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Chippendale T, Bakhsh HR, Alhaizan NA, Bin Sheeha BH. Assessment of Park Paths and Trails for Physical Activity Promotion among Older Adults in Saudi Arabia: Feasibility and Future Directions. Healthcare (Basel) 2024; 12:1572. [PMID: 39201131 PMCID: PMC11353773 DOI: 10.3390/healthcare12161572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Chronic diseases affect more than 80% of older adults. One modifiable risk factor for secondary prevention is physical activity. Public parks are an essential resource for physical activity, but environmental features may limit participation. Our aims were (1) to assess the feasibility and utility of the Path Environment Audit Tool (PEAT) for use in a larger-scale study focused on older adults and (2) to examine the physical activity-promoting features of five public parks. METHODS A descriptive study design was used to assess five public parks in Riyadh, Saudi Arabia, from April to June 2022. Additionally, process, resource, and management assessments were also conducted. RESULTS The PEAT was easy to use, but additions are recommended to increase relevance to older adults with chronic disease. Descriptive analyses revealed positive features, such as adequate lighting, but other features such as path slope were more variable. CONCLUSIONS Study findings can guide the future use of the PEAT for older adult participants and inform environmental modifications.
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Affiliation(s)
- Tracy Chippendale
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, 82 Washington Square East, 6th Floor, New York, NY 10003, USA;
| | - Hadeel R. Bakhsh
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (N.A.A.); (B.H.B.S.)
| | - Najat A. Alhaizan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (N.A.A.); (B.H.B.S.)
| | - Bodor H. Bin Sheeha
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (N.A.A.); (B.H.B.S.)
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Guerra S, Ellmers T, Turabi R, Law M, Chauhan A, Milton-Cole R, Godfrey E, Sheehan KJ. Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review. Eur Geriatr Med 2024; 15:305-332. [PMID: 38418713 PMCID: PMC10997732 DOI: 10.1007/s41999-024-00936-9] [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: 09/04/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. METHODS A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. RESULTS We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. CONCLUSION These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.
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Affiliation(s)
- Stefanny Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK.
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
| | - Toby Ellmers
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Ruqayyah Turabi
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Magda Law
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Aishwarya Chauhan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Emma Godfrey
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
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Li S, Cui G, Er Y, Ye P, Xue T, Zhang J(J, Liu X, Duan L, Lv F, Yao Y. Housing Environmental Factors Driving Falls Among Middle-Aged and Older Adults: A National Cohort Study. Innov Aging 2023; 7:igad121. [PMID: 38106373 PMCID: PMC10724174 DOI: 10.1093/geroni/igad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Indexed: 12/19/2023] Open
Abstract
Background and Objectives Housing is one of the main places where falls occur; however, few studies have examined housing environmental factors driving fall risk. This study aimed to explore the associations between housing environmental factors and falls in China. Research Design and Methods The study included data of middle-aged and older adults aged ≥45 years from 4 waves of the China Health and Retirement Longitudinal Study. We assessed 7 housing environmental factors: building materials, toilet types, household tidiness, household cooking fuels, and access to electricity, running water, and bathing facilities. Based on these, we divided housing environments into 3 types: good (0-2 poor factors), moderate (3-5 poor factors), and poor (6-7 poor factors). Falls incidence (yes or no) was self-reported during the survey period. We applied the Cox proportional hazard model to estimate the associations, adjusting for a set of covariates such as sociodemographic characteristics, lifestyles, and disease status. Results A total of 12,382 participants were analyzed, and the incidence of falls was 31.7%. According to the fully adjusted model, having a squatting toilet (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.03-1.26), household untidiness (HR = 1.09, 95% CI = 1.01-1.18), and solid fuel use for cooking (HR = 1.10, 95% CI = 1.02-1.18) were associated with a higher risk of falls (ps < .05), compared to their counterparts. We found a linear relationship between housing environments and falls (p for trend = .001). Specifically, moderate (HR = 1.16, 95% CI = 1.06-1.27) and poor housing environments (HR = 1.21, 95% CI = 1.08-1.34) were associated with a higher risk of falls compared to a good housing environment. Discussion and Implications Among middle-aged and older Chinese adults, a better household environment, including sitting toilets, tidy living conditions, and clean fuel use for cooking, may reduce the risk of falls. The evidence from our study suggests the need to implement age-friendly housing environments to prevent falls and disability in an aging society.
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Affiliation(s)
- Shaojie Li
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Guanghui Cui
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital, Beijing, China
| | - Yuliang Er
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pengpeng Ye
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Xue
- School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Junfeng (Jim) Zhang
- Global Health Institute and the Nicholas School of Environment, Duke University, Durham, North Carolina, USA
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Leilei Duan
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Faqin Lv
- Ultrasonic Department, The Third Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Chippendale T, Albert SM, Mahmood A. Efficacy of the Stroll Safe Outdoor Fall Prevention Program: A Randomized Controlled Trial. THE GERONTOLOGIST 2023; 63:1556-1565. [PMID: 36148513 DOI: 10.1093/geront/gnac145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Outdoor falls can negatively affect the independence and well-being of community-dwelling older adults. Although there is some overlap, there are also differences in risk factors for indoor and outdoor falls. There are no existing community-based fall prevention programs that specifically target outdoor fall prevention. To fill this gap, the Stroll Safe program was developed. RESEARCH DESIGN AND METHODS A cluster-randomized controlled trial design was used with randomization at the site level. Participants (N = 86) were aged 60 and older, with a history of an outdoor fall or who had a fear of falling outdoors. Eight naturally occurring retirement community program sites were randomly assigned to the treatment or wait list control group. Outcome measures included the Outdoor Falls Questionnaire, the Falls Behavioral Scale for the Older Person, and the Falls Efficacy Scale-International to examine knowledge of risks, safe strategy use, protective behaviors, and fear of falling. An Analysis of Covariance (ANCOVA) was used to compare change scores between groups with covariates included for any initial differences between groups. A linear mixed model was also conducted to account for any clustering effects. RESULTS Significant differences (ps < .05) were found between groups for knowledge of outdoor fall risks and safe strategy use. Effect sizes were large (Cohen's d = 1.2-1.9). Results were retained at 6-week follow-up. DISCUSSION AND IMPLICATIONS Stroll Safe is effective in improving knowledge of outdoor fall risks and increasing safe strategy use for community mobility. Stroll Safe fills a gap in outdoor fall prevention programs. Clinical Trials Registration Number: NCT03624777.
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Affiliation(s)
- Tracy Chippendale
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York City, New York, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Atiya Mahmood
- Gerontology Department, Simon Fraser University, Vancouver, British Columbia, Canada
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Alanazi A, Salih S. Fall Prevalence and Associated Risk Factors Among the Elderly Population in Tabuk City, Saudi Arabia: A Cross-Sectional Study 2023. Cureus 2023; 15:e45317. [PMID: 37846272 PMCID: PMC10577021 DOI: 10.7759/cureus.45317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Background Falls are common among older adults, and they constitute a major public health issue with high morbidity and mortality. Aim This study aimed to estimate the prevalence of falls and investigate the contributing risk factors among the elderly population in Tabuk City, Saudi Arabia. Methods This cross-sectional study recruited a random representative sample of the elderly aged ≥ 60 years. We collected data by interviewing the participants using a structured, Arabic-language questionnaire. It included personal information, a history of falls in the past three and 12 months, comorbidities, and environmental factors. The main outcome was a history of falls in the preceding year. Multivariable logistic regression was used to evaluate the association between potential risk factors and falls. Results The study included 296 participants. Most participants were female (66.9%), aged 60-69 years (68.2%), and married (68.9%). The self-reported prevalence of falls over the preceding 12 months was 25.3% (95% confidence interval (CI): 20.6-30.5). Older people with depressive symptoms had significantly increased vulnerability to falls (adjusted odds ratio (AOR): 0.452, 95% CI: 0.239-0.854). Environmental factors were associated with a 1.799 times (95% CI: 1.041-3.109) increased likelihood of fall, and gait impairment was the strongest risk factor (AOR: 2.775, 95% CI: 1.558-4.942). Conclusions Falls are common among the elderly population in Tabuk City, Saudi Arabia. Gait impairment, the presence of depressive symptoms, and environmental hazards were substantially associated with falls, suggesting that most falls are preventable.
