Association Between Sleep Quality and Falls: A Nationwide Population-Based Study from South Korea

Utilizing machine learning to identify fall predictors in India's aging population: findings from the LASI

BACKGROUND

Depression has a detrimental effect on an individual's mental and musculoskeletal strength multiplying the risk of fall incidents. The current study aims to investigate the association between depression and falls in older adults using machine learning (ML) approach and identify its various predictors.

METHODS

Data for the study was derived from the Longitudinal Ageing Study in India, (LASI) conducted in 2017-18 for people aged 45-years and above. The study was carried out on 44,066 individuals. Depression was measured using the CIDI-SF scale. Bivariate cross-tabulations were used to study the prevalence of falls. And its association with depression and other independent factors were assessed using the novel ML, the Conditional inference trees (CIT) method.

RESULTS

Around 10.8 percent of older adults had fall incidents. CIT model predicted region to be a significant predisposing factor for an older adult to experience falls. Multimorbidity, depression, sleep problems, and gender were other prominent factors. The model predicted that, among depressed older adults, falls incidents were around 80 percent higher than non-depressed.

CONCLUSIONS

An association between falls and depression was observed. Depressive symptoms were associated with an increased risk of falls, even after controlling for other co-factors. The CIT method leveraged us to select the most important variables to predict falls with great precision. To prevent and manage falls among the expanding and diverse older-aged population, a multilevel and cross-sectoral approach is required. Mental health, especially depression, should be dealt with greater precautions. Public health enthusiasts should focus on the physical as well as mental health of the country's older adult population.

Melatonin: A Review of the Evidence for Use in Hospital Settings

New onset insomnia is often experienced by patients during hospitalization due to environmental disruptions, pain and increased patient care activities. Patient distress arising from poor sleep quality and quantity often results in the prescribing of hypnotics. Melatonin use in hospital settings is common and is increasingly used for off label indications including primary insomnia in those aged < 55 years, prevention of delirium and to facilitate benzodiazepine discontinuation. A literature review was conducted to evaluate the efficacy, effectiveness, safety, tolerability, and cost-effectiveness of melatonin for various off-label indications in inpatient hospital settings. The review found limited high quality evidence demonstrating a clinically meaningful benefit from melatonin in improving sleep, delirium, or facilitating benzodiazepine discontinuation in the inpatient setting. Study findings were inconsistent, and those that did show statistical improvement were of uncertain clinical benefit. The review also found a paucity of data on the safety of melatonin when used in hospitalized patients, and no evidence to support cost-effectiveness. Non-pharmacological interventions are recommended as first-line treatment of insomnia and for the prevention of delirium in inpatient settings. The use of interventions without evidence for efficacy or effectiveness is contrary to the quality use of medicines principles in Australia's National Medicines Policy. Context-specific evidence on the efficacy and effectiveness of a medicine should guide clinician decision-making and prescribing, to improve the quality use of medicines.

Empowering Fall Prevention Through Integrated Lifestyle Medicine Strategies-From Recognition of Fall Risks to Implementation of Prevention of Falls for all in Practice

Falls remain the leading cause of unintentional injuries across all age groups, prompting many emergency room visits. The annual estimated cost associated with falls is believed to exceed 100 billion dollars. In addressing this trend, health professional team members emerge as key players and can assume a crucial role in bridging the gap between lifestyle medicine and fall prevention. By imparting strategies aligned with the 6 pillars of lifestyle medicine, these professionals can educate individuals on risk factors, assess fall risk, and offer activities to mitigate the likelihood of future falls. This collaborative approach empowers all to take immediate and informed action, fostering a proactive stance against the prevalent issue of fall-related injuries. Through the background and practical strategies described in this paper, health professionals of various disciplines will have access to tools and knowledge to enhance their role in preventing falls using the lens of lifestyle medicine.

The relationship between social relationships and sleep quality in older adults: Loneliness as a mediator and cognitive status as a moderator

OBJECTIVES

This study investigates the complex relationships among social support, social strain, loneliness, cognitive status, and sleep quality in adults aged 51 and above. It aims to explore loneliness as a mediator between social support, social strain, and sleep quality and to examine if, and how, the mediating effect differs by cognitive status.

METHODS

Eight years of data from the University of Michigan Health and Retirement Study were analyzed using a cross-lagged panel model. Moderated mediation analyses examined loneliness's mediating effect and cognitive status's moderating influence on the associations among social support, social strain, and sleep quality.

