Fall Risk and Outcomes Among Patients Hospitalized With Cardiovascular Disease in the Community

American Geriatrics Society response to the World Falls Guidelines

Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community-dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community-dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that could potentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults.

Combined effect of falling difficulty and cardiovascular diseases on the risk of all-cause and cardiovascular mortality in older adults: an analysis of the National Health and Nutrition Examination Survey

PURPOSE

Older adults with cardiovascular diseases (CVD) are prone to falls. This study aimed to analyze the combined effect of falling difficulty and CVD on the risk of all-cause- and CVD mortality in older adults.

METHODS

In this retrospective cohort study, people aged ≥60 years with information on falling difficulty and CVD from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) were selected. Multivariable Cox proportional hazards regression model was used to assess the associations of falling difficulty and CVD with all-cause- and CVD mortality.

RESULTS

A total of 1409 participants were included, of whom 868 (58.1%) participants died, and 237 (15.0%) died of CVD. The mean age of participants was 72.1 (0.3) years and 825 (64.7%) were female. Older adults with falling difficulty or CVD were associated with an increased risk of all-cause- and CVD mortality. Older adults in the no falling difficulty & CVD group [hazard ratio (HR) = 1.45, 95% confidence interval (CI) 1.19-1.78], the falling difficulty & no CVD group (HR = 1.45, 95%CI 1.12-1.89), and the falling difficulty & CVD group (HR = 2.13, 95%CI 1.77-2.56) were related to a higher risk of all-cause mortality compared to those in the no falling difficulty & no CVD group. The combined effect of falling difficulty and CVD was positively correlated with the risk of all-cause mortality (HR = 1.26, 95%CI: 1.18-1.34; P-trend <0.001) and CVD mortality (HR = 1.36, 95%CI: 1.18-1.56; P-trend <0.001).

CONCLUSION

The combined effect of falling difficulty and CVD was positively associated with the risk of all-cause- and CVD mortality in older adults.

The Association of Body Mass Index on Falls Risk and Mortality in Hospitalized Patients of Different Old-Age Categories Requiring Nutritional Support

Malnutrition affect clinical outcomes in hospitalized old age patients, but the data on the related outcomes on the basis of different age categories are still limited. We aimed to investigate the interplay of associations among body mass index (BMI), falls risk, and mortality rate in different older adult patient age categories. This retrospective study included hospitalized patients aged ≥ 65 years who received artificial nutrition. Demographic, biochemical, and survival data were collected. BMI was evaluated using the World Health Organization BMI cutoffs for Asians, and patients were classified into high (≥ 23.0 kg/m2), normal (18.5-22.9 kg/m2), and low (< 18.5 kg/m2) BMI groups. The Morse Fall Scale was used to assess falls risk. By age categories, all patients (n = 4,642) were divided into the 65-74 (n = 2,649) and ≥ 75 (n = 1,993) years age groups. We found that the proportion of low-BMI and high risk of falls increased with age. Further, low-BMI was associated with increased falls risk in both age groups. Overall survival rate tended to be lower in the low-BMI and ≥ 75 years group than that in other patient groups, but did not differ significantly compared with the low-BMI and 65-74 years group. Low-BMI was associated with increased falls risk and mortality; however, the association depended on specific patient age groups.

The 6-minute walk test and fall risk in patients with heart failure: A cross-sectional study

BACKGROUND

Given the increased risk of falls in patients with heart failure (HF), there is limited information in the literature about the possible relationship between fall risk and functional capacity.

OBJECTIVE

To investigate the relationship between functional capacity and fall risk in patients with HF and to determine whether there are differences in clinical parameters between patients with and without fall risk.

METHODS

The study included 64 patients with HF. The Activity-Specific Balance Confidence Scale (ABC) determined the fall risk. Functional capacity was assessed with the 6-minute walk test (6MWT). The Berg Balance Scale (BBS), the timed up-and-go test (TUG), and the five times sit-to-stand (5-STS) test were used to evaluate functional balance and mobility. Comorbidities and dyspnea perception were assessed with the Charlson Comorbidity Index (CCI) and modified Medical Research Council (mMRC), respectively.

RESULTS

The 6MWT was associated with fall risk in logistic regression with an odds ratio of 0.979 (0.970-0.989, p < 0.001). Furthermore, the 6MWT had a discriminative value for increased fall risk in patients with HF, with a cutoff value of 248 m. Patients with increased fall risk had lower 6MWT distance, BBS, and gait speed, and higher CCI and mMRC, number of falls, duration of TUG and 5STS compared to patients with no increased fall risk (p < 0.05).

