazard ratios were 1.51 (95% CI 1.28-1.77) for traumatic SDH and 1.89 (95% CI 1.52-2.36) for non-traumatic SDH. The 30-day mortality rate for those who developed SDH in the diabetes cohort was 8.94%. CONCLUSIONS This study demonstrates that incident diabetic patients are at higher risk of SDH than individuals without diabetes. Proper intervention for diabetic patients is necessary for preventing the devastating disorder.
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Affiliation(s)
- I-K Wang
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan; Division of Nephrology, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University College of Medicine, Taichung, Taiwan
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Eshkoor SA, Hamid TA, Nudin SSH, Mun CY. Association between dentures and the rate of falls in dementia. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:225-30. [PMID: 25018658 PMCID: PMC4074183 DOI: 10.2147/mder.s63220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Poor oral health, chronic diseases, functional decline, and low cognitive ability can increase the risk of falls in the elderly. Objectives The current study aimed to show the effects of oral health, diabetes mellitus (DM), hypertension (HT), heart disease, functional status, and sociodemographic factors on the risk of falls in elderly with dementia. Materials and methods The sample comprised 1,210 Malaysian elderly who were demented and noninstitutionalized. This study was a national cross-sectional survey entitled “Determinants of Health Status among Older Malaysians”. The effects of age, ethnicity, sex differences, marital status, educational level, oral health, DM, HT, heart disease, and functional status on the risk of falls were evaluated. The multiple logistic regression model was used to estimate the effects of contributing variables on the risk of falls in samples. Results The prevalence of falls was approximately 17% in subjects. It was found that age (odds ratio [OR] 1.02), non-Malay ethnicity (OR 1.66), heart disease (OR 1.92), and functional decline (OR 1.58) significantly increased the risk of falls in respondents (P<0.05). Furthermore, having teeth (OR 0.59) and dentures (OR 0.66) significantly decreased the rate of falls (P<0.05). Conclusion It was concluded that age, non-Malay ethnicity, functional decline, heart disease, and oral health significantly affected falls in dementia.
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Affiliation(s)
| | | | | | - Chan Yoke Mun
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Malaysia
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Perez-Lloret S, Rey MV, Pavy-Le Traon A, Rascol O. Droxidopa for the treatment of neurogenic orthostatic hypotension and other symptoms of neurodegenerative disorders. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.901167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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28
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Perez-Lloret S, Rey MV, Pavy-Le Traon A, Rascol O. Orthostatic hypotension in Parkinson’s disease. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
SUMMARY Orthostatic hypotension (OH) is a frequent non-motor symptom in Parkinson’s disease (PD), affecting between 22.9 and 38.4% of patients. In PD, OH is related to an increased risk of falls, and possibly to cognitive dysfunction and increased mortality. These data emphasize the importance of its prompt recognition and treatment. OH is related to pre- and post-ganglionic adrenergic denervation, but other factors, such as drugs, heat, meals or alcohol intake, might also induce or aggravate it. Evidence about the efficacy and safety of pharmacological or nonpharmacological strategies for OH treatment in PD is weak. Nonpharmacological measures include liberal addition of salt to the diet, exercise, compression stockings or physical maneuvers. Severe cases may be treated with midodrine or fludrocortisone. Some results suggest that droxidopa and fipamezole may be effective treatments. We finish this review article by discussing the most important unanswered questions about PD-related OH, which may be the focus of future research.
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Affiliation(s)
- Santiago Perez-Lloret
- Clinical Pharmacology & Epidemiology Laboratory, Pontifical Catholic University, Buenos Aires, Argentina
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - María Verónica Rey
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
- Clinical Pharmacology & Epidemiology Laboratory, Pontifical Catholic University, Buenos Aires, Argentina
| | - Anne Pavy-Le Traon
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Olivier Rascol
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
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29
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Yan W, Li X. Impact of diabetes and its treatments on skeletal diseases. Front Med 2013; 7:81-90. [DOI: 10.1007/s11684-013-0243-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 12/04/2012] [Indexed: 01/22/2023]
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