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Burns J, Landes RD, Pillai L, Virmani T. Tandem gait step-width increases more rapidly in more severely affected people with Parkinson's disease. Parkinsonism Relat Disord 2024; 127:107078. [PMID: 39096549 DOI: 10.1016/j.parkreldis.2024.107078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION Tandem gait performance reportedly predicts fall risk in people with Parkinson's disease (PwPD) and help distinguish PwPD from atypical parkinsonism. In a cross-sectional study, we previously showed that tandem gait step-width widens with increasing Hoehn and Yahr (H&Y) staging scores. In this longitudinal study, we aimed to determine if progression in tandem gait deficits is dependent on disease severity in PwPD. METHODS Participants underwent an instrumented tandem gait measurement every 6 months for at least 2 years. The mean and variability of 4 tandem gait parameters were calculated at each visit: step-width, step-length, step-time, and step-velocity. The change in these parameters over time for 3 H&Y groups (stage 1, 2 and 2.5+) compared to aging controls was determined using a random coefficients regression model. The annual percent change in tandem gait parameters was correlated with initial disease features using Kendall's τB. RESULTS 66 participants were analyzed (46 PD, 20 controls). Mean step-width increased over time in an H&Y stage-dependent manner, with H&Y 2 and H&Y 2.5+ experiencing increases of 6% and 10% per year (p = 0.001 and 0.024 respectively). Annual percent-change in step-width was correlated with initial motor Unified Parkinson's Disease Rating Scale (UPDRS) scores (Kendall's τB = 0.229), total UPDRS scores (τB = 0.249), H&Y scores (τB = 0.266) and inversely correlated with Montreal Cognitive Assessment (MoCA) scores (τB = -0.209; ps ≤ 0.019). CONCLUSION Tandem gait step-width widens over time more rapidly in more severely affected PD patients. These results suggest that tandem gait should be routinely clinically evaluated and considered in the management of imbalance in PwPD.
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Affiliation(s)
- Jennie Burns
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Reid D Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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Ma W, Liang X, Wang H, Wen Z, Liu L, Fan L, Zhang X. Association between fear of falling and mortality in middle-aged and older adults: A systematic review and meta-analysis. Geriatr Nurs 2024; 59:113-120. [PMID: 38996768 DOI: 10.1016/j.gerinurse.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Fear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear. METHODS Prominent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I2. A fixed-effect model calculated the pooled effect size. RESULTS A total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19-1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality. CONCLUSIONS FOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults.
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Affiliation(s)
- Wenlian Ma
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoli Liang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Hongyan Wang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Zhifei Wen
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linfeng Liu
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Liangliang Fan
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiangeng Zhang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China.
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García-Martínez A, García-Rosa S, Gil-Rodrigo A, Machado VT, Pérez-Fonseca C, Nickel CH, Artajona L, Jacob J, Llorens P, Herrero P, Canadell N, Rangel C, Martín-Sánchez FJ, Del Nogal ML, Miró Ò. Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: a multicentric observational study. Eur Geriatr Med 2024:10.1007/s41999-024-00992-1. [PMID: 38809489 DOI: 10.1007/s41999-024-00992-1] [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: 02/17/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Fear of falling (FOF) may result in activity restriction and deconditioning. The aim of the study was to identify factors associated with FOF in older patients and to investigate if FOF influenced long-term outcomes. METHODS Multicentric, observational, prospective study including patients 65 years or older attending the emergency department (ED) after a fall. Demographical, patient- and fall-related features were recorded at the ED. FOF was assessed using a single question. The primary outcome was all-cause death. Secondary outcomes included new fall-related visit, fall-related hospitalisation, and admission to residential care. Logistic regression and Cox regression models were used for statistical analyses. RESULTS Overall, 1464 patients were included (47.1% with FOF), followed for a median of 6.2 years (2.2-7.9). Seven variables (age, female sex, living alone, previous falls, sedative medications, urinary incontinence, and intrinsic cause of the fall) were directly associated with FOF whereas use of walking aids and living in residential care were inversely associated. After the index episode, 748 patients (51%) died (median 3.2 years), 677 (46.2%) had a new fall-related ED visit (median 1.7 years), 251 (17.1%) were hospitalised (median 2.8 years), and 197 (19.4%) were admitted to care (median 2.1 years). FOF was associated with death (HR 1.239, 95% CI 1.073-1.431), hospitalisation (HR 1.407, 95% CI 1.097-1.806) and institutionalisation (HR 1.578, 95% CI 1.192-2.088), but significance was lost after adjustment. CONCLUSION FOF is a prevalent condition in older patients presenting to the ED after a fall. However, it was not associated with long-term outcomes. Future research is needed to understand the influence of FOF in maintenance of functional capacity or quality of life.