RESULTS

Loneliness mediated the relationships between social support, social strain, and sleep quality. Individuals with better cognitive function experienced an increased influence of social support on sleep quality by mitigating loneliness.

CONCLUSION

Considering the moderating role of cognitive status, sleep interventions individualized and tailored to these differences become essential.

Demographic, socioconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India

BACKGROUND

Recent research has revealed that today's older adults report more sleep problems than their predecessors, a trend compounded by expanding social stratification. As such, this study examined the demographic, socioeconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India.

METHODS

The current study sample draws on data from 7118 respondents aged 50 years and over participating in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) wave-2 dataset. Sleep quality (good, moderate, and poor) and sleep duration (in hours and minutes) were self-reported. Adjusted multivariable logistic regression models were employed to examine the associations between sleep quality and sleep duration and several demographic, socioeconomic, and health indicators.

RESULTS

A total of 12.84% and 36.1% of older adults reported long (> 8 h) and short (< 7 h) sleep, respectively. Older adults with primary education had lower odds of poor sleep [aOR: 0.85, CI: 0.73-0.99] than peers with no formal education. The odds of poor sleep were lower among those in higher wealth quintiles than those in the poorest quintile. Older adults with higher education had higher odds of short sleep [aOR: 1.36, CI: 1.06-1.74], and those with primary education had lower odds of long sleep [aOR: 0.70, CI: 0.54-0.91] than those without formal education (base category: age-appropriate sleep, i.e., 7-8 h). Older adults who were widowed had lower odds of both short [aOR: 0.82, CI: 0.68-0.98] and long sleep [aOR:0.74, CI: 0.58-0.95] compared to those who were currently married. Older individuals with adequate nutritional intake reported lower odds of short [aOR:0.59, CI: 0.49-0.72] and higher odds of long sleep [aOR:1.52, CI: 1.20-1.93] relative to their counterparts. Older adults who reported chronic conditions and body pain had higher odds of poor sleep and short sleep than their counterparts.

CONCLUSIONS

We identified significant associations between several unmodifiable factors, including age, education, and marital status, and modifiable factors such as dietary intake, body pain, and pre-existing chronic ailments, and sleep quality and sleep duration. Our findings can assist health care providers and practitioners in developing a more holistic and empathic approach to care. Moreover, that several demographic, socioeconomic, and health-related factors are consequential for older adults' sleep health suggests that early detection through screening programs and community-based interventions is vital to improving sleep among older Indians who are most susceptible to sleep problems.

Efficacy of Mind-body Exercise to Reduce Sleep Disturbance and Depression Among Older Adults: A Systematic Review and Meta-analysis

PURPOSE

Mind-body exercise is a promising non-pharmacological approach for managing sleep disturbance and depression that are prevalent among older adults, but its efficacy remains inconclusive across the studies. This study aimed to systematically evaluate and quantify the overall effectiveness of mind-body exercises on sleep disturbance and depression in older adults.

METHODS

We searched eight databases to identify relevant articles from their inception to April 2024. Experimental studies that evaluate the effects of mind-body movement therapy on sleep disturbance and depression in older adults were included. The Cochrane Risk of Bias tool version 2.0 was used to appraise included studies. The pairwise meta-analysis was performed through the software Comprehensive Meta-Analysis Version 3.0. Moreover, subgroup analysis was utilized to understand the effect size on each form of mind-body exercise and to determine the source of heterogeneity.

RESULTS

A total of 27 studies were eligible and synthesized. The mind-body exercise appears statistically significant in reducing sleep disturbance (SMD = -0.60, 95% CI: 0.76 ∼ 0.44) and depression (SMD = -0.56, 95% CI: 0.75 ∼ 0.36) among older adults. Each form of mind-body exercise, including pilates, yoga, qigong, and tai-chi, effectively decreases sleep disturbance and depression, but there were no significant differences in the effects between these practices.

CONCLUSION

The cumulative evidence concludes that older adults who participated in mind-body exercise programs showed potential improvements in sleep disturbance and depression. This finding may serve as evidence for professionals to use this approach as a non-pharmacological approach to help older adults in the community and long-term care facilities who are having sleep disturbance and depression. More clinical trials are needed for an in-depth meta-analysis that can rank and compare the efficacy of each mind-body exercise practice.

