Investigating Risk Factors for Falls among Community-Dwelling Older Adults According to WHO's Risk Factor Model for Falls

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.

Cachexia and Cognitive Function in the Community-Dwelling Older Adults: Mediation Effects of Oral Health

BACKGROUND

Cognitive impairment and poor oral health are common problems in older adults and are associated with malnutrition. However, it is unclear how they are related to cachexia in community-dwelling older adults. The aim of this study was to examine the relationships among cachexia, cognitive function, and oral health in community-dwelling older adults.

METHODS

This study is a secondary analysis of a data-set. Data were collected in the community setting on older adults who applied for government-funded long-term care services in Hong Kong in 2017. Subjects were community-dwelling and aged ≥60 years. The outcome variable was cachexia. The predictors were cognitive function and oral health. The covariates included demographics and comorbidities associated with cachexia or malnutrition. Path analysis was employed to examine the associations among cachexia, cognitive function, and oral health using the software SAS/STAT and Mplus.

RESULTS

This analysis included 12,940 subjects. The prevalence of cachexia was 1.3%. Cognitive function was also found to have a direct effect on the oral health indicators of chewing problems (OR=1.073, p<0.001), brushing teeth problems (OR=1.349, p<0.001), and swallowing problems (coeff.=0.177, p<0.001). Oral health indicators with a direct effect on cachexia included dry mouth (OR=1.250, p<0.001), brushing teeth problems (OR = 1.185, p<0.01), and swallowing problems (OR=1.231, p<0.001). Cognitive function had no significant direct effect, but had a significant indirect effect on cachexia (OR=1.100, p<0.001) which is mediated by brushing teeth problems (OR=1.052, p<0.001) and swallowing problems (OR=1.038, p<0.001).

CONCLUSION

Cognitive impairment causes cachexia indirectly through poor oral health. This study recommends adding cognitive function when screening community-dwelling older adults for cachexia. Health policymakers should stress regular oral health screening and interventions, and encourage increased utilization of oral health services by community-dwelling older adults with cognitive problems.

Residents with Alzheimer's disease in long-term care facilities in Hong Kong: patterns of hospitalization and emergency room use

OBJECTIVES

This study examined the frequency and predictors of hospitalization and emergency room (ER) use among residents with Alzheimer's disease at admission and after 1 year in a long-term care facility.

METHOD

This secondary analysis used data collected with the Chinese version of the Residential Assessment Instrument Minimum Data Set 2.0 during the Hong Kong Longitudinal Study on Long-Term Care Facility Residents.

RESULTS

A sample of 169 residents with Alzheimer's disease who were newly admitted between 2005 and 2010 was included in the analysis. Mixed-effects modeling was adopted to assess the associations between risk factors and the frequency of hospitalization and ER use. At admission, 27 (15.98%) respondents had been hospitalized and 19 (11.24%) required ER services during the previous 90 days. At admission, polypharmacy (β = .081, p < .01) and use of psychotropic drugs (β = ‑.506, p < .05) were significantly associated with frequency of hospitalization. At 1-year follow-up, cognitive impairment (β = .088, p < .05) and polypharmacy (β = .058, p < .001) had significant positive associations with frequency of hospitalization, as well as use of ER services (β = .084, p < .01; β = .077, p < .001, respectively). Use of psychotropic drugs had a negative association with frequency of ER use at both time points.

CONCLUSION

Practitioners should periodically observe cognitive ability, polypharmacy, and use of psychotropic drugs among long-term care residents with Alzheimer's disease.

Service learning in medical and nursing training: a randomized controlled trial

The purpose of this study was to explore the long term effect of a service learning project on medical and nursing students' knowledge in aging and their attitudes toward older adults. A total of 124 students were recruited and then randomized to intervention group (IG) and control group (CG). A pre-and-post-intervention design measured students' knowledge in aging (using modified Palmore's Fact on Aging Quiz) and attitudes toward older adults (using Kogan's Old People Scale). A total of 103 students completed all the activities and questionnaires. After the intervention, there were significant differences between the IG and CG on Palmore's mental health (MH) (P = .04), Palmore's total score (P = .02) and Kogan's negative attitudes toward older adults (P = .001). All students increased their positive attitude toward older adults after the intervention. However, both the IG and CG showed a decrease in positive attitudes 1 month after the interventon, and such decrease varied, depending on the programme which students attended. The current study showed that the 10-week service learning activities significantly increased medical and nursing students' overall knowledge of aging and their understanding of mental health needs in old age, and reduced their negative attitudes toward older adults. However, the effect is not long-lasting. On the other hand, its effect on positive attitudes toward older adults cannot be concluded. Periodic contacts with older adults via service learning activities may be needed to sustain attitude change toward older adults.

Concordance between side-stream end-tidal carbon dioxide and arterial carbon dioxide partial pressure in respiratory service setting

OBJECTIVE

To explore the correlation and concordance between end-tidal carbon dioxide and arterial carbon dioxide partial pressure, and confirm the experience of the general consensus among service environments.

DESIGN

A prospective cross-sectional analysis.

SETTING

Two respiratory service units in Hong Kong.

PARTICIPANTS

Two hundred respiratory patients were recruited, in whom 219 sets of observations were recorded. Patients deemed to require arterial blood gas determination also had their end-tidal carbon dioxide partial pressure measured at that time, using two LifeSense LS1-9R Capnometers.

MAIN OUTCOME MEASURES

The agreement of end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was studied by correlation coefficients, mean and standard deviation of their difference, and the Bland-Altman plot.