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Affiliation(s)
- Abdallalh Alanazi
- Preventive Medicine Department, Public Health Administration, Tabuk, SAU
| | - Safa Salih
- Preventive Medicine Department, Public Health Administration, Tabuk, SAU
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Wende ME, Lohman MC, Friedman DB, McLain AC, LaMonte MJ, Whitsel EA, Shadyab AH, Garcia L, Chrisinger BW, Pan K, Bird CE, Sarto GE, Kaczynski AT. Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative. Womens Health Issues 2023; 33:443-458. [PMID: 37149415 PMCID: PMC10330171 DOI: 10.1016/j.whi.2023.03.009] [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: 06/28/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence. METHODS The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships. RESULTS NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling. CONCLUSIONS Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.
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Affiliation(s)
- Marilyn E Wende
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Michael J LaMonte
- Deparment of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health and Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, California
| | - Benjamin W Chrisinger
- Department of Social Policy and Intervention, Division of Social Sciences, University of Oxford, Oxford, UK
| | - Kathy Pan
- Department of Medical Oncology and Hematology, Downey Medical Center, Kaiser Permanente, Downey, California
| | - Chloe E Bird
- RAND Corporation, Santa Monica, California; Center for Health Equity Research, Tufts Medical Center, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Gloria E Sarto
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Lee H, Lim JH. Living Alone, Environmental Hazards, and Falls Among U.S. Older Adults. Innov Aging 2023; 7:igad055. [PMID: 37583969 PMCID: PMC10424630 DOI: 10.1093/geroni/igad055] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Indexed: 08/17/2023] Open
Abstract
Background and Objectives Physical conditions of living environments can affect the incidence of falls; however, prior work has focused typically on 1 domain at a time-either neighborhood or home, capturing limited environmental boundaries of older adults. We examined how neighborhood together with the home environment affect the incidence of falls over time and whether living arrangement modifies the influence of the environmental risks on falls. Research Design and Methods Using the 2012-2020 waves of the Health and Retirement Study (HRS; N = 1,893), we fitted logistic regression to estimate the incidence of falls over an 8-year study period. We used the neighborhood and housing data that are collected systematically by trained observers in the HRS to assess environmental hazards. Sidewalk quality, neighborhood disorder, and the presence of green space were measured to capture outdoor environmental hazards. Indoor environmental hazards included the presence of housing decay and poorly maintained stairways. All models were stratified by living arrangement. Results Neighborhood and housing environment were independently associated with the odds of falls net of demographic characteristics and preexisting health conditions, and effects were significant for people living alone only. The presence of green space and poorly maintained stairways were associated with greater odds of falling, net of covariates during 8 years of follow-up (odds ratios = 2.10 and 2.65, p < .05, respectively). None of the environmental risk factors were significant for those living with others. Discussion and Implications Falls in old age may be determined in part by a combination of outdoor and indoor risk factors. More research is needed to understand pathways that lead to greater vulnerability among older adults living alone to environmental hazards.
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Affiliation(s)
- Haena Lee
- Department of Sociology, Sungkyunkwan University, Seoul, South Korea
| | - Justin H Lim
- Graduate School of Environmental Studies, Seoul National University, Seoul, South Korea
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Kwon HJ, Oh J. Comparing Older Parents' and Adult Children's Fear of Falling and Perceptions of Age-Friendly Home Modification: An Integration of the Theories of Planned Behavior and Protection Motivation. Behav Sci (Basel) 2023; 13:bs13050403. [PMID: 37232640 DOI: 10.3390/bs13050403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
This study investigated how a fear of falling affects perceptions and behavioral intentions toward age-friendly home modification (AFHM) in older parents and adult children by integrating the theory of planned behavior (TPB) to explain AFHM decision-making processes and the protection motivation theory to explain the impact of a fear of falling on AFHM intention. The target population comprised older parents (≥75 years old) and adult children (45-64 years old) in Busan, South Korea (N = 600). The participants completed a self-administered questionnaire in March 2022. Independent t-test and path model analyses were conducted to compare primary constructs between older parents and adult children and analyze the relationships among a fear of falling, TPB components, and AFHM intention. Results showed that both groups had positive attitudes toward AFHM. However, adult children showed significantly higher rates of having a fear of falling, lower perceived behavioral control, and higher AFHM intention than older parents. The proposed research models were partially supported in the older-parent group and fully supported in the adult-children group. Adult children play a critical role in AFHM, along with older adults who are directly involved in an aging society. AFHM-supporting programs, including monetary and human-force assistance, education, related public advertisements, and an active AFHM market, should be expanded.
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Affiliation(s)
- Hyun Joo Kwon
- Department of Interior & Environmental Design, Pusan National University, Busan 46241, Republic of Korea
| | - Jiyoung Oh
- Research Institute of Ecology, Pusan National University, Busan 46241, Republic of Korea
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Chippendale T, Chen SW. The Stroll Safe outdoor falls prevention program: Participant experiences in eight community sites. Arch Gerontol Geriatr 2023; 108:104926. [PMID: 36641881 DOI: 10.1016/j.archger.2023.104926] [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: 11/28/2022] [Revised: 12/16/2022] [Accepted: 01/08/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Outdoor falls can negatively impact the quality of life of community-dwelling older adults. Although there are differences in risk factors for indoor and outdoor falls, none of the existing evidence-based fall prevention programs specifically targets outdoors falls. To fill this gap, the Stroll Safe program was developed. The purpose of this study was to explore participant's experiences in the Stroll Safe program RESEARCH DESIGN AND METHODS: In this qualitative study, we conducted focus groups at eight community program sites with Stroll Safe program participants. Thematic analysis, with both deductive and inductive coding were used. Researcher triangulation was employed to increase trustworthiness of the findings RESULTS: Four major themes emerged from the data, including (1) Precipitants of behavioral change, (2) Behavioral change, (3) Program design, and 4) Enjoyment of program experience. Several sub-themes were also uncovered DISCUSSION AND IMPLICATIONS: Although the qualitative findings are consistent with the quantitative findings from the efficacy trial, the results also reveal benefits that were not captured by the quantitative analysis. In addition, the findings related to the influence of the group leader and program design can be used to guide future implementation science studies.