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Affiliation(s)
- Ana García-Martínez
- Emergency Department, IDIBAPS, Hospital Clínic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
| | | | - Adriana Gil-Rodrigo
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General de Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Victoria Torres Machado
- Emergency Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Lourdes Artajona
- Emergency Department, IDIBAPS, Hospital Clínic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General de Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central de Asturias, Oviedo, Spain
| | - Naila Canadell
- Emergency Department, IDIBAPS, Hospital Clínic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - Carolina Rangel
- Emergency Department, IDIBAPS, Hospital Clínic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | | | | | - Òscar Miró
- Emergency Department, IDIBAPS, Hospital Clínic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
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Miri S, Norasteh AA. Fear of falling, quality of life, and daily functional activity of elderly women with and without a history of falling: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:2619-2625. [PMID: 38694291 PMCID: PMC11060224 DOI: 10.1097/ms9.0000000000001977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/06/2024] [Indexed: 05/04/2024] Open
Abstract
Background This study aimed to evaluate the fear of falling, quality of life, and daily functional activity of older women aged 60 years or older with or without a history of falling. Materials and methods Two hundred older adult women were recruited for the cross-sectional study in Iran. This cross-sectional study collected data from July to August 2023 through convenience sampling. The researchers collected data using a five-part questionnaire, that collected information that included demographic characteristics, the Fall Efficacy Scale in the Elderly-International Version (FES-I), 12-item Quality of Life assessment (SF-12), Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Results FES-I score in older women with a history of falls was significantly higher than those without a history of falls [median: 38.0, interquartile range (IQR): 31.5-44.0 versus median: 22.0, IQR: 20.0-30.0; P<0.001]. The median quality-of-life score using the SF-12 was significantly lower in women with a history of falls than in those without a history of falls (median: 25.0, IQR: 21.0-30.0 versus median: 35.0, IQR: 31.0-39.0; P<0.001). The ADL scores were significantly lower among women with a history of falls than those without (P<0.001). A similar result was obtained for IADL scores (P<0.001). Conclusion Overall, this study's findings highlight the adverse impact of a history of falls on three key factors: fear of falling, quality of life, and daily functional activity (including both basic and instrumental activities). The findings delineate that, ultimately, the history of falls can serve as a valuable indicator for better understanding trends in elderly care and addressing the associated challenges.
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Affiliation(s)
- Sahar Miri
- Department of Corrective Exercise and Sport Injury, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
| | - Ali Asghar Norasteh
- Department of Physiotherapy, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Belloni G, Büla C, Santos-Eggimann B, Henchoz Y, Fustinoni S, Seematter-Bagnoud L. Fear of falling and all-cause mortality among young-old community-dwelling adults: a 6-year prospective study. Eur J Ageing 2022; 19:293-300. [PMID: 35663911 PMCID: PMC9156588 DOI: 10.1007/s10433-021-00635-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
This study investigated whether fear of falling (FOF) measured by two different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), is associated with mortality at 6-year follow-up. Participants (n = 1359, 58.6% women) were community-dwelling persons enrolled in the Lausanne cohort 65 + , aged 66 to 71 years at baseline. Covariables assessed at baseline included demographic, cognitive, affective, functional and health status, while date of death was obtained from the office in charge for population registration. Unadjusted Kaplan Meyer curves were performed to show the survival probability for all-cause mortality according to the degree of FOF reported with FES-I and SQ-FAR, respectively. Bivariable and multivariable Cox regression analyses were performed to assess hazard ratios, using time-in-study as the time scale variable and adjusting for variables significantly associated in bivariable analyses. During the 6-year follow-up, 102 (7.5%) participants died. Reporting the highest level of fear at FES-I (crude HR 3.86, 95% CI 2.37-6.29, P < .001) or "FOF with activity restriction" with SQ-FAR (crude HR 2.42, 95% CI 1.44-4.09, P = .001) were both associated with increased hazard of death but these associations did not remain significant once adjusting for gender, cognitive, affective and functional status. As a conclusion, although high FOF and related activity restriction, assessed with FES-I and SQ-FAR, identifies young-old community-dwelling people at increased risk of 6-year mortality, this association disappears when adjusting for potential confounders. As a marker of negative health outcomes, FOF should be screened for in order to provide personalized care and reduce subsequent risks.
