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O'Halloran AM, Cremers J, Vrangbæk K, Roe L, Bourke R, Mortensen LH, Westendorp RGJ, Kenny RA. Cardiovascular disease and the risk of incident falls and mortality among adults aged ≥ 65 years presenting to the emergency department: a cohort study from national registry data in Denmark. BMC Geriatr 2024; 24:93. [PMID: 38267873 PMCID: PMC10809657 DOI: 10.1186/s12877-023-04618-2] [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: 08/04/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Falls cause 58% of injury-related Emergency Department (ED) attendances. Previous research has highlighted the potential role of cardiovascular risk factors for falls. This study investigated the impact of cardiovascular disease (CVD) risk on three-year incident falls, with presentation to the ED, and mortality. METHODS A matched cohort study design was employed using national registry data from 82,292 adults (33% male) aged ≥ 65 years living in Denmark who attended the ED in 2013. We compared age and gender matched ED attendees presenting with a fall versus another reason. The cohort was followed for three-year incident falls, with presentation to the ED, and mortality. The impact of falls-related CVDs was also examined. RESULTS Three-year incident falls was twofold higher among age and gender matched ED attendees aged ≥ 65 years presenting with a fall versus another reason at baseline. A presentation of falls with hip fracture had the highest percentage of incident falls in the 65-74 age group (22%) and the highest percentage mortality in all age groups (27-62%). CVD was not a significant factor in presenting with a fall at the ED, nor did it contribute significantly to the prediction of three-year incident falls. CVD was strongly associated with mortality risk among the ED fall group (RR = 1.81, 95% CI: 1.67-1.97) and showed interactions with both age and fall history. CONCLUSION In this large study of adults aged ≥ 65 years attending the ED utilising data from national administrative registers in Denmark, we confirm that older adults attending the ED with a fall, including those with hip fracture, were at greatest risk for future falls. While CVD did not predict incident falls, it increased the risk of mortality in the three-year follow up with advancing age. This may be informative for the provision of care pathways for older adults attending the ED due to a fall.
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Affiliation(s)
- Aisling M O'Halloran
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland.
| | - Jolien Cremers
- Data Science Lab, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Centre for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark
- Department of Political Science, University of Copenhagen, Copenhagen, Denmark
| | - Lorna Roe
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Robert Bourke
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Laust H Mortensen
- Data Science Lab, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rose Anne Kenny
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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De Stefano P, Ménétré E, Stancu P, Mégevand P, Vargas MI, Kleinschmidt A, Vulliémoz S, Wiest R, Beniczky S, Picard F, Seeck M. Added value of advanced workup after the first seizure: A 7-year cohort study. Epilepsia 2023; 64:3246-3256. [PMID: 37699424 DOI: 10.1111/epi.17771] [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: 04/19/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE This study was undertaken to establish whether advanced workup including long-term electroencephalography (LT-EEG) and brain magnetic resonance imaging (MRI) provides an additional yield for the diagnosis of new onset epilepsy (NOE) in patients presenting with a first seizure event (FSE). METHODS In this population-based study, all adult (≥16 years) patients presenting with FSE in the emergency department (ED) between March 1, 2010 and March 1, 2017 were assessed. Patients with obvious nonepileptic or acute symptomatic seizures were excluded. Routine EEG, LT-EEG, brain computed tomography (CT), and brain MRI were performed as part of the initial workup. These examinations' sensitivity and specificity were calculated on the basis of the final diagnosis after 2 years, along with the added value of advanced workup (MRI and LT-EEG) over routine workup (routine EEG and CT). RESULTS Of the 1010 patients presenting with FSE in the ED, a definite diagnosis of NOE was obtained for 501 patients (49.6%). Sensitivity of LT-EEG was higher than that of routine EEG (54.39% vs. 25.5%, p < .001). Similarly, sensitivity of MRI was higher than that of CT (67.98% vs. 54.72%, p = .009). Brain MRI showed epileptogenic lesions in an additional 32% compared to brain CT. If only MRI and LT-EEG were considered, five would have been incorrectly diagnosed as nonepileptic (5/100, 5%) compared to patients with routine EEG and MRI (25/100, 25%, p = .0001). In patients with all four examinations, advanced workup provided an overall additional yield of 50% compared to routine workup. SIGNIFICANCE Our results demonstrate the remarkable added value of the advanced workup launched already in the ED for the diagnosis of NOE versus nonepileptic causes of seizure mimickers. Our findings suggest the benefit of first-seizure tracks or even units with overnight EEG, similar to stroke units, activated upon admission in the ED.