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Affiliation(s)
- Tracy Chippendale
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, 82 Washington Square East, 6th floor, New York, NY 10003, United States.
| | - Szu-Wei Chen
- Program in Occupational Therapy, Washington University School of Medicine, United States
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Sheth S, Cogle CR. Home Modifications for Older Adults: A Systematic Review. J Appl Gerontol 2023; 42:1151-1164. [PMID: 36655622 DOI: 10.1177/07334648231151669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
While ≧10,000 Americans turn 65 years old every day, only 10% of American homes are "aging ready." Unsafe homes can exacerbate disability, lead to falls, and increase the likelihood of hospitalization. With increased investments in home and community-based services, public health stakeholders are considering home modifications to promote successful aging. While several home modification models exist, there is significant heterogeneity between models and no consensus on critical features. PubMed, EMBASE, and Web of Science were reviewed and twelve randomized controlled trials of home modifications for older adults were identified and evaluated for model structure, reported outcomes, and risk of bias. Overall, occupational therapist-driven home modifications supplemented with clinical, physical activity, and/or behavioral components saw the greatest success. This systematic review discusses the components of these models, highlights particularly effective and frequently used features, and the practice and research needed to create effective next-generation home modification models which promote healthy longevity.
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Affiliation(s)
- Sohum Sheth
- College of Medicine, 12233University of Florida, Gainesville, FL, USA
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Lohman MC, Fallahi A, Mishio Bawa E, Wei J, Merchant AT. Social Mediators of the Association Between Depression and Falls Among Older Adults. J Aging Health 2023:8982643231152276. [PMID: 36633960 DOI: 10.1177/08982643231152276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the role of social factors in the association between depression and falls among older adults. METHODS The sample included data from 3443 older adults from three waves of the Health and Retirement Study (2010-2014). A Lifestyle Questionnaire was used to measure social engagement, social network contact, and neighborhood social context. Mediating effects of social factors were estimated through causal mediation analysis. Results: Poorer social engagement and network contact were associated with greater likelihood of falls, while poorer neighborhood context was associated with greater likelihood of fall injuries. Social engagement mediated a significant portion of the effect of depression on falls (OR: 1.03, 95% CI: 1.00, 1.06), and neighborhood context mediated a portion of the effect of depression on fall injuries (OR: 1.03, 95% CI: 1.00, 1.07). Discussion: The direct and indirect impacts of social factors suggest that considering them may help improve existing fall prevention approaches.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Afsaneh Fallahi
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Eric Mishio Bawa
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
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12
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Perceived neighbourhood environment and falls among community-dwelling adults: cross-sectional and prospective findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). Eur J Ageing 2022; 19:1121-1134. [PMID: 36692742 PMCID: PMC9729615 DOI: 10.1007/s10433-022-00685-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 01/26/2023] Open
Abstract
We investigated the association between perceived neighbourhood characteristics and falls in community-dwelling adults, using data from Wave 5 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). We included 25,467 participants aged 50 to 103 years (mean age 66.2 ± 9.6, 58.5% women), from fourteen European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Israel, Italy, Luxembourg, Slovenia, Spain, Sweden, Switzerland). At baseline, we recorded individual-level factors (socio-demographic, socio-economic and clinical factors), contextual-level factors (country, urban versus rural area, European region) and perceived neighbourhood characteristics (vandalism or crime, cleanliness, feeling part of neighbourhood, helpful neighbours, accessibility to services) for each participant. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The associations between neighbourhood characteristics and falls were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. Participants reporting-versus not reporting-vandalism or crime had an increased falls risk of 1.16 (1.02-1.31) at follow-up, after full adjustment; lack of cleanliness, feeling part of the neighbourhood, perceiving neighbours as helpful and difficult accessibility to services were not associated with falls. Vandalism or crime was consistently associated with increased falls risks in women, adults without functional impairment and urban areas residents. In conclusion, adverse neighbourhood environments may account for inequality in falls risk among middle-aged and older adults and could be added to fall risk stratification tools. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-022-00685-3.
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Cheng GJ, Nicklett EJ. Racial and Ethnic Differences in the Relationship Between Neighborhood Environment and Physical Activity Among Middle-Aged and Older Adults. J Aging Health 2022; 34:1163-1177. [PMID: 35603774 PMCID: PMC10790400 DOI: 10.1177/08982643221103359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Objectives:To examine the associations between neighborhood environment-perceived neighborhood social cohesion and perceived neighborhood physical environment-and physical activity (PA) and whether these associations differ by race/ethnicity. Methods: We analyzed data from the Health and Retirement Study, a longitudinal study of US adults aged 50+ from 2006 to 2014 (N = 17,974), using multivariate mixed-effects linear models. PA was repeatedly measured using metabolic equivalent of task estimated values accounting for the vigor and frequency of self-reported PA. Results: In multivariate models, higher levels of PA were positively associated with higher rated neighborhood social cohesion and neighborhood physical environment scores. The effects of social cohesion were stronger among non-Hispanic Whites than among non-Hispanic Black and Hispanic/Latinx participants, while race/ethnicity did not moderate the association between PA and physical environment. Discussion: Intervention strategies that address social and physical barriers of neighborhoods could promote PA in older adults. Key implications for future research are discussed.
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Affiliation(s)
- Greta Jianjia Cheng
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Emily J. Nicklett
- Department of Social Work, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, US
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A qualitative investigation exploring neighbourhood environment, risks and fear of falling, and fall prevention strategies among urban-dwelling older adults in a high-density city. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
Falls in older adulthood can have serious consequences. It is therefore important to identify ways to prevent falls, particularly from the voice of older adults. Bottom-up qualitative exploration of the perspectives of older adults can provide rich insights that can help inform the development of effective fall prevention programmes. However, currently there is a dearth of such empirical data, especially among urban-dwelling older adults in high-density cities where fall rates are high. The current study aimed to examine qualitatively perceptions of neighbourhood physical environment in relation to falls, perceived risks and fear of falling, and strategies and behaviours for fall prevention in a sample of urban-dwelling older adults in the high-density city of Hong Kong. Face-to-face semi-structured in-depth interviews were conducted with 50 community-dwelling older adults. Interviews were transcribed verbatim and analysed using thematic analysis techniques. Five general themes were revealed: risks and circumstances of falls, consequences of falls, fear of falling and its consequences, neighbourhood environment, and strategies and behaviours of fall prevention. While older adults discussed the risks of falling and held a fear of falling, these beliefs were mixed. In addition to fall prevention strategies (e.g. keep balance), current findings highlighted the importance of establishing protective factors (e.g. flat and even walking paths) and reducing risk factors (e.g. neighbourhood clutter) in neighbourhood environments. For urban-dwelling older adults in high-density cities, current findings highlight the importance of focusing efforts at the built environment level in addition to strategies and behaviours of fall prevention at the individual level.
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Kim YS, Yao Y, Lee SW, Veronese N, Ma SJ, Park YH, Ju SY. Association of frailty with fall events in older adults: A 12-year longitudinal study in Korea. Arch Gerontol Geriatr 2022; 102:104747. [PMID: 35700558 DOI: 10.1016/j.archger.2022.104747] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence has shown that frailty is associated with the risk of falls in older people. However, the components of frailty that have the highest association with fall events are largely unknown. METHODS This study analyzed panel data from the Korean Longitudinal Study of Aging. We used the Korean Frailty Instrument, which includes domains for social isolation, exhaustion and weakness estimated by grip strength, to assess frailty. Fall event data were collected during follow-up visits. RESULTS A total of 3122 community-dwelling adults aged 65 years or older were included at baseline in 2006 and were followed up every 2 years until 2018. The participants with frailty had a higher risk of falls than those without frailty (OR=1.31, 95% CI=1.11-1.54, P = 0.001; fully adjusted model). We found that three components of frailty, namely, social isolation, exhaustion, and weakness, were independently and significantly related to fall events in the unadjusted model. In the fully adjusted model, social isolation and exhaustion were significantly associated with fall events (OR=1.38, 95% CI=1.18-1.61, P < 0.001 and OR=1.28, 95% CI=1.10-1.51, P = 0.006, respectively), and there was no significant association between weakness and the risk of falls (OR=1.11, 95% CI=0.91-1.34, P = 0.307). CONCLUSIONS AND IMPLICATIONS Frailty was associated with more fall events in Korean older adults. Social isolation and exhaustion but not weakness were significantly associated with fall events. Our study suggests that interventions should be tailored to older adults with social and psychological frailty.
