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Divandari N, Bird ML, Vakili M, Jaberzadeh S. The Association Between Cognitive Domains and Postural Balance among Healthy Older Adults: A Systematic Review of Literature and Meta-Analysis. Curr Neurol Neurosci Rep 2023; 23:681-693. [PMID: 37856048 PMCID: PMC10673728 DOI: 10.1007/s11910-023-01305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW This review aims to explore which cognitive domain is more closely associated with which type of balance (static or dynamic). RESENT FINDING Based on recent reviews, inhibitory control, a part of cognition, plays a crucial role in balance performance. Previous reviews report significant links between cognition, mobility, and physical function in older adults. However, evidence regarding the relationship between cognition and balance scores remains inconclusive. The strength of association between cognition and balance appears to be domain-specific and task-specific. Executive function exhibits the strongest correlation with balance, while episodic memory shows a small link with dynamic balance. Processing speed and global cognition demonstrate moderate correlations. Additionally, there is a slight association between cognitive domains and static balance. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions for managing balance-related concerns that are domain-specific and task-specific.
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Affiliation(s)
- Nahid Divandari
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Melbourne, Frankston, VIC, 3199, Australia.
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Newnham Tasmania 7248, Launceston, Australia
| | - Mahdi Vakili
- Mowbray Medical Clinic, Invermay, TAS, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Melbourne, Frankston, VIC, 3199, Australia
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Lai WX, Chan AWM, Matchar DB, Ansah JP, Lien CTC, Ismail NH, Wong CH, Xu T, Ho VWT, Tan PJ, Lee JML, Sim RSC, Manap N. Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach. BMC Geriatr 2023; 23:586. [PMID: 37740182 PMCID: PMC10517526 DOI: 10.1186/s12877-023-04294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/08/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults. METHODS A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies. RESULTS Four patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae. CONCLUSION This work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.
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Affiliation(s)
- Wei Xuan Lai
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore.
| | | | - David Bruce Matchar
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore
- Department of Medicine, Duke University, Durham, NC, USA
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Tower, Singapore, Singapore
| | - John Pastor Ansah
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | | | - Noor Hafizah Ismail
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore, Singapore
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tianma Xu
- Health & Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Vanda Wen Teng Ho
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Pey June Tan
- Ageing and Age-Associated Disorders Research Group, Health and Translational Medicine Cluster, University of Malaya, Kuala Lumpur, Malaysia
| | - June May Ling Lee
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Rita Siew Choo Sim
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore
| | - Normala Manap
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
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Leroy V, Martinet V, Nunkessore O, Dentel C, Durand H, Mockler D, Puisieux F, Fougère B, Chen Y. The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2628. [PMID: 36767992 PMCID: PMC9915123 DOI: 10.3390/ijerph20032628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment. METHODS According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist. RESULTS We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another. CONCLUSION It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
- Memory Clinic, Tours University Hospital, 37000 Tours, France
| | - Valérie Martinet
- Department of Geriatrics, Saint-Pierre Hospital, ULB, 1000 Brussels, Belgium
| | | | | | - Hélène Durand
- Department of Neurology, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - David Mockler
- Medical Library, Trinity Centre for the Health Sciences, St James’ Hospital, D08 W9RT Dublin, Ireland
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- EA2694, Lille University, 59000 Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University of Lille, 59000 Lille, France
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Woo MT, Davids K, Chow JY, Jaakkola T. Acute effects of wearing compression knee-length socks on ankle joint position sense in community-dwelling older adults. PLoS One 2021; 16:e0245979. [PMID: 33556067 PMCID: PMC7869987 DOI: 10.1371/journal.pone.0245979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022] Open
Abstract
Functional proprioceptive information is required to allow an individual to interact with the environment effectively for everyday activities such as locomotion and object manipulation. Specifically, research suggests that application of compression garments could improve proprioceptive regulation of action by enhancing sensorimotor system noise in individuals of different ages and capacities. However, limited research has been conducted with samples of elderly people thus far. This study aimed to examine acute effects of wearing knee-length socks (KLS) of various compression levels on ankle joint position sense in community-dwelling, older adults. A total of 26 participants (12 male and 14 female), aged between 65 and 84 years, were randomly recruited from local senior activity centres in Singapore. A repeated-measures design was used to determine effects on joint position awareness of three different treatments–wearing clinical compression socks (20–30 mmHg); wearing non-clinical compression socks (< 20 mmHg); wearing normal socks, and one control condition (barefoot). Participants were required to use the dominant foot to indicate 8 levels of steepness (2.5°, 5°, 7.5°, 10°, 12.5°, 15°, 17.5°, and 20°), while standing on a modified slope box, in a plantar flexion position. Findings showed that wearing clinical compression KLS significantly reduced the mean absolute errors compared to the barefoot condition. However, there were no significant differences observed between other KLS and barefoot conditions. Among the KLS of various compression levels, results suggested that only wearing clinical compression KLS (20–30 mmHg) improved the precision of estimation of ankle joint plantar flexion movement, by reducing absolute performance errors in elderly people. It is concluded that wearing clinical compression KLS could potentially provide an affordable strategy to ameliorate negative effects of ageing on the proprioception system to enhance balance and postural control in community-dwelling individuals.