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Affiliation(s)
- Pia De Stefano
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Eric Ménétré
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrick Stancu
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Andreas Kleinschmidt
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Vulliémoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Berne, Bern, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus and Danish Epilepsy Center, Dianalund, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Fabienne Picard
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
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Kavi KS, Gall NP. Trauma and syncope: looking beyond the injury. Trauma Surg Acute Care Open 2023; 8:e001036. [PMID: 36744295 PMCID: PMC9896213 DOI: 10.1136/tsaco-2022-001036] [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: 10/06/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Background 42% of the population experience syncope by the age of 70, accounting for up to 6% of hospital admissions that frequently present as falls. The etiologies of some falls are benign, and others, such as cardiac syncope, are associated with a greater mortality and must be identified. Methods This review article aims to bridge the literature gap by providing a comprehensive practice review and critical summary of the current syncope guidance relating to the trauma patient. Results The National Institute for Health and Care Excellence, the American College of Cardiology, and European Society of Cardiology published syncope risk stratification guidance. The inclusion of certain high-risk features represented in all three guidelines suggests their significance to identify cardiac syncope including heart failure, abnormal vital signs, syncope during exercise with little to no prodrome, family history of sudden cardiac death, and ECG abnormalities. Of 11 syncope risk stratification scoring systems based on these guidelines, only 2 are externally validated in the emergency department, neither of which are validated for major trauma use. Adherence to thorough history-taking, examination, orthostatic blood pressure recording, and an ECG can diagnose the cause of syncope in up to 50% of patients. ECG findings are 95% to 98% sensitive in the detection of serious adverse outcomes after cardiac syncope and should form part of a standardized syncope trauma assessment. Routine blood testing in trauma is often performed despite evidence that it is neither useful nor cost effective, where the screening of cardiac enzymes and D-dimer rarely influences management. Discussion In the absence of a gold-standard clinical test to identify the cause of a syncopal episode, standardized syncope guidelines as described in this review could be incorporated into trauma protocols to analyze high-risk etiologies, improve diagnostic accuracy, reduce unnecessary investigations, and develop an effective and safer management strategy.
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Affiliation(s)
- Kieran S Kavi
- Department of Emergency Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nicholas P Gall
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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Hwang JS, Kim SH. Severe Ground Fall Injury Associated with Alcohol Consumption in Geriatric Patients. Healthcare (Basel) 2022; 10:healthcare10061111. [PMID: 35742162 PMCID: PMC9222245 DOI: 10.3390/healthcare10061111] [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: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigated characteristics of geriatric patients sustaining ground fall injury related to alcohol consumption and analyzed factors associated with the severity of such injuries in both alcohol- and non-alcohol-related cases. We retrospectively reviewed geriatric patients sustaining ground falls who were admitted to six university hospitals from 2011 to 2018. Patients were classified into alcohol and non-alcohol groups. Their general characteristics, clinical characteristics, and factors of injury severity were analyzed. A total of 31,177 patients were reviewed. Factors significantly associated with alcohol-related ground-fall injuries were: male, 65~84 years old, injury time other than 06:00~11:59, transportation to emergency department (ED) by ambulance and from other hospitals, injured in residential facilities, transportation areas, public or commercial facilities, activities other than paid or unpaid, non-slippery floor, obstacles, concrete floor, and absence of lights. Factors associated with severe injury after ground fall in alcohol-related cases were: male, injury time at between 06:00 and 17:59, transportation to the ED via ambulance from other hospitals, injured in residential facility, and slippery floor. Risk factors for severity in alcohol-related geriatric fall injury included: male sex, daytime injury, transportation by ambulance, injury in a residential facility, and slippery floor condition. Prophylactic measures and therapeutic interventions by ED teams are needed for the management of such cases.
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Affiliation(s)
| | - Sun Hyu Kim
- Correspondence: ; Tel.: +82-52-250-8405; Fax: +82-52-250-8071
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Ng BP, Lu J, Tiu GF, Thiamwong L, Zhong Y. Bathroom modifications among community-dwelling older adults who experience falls in the United States: A cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:253-263. [PMID: 33894087 PMCID: PMC10028600 DOI: 10.1111/hsc.13398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, we examined factors associated with bathroom modifications among older adults with at least one fall in the United States. We analysed the nationally representative 2016 Medicare Current Beneficiary Survey Public Use File of Medicare beneficiaries aged ≥65 years with ≥1 fall (n = 2,404). A survey-weighted logistic model was used to examine associations between bathroom modifications and factors including socio-demographic characteristics, health-related conditions, and fear of falling. Among Medicare beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts and aging-in-place.
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Affiliation(s)
- Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Jingping Lu
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, USA
| | - Georgianne F. Tiu
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - YunYing Zhong
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
- Department of Hospitality Service, University of Central Florida, Orlando, FL, USA
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Atakro CA. Knowledge of Ghanaian Graduating Undergraduate Nurses About Ageing. SAGE Open Nurs 2021; 7:23779608211020957. [PMID: 34423128 PMCID: PMC8371287 DOI: 10.1177/23779608211020957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Knowledge on ageing has an impact on the quality of care provided to older people. Although older Ghanaians provide various forms of support to family and communities, many of them experience poor nursing care in the Ghanaian health system. There is, however, dearth of evidence regarding knowledge of ageing among Ghanaian nurses. Objective This study therefore used a descriptive survey approach to investigate knowledge of graduating undergraduate nurses on physiological, and psychosocial changes in ageing. Methods Seventy graduating undergraduate nurses were surveyed to identify their knowledge on physiological and psychosocial changes leading to care needs of older people in Ghana. Three undergraduate nursing programs with gerontological nursing courses were purposively selected for the study. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study. Results The response rate in the study was 42%. Findings of the study show graduating undergraduate nursing students have inadequate knowledge on ageing. Several gaps in knowledge regarding ageing were identified. Although undergraduate nursing schools had gerontological nursing courses in their programs, over 90% of participating graduating nursing students indicated pain, anxiety and depression are normal aspects in the ageing process. Conclusion It is imperative to improve the current curricula content on gerontological nursing in Ghanaian nursing schools to equip nurses with knowledge and skills needed to provide quality healthcare to older people in Ghana. Improving knowledge on ageing through evidence-informed gerontological nursing curricula content will lead to better nursing care of older Ghanaians. Providing educational opportunities for improved quality nursing care of older Ghanaians is in line with the United Nations (UN) Sustainable Development Goal 3, which aims at providing equal and quality healthcare to all age groups by 2030.