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Affiliation(s)
- Young-Sang Kim
- Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
| | - So-Won Lee
- Department of Social Welfare, Catholic University of Korea, Bucheon, Republic of Korea
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; Chair for Biomarkers of Chronic Diseases, King Saud University, Saudi Arabia
| | - Soo-Jin Ma
- Department of Family Medicine, Veterans Health Service Medical Center, Department of Hospital Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Hee Park
- Department of Nursing, Daejeon Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sang-Yhun Ju
- Department of Family Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Family Medicine, Seongnam Central Hospital, Seongnam, Republic of Korea.
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16
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Jung S, Tak SH. Factors of Functional Disability in the Social Participation of Older Adults Living Alone With Fall Experience. J Appl Gerontol 2022; 41:2197-2204. [DOI: 10.1177/07334648221104791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The fall experiences of older adults living alone lead to restrictions in their social participation. This study aimed to examine the factors that influence functional disability in social participation (FSP) among older adults who live alone and have experienced falls. This study used secondary data of 493 older adults living alone who experienced a fall, which were collected from the 2017 National Survey of Older Koreans. Multiple linear regression analyses were performed. Factors, such as old age, sex, economic status, frequency of drinking, and number of acquaintances, significantly related to functional disability in terms of social participation. In addition, poor muscle strength, depression, and cognitive decline comprised predictors of FSP. The findings of this study revealed that it is important to comprehensively evaluate the social participation of older adults who live alone and have experienced falls.
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Affiliation(s)
- SuJung Jung
- Department of Nursing, College of Healthcare & Biotechnology, Semyung UniversityJecheon, South Korea
| | - Sunghee H. Tak
- The Research Institute of Nursing Science, College of Nursing, Seoul National UniversitySeoul, South Korea
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17
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Chronic pain as a moderator between fear of falling and poor physical performance among community-dwelling older adults. Geriatr Nurs 2022; 45:140-146. [DOI: 10.1016/j.gerinurse.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
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de Souza Moreira B, Cristina de Souza Andrade A, Xavier CC, Proietti FA, Braga LDS, Friche AADL, Teixeira Caiaffa W. Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:522-534. [PMID: 32568556 DOI: 10.1080/09603123.2020.1782354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.
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Affiliation(s)
- Bruno de Souza Moreira
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Luciana de Souza Braga
- Department of Preventive and Social Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amélia Augusta de Lima Friche
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Waleska Teixeira Caiaffa
- Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte (OSUBH), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Lee S. Falls associated with indoor and outdoor environmental hazards among community-dwelling older adults between men and women. BMC Geriatr 2021; 21:547. [PMID: 34641812 PMCID: PMC8507100 DOI: 10.1186/s12877-021-02499-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hazardous environmental exposures are recognized risk factors for falls among older adults. However, the gender differences in the associations of falls with indoor and outdoor environmental hazards are scarce. This study examined the indoor and outdoor environmental risk factors for falls and compared the data for men and women among U.S. older adults using nationally representative data. METHODS We used the 2011 National Health and Aging Trends Study (NHATS) for a cross-sectional analysis of 6680 community-dwelling adults aged ≥65 years in the United States. A series of logistic regressions was used to identify the indoor and outdoor environmental hazards associated with falls stratified by gender after adjusting for sociodemographic, health, and behaviors. We also tested for significant interactions with gender. RESULTS Compared to men, women had a higher prevalence of falls. In the model adjusted for sociodemographic, health, and behavioral conditions, there were gender differences in the association of falls with the presence of indoor and outdoor environmental hazards. Gender-specific analyses showed that women with the presence of indoor environmental hazards (OR = 1.37, 95% CI = 1.04.-1.79) had higher odds of falls, whereas for men, the presence of outdoor environmental hazards (OR = 1.34, 95% CI = 1.02-1.75) was associated with falls. We also found a significant interaction term between outdoor environmental hazards and gender (OR = 0.65, 95% CI = 0.47-0.90). The interaction plot indicated that the presence of outdoor environmental hazards increased the risks of falling in men but not in women. CONCLUSIONS Significant gender differences exist in the association of falls with indoor and outdoor environmental hazards among older men and women. Our findings suggest that gender-tailored prevention programs to increase awareness of the environmental hazards and gender-specific environmental interventions are needed to help prevent falls.
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Affiliation(s)
- Sungmin Lee
- Department of Landscape Architecture and Urban Planning, Texas A&M University, 3137 TAMU, College Station, TX, 77840, USA.
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20
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Okoye SM, Samuel LJ, Fabius C, Mulcahy J, Reider L, Szanton SL, Wolff JL. Home and Neighborhood Context of Falls Among Black and White Older Americans. J Aging Health 2021; 33:721-731. [PMID: 33877940 PMCID: PMC8416780 DOI: 10.1177/08982643211009436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To examine social and physical environmental fall-risk factors in a nationally representative sample of community-living older adults overall and by racial group. Methods: We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study (n = 5581) linked to census tract measures from the American Community Survey. Recurrent falls are defined as 2+ self-reported falls over 12 months. Results: Older adults with recurrent falls were more likely to have lower education, lower income, financial hardship, live in homes with disorder and disrepair and in neighborhoods without sidewalks, with high social deprivation, and in nonmetropolitan counties. Home disrepair, lack of sidewalks, and residence in a nonmetropolitan county were important fall-risk factors among White older adults only. Financial hardship was an important risk factor among Black older adults. Discussion: Environmental factors are associated with recurrent falls among older Americans and should be incorporated into fall-risk profiles and prevention efforts.
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Affiliation(s)
- Safiyyah M. Okoye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura J. Samuel
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Chanee Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John Mulcahy
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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21
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Seo Y, Kim M, Shin H, Won C. Perceived Neighborhood Environment Associated with Sarcopenia in Urban-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6292. [PMID: 34200703 PMCID: PMC8296063 DOI: 10.3390/ijerph18126292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
Sarcopenia is associated with adverse health outcomes among older individuals. However, little is known about its association with neighborhood environmental factors. We explored the relationship between sarcopenia and perceived neighborhood environmental factors among community-dwelling older adults aged 70-84 years. We analyzed 1778 participants (mean age of 75.9 ± 3.8 years; 54.0% women) who lived in urban areas and underwent dual-energy X-ray absorptiometry from the Korean Frailty and Aging Cohort Study. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 definition. Perceived neighborhood environmental factors were assessed using the Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). In the multivariate analysis, compared to the fifth quintile of the IPAQ-E score, the odds ratios (ORs) and 95% confidence intervals (CIs) for sarcopenia in the first, second, third, and fourth quintiles were 2.13 (1.40-3.24), 1.72 (1.12-2.64), 1.75 (1.15-2.66), and 1.62 (1.06-2.47), respectively. These neighborhood environmental characteristics were linked with an increased likelihood of sarcopenia: no public transportation access (OR = 2.04; 95% CI = 1.19-3.48), poor recreational facilities access (OR = 1.39; 95% CI = 1.01-1.90), absence of destination (OR = 1.53; 95% CI = 1.06-2.20), many hill hazards (OR = 1.36; 95% CI = 1.03-1.78), and lack of traffic safety (OR = 1.35; 95% CI = 1.02-1.78). Thus, better neighborhood environmental strategies may help prevent sarcopenia among urban-dwelling older adults.