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Affiliation(s)
- Giulia Belloni
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, CH-1011 Lausanne, Switzerland
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, CH-1011 Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yves Henchoz
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sarah Fustinoni
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, CH-1011 Lausanne, Switzerland
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Tsai CY, Lin ES, Li YT, Tung TH, Chen WC. The Relationship Between Storey of Buildings and Fall Risk. Front Public Health 2021; 9:665985. [PMID: 34869135 PMCID: PMC8633840 DOI: 10.3389/fpubh.2021.665985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study examined the association between storey of building and fall risk in older adults' residences and residents' level of fear of falling. Methods: The National Health and Ageing Trends Study (NHATS) collected information that would provide an understanding of basic trends people aged 65 years and older. Using a longitudinal survey, the present study employed the first round of NHATS data that was collected in 2011. In the first round, 12,411 participants were enrolled, and 8,077 interviews were completed. The study sample sizes for falling and worry about falling are 6,153 and 6,142, respectively. Results: Unadjusted analysis revealed that storey of building was a risk factor for fall and worry about falling. There was a higher prevalence for fall and worry about falling when subjects lived in single storey of building compared with the subjects live in multi-storey. Logistic regression analysis showed no highly significant between storey of building and the fall/fear of falling. Conclusion: Several clinical factors independently were indicated pertaining to the fall and worry about falling in older adult's residences.
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Affiliation(s)
- Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,MS Program in Transdisciplinary Long Term Care and Department of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - En-Sheng Lin
- Department of Psychiatry, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Yang-Tzu Li
- Department of Long Term Care, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Tao-Hsin Tung
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Wei-Cheng Chen
- TAIWAN STIPENDIARY CO., LTD., Kaohsiung, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
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SARC-F and the Risk of Falling in Middle-Aged and Older Community-Dwelling Postmenopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111570. [PMID: 34770084 PMCID: PMC8583486 DOI: 10.3390/ijerph182111570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The objective of the present study was to determine the ability of the SARC-F questionnaire to identify individuals at risk of falling among middle-aged and older community-dwelling postmenopausal women. (2) Methods: An analytical cross-sectional study was conducted on 157 women (70.80 ± 8.37 years). The SARC-F questionnaire was used to screen for risk of sarcopenia. Fear of falling and balance confidence, as measured by the Falls Efficacy Scale-International (FES-I) and the Activities-Specific balance Scale-16 items (ABC-16) respectively, were used to assess risk of falling. Anxiety and depression (Hospital Anxiety and Depression Scale), fatigue (Fatigue Severity Scale), body mass index, waist-to-hip ratio, and sleep duration were also determined. (3) Results: Logistic regression showed that higher risk of falling as assessed by FES-I was associated with higher SARC-F scores (OR = 1.656), anxiety levels (OR = 1.147), and age (OR = 1.060), while increased SARC-F scores (OR = 1.612), fatigue (OR = 1.044), and shorter sleep duration (OR = 0.75) were related to ABC-16 scores. In addition, a SARC-F cutoff of 1.50 (83.33% sensitivity and 59.13% specificity) and 3.50 (44.44% sensitivity and 89.26% specificity) were shown to be able to discriminate participants at risk of falling according to the FES-I and the ABC-16, respectively. (4) Conclusions: our results show that SARC-F is an independent predictor of the risk of falling among middle-aged and older community-dwelling postmenopausal women.