CONCLUSIONS

The study results demonstrated that 6MWT may be a clinically useful tool in quickly identifying potential balance problems and increased fall risk by providing insight into fall risk/balance confidence in addition to assessing functional capacity.

Cardiovascular disease, muscle function, and long-term falls risk: The Perth Longitudinal Study of Ageing Women

BACKGROUND

A few cross-sectional studies have highlighted inconsistent associations between cardiovascular disease (CVD) and musculoskeletal conditions. We sought to investigate the relationship between clinical CVD including subtypes, compromised muscle function, as well as incident self-reported and injurious falls in older women.

MATERIALS AND METHODS

1431 community-dwelling older women (mean age ± SD; 75.2 ± 2.7 years) were included in over 14.5 years of a prospective study, the Perth Longitudinal Study of Ageing in Women. CVD (up to 18-years prior to the baseline visit) and injurious fall hospitalizations over 14.5 years were obtained from linked health records. Self-reported falls for five years were obtained via a written adverse event diary posted every four months. Timed-Up-and-Go (TUG) test and hand grip strength were used to assess mobility and muscle strength, respectively. Mobility impairment was defined as TUG performance >10.2 sec and muscle weakness characterized as grip strength <22 kg.

RESULTS

Over 5-years, 411 (28.7%) women reported a falls, while 567 (39.6%) were hospitalized due to an injurious fall over 14.5 years. Prior CVD events were associated with 32% (HR 1.32 95%CI, 1.06-1.64) and 29% (HR 1.29 95%CI, 1.07-1.56) increased risk of self-reported and injurious falls, respectively, in multivariable-adjusted models. When considering subtypes of CVD, only cerebrovascular disease was related to self-reported (HR 1.77; 95%CI, 1.15-2.72) and injurious falls requiring hospitalization (HR 1.51; 95%CI, 1.00-2.27). CVD was also associated with cross-sectional and prospective mobility impairments. However, no evidence for such relationships was observed for muscle weakness.

CONCLUSIONS

Prevalent CVD events, particularly cerebrovascular disease, are related to an increased risk of long-term falls. These findings highlight the need to recognize increased falls risk in patients with CVD. Further, there is a need to understand whether incorporating prevalent CVD into falls screening tools improves risk stratification or affects model calibration.

Using the RE-AIM framework to evaluate physical activity-based fall prevention interventions in older adults with chronic conditions: A systematic review

Falls are a serious public health problem, especially for older adults with chronic conditions. The purpose of this systematic review was to evaluate the translational potential of physical activity-based balance interventions for older adults with common chronic conditions guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Databases were searched (2011-2021) to identify studies with physical activity-based fall prevention interventions for older adults with chronic conditions. Data were collected using the RE-AIM coding guide and Mixed Methods Appraisal Tool for evidence quality. The search yielded 122 articles, of which 14 distinct studies were included. The most reported RE-AIM dimensions across the studies were Reach (46.2%) and Implementation (40.5%), with Effectiveness/Efficacy (29.4%), Adoption (2.0%), and Maintenance (5.4%) being the least reported. Studies were largely conducted in controlled research environments with minimal staff involvement and without long-term follow-up periods. While studies found that physical activity-based programs were effective in improving balance, information on representativeness and adoption/maintenance of programs was lacking. Studies included sufficient details about the intervention (content, dosage, progression). External validity RE-AIM indicators were reported less frequently than internal validity indicators. The studies were of moderate quality overall. Studies often lacked information on indicators critical for understanding how to implement these programs. This review signals the need to investigate the translation of these interventions from controlled research settings to clinical settings to improve the public impact of fall prevention for this population.

Association Between Multimorbidity and Rate of Falls: A 3-Year 5-Country Prospective Study in Generally Healthy and Active Community-Dwelling Adults Aged ≥70 Years

OBJECTIVE

To examine the association between the baseline number of chronic diseases and multimorbidity with regard to the incidence of all and injurious falls over 3 years among European community-dwelling older adults.

DESIGN

Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial.

SETTING AND PARTICIPANTS

Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status.

METHODS

The main outcomes were the number of all falls and injurious falls experienced over 3 years. The number of chronic diseases and multimorbidity, defined as the presence of 3 or more chronic diseases at baseline, were assessed with the Self-Administered Comorbidity Questionnaire by Sangha et al.