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Affiliation(s)
- Confidence Alorse Atakro
- School of Nursing and Midwifery, Faculty of Health and Applied Sciences, Christian Service University College, Kumasi, Ghana
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Edge Artificial Intelligence: Real-Time Noninvasive Technique for Vital Signs of Myocardial Infarction Recognition Using Jetson Nano. ADVANCES IN HUMAN-COMPUTER INTERACTION 2021. [DOI: 10.1155/2021/6483003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The history of medicine shows that myocardial infarction is one of the significant causes of death in humans. The rapid evolution in autonomous technologies, the rise of computer vision, and edge computing offers intriguing possibilities in healthcare monitoring systems. The major motivation of the work is to improve the survival rate during a cardiac arrest through an automatic emergency recognition system under ambient intelligence. We present a novel approach to chest pain and fall posture-based vital sign detection using an intelligence surveillance camera to address the emergency during myocardial infarction. A real-time embedded solution persuaded from “edge AI” is implemented using the state-of-the-art convolution neural networks: single shot detector Inception V2, single shot detector MobileNet V2, and Internet of Things embedded GPU platform NVIDIA’s Jetson Nano. The deep learning algorithm is implemented for 3000 indoor color image datasets: Nanyang Technological University Red Blue Green and Depth, NTU RGB + D dataset, and private RMS dataset. The research mainly pivots on two key factors in creating and training a CNN model to detect the vital signs and evaluate its performance metrics. We propose a model, which is cost-effective and consumes low power for onboard detection of vital signs of myocardial infarction and evaluated the metrics to achieve a mean average precision of 76.4% and an average recall of 80%.
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Haddad YK, Luo F, Bergen G, Legha JK, Atherly A. Special Report from the CDC Antidepressant subclass use and fall risk in community-dwelling older Americans. JOURNAL OF SAFETY RESEARCH 2021; 76:332-340. [PMID: 33653566 PMCID: PMC8139010 DOI: 10.1016/j.jsr.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Falls among older adults are a significant health concern affecting more than a quarter of older adults (age 65+). Certain fall risk factors, such as medication use, increase fall risk among older adults (age 65+). AIM The aim of this study is to examine the association between antidepressant-medication subclass use and self-reported falls in community-dwelling older adults. METHODS This analysis used the 2009-2013 Medicare Current Beneficiary Survey, a nationally representative panel survey. A total of 8,742 community-dwelling older adults, representing 40,639,884 older Medicare beneficiaries, were included. We compared self-reported falls and psychoactive medication use, including antidepressant subclasses. These data are controlled for demographic, functional, and health characteristics associated with increased fall risk. Descriptive analyses and multivariate logistic regression analyses were conducted using SAS 9.4 and Stata 15 software. RESULTS The most commonly used antidepressant subclass were selective serotonin reuptake inhibitors (SSRI) antidepressants (13.1%). After controlling for characteristics associated with increased fall risk (including depression and concurrent psychoactive medication use), the risk of falling among older adults increased by approximately 30% among those who used a SSRI or a serotonin-norepinephrine reuptake inhibitors (SNRI) compared to non-users. The adjusted risk ratio (aRR) for SSRI was 1.29 (95% CI = 1.13, 1.47) and for SNRI was 1.32 (95% CI = 1.07, 1.62). CONCLUSION SSRI and SNRI are associated with increased risk of falling after adjusting for important confounders. Medication use is a modifiable fall risk factor in older adults and can be targeted to reduce risk of falls. Practical Applications: Use of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors increased the risk of falling in older adults by approximately 30%, even after controlling for demographic, functional, and health characteristics, including depression. Health care providers can work towards reducing fall risk among their older patients by minimizing the use of certain medications when potential risks outweigh the benefits.