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Affiliation(s)
- Mei Teng Woo
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,School of Sports, Health and Leisure, Republic Polytechnic, Singapore, Singapore
| | - Keith Davids
- Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, United Kingdom
| | - Jia Yi Chow
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Timo Jaakkola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Ma Y, Li X, Pan Y, Zhao R, Wang X, Jiang X, Li S. Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study. Eur J Neurol 2020; 28:381-388. [PMID: 33030300 DOI: 10.1111/ene.14572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Falling is considered an important public health problem among older people. A recent cross-sectional study suggested that cognitive frailty (CF) is associated with falls. We aimed to explore whether CF is a risk factor for falls in a population-based longitudinal study. METHODS Using data from the Rugao Longevity and Aging Study, physical frailty was assessed according to the modified Fried's phenotype, and the 20% of participants with the lowest scores on the Revised Hasegawa Dementia Scale were defined as having cognitive impairment (CoI). Cognitive frailty (CF) was defined as the coexistence of physical frailty and CoI, but excluded severe CoI (revised Hasegawa Dementia Scale score ≤ 10). The outcome of number of falls in the previous 12 months was measured using a questionnaire. RESULTS At baseline, the prevalence of CF was 2.6% and the prevalence of two or more falls was 6.7%. Cross-sectional analysis found that two or more falls was associated with physical frailty without CoI (odds ratio [OR] 6.79, 95% confidence interval [CI] 3.17-14.56), pre-frailty with CoI (OR 4.54, 95% CI 2.44-8.44) and CF (OR 3.51, 95% CI 1.18-10.44). Slow gait with CoI was associated with two or more falls (OR 2.21, 95% CI 1.08-4.53). At 3-year follow-up, the prevalence of two or more falls was 10.6%. Logistic regression analysis showed that, compared with the robust and non-CoI elderly groups, the CF elderly group had a higher risk of two or more falls (OR 3.41, 95% CI 1.11-10.50). CONCLUSIONS Cognitive frailty was associated with two or more falls at baseline and might be a risk factor for two or more falls after 3 years. Early screening of CF might be beneficial in the prevention of falls.
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Affiliation(s)
- Y Ma
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Y Pan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - R Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai, China
| | - X Jiang
- Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | - S Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Woo MT, Davids K, Liukkonen J, Chow JY, Jaakkola T. Immediate effects of wearing knee length socks differing in compression level on postural regulation in community-dwelling, healthy, elderly men and women. Gait Posture 2018; 66:63-69. [PMID: 30165286 DOI: 10.1016/j.gaitpost.2018.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/08/2018] [Accepted: 08/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stimulation of lower limbs' cutaneous receptors and mechanoreceptors through compression garments could potentially increase somatosensory system efficiency and aid postural regulation in elderly individuals. RESEARCH QUESTION This study examined immediate effects of wearing knee length socks (KLS) of various compression levels on somatosensory function in community-dwelling healthy elderly men and women during a double-limb standing, balancing task. METHODS A total of forty-six elderly participants (Male = 23), aged between 65 and 84 years old, randomly selected from the Singapore community-dwelling, healthy population. Three treatment interventions (wearing clinical compression socks; wearing non-clinical compression socks; wearing commercial socks) and one control condition (barefoot), in a counterbalanced order, were administered to participants while they performed a 30-s Romberg test, with four levels of performance difficulty: (1) standing on a stable surface with vision (SO); (2) a stable surface without vision (SC); (3) a foam surface with vision (FO); and (4), a foam surface without vision (FC). RESULTS Results showed that immediate effects of applying KLS of various compression levels significantly reduced sway area, trace length, velocity, and anterior-posterior (AP) sway as compared to barefoot condition (control) during the FO task condition. SIGNIFICANCE This finding indicates the positive immediate effects of garments on somatosensory system function and postural regulation in the elderly men and women, especially when standing on the unstable surface. Wearing compression KLS could be included as a viable intervention on top of other forms of balance training to reduce risk of falling in elderly people.
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Affiliation(s)
- Mei Teng Woo
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; School of Sports, Health and Leisure, Republic Polytechnic, Singapore.
| | - Keith Davids
- Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, United Kingdom
| | - Jarmo Liukkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jia Yi Chow
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore
| | - Timo Jaakkola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Shah CP, Horner S, Sanders DS, Armstrong S, Sanders S. Is Excess Alcohol Consumption an Unrecognized Factor Contributing to Falls? Geriatr Orthop Surg Rehabil 2018; 9:2151459318760346. [PMID: 29623235 PMCID: PMC5881968 DOI: 10.1177/2151459318760346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Susan Horner
- Templar Day Hospital, St John's Hospital, Howden, Livingston, United Kingdom
| | | | - Susan Armstrong
- Templar Day Hospital, St John's Hospital, Howden, Livingston, United Kingdom
| | - Sureshini Sanders
- Templar Day Hospital, St John's Hospital, Howden, Livingston, United Kingdom
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