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Affiliation(s)
- Yuri Seo
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul 02447, Korea; (Y.S.); (H.S.)
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, College of Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Hyungeun Shin
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul 02447, Korea; (Y.S.); (H.S.)
| | - Changwon Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul 02447, Korea
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22
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Pan C, Wang C, Shrestha B, Wang P. 3-D health trajectories and related childhood predictors among older adults in China. Sci Rep 2021; 11:9874. [PMID: 33972630 PMCID: PMC8110566 DOI: 10.1038/s41598-021-89354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to identify the multi-trajectories of 3-D health of older adults in China and to explore whether the childhood predictors are associated with 3-D health trajectory. Data came from five waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011 to 2018). A multi-trajectory modeling approach was carried out to jointly estimate the trajectories of 3-D health. A multinomial regression model was used to investigate the relationships between childhood predictors and the joint trajectories. We identified three typical joint 3-D health trajectories. Female, childhood health, maternal and paternal educations, childhood friendships, family and neighborhood predictors could all affect 3-D health trajectories of older adults directly or indirectly through adult variables. The 3-D health trajectories showed increasing trends, thus the government should perform more interventions toward the childhood predictors for better health of older adults.
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Affiliation(s)
- Chaoping Pan
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan City, 430071, Hubei Province, China
| | - Cen Wang
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan City, 430071, Hubei Province, China
| | - Bhawana Shrestha
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan City, 430071, Hubei Province, China
| | - Peigang Wang
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan City, 430071, Hubei Province, China.
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Is the self-perception of the built neighborhood associated with fear of falling in community-dwelling older adults? Arch Gerontol Geriatr 2021; 95:104395. [PMID: 33765655 DOI: 10.1016/j.archger.2021.104395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Characteristics of a built neighborhood may aggravate agravett to fear of falling in older adults and this knowledge are important to contribute to developing strategies aimed at reducing fear of falling and their consequences. OBJECTIVE To verify the association between self-perception of built neighborhood characteristics and fear of falling in community-dwelling older adults. MATERIALS AND METHODS This was a cross-sectional study including 308 community-dwelling older adults. The outcome was fear of falling evaluated through Falls Efficacy Scale International. Older adults were classified with high fear of falling when they obtained values ≥ 23 points and classified as low fear of falling with score < 23 point. The built neighborhood variables were evaluated by the adapted Neighborhood Environment Walkability Scale. Multivariable logistic regression was performed to verify associations between the variables. RESULTS The prevalence of fear of falling was 48.40%. Significant negative associations were observed between residing near a bus stop, outdoor gyms, safe places to walk during the day, and positive associations between garbage accumulation and/or open sewers and high crime rates and fear of falling. CONCLUSION The association between self-perceived characteristics of built neighborhoods and fear of falling points to the need for improvements in urban infrastructure, especially public spaces, in order to reduce fear of falling in community-dwelling older adults.
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Falls and life-space mobility: longitudinal analysis from The International Mobility in Aging Study. Aging Clin Exp Res 2021; 33:303-310. [PMID: 32270408 DOI: 10.1007/s40520-020-01540-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate a 4-year longitudinal relationship between falls, recurrent falls, and injurious falls, according to different levels of life-space mobility (LSM). METHODS Longitudinal analysis of an international cohort study. The participants were older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline. Three waves of data (2012, 2014, 2016) were used. Fall history during the past year was recorded. Recurrent fallers were identified as those who fell at least twice and injurious fallers as participants who required medical attention. LSM measurements included Total Life-Space (LS-C), Maximal Life-Space (LS-M), Assisted Life-Space (LS-A), Independent Life-Space (LS-I) and Restricted Life-space (LS-ID) scores. Generalized estimation equation (GEE) models were used to determine whether life-space mobility measures and their change over time differed between recurrence of falls and injurious falls. RESULTS At baseline, the prevalence of falls in the last year was 28%. 11.8% reported recurrent falls and 2.6% had serious injurious falls in the last year preceding the assessments. Recurrent fallers were more likely to be female, with insufficient income and, with comorbidities. GEE models showed that life-space mobility was lower among those with recurrent falls or serious injurious falls compared to those who never fell, but the rate of change did not differ over the 4-year follow-up except for the LS-A and LS-I scores, where some improvements were observed over time. CONCLUSIONS AND IMPLICATIONS Falls were independently associated with a decrease in LSM over 4 years. Targeting older adults with recurrent and injurious falls with appropriate interventions may improve community mobility and social participation.
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"Enticing" but Not Necessarily a "Space Designed for Me": Experiences of Urban Park Use by Older Adults with Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020552. [PMID: 33440760 PMCID: PMC7827794 DOI: 10.3390/ijerph18020552] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
Urban parks are spaces that can enhance older adults’ physical, social and psychological wellbeing. As the prevalence of older adults with disability increases, it is important that urban parks are accessible to this population so that they too might gain health benefits. There is limited literature investigating the experiences of urban parks by older adults with disability. This qualitative study, set in a region of New Zealand, explored the experiences, including accessibility, of urban parks by 17 older adults (55 years and older) with self-reported disabilities. Three focus groups (n = 4, 5 and 4 people) and four individual interviews were undertaken. Data were analyzed using the General Inductive Approach. Two primary themes of “Enticing” and “Park use considerations” are presented. Urban parks and green spaces are perceived to provide an environment for older adults with a disability to improve their physical, psychosocial and spiritual health, and social connectedness. Parks that are not age, ability or culture diverse are uninviting and exclusive. Meaningful collaboration between park designers, city councils and people with disability is required to maximize the public health benefits of parks and make parks inviting and accessible for users of all ages, cultures and abilities. Park co-design with people with disability may provide one means of improving accessibility and park usability and thus park participation by older adults with disability.
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Qian XX, Chau PH, Kwan CW, Lou VWQ, Leung AYM, Ho M, Fong DYT, Chi I. Investigating Risk Factors for Falls among Community-Dwelling Older Adults According to WHO's Risk Factor Model for Falls. J Nutr Health Aging 2021; 25:425-432. [PMID: 33786558 DOI: 10.1007/s12603-020-1539-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The World Health Organization developed the Risk Factor Model for Falls to describe fall risks in a comprehensive manner. However, there was a lack of study adopting such framework in quantifying falls risk from different factors in a single model. Therefore, this study examined the risk factors from four domains in the Risk Factor Model for Falls among older adults. DESIGN Secondary data analysis of 10-year assessment records of the Minimum Data Set-Home Care instrument. SETTING Hong Kong. PARTICIPANTS 89,100 community-dwelling adults aged 65 and over who first applied for publicly funded long-term care services from 2005 to 2014. MEASUREMENTS The Minimum Data Set-Home Care instrument was used to ascertain older adults' care needs and match them with appropriate services. Additionally, meteorological records from the same period were extracted from the Hong Kong Observatory. The logistic regression model was used to examine risk factors and their associations with falls. RESULTS In total 70 factors were included in the analysis, of which 37 were significantly associated with falls. Behavioral risk factors generally had greater odds ratios of falling, as compared with biological, socioeconomic, and environmental factors. Out of all significant factors, functional status, alcohol drinking, and locomotion outdoors had the largest odds ratios of falling. CONCLUSION Behavioral risk factors for falls are of remarkable influence yet are modifiable among older adults. Hence, falls prevention programs may need to prioritize addressing these factors.