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Affiliation(s)
- Yara K Haddad
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Feijun Luo
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gwen Bergen
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jaswinder K Legha
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam Atherly
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Nagami S, Maeda K, Fukunaga S, Ikeno M, Oku Y. Safety of transcutaneous electrical sensory stimulation of the neck in terms of vital parameters in dysphagia rehabilitation. Sci Rep 2019; 9:13481. [PMID: 31530879 PMCID: PMC6749101 DOI: 10.1038/s41598-019-49954-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
Transcutaneous electrical sensory stimulation (TESS) devices are approved for use in Japan, but their safety when used through the neck skin for dysphagia rehabilitation has not been reported. This study aimed to verify the safety of TESS use through the neck skin. Twenty patients (mean age 86.5 ± 5.1 years) with aspiration pneumonia undergoing dysphagia rehabilitation were included in this retrospective observational and matched control study. We compared vital signs in 10 subjects who underwent swallowing rehabilitation with the TESS device, and matched control patients over 7 days. The results were the following: tachycardia, 0.60 ± 1.07 vs. 0.70 ± 0.67 days; high blood pressure, 0.40 ± 0.70 vs. 0.50 ± 1.08 days; low blood pressure, 0.40 ± 0.70 vs. 0.10 ± 0.32 days; low oxygen saturation, 0.60 ± 1.58 vs. 0.50 ± 1.08 days, p = 0.870; oxygen administration, 0.80 ± 2.20 vs. 1.20 ± 2.15 days; tachypnea, 0.50 ± 0.71 vs. 0.50 ± 0.53 days; elevated body temperature, 2.00 ± 1.41 vs. 1.60 ± 1.96 days. There were no significant differences in clinical stability between the TESS and control groups of patients with aspiration pneumonia. TESS through the neck appears safe as an intervention in dysphagia rehabilitation.
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Affiliation(s)
- Shinsuke Nagami
- Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki City, Japan
- Department of Physiology, Hyogo College of Medicine, Nishinomiya City, Japan
| | - Keisuke Maeda
- Palliative Care Center, Aichi Medical University, Nagakute City, Japan.
- Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Tamana City, Japan.
| | - Shinya Fukunaga
- Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki City, Japan
| | - Masahiro Ikeno
- Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki City, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya City, Japan
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Lesser A, Israni J, Kent T, Ko KJ. Association Between Physical Therapy in the Emergency Department and Emergency Department Revisits for Older Adult Fallers: A Nationally Representative Analysis. J Am Geriatr Soc 2018; 66:2205-2212. [PMID: 30132800 DOI: 10.1111/jgs.15469] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/03/2018] [Accepted: 05/06/2018] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Tyler Kent
- West Health Institute; La Jolla California
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Tan PJ, Khoo EM, Chinna K, Saedon NI, Zakaria MI, Ahmad Zahedi AZ, Ramli N, Khalidin N, Mazlan M, Chee KH, Zainal Abidin I, Nalathamby N, Mat S, Jaafar MH, Khor HM, Khannas NM, Majid LA, Tan KM, Chin AV, Kamaruzzaman SB, Poi P, Morgan K, Hill KD, MacKenzie L, Tan MP. Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial. PLoS One 2018; 13:e0199219. [PMID: 30074996 PMCID: PMC6075745 DOI: 10.1371/journal.pone.0199219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/02/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia. Design Pragmatic, randomized-controlled trial. Setting Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia. Participants Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months. Intervention Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment. Primary and secondary outcome measures The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall. Results Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613–1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846–1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782–1.522)] and mortality rate [RR = 0.896 (95% CI 0.335–2.400)] did not differ between groups. Conclusion Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations. Trial registration ISRCTN Registry no. ISRCTN11674947
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Affiliation(s)
- Pey June Tan
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Geriatric Education and Research Institute, Singapore
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor I’zzati Saedon
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Idzwan Zakaria
- Department of Trauma and Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Norlina Ramli
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nurliza Khalidin
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Limpur, Malaysia
| | - Kok Han Chee
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Imran Zainal Abidin
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nemala Nalathamby
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Hasif Jaafar
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norfazilah Mohamad Khannas
- Department of Rehabilitation Medicine, Kuala Lumpur, University of Malaya Medical Centre, Kuala Limpur, Malaysia
| | - Lokman Abdul Majid
- Department of Rehabilitation Medicine, Kuala Lumpur, University of Malaya Medical Centre, Kuala Limpur, Malaysia
| | - Kit Mun Tan
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai-Vyrn Chin
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Philip Poi
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karen Morgan
- Department Psychology and Behavioural Science, Perdana University-RCSI School of Medicine, Serdang, Selangor, Malaysia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lynette MacKenzie
- Department of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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12
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Stevens JA, Sleet DA, Rubenstein LZ. The Influence of Older Adults' Beliefs and Attitudes on Adopting Fall Prevention Behaviors. Am J Lifestyle Med 2018; 12:324-330. [PMID: 32063817 PMCID: PMC6993092 DOI: 10.1177/1559827616687263] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/18/2016] [Accepted: 12/12/2016] [Indexed: 01/08/2023] Open
Abstract
Among Americans aged 65 years and older, falls are the leading cause of injury death and disability, and finding effective methods to prevent older adult falls has become a public health priority. While research has identified effective interventions delivered in community and clinical settings, persuading older adults to adopt these interventions has been challenging. Older adults often do not acknowledge or recognize their fall risk. Many see falls as an inevitable consequence of aging. Health care providers can play an important role by identifying older adults who are likely to fall and providing clinical interventions to help reduce fall risks. Many older people respect the information and advice they receive from their providers. Health care practitioners can encourage patients to adopt effective fall prevention strategies by helping them understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention such as remaining independent. To help clinicians integrate fall prevention into their practice, the Centers for Disease Control and Prevention launched the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative. It provides health care providers in primary care settings with resources to help them screen older adult patients, assess their fall risk, and provide effective interventions.