Sleep quality and falls in middle-aged and older adults: ELSI-Brazil study

OBJECTIVE

To verify the association between low self-reported sleep quality (LSQ) and fall in middle-aged and older adults every half-decade of life.

METHOD

A cross-sectional study was conducted using data from the first wave (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is nationally representative. The sample consisted of 8,950 participants who were allocated into eight age groups: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥ 85 years. The questionnaires used included self-reported sleep quality and the International Physical Activity Questionnaire short version. Fisher's exact test followed by binary logistic regression analysis was performed to identify the odds ratio of sleep quality for fall occurrence, controlled for confounding variables.

RESULTS

Individuals aged 50-105 years (63.6 ± 10.2 years), 57.0% females and 43.0% males, participated in this study. Overall, 21.5% of participants experienced at least one fall. The relative frequency of participants classified as having high or LSQ remained constant across each half-decade of life. The LSQ exhibited a statistically significant OR (p < 0.05) for falls across age groups up to 84, even after accounting for confounding variables.

CONCLUSION

LSQ is significantly associated with an increased occurrence of fall in adults aged >50 years, but not for ≥ 85 years regardless of sex and physical activity level.

Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015

BACKGROUND

Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India.

METHODS

Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses.

RESULTS

Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085).

CONCLUSION

That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

The Associations Between Depression, Regular Exercises, and Falls Among the CommunityDwelling Older People

The aim of this study was to explore the relationship between regular exercise, depression, and fall among the community older people to find out the predictors of fall. This study applied cross-sectional and correlational study design. The study recruited 285 community older people by using the questionnaires which included social-demographic data, regular exercise, depression, and whether fall history questionnaires were used in this study. The mean score of the depression scale for older people was 3.47 (SD 2.92). People who took anti-hypertensive or anti-diabetes drugs have higher risks of falls than those who did not (B = 1.659; p < .001; Exp (B) = 5.256). Community-dwelling older people with regular exercise have a lower risk of falls than those without (B = -1.485; p < .001; Exp(B) = 0.227). Rehabilitation programs designed to improve both the older people's physical function and mental health played very important roles in preventing falls. It is necessary to undergo depression screening programs for the community older people in order to detect older people depression in advance and prevent the incidence of falls.

The combination of locomotive syndrome and poor sleep quality is a risk factor of falls among community-dwelling middle-aged and older women: A cross-sectional study

AIM

The combination of locomotive syndrome (LS) and poor sleep quality (PQ) has not yet been shown to result in falls or to affect bone conditions in old age and middle age. [Correction added on 1 December 2023, after first online publication: The preceding sentence has been updated for clarity.] METHODS: This cross-sectional study enrolled 2233 community-dwelling middle-aged to older Japanese women. LS and PSQ were assessed by the stand-up test, two-step test, the 25-question Geriatric Locomotive Function Scale, and the Pittsburgh Sleep Quality Index (PSQI). Participants with both LS 1-3 (any) and a PSQI score ≥6 were classified as belonging to the LS(+)/PSQ(+) group. The incidence of falls in the previous month was collected using a self-administered questionnaire. Bone conditions were evaluated using an ultrasonic bone densitometer.

RESULTS

The LS(+)/PSQ(+) group independently had a higher risk of falls after adjusting for confounding factors than the LS(-)/PSQ(-) group using multiple logistic regression analysis (odds ratio 1.92, 95% confidence interval 1.01-3.65, P < 0.05). No relationships between LS(-)/PSQ(+) and LS(+)/PSQ(-) groups and the incidences of fall were observed (P > 0.05). [Correction added on 1 December 2023, after first online publication: The two preceding sentences have been corrected to provide greater clarity.] The LS(+)/PSQ(+) group had lower trabecular bone density and cortical bone thickness than the LS(-)/PSQ(-) group (P < 0.05).

CONCLUSION

The combination of LS and PSQ is an independent risk factor of falls, indicating that assessing both LS and PSQ could be useful in detecting middle-aged and older women with low bone density and thickness who fall easily at an early stage. Geriatr Gerontol Int 2023; 23: 912-918.

Fall risk in older adults hospitalized with tumours: Contributing factors and prediction model

AIM

Rates vary widely across hospitals globally and typically range from 3 to 11 falls per 1000 bed days and as 7-11 in Affiliated Hospital of Nantong University. This study determined to explore contributing factors and poor prognosis of fall in elderly tumour patients in China.