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Cao C, Cade WT, Li S, McMillan J, Friedenreich C, Yang L. Association of Balance Function With All-Cause and Cause-Specific Mortality Among US Adults. JAMA Otolaryngol Head Neck Surg 2021; 147:460-468. [PMID: 33704356 DOI: 10.1001/jamaoto.2021.0057] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Difficulty maintaining balance is common among individuals aged 40 years or older and increases the risk of falls. However, little is known about the association of balance function with long-term mortality outcomes in adults. Objective To investigate the association of balance function with all-cause and cause-specific mortality among US adults. Design, Setting, and Participants A prospective, population-based cohort study of a nationally representative sample of 5816 adults (weighted population, 92 260 641) from the US National Health and Nutrition Examination Survey was conducted from 1999 to 2004. Individuals aged 40 years or older who completed the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces were included. Participants were linked to mortality data from the test date through December 31, 2015. Data analysis was conducted from February 1 to June 1, 2020. Exposures The modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces was used to measure balance function and define balance disorder according to sensory input. Main Outcomes and Measures Mortality associated with all causes, cardiovascular disease (CVD), and cancer. Results A total of 5816 adults (weighted mean [SE] age, 53.6 [0.2] years; 2897 [49.8%] women) were included in this cohort study. During up to 16.8 years of follow-up (median, 12.5 years; 68 919 person-years), 1530 deaths occurred, including 342 associated with CVD and 364 associated with cancer. Participants with balance disorder were at a higher risk of death from all causes, CVD, and cancer. After adjusting for sociodemographic characteristics, lifestyle factors, and chronic conditions, the hazard ratios (HRs) among participants with balance disorder compared with those without balance disorder were 1.44 (95% CI, 1.23-1.69) for all-cause mortality, 1.65 (95% CI, 1.17-2.31) for CVD mortality, and 1.37 (95% CI, 1.03-1.83) for cancer mortality. Furthermore, vestibular balance disorder was associated with increased mortality from all causes (HR, 1.31; 95% CI, 1.08-1.58), CVD (HR, 1.59; 95% CI, 1.12-2.27), and cancer (HR, 1.39; 95% CI, 1.04-1.86). Conclusions and Relevance In this nationally representative sample of US adults, balance disorder was associated with an increased risk of all-cause, CVD, and cancer mortality. Further studies are needed to confirm these findings and evaluate whether the observed associations represent a causal biological phenomenon and, if so, whether the effect is modifiable with a multicomponent exercise program.
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Affiliation(s)
- Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri
| | - W Todd Cade
- Doctor of Physical Therapy Division, Department of Orthopedics, Duke University School of Medicine, Durham, North Carolina
| | - Shengxu Li
- Children's Minnesota Research Institute, Children's Hospitals and Clinics of Minnesota, Minneapolis
| | - Jacqueline McMillan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christine Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Rhee MK, Jang Y, Kim SY, Chang S. The moderating role of social factors in the relationship between an incident of fall and depressive symptoms: a study with a national sample of older adults in South Korea. Aging Ment Health 2021; 25:1086-1093. [PMID: 32426987 DOI: 10.1080/13607863.2020.1758911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of the study was to examine the effect of an incident of fall on depressive symptoms and the moderating role of social factors (marital status, living arrangement, family network, and friend network) in older adults in South Korea. We hypothesized that the adverse mental health effect of a fall would be pronounced among those who lack social resources (e.g., no spouse, living alone, and social disconnectedness). METHOD Using the 2017 National Survey of Older Koreans, data were drawn from 8,522 survey participants (aged 65 or older). Multivariate linear regression models of depressive symptoms were examined with an array of predictors: (1) demographic and health variables, (2) social factors, (3) an incident of fall, and (4) interactions between falls and social factors. RESULTS More than 15% of the sample had at least one fall in the past 12 months. Higher levels of depressive symptoms were associated with an incident of fall, not married and living alone, and lack of family and friend networks. Not married and living alone and family network significantly moderated the relationship between falls and depressive symptoms. The adverse mental health effect of a fall was more pronounced among those who were not married and living alone and who reported not having any close family members than their counterparts. CONCLUSION The findings highlight the critical role of family and social resources in protecting older Koreans from the negative mental health consequences of a fall. Findings also provide implications for developing fall prevention and management programs, suggesting prioritizing older adults with limited social resources.