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Affiliation(s)
- Judy A. Stevens
- Judy A. Stevens, PhD, National Center for
Injury Prevention and Control, 4770 Buford Highway NE, Mailstop F-62, Atlanta,
GA 30341; e-mail:
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13
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Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System. Prehosp Disaster Med 2017; 33:29-35. [DOI: 10.1017/s1049023x1700704x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractIntroductionEarly recognition of an acute myocardial infarction (AMI) can increase the patient’s likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender.Hypothesis/ProblemNo studies currently exist that describe the EMD’s ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers.MethodsThe retrospective descriptive study utilized data from three sources: emergency medical dispatch, Emergency Medical Services (EMS), and emergency departments (EDs)/hospitals. The primary outcome measure was the distributions of AMI cases, as categorized by Chief Complaint Protocol, dispatch priority code and level, and patient age and gender. The EMS and ED/hospital data came from the Utah Department of Health (UDoH), Salt Lake City, Utah. Dispatch data came from two emergency communication centers covering the entirety of Salt Lake City and Salt Lake County, Utah.ResultsOverall, 89.9% of all the AMIs (n=606) were coded in one of the three highest dispatch priority levels, all of which call for ALS response (called CHARLIE, DELTA, and ECHO in the studied system). The percentage of AMIs significantly increased for patients aged 35 years and older, and varied significantly by gender, dispatch level, and chief complaint. A total of 85.7% of all deaths occurred among patients aged 55 years and older, and 88.9% of the deaths were handled in the ALS-recommended priority levels.ConclusionAcute myocardial infarctions may present as a variety of clinical symptoms, and the study findings demonstrated that more than one-half were identified as having chief complaints of Chest Pain or Breathing Problems at the dispatch point, followed by Sick Person and Unconscious/Fainting. The 35-year age cutoff for assignment to higher priority levels is strongly supported. The Falls and Sick Person Protocols offer opportunities to capture atypical AMI presentations.ClawsonJJ, GardettI, ScottG, FivazC, BarronT, BroadbentM, OlolaC. Hospital-confirmed acute myocardial infarction: prehospital identification using the Medical Priority Dispatch System. Prehosp Disaster Med. 2018;33(1):29–35.
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14
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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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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017; 136:e60-e122. [DOI: 10.1161/cir.0000000000000499] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | | | - David G. Benditt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mitchell I. Cohen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Daniel E. Forman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Blair P. Grubb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mohamed H. Hamdan
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Andrew D. Krahn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mark S. Link
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Satish R. Raj
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Roopinder Kaur Sandhu
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Dan Sorajja
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Benjamin C. Sun
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Clyde W. Yancy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
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Sharma PK, Bunker CH, Singh T, Ganguly E, Reddy PS, Newman AB, Cauley JA. Burden and Correlates of Falls among Rural Elders of South India: Mobility and Independent Living in Elders Study. Curr Gerontol Geriatr Res 2017; 2017:1290936. [PMID: 28694824 PMCID: PMC5485263 DOI: 10.1155/2017/1290936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/25/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022] Open
Abstract
AIM Falls are an important contributor to loss of function, morbidity, and mortality in elders. Little is known about falls in Indian populations. The objective of this cross-sectional report was to identify the prevalence and correlates of falls in a cohort of 562 rural southern Indian men and women. METHODS Risk factors included demographics, anthropometrics, self-reported health, medical history, physical function, vision, depression, and lifestyle. Odds ratios were calculated using logistic regression. RESULTS 71 (13%) subjects reported at least 1 fall in the past year. Prevalence was higher among women (17%) than men (8%), P = 0.003. Sex and age showed significant interaction (P = 0.04) whereby falls prevalence increased with age among women but decreased among men. Correlates of falls among men included a history of osteoarthritis (OA) (odds ratio (OR): 6.91; 95% CI: 1.4-33.1), depression (OR:9.6; 3.1-30.1), and greater height (OR per 1 standard deviation increase: 2.33; 1.1-5.1). Among women, poor physical performance (OR: 3.33; 1.13-9.86) and history of cardiovascular disease (CVD) (OR: 2.42; 1.01-5.80) were independently associated with falls. IMPLICATIONS Prevalence of falls in elderly South Indians was lower than published reports from western countries and likely reflects low exposure to fall risks. Patterns with age differed in men and women and may reflect sex differences in the accuracy of age recall. Presence of comorbidities specifically OA, CVD, and depression was independent correlate of falling.
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Affiliation(s)
| | - Clareann H. Bunker
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Tushar Singh
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Enakshi Ganguly
- SHARE India, MediCiti Institute of Medical Sciences, Telangana, India
| | - P. Sudhakar Reddy
- SHARE India, MediCiti Institute of Medical Sciences, Telangana, India
| | - Anne B. Newman
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jane A. Cauley
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
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18
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Pasqualetti G, Calsolaro V, Bini G, Dell’Agnello U, Tuccori M, Marino A, Capogrosso-Sansone A, Rafanelli M, Santini M, Orsitto E, Ungar A, Blandizzi C, Monzani F. Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope. Clin Interv Aging 2017; 12:687-695. [PMID: 28450779 PMCID: PMC5399985 DOI: 10.2147/cia.s127824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65-105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17-1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27-0.58], 0.40 [0.24-0.68], 0.35 [0.14-0.82], and 0.31 [0.20-0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07-5.90] and 1.24 [1.07-1.44], respectively). Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50-0.84], 0.52 [0.30-0.89], 0.40 [0.20-0.77], and 0.26 [0.13-0.55]), respectively. These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.