RESULTS

Among the 2155 participants included in the analyses (mean age: 74.9 years, 62% were women, 52% were physically active more than 3 times a week), 569 (26.4%) had multimorbidity at baseline. Overall, each 1-unit increase in the baseline number of chronic diseases was linearly associated with a 7% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) 1.07, 95% CI 1.03-1.12, P < .001] and a 6% increased incidence rate of injurious falls (aIRR 1.06, 95% CI 1.02-1.11, P = .003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (aIRR 1.21, 95% CI 1.07-1.37, P = .002) and a 17% increased incidence rate of injurious falls (aIRR 1.17, 95% CI 1.03-1.32, P = .02).

CONCLUSIONS AND IMPLICATIONS

Baseline number of prevalent chronic diseases and multimorbidity in generally healthy and active community-dwelling older adults were associated with increased incidence rates of all and injurious falls over 3 years. These findings support that multimorbidity may need consideration as a risk factor for falls, even in generally healthy and active older adults.

Obesity Status and Physical Rehabilitation in Older Patients Hospitalized With Acute HF: Insights From REHAB-HF

BACKGROUND

In the REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial, a novel, early, transitional, multidomain rehabilitation intervention improved physical function, frailty, quality of life (QOL), and depression in older patients hospitalized for acute decompensated heart failure (ADHF), but the potential impact of baseline obesity on this intervention has not been studied.

OBJECTIVES

This study assessed for treatment interactions by body mass index (BMI) subgroups for a novel rehabilitation intervention in ADHF.

METHODS

Three-month outcomes including Short Physical Performance Battery (SPPB) (primary outcome), 6-minute walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire (KCCQ) were assessed by baseline BMI (≥30 kg/m2 vs <30 kg/m2). Six-month end points included all-cause rehospitalization and death. All analyses were adjusted for age, sex, clinical site, and ejection fraction category, and 3-month outcomes were also adjusted for baseline measure. The prespecified significance level for treatment interaction by BMI category was P ≤ 0.10.

RESULTS

Of 349 trial participants, 204 (58%) had BMI ≥30 kg/m2 and 145 (42%) <30 kg/m2. Compared with patients with BMI <30 kg/m2, participants with BMI ≥30 kg/m2 were younger (age 71 ± 7 years vs 75 ± 9 years), more frequently women (57% vs 46%), and had significantly worse baseline physical function and QOL. Although interaction P values for 3-month outcomes by BMI were not significant (interaction P > 0.15 for overall measures), adjusted SPPB effect sizes were nominally larger for participants with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2: +1.7 (95% CI: 0.8-2.7) vs +1.1 (95% CI: -0.1 to 2.2). This difference in SPPB effect size was due largely to improvements in the balance component of the SPPB for participants with BMI ≥30 kg/m2: +0.6 (95% CI: 0.2-1.0) vs 0.0 (-0.6 to 0.5) for those with BMI <30 kg/m2 (interaction P = 0.02). In contrast, adjusted 6MWD and KCCQ effect sizes were smaller for participants with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2: +21 meters (-17 to 59) vs +53 meters (6-100), and +5.0 (-4 to 14) vs +11 (-0.5 to 22), respectively. There was no significant interaction by BMI for 6-month clinical outcomes (all interaction P > 0.30).

CONCLUSIONS

Older patients with ADHF benefit from the rehabilitation therapy regardless of BMI. Benefits for patients with obesity may be more evident in the multidomain measure of physical function (SPPB), compared with the 6MWD or KCCQ, which may be driven, in part, by the unique aspects of the novel rehabilitation intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).

Geriatric Cardiology: Coming of Age

Older adults with cardiovascular disease (CVD) contend with deficits across multiple domains of health due to age-related physiological changes and the impact of CVD. Multimorbidity, polypharmacy, cognitive changes, and diminished functional capacity, along with changes in the social environment, result in complexity that makes provision of CVD care to older adults challenging. In this review, we first describe the history of geriatric cardiology, an orientation that acknowledges the unique needs of older adults with CVD. Then, we introduce 5 essential principles for meeting the needs of older adults with CVD: 1) recognize and consider the potential impact of multicomplexity; 2) evaluate and integrate constructs of cognition into decision-making; 3) evaluate and integrate physical function into decision-making; 4) incorporate social environmental factors into management decisions; and 5) elicit patient priorities and health goals and align with care plan. Finally, we review future steps to maximize care provision to this growing population.