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Affiliation(s)
- X X Qian
- Pui Hing Chau, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, Tel: (+852) 3917 6626,
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27
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Lin YC, Chang YH. Poor Appetite and Eating Difficulties Can Predict the Long-Term Risk of Falling: A Longitudinal Study in Middle-Aged and Older Adults. J Appl Gerontol 2020; 40:1465-1474. [PMID: 33267709 DOI: 10.1177/0733464820976439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study investigates whether self-reported nutritional status affects falling among middle-aged and older adults. METHOD We used 8-year follow-up data from the Taiwan Longitudinal Study on Aging. At baseline, respondents' appetite, changes in amount of food intake, and eating difficulties were assessed in a questionnaire-based survey in addition to anthropometric measurements (body mass index, mid-arm circumferences, and involuntary body weight loss). Their associations with falls in the follow-up were examined using multivariable log-binomial regression. RESULTS The study included 2,519 respondents aged 50 years and older. Poor appetite (prevalence ratio [PR] = 1.25, 95% confidence interval [CI] = [1.07, 1.46]) and eating difficulties (PR = 1.16, 95% CI = [1.02, 1.32]) significantly predicted falling 8 years later with adjustments for sociodemographics, health behaviors, comorbidities, and anthropometric measures by taking into account probabilities of follow-up. CONCLUSION Poor appetite and eating difficulties can predict falling in the long-term independent of anthropometric measurements among middle-aged and older adults.
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Affiliation(s)
- Yu-Chun Lin
- China Medical University Hospital, Taichung City, Taiwan
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28
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Seo Y, Kim M, Shim H, Won CW. Differences in the Association of Neighborhood Environment With Physical Frailty Between Urban and Rural Older Adults: The Korean Frailty and Aging Cohort Study (KFACS). J Am Med Dir Assoc 2020; 22:590-597.e1. [PMID: 33221166 DOI: 10.1016/j.jamda.2020.09.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We examined the difference in the relationship between perceived neighborhood environments and physical frailty between urban and rural older adults. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Urban and rural community in South Korea; a total of 2593 community-dwelling older adults aged 70-84 years (mean age: 76.0 years, 51.0% women) in the Korean Frailty and Aging Cohort Study (KFACS). METHODS The neighborhood environment was assessed using the 17-item Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). The IPAQ-E had 7 environmental factors (residential density, access to destinations, neighborhood infrastructure, neighborhood safety, social environment, aesthetic qualities, and street connectivity). Physical frailty was defined using the Fried frailty criteria with modified cutoffs. RESULTS The number of participants residing in urban and rural areas was 1902 and 691, respectively. The prevalence of frailty was 5.3% and 12.0% in urban and rural areas, respectively. In urban areas, frailty was associated with the total IPAQ-E score (β = -0.007, P = .009) after adjusting for confounding factors. There was no association in the rural areas (β = -0.003, P = .535). In urban older adults, logistic regression showed that absence of destination [odds ratio (OR) 2.58, 95% confidence interval (CI) 1.36-4.90] and no crime safety at night (OR 2.00, 95% CI 1.12-3.57) were associated with a higher risk of frailty. In rural older adults, poor access to recreational facilities (OR 2.17, 95% CI 1.07-4.40) and no aesthetics (OR 2.49, 95% CI 1.22-5.10) were associated with frailty. CONCLUSIONS AND IMPLICATIONS Our study indicated that the presence of destination and crime safety at night was significantly associated with physical frailty among older adults living in urban areas, whereas aesthetics and recreational facilities were significantly associated with physical frailty in rural older adults.
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Affiliation(s)
- Yuri Seo
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea.
| | - Hayoung Shim
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Canan Outdoor Multisurface Terrain Enhance the Effects of Fall Prevention Exercise in Older Adults? A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197023. [PMID: 32992927 PMCID: PMC7579330 DOI: 10.3390/ijerph17197023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
Walking on complex surface conditions in outdoor environments is important for active aging. This study aimed at examining whether fall prevention exercise integrated with an outdoor multisurface terrain compared with indoor solid ground was more beneficial for older adults. Twenty-two older nursing home residents were randomly assigned to outdoor multisurface terrain (n = 11, 79.5 ± 2.1 years) or indoor solid ground (n = 11, 78.8 ± 5.2 years) groups. Training occurred five times per week (30 min) for 3 weeks. The following performance test outcomes were measured: 10 m walk test (10 mWT), multisurface terrain walk test (MTWT), 2 min walk test (2 MWT), timed up and go test (TUGT), single-leg standing test with eyes open (SLSTEO), single-leg standing test with eyes closed (SLSTEC), and closed cycles test (CCT). Compared with baseline, the outdoor multisurface terrain training significantly improved performance in all tests (p < 0.01). The improvements of the outdoor multisurface terrain group after intervention were significantly higher than those of the indoor solid group in the 10 mWT (p = 0.049), MTWT (p = 0.02), and 2 MWT (p = 0.000). Exercise combined with outdoor multisurface terrain training may be an efficacious approach and a feasible environmental intervention for fall prevention in older adults.
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Akande-Sholabi W, Ogundipe FS, Adebusoye LA. Medications and the risk of falls among older people in a geriatric centre in Nigeria: a cross-sectional study. Int J Clin Pharm 2020; 43:236-245. [PMID: 32910373 DOI: 10.1007/s11096-020-01140-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
Abstract
Background Falls are a major cause of morbidity and hospitalization in older people. Many drugs have been shown to increase the risk of falls in this population. Few empirical data exist on the use of fall-risk-increasing drugs among older people of sub-Saharan Africa countries. Objective This study aimed to assess the prevalence and predictors of falls, and the association between FRIDs, drugs causing orthostatic hypotension and falls. Setting Geriatric center, University College Hospital, Ibadan, Nigeria. Methods A cross-sectional study of 400 older patients aged ≥ 60 years selected consecutively at the geriatric centre, between September and November 2019, were interviewed using a semi-structured questionnaire. Socio-demographic information, medication utilization, and history of falls were obtained. Bivariate and multivariate analyses were carried out using SPSS 23. Alpha was set at 0.05. Main outcome measure Prevalence and predictors of falls among ambulatory older patients. Results The mean age of the older patients was 72.4 ± 7.3 years and 255 (63.7%) were females. The total number of FRIDs and ODs used by older patients was 578 (35.2%). The prevalence of fall was 181 (45.3%) which was significantly higher among the females compared with the males (51.8% vs 33.8%) p = 0.01. Classes of medications such as anti-Parkinson's (p = 0.027), sedatives (p = 0.033), antipsychotics (p = 0.011) and anticholinergic (p = 0.027) were significantly associated with fall. Predictive factors for falls on logistic regression were female [OR = 2.375; 95% CI 0.274-3.704, p = 0.001] and use of antipsychotics [OR = 5.132; 95% CI 1.352-19.480, p = 0.016]. Conclusion The prevalence of falls was high and being a woman ≥ 60 years is a major risk factor for falling. Interventions to decrease falls in older patients by drug modification and deprescribing of FRIDs and ODs might reduce fall-related injuries. Thus, a multidisciplinary approach is essential for intervention to reduce the risk of falls and improve therapeutic outcomes among older patients.