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Affiliation(s)
| | | | | | | | - Marco Tuccori
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Alessandra Marino
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Martina Rafanelli
- Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence
| | - Massimo Santini
- Emergency Department, University Hospital of Pisa, Pisa, Italy
| | - Eugenio Orsitto
- Emergency Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Ungar
- Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence
| | - Corrado Blandizzi
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 14:e155-e217. [PMID: 28286247 DOI: 10.1016/j.hrthm.2017.03.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/26/2022]
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20
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Blevins TC, Farooki A. Bone effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus. Postgrad Med 2016; 129:159-168. [DOI: 10.1080/00325481.2017.1256747] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Azeez Farooki
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Poi PJH, Chee KH, Imran ZA, Tan MP. Evaluation of Two New Indices of Blood Pressure Variability Using Postural Change in Older Fallers. Medicine (Baltimore) 2016; 95:e3614. [PMID: 27175670 PMCID: PMC4902512 DOI: 10.1097/md.0000000000003614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.
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Affiliation(s)
- Choon-Hian Goh
- From the Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya (C-HG, SBK, A-VC, PJHP, MPT), Department of Biomedical Engineering, Faculty of Engineering, University of Malaya (C-HG, S-CN), Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya (SBK, A-VC, PJHP, MPT), and Division of Cardiology, Department of Medicine (KHC, ZAI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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22
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Natan MB, Heyman N, Israel JB. Identifying Risk Factors for Elder Falls in Geriatric Rehabilitation in Israel. Rehabil Nurs 2016; 41:54-9. [DOI: 10.1002/rnj.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/10/2022]
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Alsubiheen A, Petrofsky J, Daher N, Lohman E, Balbas E. Effect of Tai Chi Exercise Combined with Mental Imagery Theory in Improving Balance in a Diabetic and Elderly Population. Med Sci Monit 2015; 21:3054-61. [PMID: 26454826 PMCID: PMC4603617 DOI: 10.12659/msm.894243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background One of the effects of diabetes mellitus (DM), peripheral neuropathy, affects the sensation in the feet and can increase the chance of falling. The purpose of the study was to investigate the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on improving balance in people with diabetes and an age matched control group. Material/Methods Seventeen healthy subjects and 12 diabetic sedentary subjects ranging from 40–80 years of age were recruited. All subjects in both groups attended a Yang style of TC class using MI strategies, 2 sessions a week for 8 weeks. Each session was one hour long. Measures were taken using a balance platform test, an Activities-specific Balance Confidence (ABC) Scale, a one leg standing test (OLS), functional reach test (FRT) and hemoglobin A1C. These measures were taken twice, pre and post-study, for both groups. Results Both groups experienced significant improvements in ABC, OLS, FRT (P<0.01) after completing 8 weeks of TC exercise with no significant improvement between groups. Subjects using the balance platform test demonstrated improvement in balance in all different tasks with no significant change between groups. There was no significant change in HbA1C for the diabetic group. Conclusions All results showed an improvement in balance in the diabetic and the control groups; however, no significant difference between the groups was observed. Since the DM group had more problems with balance impairment at baseline than the control, the diabetic group showed the most benefit from the TC exercise.
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Affiliation(s)
| | - Jerrold Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, CA, USA
| | - Noha Daher
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Everett Lohman
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Edward Balbas
- Physical Medicine and Rehabilitation, Pain Management, Hoag Hospital, Newport Beach, CA, USA
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Zia A, Kamaruzzaman SB, Tan MP. Blood pressure lowering therapy in older people: Does it really cause postural hypotension or falls? Postgrad Med 2015; 127:186-93. [DOI: 10.1080/00325481.2015.996505] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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López-Soto PJ, Manfredini R, Smolensky MH, Rodríguez-Borrego MA. 24-hour pattern of falls in hospitalized and long-term care institutionalized elderly persons: A systematic review of the published literature. Chronobiol Int 2014; 32:548-56. [DOI: 10.3109/07420528.2014.987295] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bauman CA, Milligan JD, Patel T, Pritchard S, Labreche T, Dillon-Martin S, Ilich A, Riva JJ. Community-based falls prevention: lessons from an Interprofessional Mobility Clinic. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:300-11. [PMID: 25202159 PMCID: PMC4139769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Falls are a common and serious risk with an aging population. Chiropractors commonly see firsthand the effects of falls and resulting injuries in their senior patients and they can reduce falls risk through active screening. Ongoing research has provided proven approaches for making falls less likely. Screening for falls should be done yearly for all patients 65 years and older or in those with a predisposing medical condition. Additional specific falls prevention professional education would enable the chiropractor to best assist these patients. Collaboration and communication with the patient's family physician offers an opportunity for improved interprofessional dialogue to enhance patient care related to falls risk. Frequently falls prevention strategies are implemented by an interprofessional team. Chiropractors increasingly contribute within multidisciplinary teams. Collaboration by the chiropractor requires both simple screening and knowledge of health care system navigation. Such awareness can permit optimal participation in the care of their patient and the best outcome.