Falls in oldest-old adults hospitalized in acute geriatric ward

PURPOSE

The study aims to identify risk factors for falling among acutely ill older patients, hospitalized in acute geriatric ward.

METHODS

A retrospective study of 260 cases of patients who had fallen and 439 controls was conducted in a geriatric ward. We retrieved from the electronic hospital records data including patient demographics, medical diagnoses, and laboratory results, and drugs taken prior to the fall were reviewed. In addition, data on functional and cognitive status were recorded. Admission Morse Falls Scale for every patient was also retrieved.

RESULTS

The following on-admission diagnoses were associated with a higher incidence of falls during hospitalization: hypertension (84% vs. 38%), congestive heart failure (CHF), 74% vs 16%, dementia (36% vs. 5%), and delirium (36% vs 5%). A higher percentage of fallers compared to controls consumed beta blockers (69% vs. 53%), benzodiazepines (46% vs. 32%), antidepressants (33% vs. 23%), oral diabetes drugs (20% vs. 11%) and opiates (8% vs. 4%). On-admission Morse Falls Scale score was found to be higher in the patients who fell (59 vs.53). The strongest predictors of falling during hospitalization were CHF, hypertension, dementia, delirium, assisted mobility and dependence.

CONCLUSION

A systematic screening of risk factors for falls and identification of them might contribute to reducing the risk associated with falls during hospitalization.

Preventing and Managing Falls in Adults With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Falls and fear of falling are a major health issue and associated with high injury rates, high medical care costs, and significant negative impact on quality of life. Adults with cardiovascular disease are at high risk of falling. However, the prevalence and specific risks for falls among adults with cardiovascular disease are not well understood, and falls are likely underestimated in clinical practice. Data from surveys of patient-reported and medical record-based analyses identify falls or risks for falling in 40% to 60% of adults with cardiovascular disease. Increased fall risk is associated with medications, structural heart disease, orthostatic hypotension, and arrhythmias, as well as with abnormal gait and balance, physical frailty, sensory impairment, and environmental hazards. These risks are particularly important among the growing population of older adults with cardiovascular disease. All clinicians who care for patients with cardiovascular disease have the opportunity to recognize falls and to mitigate risks for falling. This scientific statement provides consensus on the interdisciplinary evaluation, prevention, and management of falls among adults with cardiac disease and the management of cardiovascular care when patients are at risk of falling. We outline research that is needed to clarify prevalence and factors associated with falls and to identify interventions that will prevent falls among adults with cardiovascular disease.

A Survey of IoT-Based Fall Detection for Aiding Elderly Care: Sensors, Methods, Challenges and Future Trends

Remote monitoring of a fall condition or activities and daily life (ADL) of elderly patients has become one of the essential purposes for modern telemedicine. Internet of Things (IoT) and artificial intelligence (AI) techniques, including machine and deep learning models, have been recently applied in the medical field to automate the diagnosis procedures of abnormal and diseased cases. They also have many other applications, including the real-time identification of fall accidents in elderly patients. The goal of this article is to review recent research whose focus is to develop AI algorithms and methods of fall detection systems (FDS) in the IoT environment. In addition, the usability of different sensor types, such as gyroscopes and accelerometers in smartwatches, is described and discussed with the current limitations and challenges for realizing successful FDSs. The availability problem of public fall datasets for evaluating the proposed detection algorithms are also addressed in this study. Finally, this article is concluded by proposing advanced techniques such as lightweight deep models as one of the solutions and prospects of futuristic smart IoT-enabled systems for accurate fall detection in the elderly.