DESIGN

A cross-sectional study.

METHODS

161 older adults were invited to participate in this study and completed a self-reported questionnaire, took blood tests, and received the exam of musculoskeletal ultrasound.

RESULTS

Among 161 patients, falls occurred in 41 cases, accounting for 24.8%. 51.6% of older adults suffered from intermediate-to-high risk of falls. Fall history, reduced self-care ability, sleep disturbance, hearing impairment, hyperkyphosis, chronic disease, platelet count, and the thickness of left muscle rectus femoris (LF-MLT), and left cross-sectional area (LF-CSA) were all contributing factors of fall, and higher risk of fall indicating lower quality of life. A fall prediction model was established in this study based on above contributing factors with good prediction efficiency (AUC = 0.920).

PATIENT OR PUBLIC CONTRIBUTION

The patient volunteers participated in this study and provided valuable data for the final analysis and the acquisition of conclusion.

Association between cognitive frailty and falls among older community dwellers in China: A Chinese longitudinal healthy longevity survey-based study

Background

The combined effect of cognitive impairment (CoI) and frailty on falls is controversial. This study aimed to explore whether older adults with cognitive frailty (CF) were at a higher risk of falls than those with only CoI or frailty and to present a fall prediction model based on CF.

Methods

A total of 4,067 adults aged ≥ 60 years were included from the Chinese Longitudinal Healthy Longevity Survey through face-to-face interviews. Cognitive function and frailty were assessed using the mini-mental state examination scale and frailty index, respectively. Logistic regression was used to determine fall-associated risk factors and develop a fall prediction model. A nomogram was then plotted. The model performance was evaluated using the area under the curve (AUC), concordance index (C-index), and calibration curve. All analyses were performed using SPSS and R statistical packages.

Results

The prevalence of CF and falls were 1.4 and 19.4%, respectively. After adjusting for covariates, the odds ratio of CF, frailty only, and CoI only for falls were 2.27 (95% CI: 1.29-3.97), 1.41 (95% CI: 1.16-1.73), and 0.99 (95% CI: 0.43-2.29), respectively. CF, sex, age, hearing difficulty, depression, anxiety, disability in instrumental activities of daily living, and serious illness in the past 2 years were independently associated with falls. A prediction model based on these factors yielded an AUC of 0.646 and a C-index of 0.641.

Conclusion

Cognitive frailty (CF) exerted a cumulative effect on falls than did CoI or frailty alone. Joint assessments of cognitive function and frailty status may be beneficial for fall risk screening in community. A prediction model using CF as a factor could be helpful for this process.

Visual impairment and falls among older adults and elderly: evidence from longitudinal study of ageing in India

BACKGROUND

The present study determines the prevalence and correlates of falls, multiple falls, and injuries, focusing on visual impairment among the older adult and elderly population in India. Additionally, owing to the higher prevalence of falls and visual impairment among women, a sex-stratified analysis has also been done in the present study.

METHODS

The study utilized the data from the first wave of the Longitudinal Ageing Study in India (LASI wave-1), conducted during 2017-2018. Bivariate with chi-square and multivariate analyses were performed to fulfill the objective.

RESULTS

Around 34% of population had low vision (male:30% and female: 38%), while blindness prevalence was 1.63% (males: 1.88% and females: 1.41%). The fall was higher among females and increased across the gender with increasing visual impairment and blindness levels. The unadjusted odds of falls were 16% higher among individuals with low vision and 40% higher among individuals with blindness than with normal vision, and comparatively higher odds among females than males.

CONCLUSION

In summary, falls and visual impairment is public health challenge and needs to be addressed. Visual impairment is preventable in most cases, so it may be a modifiable target for reducing the risk of falls.

Prevalence of sleep-related problems and risks in a community-dwelling older adult population: a cross-sectional survey-based study

Background

Despite evidence of adverse health consequences of inadequate restorative sleep for older adults, assessment of sleep quantity, quality, and use of sleep aids is not routinely done. We aimed to characterize sleep problems, sleep risks, and advice received about sleep in a community-dwelling older adult population, overall and in subgroups with health conditions and functional difficulties.