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Affiliation(s)
- Craig A. Bauman
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - James D. Milligan
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - Tejal Patel
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Sarah Pritchard
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - Tammy Labreche
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario
| | | | - Alexandra Ilich
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - John J. Riva
- Department of Family Medicine, McMaster University, Hamilton, Ontario
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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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An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT). BMC Geriatr 2014; 14:78. [PMID: 24951180 PMCID: PMC4080753 DOI: 10.1186/1471-2318-14-78] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults. Methods Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life. Discussion Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community. Trial registration ISRCTN11674947
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Martínez P, Pilar Sáez M, Rubio JA, Cánovas E, Esteban E, Botas J. [Experience with the use of an implantable loop recorder in a series of older people with falls and suspected arrhythmic syncopes]. Rev Esp Geriatr Gerontol 2014; 49:121-124. [PMID: 24548525 DOI: 10.1016/j.regg.2013.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/18/2013] [Accepted: 07/22/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To review our experience on using an implantable loop recorder (ILR) in patients with recurrent falls, when an arrhythmogenic cause is suspected. MATERIAL AND METHODS This is a retrospective, observational study of patients with repetitive unexplained falls, suspected syncope, or electrocardiographic abnormalities. All of them had been evaluated by a cardiologist, who decided to implant a loop recorder (ILR) for an accurate diagnosis. RESULTS A total of 13 patients received an ILR. The average falls rate for the sample was 3.3. The mean age was 78 years, and 46% were female, with a mean follow-up period of 24 months. During this time, three patients did not suffer from a new fall. An arrhythmogenic diagnosis was obtained in 5 patients: bradycardia was identified in 4 cases, and tachycardia in one of them. The symptoms did not coincide with a documented arrhythmia in the rest of the patients. CONCLUSION ILR is a helpful tool to establish an arrhythmogenic cause of unexplained and recurrent falls, in this selected sample of older adults.
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Affiliation(s)
- Paula Martínez
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - José Amador Rubio
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - Ester Cánovas
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Elena Esteban
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Javier Botas
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Stevens JA, Rudd RA. Circumstances and contributing causes of fall deaths among persons aged 65 and older: United States, 2010. J Am Geriatr Soc 2014; 62:470-5. [PMID: 24617970 DOI: 10.1111/jgs.12702] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine whether the increasing fall death rate among people aged 65 and older is due in part to temporal changes in recording the underlying cause of death. DESIGN Analyses of multiple cause of death data using the online Centers for Disease Control and Prevention Wide-ranging ON-line Data for Epidemiologic Research system, which uses the National Center for Health Statistics' Multiple Cause of Death data set. SETTING United States, 1999 to 2010. PARTICIPANTS People aged 65 and older with a fall listed on their death record as the underlying or a contributing cause of death. MEASUREMENTS Circumstances and contributing causes off all deaths--records listing International Classification of Diseases, Tenth Revision, codes W00 to W19 as the underlying cause of death--and underlying causes for records with falls as a contributing cause were examined. Joinpoint regression analysis was used to assess trends in the proportion of fall and fall-associated deaths to total deaths for 1999 to 2010. RESULTS In 2010, there were 21,649 fall deaths and 5,402 fall-associated deaths among people aged 65 and older; 48.7% of fall deaths involved a head injury. Approximately half the fall death records included diseases of the circulatory system as contributing causes. From 1999 to 2010, there was a trend toward more-specific reporting of falls circumstances, although total deaths remained unchanged. The proportion of fall deaths to total deaths increased 114.3%, and that of fall-associated deaths to total deaths increased 43.1%. CONCLUSION The reasons behind the increasing older adult fall death rate deserve further investigation. Possible contributing factors include changing trends in underlying chronic diseases and better reporting of falls as the underlying cause of death.
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Affiliation(s)
- Judy A Stevens
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
A rapid change in ageing demographic is taking place worldwide such that healthcare professionals are increasingly treating old and very old patients. Syncope in the elderly is a challenging presentation that is under-recognised, particularly in the acute care setting. The reason for this is that presentation in the older person may be atypical: patients are less likely to have a prodrome, may have amnesia for loss of consciousness and events are frequently unwitnessed. The older patient thus may present with a fall rather than transient loss of consciousness. There is an increased susceptibility to syncope with advancing age attributed to age-related physiological impairments in heart rate and blood pressure, and alterations in cerebral blood flow. Multi-morbidity and polypharmacy in these complex patients increases susceptibility to syncope. Cardiac causes and more than one possible cause are also common. Syncope is a major cause of morbidity and mortality and is associated with enormous personal and wider health economic costs. In view of this, prompt assessment and early targeted intervention are recommended. The purpose of this article is to update the reader regarding the presentation and management of syncope in this rapidly changing demographic.