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Affiliation(s)
- Wuraola Akande-Sholabi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Francis S Ogundipe
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Lawrence A Adebusoye
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
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31
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Lohman MC, Sonnega AJ, Nicklett EJ, Estenson L, Leggett AN. Comparing Estimates of Fall-Related Mortality Incidence Among Older Adults in the United States. J Gerontol A Biol Sci Med Sci 2020; 74:1468-1474. [PMID: 30358818 DOI: 10.1093/gerona/gly250] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Falls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality. METHODS Cause-of-death data from the National Death Index (NDI; 1999-2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths. RESULTS The overall incidence rate of fall-related mortality was greater in HRS-NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality. CONCLUSION Incidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Amanda J Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | | | - Amanda N Leggett
- Program for Positive Aging, University of Michigan, Ann Arbor.,Department of Psychiatry, University of Michigan, Ann Arbor
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32
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McCormack GR, Cabaj J, Orpana H, Lukic R, Blackstaffe A, Goopy S, Hagel B, Keough N, Martinson R, Chapman J, Lee C, Tang J, Fabreau G. A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2019; 39:187-200. [PMID: 31091062 DOI: 10.24095/hpcdp.39.5.03] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population. METHODS From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features. RESULTS Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found. CONCLUSION Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.
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Affiliation(s)
- Gavin R McCormack
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Faculty of Environmental Design, University of Calgary, Alberta, Canada
| | - Jason Cabaj
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Alberta Health Services, Alberta, Canada
| | - Heather Orpana
- Public Health Agency of Canada, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ontario, Canada
| | - Ryan Lukic
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Anita Blackstaffe
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - Brent Hagel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary
| | - Noel Keough
- Faculty of Environmental Design, University of Calgary, Alberta, Canada
| | | | | | - Celia Lee
- Sustainable Calgary, Alberta, Canada
| | | | - Gabriel Fabreau
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Zhang F, Li D. Multiple Linear Regression-Structural Equation Modeling Based Development of the Integrated Model of Perceived Neighborhood Environment and Quality of Life of Community-Dwelling Older Adults: A Cross-Sectional Study in Nanjing, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4933. [PMID: 31817493 PMCID: PMC6950374 DOI: 10.3390/ijerph16244933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023]
Abstract
Due to the poor functioning in daily living activities, community-dwelling older adults spend more time in their neighborhood environment. The perceived neighborhood environment is crucial to their quality of life (QoL). To explore the complex influences of perceived neighborhood environment on QoL, a questionnaire was designed to measure their perception of each factor of neighborhood environment and each domain of QoL. Based on collected data, the reliability test was applied to revise the questionnaire. Multiple linear regression (MLR) and structural equation modeling (SEM) were adopted to hypothesize and test the integrated model for community-dwelling older adults. The results show that community-dwelling older adults' perceptions of neighbor support, facilities related to physical exercise and recreation, and accessibility to facilities impact their overall QoL with diverse coefficients of 0.437, 0.312, and 0.295, respectively; neighbor support (0.207) on physical health; sidewalk condition (0.134), natural environment (0.260), and facilities related to daily life (0.165) on psychological health; and neighbor support (0.298), facilities related to daily life (0.206), and design-related safety (0.225) on social relationship. This revealed that perceptions of neighborhood environment have diverse impacts on their QoL. This study can provide targeted retrofit strategies for communities to enhance QoL of community-dwelling older adults efficiently.
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Affiliation(s)
- Fan Zhang
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing 211189, Jiangsu, China
| | - Dezhi Li
- Engineering Research Center of Building Equipment, Energy and Environment, Southeast University, Nanjing 211189, Jiangsu, China
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Association between Recent Falls and Changes in Outdoor Environments near Community-Dwelling Older Adults' Homes over Time: Findings from the NHATS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183230. [PMID: 31487783 PMCID: PMC6766072 DOI: 10.3390/ijerph16183230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 11/25/2022]
Abstract
Neighborhood environments have been increasingly associated with incidents of falling and the fear of falling. However, little is known about the causal impact of neighborhood environments on falling. This study identifies whether changes in outdoor environmental attributes over a one-year period are associated with the occurrence of recent falls among community-dwelling older adults aged 65 and older in the United States. Data were obtained from 4802 adults aged 65 years or older from the National Health and Aging Trends Study (NHATS). Logistic regression analyses were performed to identify neighborhood risk factors linked to the odds of experiencing recent falls at the one-year follow-up. Almost one in ten subjects (9.7% of 4802 subjects) who had not fallen before reported experiencing recent falls after one year. After adjusting for sociodemographic, health, and walking-related behavioral covariates, these subjects were more likely to reside in areas with higher environmental barriers on sidewalks/streets and uneven walking surfaces or broken steps, compared to non-fallers. Our findings suggest that safe and well-maintained outdoor environments may help prevent falls among community-dwelling older adults who engage in outdoor activities. Clinical and environmental interventions for promoting both safe walking and safe environments are warranted.
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Elias Filho J, Borel WP, Diz JBM, Barbosa AWC, Britto RR, Felício DC. Prevalence of falls and associated factors in community-dwelling older Brazilians: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2019; 35:e00115718. [PMID: 31483046 DOI: 10.1590/0102-311x00115718] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 04/29/2019] [Indexed: 11/21/2022] Open
Abstract
Falls determine huge epidemiological, clinical, and economic burden in the older population worldwide, presenting high odds of severe disability. The present study aimed to estimate the prevalence of falls and associated factors in older Brazilians using a systematic review with meta-analysis. Searches were performed in SciELO, PubMed, LILACS, Web of Science, Scopus and PsycINFO databases with no date or language restrictions. Studies on community-dwelling older persons aged ≥ 60 years from both sexes and with a sample size of ≥ 300 participants included. Exclusion criteria were studies conducted specifically for older adults diagnosed with chronic disabling diseases that predispose them to falls. Risk of bias of included studies was assessed using a critical appraisal tool focusing on prevalence designs. A random-effects meta-analysis was used to pool the prevalence of falls across studies. Exploratory analysis was conducted examining subgroup estimates, prevalence ratios and meta-regression. Thirty-seven studies involving 58,597 participants were included. Twelve-month prevalence of falls was 27% (95%CI: 24.3-30.0), with significantly higher estimates in female than male (PR = 1.57; 95%CI: 1.32-1.86), in age group ≥ 80 years than age group 60-69 years (PR = 1.46; 95%CI: 1.15-1.84), and in participants from the Central region than participants from the South region (PR = 1.36; 95%CI: 1.10-1.69) of Brazil. Risk of bias scores did not impact heterogeneity in the 12-month meta-analysis. These estimates strongly support evidence-based public interventions to prevent falls in older Brazilians, especially in women and the oldest-old population.
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Lee S, Lee C, Ory MG, Won J, Towne SD, Wang S, Forjuoh SN. Fear of Outdoor Falling Among Community-Dwelling Middle-Aged and Older Adults: The Role of Neighborhood Environments. THE GERONTOLOGIST 2019; 58:1065-1074. [PMID: 28958081 DOI: 10.1093/geront/gnx123] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/03/2017] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighborhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults. Research Design and Methods A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighborhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighborhood environmental variables associated with fear of outdoor falling. Results Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247-7.094), be female (OR = 4.423, 95% CI = 1.830-10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124-6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472-15.137). Among the neighborhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188-0.935), drainage ditches (OR = 2.383, 95% CI = 1.136-5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742-8.288) were associated with the odds of having a fear of outdoor falling. Discussion and Implications In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults.