Methods

This cross-sectional study used weighted self-report data for 5074 Kaiser Permanente Northern California members aged 65-79y who responded to a 2017 or 2020 Member Health Survey. We estimated usual amount of sleep (< 6, 6 to < 7, ≥7 hours) and prevalence of sleep problems (frequent insomnia, frequent daytime fatigue, poor quality sleep, and potential sleep apnea (OSA) symptoms (frequent very loud snoring, apnea episodes)) for older adults overall, by self-rated health, and in subgroups reporting hypertension, diabetes, heart disease, frequent problems with balance/walking, and frequent memory problems. We also estimated percentages who regularly used sleep aids and had discussed sleep adequacy with a healthcare professional in the past year.

Results

Approximately 30% of older adults usually got less than the recommended ≥7 hours sleep per day, and 9% experienced frequent daytime fatigue, 13% frequent insomnia, 18% frequent insomnia/poor quality sleep, and 8% potential OSA symptoms. Prevalence of frequent insomnia was higher among women than men (16% vs. 11%). Higher percentages of those in fair/poor health and those with frequent balance/walking and memory problems reported sleeping < 6 hours per day and having all four types of sleep problems. Nearly 20% of all older adults (22% of women vs. 17% of men) and 45% of those with frequent insomnia (no sex difference) reported regular sleep aid use. Only 10% of older adults reported discussing sleep with a healthcare professional whereas > 20% reported discussing diet and exercise.

Conclusions

Large percentages of older adults experience sleep problems or get less sleep than recommended for optimal sleep health. Older patients should routinely be assessed on multiple components of sleep health (sleep hygiene, quantity, quality, problems, and sleep aid use) and educated about sleep hygiene and the importance of getting adequate restorative sleep for their overall health and wellbeing.

Falls Among Older Adults During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study in Vietnam

Purpose

We aimed to investigate the prevalence and factors associated with falls in older adult outpatients during the coronavirus disease (COVID-19) pandemic in Vietnam.

Patients and Methods

From February 2022 to June 2022, this cross-sectional study included 814 patients (aged ≥60 years; mean age 71.8 ± 7.3 years; women, 65.2%) attending three geriatric clinics for a comprehensive geriatric assessment. Self-reported fall events in the past 12 months and post-COVID-19 falls were assessed. Factors associated with falls were determined using logistic regression analysis.

Results

In total, 188 patients (23.1%) had falls (single fall, 75.5%; recurrent falls, 24.5%). The most frequent location, time, and circumstance of falls were the bedroom (43.1%), morning (54.3%), and dizziness (34.6%), respectively. Most patients experienced health issues after falls (bruise/grazes, 53.7%; fracture, 12.8%; immobility, 9.6%; hospital admission, 14.9%). In the adjusted model, factors associated with falls were being underweight (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.37–4.56, P = 0.003), limitations in instrumental activities of daily living (OR 2.03, 95% CI 1.05–3.95, P = 0.036), poor sleep quality (OR 1.83, 95% CI 1.10–3.05, P = 0.020), and fear of falling (OR 3.45, 95% CI 2.23–5.33, P <0.001). Among 357 COVID-19 infected patients, post-COVID-19 falls occurred in 35 patients (9.8%) and were associated with fear of falling (OR 3.14, 95% CI 1.18–8.40, P = 0.023) and post-COVID-19 lower limb weakness (OR 2.55, 95% CI 1.07–6.10, P = 0.035).

Conclusion

Our study found a substantial prevalence of falls among older outpatients during the COVID-19 pandemic in Vietnam. Management of factors associated with falls may be needed to reduce the burden of falls in the older population.

Gender-Specific Association Between Nighttime Sleep Duration and Falls Among Community-Dwelling Middle-Aged and Older Adults in China

This study was conducted using the data from 2015 China Health and Retirement Longitudinal Study (CHARLS). Gender-specific association between nighttime sleep duration (NSD) and falls were evaluated through multiple logistic regression by adjusting for confounding variables. Of the 22,899 respondents, 18,446 were eligible and 3,144 (16.99%) had more than a single fall. Short and long NSD were associated with high occurrences of falls in the total and female population, but only a short NSD was associated with a high occurrence of falls in the male population. In conclusion, NSD was strongly and significantly associated with falls, but the association was gender-specific. Accordingly, increasing targeted, evidence-based and gender-specific preventions for NSD and sleep disturbance are necessary among primary care interventions to prevent falls.