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Affiliation(s)
- Helen O' Brien
- Department of Medical Gerontology, TCIN, St James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Department of Medical Gerontology, TCIN, St James's Hospital, Dublin, Ireland
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McMahon CG, Kenny RA, Bennett K, Bouamra O, Lecky F. Diurnal variation in mortality in older nocturnal fallers. Age Ageing 2012; 41:29-35. [PMID: 21914664 DOI: 10.1093/ageing/afr119] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of older trauma patients is rising in Westernised populations. Age has an independent adverse affect on survival from injury. Factors contributing to this increased mortality are incompletely understood. OBJECTIVE To examine the independent effects of age, time and mechanism of injury on survival from trauma at 30 days. METHODS We analysed prospectively collected data from the Trauma Audit and Research Network database. Isolated femoral neck and pubic rami fractures are not included in this data set. Univariate and multivariate regression analyses were undertaken. Independent effects of age, time of injury and mechanism of injury on survival following trauma were evaluated. RESULTS A total of 137,521 trauma patients were included in the study. Trauma victims aged over 65 years had increased odds of death of 9.58 (95% CI: 8.78-10.45), adjusting for known confounders of outcome. Analysis of two-way interactions of age and time of arrival to hospital, revealed patients ≥65 years had a higher odds of death if they presented between midnight and 8 a.m., compared with 08:00-16:00 h; OR = 1.5, (95% CI: 1.29-1.73). Further analysis of this older group, examining the interaction of time and mechanism of injury, revealed a doubling of the odds of death in patients injured following a fall <2 m, when they presented between midnight and 8 a.m.; OR = 2.1, (95% CI: 1.32-3.30). This diurnal variation in mortality was exclusive to older fallers. CONCLUSIONS Age over 65 years has an independent detrimental affect on survival from trauma. A distinct diurnal variation in mortality from injury occurs in older patients injured as a result of a low velocity fall.
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O'Dwyer C, Bennett K, Langan Y, Fan CW, Kenny RA. Amnesia for loss of consciousness is common in vasovagal syncope. Europace 2011; 13:1040-5. [DOI: 10.1093/europace/eur069] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Petrofsky JS, Focil N, Prowse M, Kim Y, Berk L, Bains G, Lee S. Autonomic stress and balance--the impact of age and diabetes. Diabetes Technol Ther 2010; 12:475-81. [PMID: 20470232 DOI: 10.1089/dia.2009.0125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Balance is impaired in the elderly and people with diabetes. However, the effect of attempted balance on the autonomic nervous system has not been investigated. METHODS Ten control subjects, 10 subjects with type 2 diabetes (age range, 21-75 years), and 10 older subjects age-matched to the subjects with diabetes were examined to determine the effect of diabetes and age on balance and the associated autonomic stress. Subjects were asked to stand on a balance platform for 1-min periods under four conditions: (1) quiet standing, (2) quiet standing with eyes closed, (3) quiet standing eyes closed with the platform allowed to move side to side over a central pivot that allows the edge of the platform to rotate 4 inches up and down, and (4) the same platform with eyes closed. Blood pressure, electrocardiogram, and sway were recorded. RESULTS Balance was worst in the subjects with diabetes, while the cardiovascular stress, as assessed by both heart rate and blood pressure, was greatest in the older group of subjects. But subjects with diabetes, while having a greater blood pressure response to the stress induced by balance, showed a poor heart rate response, probably due to diabetes-induced autonomic damage. CONCLUSION Autonomic damage in the subjects with diabetes masked much of the stress of the inability to optimize balance in this population.
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Affiliation(s)
- Jerrold Scott Petrofsky
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California 92350, USA.
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Jakovljevic M. Predictive validity of a modified fall assessment tool in nursing homes: Experience from Slovenia. Nurs Health Sci 2009; 11:430-5. [DOI: 10.1111/j.1442-2018.2009.00471.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Petrofsky JS, Lohman E, Lohman T. A device to evaluate motor and autonomic impairment. Med Eng Phys 2009; 31:705-12. [PMID: 19251462 DOI: 10.1016/j.medengphy.2009.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 01/26/2009] [Accepted: 01/28/2009] [Indexed: 10/21/2022]
Abstract
Various devices have been developed to assess impairment of the autonomic nervous system, while other devices have been developed to evaluate the motor system. However, no devices have been developed to examine the interaction between the autonomic and somatic nervous systems. Therefore, the device described here, a square platform which was 0.7x0.7 m in length and 0.1m thick, was developed to examine somatic-autonomic interaction. The device can be used by placing it directly on the floor or on 1 of 2 pivots; one that allowed the platform to move 0.2m (+/-44.1 degrees) in the front to back or side to side direction and one that allowed both movements together. Strain gauge load cells in the platform measured sway and tremor during the subjects attempt to balance and a continuous blood pressure monitor and the ECG were used to assess the response of the autonomic nervous system (heart rate variability). The device was tested on 5 normal subjects and the following was evaluated: (1) sway during standing, (2) weight shift during standing, (3) frequency of sway and extent of sway during standing, (4) sympathetic and parasympathetic alterations in the ANS during attempted balance, and (5) phase delays between motor and autonomic responses. The results showed that, with increasing balance challenge, sway increased, tremor increased, the sway angle increased and sway was positively correlated with heart rate and negatively correlated with blood pressure. A balance challenge significantly increased sympathetic activity but not parasympathetic activity. This device should have useful applications in assessing motor impairments and sensory and autonomic impairments in a variety of conditions.
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Affiliation(s)
- Jerrold S Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, CA 92350, USA.
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