Prioritizing movement to address the frailty phenotype in heart failure

Frailty is a highly prevalent multisystem syndrome in older adults with heart failure (HF) and is associated with poor clinical prognosis and increased complexity of care. While frailty is neither disease nor age specific, it is a clinical manifestation of aging-related processes that reflects a reduced physiological ability to tolerate and recover from stress associated with aging, disease, or therapy. Within this context, physical frailty, which is distinctly oriented to physical functional domains (e.g., muscle weakness, slowness, and low activity), has been recognized as a critical vital sign in older persons with HF. Identification and routine assessment of physical frailty, using objective physical performance measures, may guide the course of patient-centered treatment plans that maximize the likelihood of improving clinical outcomes in older HF patients. Exercise-based rehabilitation is a primary therapy to improve cardiovascular health in patients with HF; however, the limited evidence supporting the effectiveness of exercise tailored to older and frail HF patients underscores the current gaps in management of their care. Interdisciplinary exercise interventions designed with consideration of physical frailty as a therapeutic target may be an important strategy to counteract functional deficits characteristic of frailty and HF, and to improve patient-centered outcomes in this population. The purpose of this current review is to provide a better understanding of physical frailty and its relation to management of care in older patients with HF. Implications of movement-based interventions, including exercise and physical rehabilitation, to prevent or reverse physical frailty and improve clinical outcomes will further be discussed.

Abdominal aortic calcification is associated with a higher risk of injurious fall-related hospitalizations in older Australian women

BACKGROUNDS AND AIMS

Abdominal aortic calcification (AAC) is associated with weaker grip strength, an established risk factor for fall-related hospitalizations. However, its association with long-term fall-related hospitalisations remains unknown. This study investigated the association between AAC and long-term fall-related hospitalizations in community-dwelling older women.

METHODS

Fall-related hospitalizations were obtained from linked data over 14.5-years in a prospective cohort of 1053 older women (mean age 75.0 ± 2.6 years). At baseline (1998/99), AAC was assessed from lateral spine images obtained using dual-energy X-ray absorptiometry, and scored using a semi-quantitative method (AAC24, range 0-24). The presence of any AAC was defined by AAC24 ≥ 1.

RESULTS

Over 14.5-years, 413 (39.2%) women experienced a fall-related hospitalization. In the multivariable-adjusted model, each unit increase in baseline AAC24 was associated with a 3% increase in relative hazards for a fall-related hospitalization (HR 1.03 95%CI, 1.01 to 1.07). Compared to women with no AAC, women with any AAC had a 40% (HR 1.40 95%CI, 1.11 to 1.76) and 39% (HR 1.39 95%CI, 1.10 to 1.76) greater risk for fall-related hospitalizations in the minimal and multivariable-adjusted models, respectively. This relationship was not attenuated by including measures of muscle function such as grip strength and timed-up-and-go.

CONCLUSIONS

The presence of AAC is associated with long-term fall-related hospitalizations risk, independent of muscle function, in community-dwelling older women. Concurrent assessment of AAC may be a simple and cost-effective way to identify older women at higher risk of falling as part of routine osteoporosis screening.

Fear of Falling Among Community-Dwelling Older Adults with Heart Disease: Findings from an International Mobility in Aging Study (IMIAS)

Background: Older adults with heart disease (HD) are more likely to report a higher prevalence of falls compared to those without HD. A knowledge gap currently exists regarding the factors associated with fear of falling (FOF) among older adults with HD. Therefore, this study aimed to estimate FOF and identify factors associated with FOF among older adults with HD. Methods: Data came from a secondary analysis of the International Mobility in Aging Study (IMIAS) baseline (2012) data. FOF was measured using the Falls Efficacy Scale-International (FES-I). Stepwise linear regression was used to identify factors associated with FOF. Results: A total of 429 participants identified themselves as having heart disease diagnosed by their physician (mean age 69.5 ± 2.9). Older adults with HD reported on average (25.6) higher FOF than those without HD. For older adults with HD, FES-I increased significantly by 1.3, 1.0, and 0.6 points, when the Short Physical Performance Battery, the Leganes Cognitive Test, and QOL total scores decreased by one point. FES-I also significantly increased by 3.2 when income was insufficient compared to sufficient or very sufficient income. Discussion: FOF is multifactorial, and our findings provide a base for developing future management rehabilitation intervention programs aimed at decreasing FOF among older adults with HD.

An eight-camera fall detection system using human fall pattern recognition via machine learning by a low-cost android box

Falls are a leading cause of unintentional injuries and can result in devastating disabilities and fatalities when left undetected and not treated in time. Current detection methods have one or more of the following problems: frequent battery replacements, wearer discomfort, high costs, complicated setup, furniture occlusion, and intensive computation. In fact, all non-wearable methods fail to detect falls beyond ten meters. Here, we design a house-wide fall detection system capable of detecting stumbling, slipping, fainting, and various other types of falls at 60 m and beyond, including through transparent glasses, screens, and rain. By analyzing the fall pattern using machine learning and crafted rules via a local, low-cost single-board computer, true falls can be differentiated from daily activities and monitored through conventionally available surveillance systems. Either a multi-camera setup in one room or single cameras installed at high altitudes can avoid occlusion. This system’s flexibility enables a wide-coverage set-up, ensuring safety in senior homes, rehab centers, and nursing facilities. It can also be configured into high-precision and high-recall application to capture every single fall in high-risk zones.