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Affiliation(s)
- Sungmin Lee
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Chanam Lee
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Marcia G Ory
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station
| | - Jaewoong Won
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Samuel D Towne
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station
| | - Suojin Wang
- Department of Statistics, College of Science, Texas A&M University, College Station
| | - Samuel N Forjuoh
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station.,Department of Family & Community Medicine, Baylor Scott & White Health, College of Medicine, Texas A&M Health Science Center, Temple
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37
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Lee S, Oh E, Hong GRS. Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E982. [PMID: 29757960 PMCID: PMC5982021 DOI: 10.3390/ijerph15050982] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Abstract
Background: Although fear of falling (FOF) has been studied since FOF has negative consequences for the elderly, there is limited information about the risk factors of FOF, including the environment. The purpose of this study was to describe individual and environmental factors of FOF between those with and without a fall history from an ecological aspect and to examine whether individual and environmental factors differently affect the FOF according to the state of fall history in community-dwelling older adults in Korea. Methods: Data from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Adults were used. Participants were 7730 older adults. Hierarchical logistic regression analysis was conducted to examine the predictors of FOF. Results: According to the ecological model, female and discomfort with the neighborhood environment were significantly associated with greater odds of reporting FOF in both older adults with fall history and those without. A significant interaction was not observed between any variable of FOF in participants with and without a fall history. Conclusions: An ecological model including individual and environmental factors should be considered when conducting research and designing programs and decision policies related to FOF for older adults with and without a history of falling.
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Affiliation(s)
- Seonhye Lee
- Department of Nursing, Gyeongnam National University of Science and Technology, #33 Dongjinro, Jinju, Gyeongnam 52725, Korea.
| | - Eunmi Oh
- School of Nursing, Hanyang University, #222 Wangsimliro, Sungdong-gu, Seoul 04763, Korea.
| | - Gwi-Ryung Son Hong
- School of Nursing, Hanyang University, #222 Wangsimliro, Sungdong-gu, Seoul 04763, Korea.
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Effectiveness of statewide falls prevention efforts with and without group exercise. Prev Med 2017; 105:5-9. [PMID: 28823686 DOI: 10.1016/j.ypmed.2017.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/07/2017] [Accepted: 08/14/2017] [Indexed: 11/21/2022]
Abstract
Group-based falls prevention programs vary in use of exercise, education, home modification, and other program elements. Pennsylvania's Department of Aging offers two large-scale falls prevention programs that differ in these components, allowing a strong test of the effectiveness of exercise in reducing falls incidence relative to less intensive education-based programs. In 2016-2017, we followed three groups of older adults attending senior centers: (i) older adults who completed Healthy Steps in Motion (HSIM, n=560), an 8-week exercise program, (ii) older adults completing Healthy Steps for Older Adults (HSOA, n=651), a falls education workshop with assessment and referral; and (iii) older adults not completing falls prevention programs (n=787). Participants were followed for up to 6months with monthly ascertainment of falls. We estimated Poisson regression models to compare incidence rate ratios. The groups did not differ in falls risk at baseline or attrition over follow-up. HSIM participants reported 5.3 fall months per 100 person-months of follow-up. The group not completing falls prevention programming reported 7.3 (incidence rate ratio [IRR], 0.72 [0.59, 0.89]), and the group completing HSOA 6.5 (IRR, 0.82 [0.66, 1.02]). In stratified analyses, falls incidence was lower in HSIM for older adults reporting better balance and no falls in the prior 12months. Non-exercise-based falls prevention programs may also reduce falls, perhaps through indirect physical benefits such as greater social engagement and increased activity.
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Lohman MC, Crow RS, DiMilia PR, Nicklett EJ, Bruce ML, Batsis JA. Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample. J Epidemiol Community Health 2017; 71:1191-1197. [PMID: 28947669 PMCID: PMC5729578 DOI: 10.1136/jech-2017-209769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool's predictive validity or adaptability to survey data. METHODS Data from five annual rounds (2011-2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 years and older in the USA. Analytic sample respondents (n=7392) were categorised at baseline as having low, moderate or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. RESULTS Participants classified as having moderate and high fall risk had 2.62 (95% CI 2.29 to 2.99) and 4.76 (95% CI 3.51 to 6.47) times greater odds of falling during follow-up compared with those with low risk, respectively, controlling for sociodemographic and health-related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. CONCLUSION The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardise screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted.
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Affiliation(s)
- Matthew C Lohman
- Department of Psychiatry, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA
| | - Rebecca S Crow
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Section of General Internal Medicine, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Research, Lebanon, New Hampshire, USA
| | - Peter R DiMilia
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Research, Lebanon, New Hampshire, USA
| | - Emily J Nicklett
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Martha L Bruce
- Department of Psychiatry, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA
| | - John A Batsis
- Department of Psychiatry, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Section of General Internal Medicine, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Research, Lebanon, New Hampshire, USA
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Ory MG, Smith ML. What If Healthy Aging Is the 'New Normal'? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111389. [PMID: 29140264 PMCID: PMC5708028 DOI: 10.3390/ijerph14111389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 10/18/2017] [Accepted: 11/07/2017] [Indexed: 12/21/2022]
Abstract
We dedicate this special issue to our colleague, Dr. Lucinda Bryant (1941-2016).[...].
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Affiliation(s)
- Marcia G Ory
- Center for Population Health and Aging, Texas A&M Health Science Center, College Station, TX 77843, USA.
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M Health Science Center, College Station, TX 77843, USA.
- College of Public Health, The University of Georgia, Athens, GA 30602, USA.
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The role of the environment in falls among stroke survivors. Arch Gerontol Geriatr 2017; 72:1-5. [PMID: 28482268 DOI: 10.1016/j.archger.2017.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 04/10/2017] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stroke survivors' risk of falls may be particularly sensitive to the environment due to deficits such as visuospatial neglect or homonymous hemianopia. We sought to identify the prevalence of falls among stroke survivors and investigate the possible role of the environment in falling. MATERIALS AND METHODS Data from the National Health and Aging Trends Study (NHATS), a nationally representative population of community-dwelling adults over 65, were used. We compared the prevalence of falling in the past month between stroke survivors and demographic and comorbidity matched controls using sequential Poisson regression models. RESULTS The proportion of stroke survivors reporting a fall in the previous month was 18.8% compared to 10.8% among matched controls (PR: 1.74; 95% CI: 1.36-2.25). These differences were attenuated after adjusting for known confounders, mediators and aspects of the environment (PR: 1.17; 95% CI: 0.86-1.60). Indoor tripping hazards were associated with falls (PR: 1.24; 95% CI: 1.01-1.53). The association between stroke and falls was modified by neighborhood social disorder, such that in areas of low social disorder, falls in the previous month were more common in stroke survivors compared to non-stroke controls. CONCLUSIONS The difference in falls among stroke survivors and matched controls is largely explained by known risk factors and physical capacity. Indoor tripping hazards were associated with falls among stroke survivors and matched controls. Explanations of why the association between stroke and falls was protective in areas of high social disorder are unclear, but may warrant additional research.
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