RESULTS

Overall, the correlation was low and insignificant (r=0.1185, P=0.0801). The mean of the difference was 7.2 torr (95% confidence interval, 5.5-8.9) and significant (P<0.001). The limits of agreement by Bland-Altman analysis were -18.1 to 32.5 torr, which were too large to be acceptable. In the sub-group on room air, the mean difference was reduced to 2.26 torr, the correlation between end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was 0.2194 (P=0.0068), though statistically significant, the extent of correlation was still low.

CONCLUSION

End-tidal carbon dioxide partial pressure did not show significant correlation or concordance with arterial carbon dioxide partial pressure, especially when supplemental oxygen was used. End-tidal carbon dioxide partial pressure currently cannot replace arterial blood gas measurement as a tool for monitoring arterial carbon dioxide partial pressure. Possible reasons for the discrepancy with previous studies include small sample size in previous studies, lack of research facilities in service settings, and publication bias against negative studies.

Use of the Minimum Data Set--Home Care: a cluster randomized controlled trial among the Chinese older adults

The objective of this study was to test whether the utilization of Minimum Data Set-Home Care (MDS-HC) as a case finding instrument for Chinese attenders of elderly health centres in Hong Kong had a beneficial impact on the physical and mental health status of those older clients. The dependent variables were 13 outcome variables measuring different dimensions of participants' physical and mental health status. Using a cluster randomized controlled trial design, we assigned three of six participating elderly health centres to the experimental group and the other three to the control group. The respondents were 925 (472 in the experimental group and 453 in the control group) elderly health centre attenders aged 65 years or above. They were assessed by MDS-HC and 734 (382 in the experimental group and 352 in the control group) of them were re-assessed one year later. In the experimental group, the medical doctors had been given their patients' profile of potential problem areas identified by MDS-HC before they treated their patients whereas in the control, the medical doctors treated their patients with their usual practice. We found that older attenders in the experimental group improved more than the ones in the control group in only two out of 13 areas. Surprisingly, the patients in the experimental group deteriorated even more than the ones in the control group in terms of bowel incontinence. Our results indicated that the function of the MDS-HC in case finding or screening is limited in the Hong Kong primary medical care setting.

Influence curves for factor loadings

Influence curves for the initial and rotated loadings are derived for the maximum likelihood factor analysis (MLFA) model. Cook's distances based on the empirical influence curves of factor loadings are proposed for the identification of influential observations. The distances are shown to be invariant under scale transformation and factor rotation. We find that an observation with a very large Cook's distance based on the sample influence curve may not necessarily exert an excessive influence on the factor loadings pattern but may change the ordering of the factors. The issue of the switching of factors is also studied by means of the empirical influence curve and factor scores.

Elderly suicide in Hong Kong--a case-controlled psychological autopsy study

OBJECTIVE

To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case-controlled psychological autopsy approach.

METHOD

Informants of 70 subjects aged 60 or above who had committed suicide as well as a community sample of 100 elderly controls were interviewed. Subjects and controls were assessed for the presence of mental illness, history of suicide attempt and data on health care utilization.

RESULTS

Eighty-six per cent of suicide subjects suffered from a psychiatric problem before committing suicide, compared with 9% of control subjects. Among the psychiatric problems, major depression was the commonest diagnosis. Seventy-seven per cent of suicide subjects had consulted a doctor within 1 month of suicide. One-third of suicide subjects had a history of suicide attempt. Rates of current psychiatric diagnosis, rates of medical consultation and history of suicide attempt are all significantly higher in suicide subjects than controls.

CONCLUSION

Our findings support the view that depressive disorders and a past history of suicide attempt are risk factors of late-life suicide in the Chinese population of Hong Kong, similar to findings in western studies.

Reference values for change in body mass index from birth to 18 years of age

Body mass index (BMI) has become the measure of choice for determination of nutritional status during the paediatric years, as in adults. Recently, several cross-sectional BMI childhood reference values standards have been published. In order precisely to evaluate childhood nutritional interventions, reference values allowing for the evaluation of changes in BMI values are also needed. For the first time, such reference values can be presented based on 3650 longitudinally followed healthy Swedish children born full term. The reference values for the change in BMI are given as the change in BMI standard deviation scores. The reference values are given as means of mathematical functions adjusting for gender, age of the child and the length of the interval between two measurements for interval lengths of 0.25 to 1.0 y before 2 y of age and of 1 to 5 y between birth and 18 y. The usefulness of the reference values is proved by a graph that forms a part of a clinical computer program; the -2 to +2 standard deviation range of the predicted change in BMI can be computed for an individual child and drawn in the graph as an extended support for clinical decision-making.

CONCLUSION

For the first time this communication gives access to BMI growth rate values that can be used both in research and in the clinic to evaluate various interventions, be they nutritional, surgical or therapeutic.

Inhibition of pancreatic glucagon responses to arginine by somatostatin in normal man and in insulin-dependent diabetics

Somatostatin, a recently synthesized hypothalamic peptide thought to represent growth hormone-release-inhibiting factor, has been previously shown to inhibit pancreatic glucagon secretion in species other than man. To determine whether somatostatin also inhibits human glucagon secretion, plasma glucagon responses during intravenous infusion of arginine alone (250 mg. per kilogram over twenty-five minutes) and in combination with synthetic cyclic somatostatin (20,μg. per minute) were compared in six normal and six insulin-dependent diabetic subjects.

Somatostatin abolished glucagon responses to arginine in both groups, with plasma glucagon declining transiently below basal levels; this occurred despite the fact that the diabetic subjects had fasting hyperglucagonemia and exaggerated glucagon responses during control arginine infusions. In both groups plasma glucose rises seen after arginine were diminished during somatostatin infusions, and, in the normal subjects, insulin responses were also inhibited.

These results demonstrate that somatostatin is a potent inhibitor of glucagon secretion in man. Accordingly, it may prove useful as an adjunct to insulin therapy in treatment of insulin-requiring diabetes mellitus.