Bone Mineral Density and Content Among Patients With Coronary Artery Disease: A Comparative Study

INTRODUCTION

Some studies indicate an association between coronary artery disease (CAD) and osteoporosis. This case-control study examined the association between body composition and bone mineral content (BMC) and density (BMD) among patients with CAD.

MATERIALS AND METHODS

A group of men (n = 73) with established CAD and age and sex matched controls (n=65) were included in the study. Data collected included socio-demographic information, disease related data (from cases), anthropometric measurements, serum vitamin D, calcium and phosphorous and body composition analysis using DEXA. Two groups were compared using independent sample t-test, Mann Whitney U-test or Chi square test. Pearson correlation and regression models were used to test the associations between body compartments.

RESULTS

Among cases, the mean disease duration was 29 (range 5-192) months and 15% had triple vessel disease. Patients had higher mean total body fat mass (TBFM) (18869.7 vs 16733.0) g, p = 0.018), truncal fat mass (TRFM) (9259.1 vs 7992.5 g, p = 0.009) and fat percentage (28.6 vs 25.9%, p = 0.001) compared to controls. Median serum vitamin D level was significantly lower among patients (20.0 ng/mL) compared to controls (27.1 ng/mL) (p = 0.003). In both groups, TBFM and total body lean mass (TBLM) both showed significant positive correlations with total body BMD/BMC and regional BMDs. Of the two, TBLM emerged the best predictor of TBBMC/TBBMD. These associations were greater among patients than controls.

CONCLUSIONS

TBLM appears to be the strongest predictor of TBBMD and TBBMC in patients and controls. The strength of associations was greater among patients compared to controls even after adjusting for possible confounders .

Hearing Loss and Physical Functioning Among Adults with Heart Failure: Data from NHANES

Background

Hearing loss (HL) is associated with poor physical functioning among older adults, yet this association has not been examined in heart failure (HF), a disease in which both hearing loss and poor physical functioning are highly prevalent. We investigated whether this association exists in HF since HL represents a potentially modifiable risk factor for poor physical functioning.

Methods

We studied adults aged ≥70 years with self-reported HF in the National Health and Nutrition Examination Survey (NHANES). HL was assessed and categorized using pure-tone averages. Activities of daily living (ADLs), instrumental ADLs (IADLs), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activity (GPA) were assessed. Negative binomial regression was used to examine the association between HL and physical functioning

Results

One hundred eighty-one participants comprised our population. Those with ≥ moderate HL had more difficulty with ADLs (37.0% vs 24.0%, p=0.02), IADLs (36.0% vs 23.0%, p=0.05), and LEM (37.3% vs 20.0%, p=0.009), compared to participants with none or mild HL. In multivariable models, ≥ moderate HL was significantly associated with difficulty in physical functioning across four of the five domains: ADLs: PR: 1.71 (95% CI: 1.07-2.72); IADLs: PR: 1.71 (1.24-2.34); LEM: PR: 1.51 (1.01-2.26); and GPA: PR: 1.19 (1.00-1.41).

Conclusion

Among older adults with HF, moderate or greater HL was associated with a higher prevalence of difficulty with ADLs, IADLs, and LEM, compared to mild or no HL.

Precision Measurements to Assess Baseline Status and Efficacy of Healthy Living Medicine

Precision medicine recently has gained popularity, calling for more individualized approaches to prevent and/or reduce chronic-disease risk and to reduce non-communicable diseases such as cardiovascular disease (CVD). Encompassed under Precision medicine initiatives is the concept of healthy living medicine (HLM), which emphasizes the promotion of lifestyle and behavioral practices including physical activity and healthy dietary pattern. Precision measurements have the potential to improve the understanding of how risk factors influence disease trajectory, and further inform on how to precisely tailor clinical strategies to manage risk factors to prevent disease manifestation, and refine therapies according the patient's demographic, environment, and disease etiology. The purpose of this review is to summarize the application of established and emerging measurements that may be used in HLM to manage and optimize care in CVD prevention.