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Affiliation(s)
- Min-Kyoung Rhee
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Soo Young Kim
- Department of Social Welfare, Kyungsung University, Busan, South Korea
| | - Sujie Chang
- Department of Social Welfare, Kyungsung University, Busan, South Korea
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The modified Healthy Aging Index is associated with mobility limitations and falls in a community-based sample of oldest old. Aging Clin Exp Res 2021; 33:555-562. [PMID: 32356134 DOI: 10.1007/s40520-020-01560-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS The Healthy Aging Index (HAI) is useful in capturing the health status of multiple organ systems in older adults. Previous studies have mainly focused on the association of HAI with mortality and disability. We constructed a modified HAI (mHAI) to examine its association with mobility limitations and falls in a community-based sampling of older Chinese adults. METHODS We investigated 399 community-dwelling older adults aged 80 years or older, and constructed the mHAI with five non-invasive tests (systolic blood pressure, the Montreal Cognitive Assessment test, glucose concentrations, cystatin C levels, and self-reported respiratory problems). RESULTS The mean mHAI score for the participants in our study was 3.6. After multivariate adjustment, per unit increase in mHAI score was associated with self-reported difficulty in stooping, kneeling, or crouching (odds ratio [OR] = 1.16, 95% confidence interval [CI] 1.00-1.34), and walking 400 m (OR = 1.21, 95% CI 1.03-1.42). Per unit increase in mHAI score was also associated with poor balance (OR = 1.29, 95% CI 1.07-1.55), lower extremity strength limitation (OR = 1.30, 95% CI 1.10-1.52), low handgrip strength (OR = 1.25, 95% CI 1.08-1.46), and slow gait speed (OR = 1.21, 95% CI 1.02-1.42). The association between mHAI and falls was also significant (per unit of mHAI OR = 1.21, 95% CI 1.04-1.40). CONCLUSION The mHAI can be used as a simple assessment tool to determine mobility status in older adults and identify those at high risk for falls.
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Singh S, Atkinson EJ, Achenbach SJ, LeBrasseur N, Bancos I. Frailty in Patients With Mild Autonomous Cortisol Secretion is Higher Than in Patients with Nonfunctioning Adrenal Tumors. J Clin Endocrinol Metab 2020; 105:5867964. [PMID: 32628749 PMCID: PMC7382051 DOI: 10.1210/clinem/dgaa410] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Mild autonomous cortisol secretion (MACS) affects up to 50% of patients with adrenal adenomas. Frailty is a syndrome characterized by the loss of physiological reserves and an increase in vulnerability, and it serves as a marker of declining health. OBJECTIVE To compare frailty in patients with MACS versus patients with nonfunctioning adrenal tumors (NFAT). DESIGN Retrospective study, 2003-2018. SETTING Referral center. PATIENTS Patients >20 years of age with adrenal adenoma and MACS (1 mg overnight dexamethasone suppression (DST) of 1.9-5 µg/dL) and NFAT (DST <1.9 µg/dL). MAIN OUTCOME MEASURE Frailty index (range 0-1), calculated using a 47-variable deficit model. RESULTS Patients with MACS (n = 168) demonstrated a higher age-, sex-, and body mass index-adjusted prevalence of hypertension (71% vs 60%), cardiac arrhythmias (50% vs 40%), and chronic kidney disease (25% vs 17%), but a lower prevalence of asthma (5% vs 14%) than patients with NFAT (n = 275). Patients with MACS reported more symptoms of weakness (21% vs 11%), falls (7% vs 2%), and sleep difficulty (26% vs 15%) as compared with NFAT. Age-, sex- and BMI-adjusted frailty index was higher in patients with MACS vs patients with NFAT (0.17 vs 0.15; P = 0.009). Using a frailty index cutoff of 0.25, 24% of patients with MACS were frail, versus 18% of patients with NFAT (P = 0.028). CONCLUSION Patients with MACS exhibit a greater burden of comorbid conditions, adverse symptoms, and frailty than patients with NFAT. Future prospective studies are needed to further characterize frailty, examine its responsiveness to adrenalectomy, and assess its influence on health outcomes in patients with MACS.
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Affiliation(s)
- Sumitabh Singh
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth J Atkinson
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sara J Achenbach
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nathan LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Correspondence and Reprint Requests: Irina Bancos, MD, Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905. E-mail:
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