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Boyle JT, Boeve AR, Moye JA, Driver JA, Ruopp M, O'Malley K. Insomnia Symptoms and Environmental Disruptors: A Preliminary Evaluation of Veterans in a Subacute Rehabilitation. Clin Gerontol 2024; 47:494-506. [PMID: 38320999 DOI: 10.1080/07317115.2024.2313494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVES Evaluate insomnia symptoms and environmental disruptors at admission and discharge in a subacute rehabilitation care setting. METHODS Veterans (age ≥50) admitted to a Veterans Health Administration (VA) Hospital subacute rehabilitation between March and August 2022 completed baseline (N = 46) and follow up (N = 33) assessments with the Insomnia Severity Index (ISI), Sleep Need Questionnaire (SNQ), Epworth Sleepiness Scale (ESS), and an assessment of environmental sleep disruptors. Veterans were offered sleep resources after admission evaluations and outpatient referrals after discharge evaluations. Pearson correlation determined associations between length of stay (LOS), ISI, SNQ, and ESS scores at admission and discharge; chi-square and Wilcoxon Signed Rank Tests compared insomnia at admission and discharge. RESULTS One-half of participants reported clinically meaningful insomnia symptoms and sleep needs at baseline with no significant change at discharge. Almost all (89.1%) Veterans reported sleep was disturbed by environmental factors, primarily staff awakenings. LOS was correlated with ESS scores at discharge (r = .52, p = .002). CONCLUSIONS Environmental sleep disruption was common during a subacute rehabilitation admission and were not adequately addressed through sleep resources and treatment due to low uptake. CLINICAL IMPLICATIONS Providers should assess sleep at admission and lessen environmental sleep disruptors by reducing noise, light, and non-essential awakenings at night.
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Affiliation(s)
- Julia T Boyle
- Office of Research and Development, VA Boston Healthcare System, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Angelica R Boeve
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychology, University of Maine, Orono, Maine, USA
- Department of Psychology, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer A Moye
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jane A Driver
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Marcus Ruopp
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kelly O'Malley
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Canever JB, Zurman G, Vogel F, Sutil DV, Diz JBM, Danielewicz AL, Moreira BDS, Cimarosti HI, de Avelar NCP. Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis. Sleep Med 2024; 119:118-134. [PMID: 38669835 DOI: 10.1016/j.sleep.2024.03.040] [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: 01/30/2024] [Revised: 03/09/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.
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Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil; Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Gabriela Zurman
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Felipe Vogel
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daiana Vieira Sutil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Ana Lúcia Danielewicz
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais and Oswaldo Cruz Foundation - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Iturvides Cimarosti
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Reisert H, Miner B, Farhadian S. Sleep deficiency among people living with human immunodeficiency virus: A growing challenge. HIV Med 2024; 25:5-15. [PMID: 37485570 PMCID: PMC10803648 DOI: 10.1111/hiv.13526] [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: 01/13/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to consolidate and summarize the existing literature on sleep deficiency among people living with human immunodeficiency virus (HIV; PLWH), to discuss the potential impact of antiretroviral therapy on sleep deficiency and to identify priorities for future research in this area. RECENT FINDINGS Three important domains of sleep deficiency include alterations in sleep quality (including sleep disorders), duration and timing. The existing HIV and sleep deficiency literature, which is robust for sleep quality but sparser for sleep duration or sleep timing, has identified epidemiological correlates and outcomes associated with sleep deficiency including sociodemographic factors, HIV-specific factors, aspects of physical and mental health and cognition. SUMMARY Sleep deficiency is a common problem among PLWH and is likely underdiagnosed, although more high-quality research is needed in this area. Sleep quality has received the most attention in the literature via methodologies that assess subjective/self-reported sleep quality, objective sleep quality or both. There is significantly less research on sleep duration and minimal research on sleep timing. Use of certain antiretroviral therapy drugs may be associated with sleep deficiency for some individuals. Future research should utilize larger, longitudinal studies with consistent, comprehensive and validated methods to assess both subjective and objective measures of sleep deficiency to better understand the prevalence, correlates and clinical implications of sleep deficiency in PLWH.
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Affiliation(s)
- Hailey Reisert
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Brienne Miner
- Yale School of Medicine, Section of Geriatrics, New Haven, CT, USA
| | - Shelli Farhadian
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale School of Medicine, Department of Neurology, New Haven, CT, USA
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Chen Z, Tian F, Zeng Y. Polypharmacy, potentially inappropriate medications, and drug-drug interactions in older COVID-19 inpatients. BMC Geriatr 2023; 23:774. [PMID: 38001406 PMCID: PMC10675895 DOI: 10.1186/s12877-023-04487-9] [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: 06/05/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess the impact of polypharmacy, potentially inappropriate medications, and drug-drug interactions on in-hospital mortality in older COVID-19 inpatients. METHODS A cross-sectional study was conducted using electronic medical data from a tertiary hospital in Chengdu from December 2022 to January 2023. The 2019 AGS/Beers criteria was used to evaluate the potentially inappropriate mediation (PIM) status of older COVID-19 inpatients (age ≥ 65 years), the drug-drug interactions were evaluated on Medscape, and multivariate logistic regression was used to identify the risk factors associated with in-hospital mortality. RESULTS A total of 206 older COVID-19 inpatients were included in the study. The mean number of drugs per day was 13.04. The prevalence of PIM use based on the 2019 AGS Beers Criteria was 66.99%. The prevalence of drug-drug interactions was 61.65%. Logistic regression demonstrated that age ≥ 80 (OR: 10.321, 95% CI: 1.649, 64.579, P = 0.013), renal insufficiency (OR: 4.740, 95% CI: 1.366, 16.447, P = 0.014), long-term hospitalization (OR: 6.637, 95% CI: 1.030, 42.779, P = 0.046), severe pneumonia (OR: 50.230, 95% CI: 5.180, 487.041, P = 0.001) were influencing factors associated with in-hospital mortality in older COVID-19 inpatients. CONCLUSIONS The polypharmacy, potentially inappropriate medications, and drug-drug interactions were seen in many older COVID-19 inpatients.
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Affiliation(s)
- Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Ya Zeng
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
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Rozing MP, Wium-Andersen MK, Wium-Andersen IK, Jørgensen TSH, Jørgensen MB, Osler M. Use of hypnotic-sedative medication and risk of falls and fractures in adults: A self-controlled case series study. Acta Psychiatr Scand 2023; 148:394-404. [PMID: 37665682 DOI: 10.1111/acps.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To evaluate the risk of falls and fractures in users of benzodiazepines, Z-drugs, or melatonin. METHODS We followed 699,335 adults with a purchase of benzodiazepines, Z-drugs, or melatonin in the Danish National Prescription Registry between 2003 and 2016 for falls and fractures in the Danish National Patient Registry between 2000 and 2018. A self-controlled case-series analysis and conditional Poisson regression were used to derive incidence rate ratios (IRR) of falls and fractures during six predefined periods. RESULTS In total 62,105 and 36,808 adults, respectively, experienced a fall or fracture. For older adults, the risk of falls was highest during the 3-month pre-treatment period (IRRmen+70 , 4.22 (95% confidence interval, 3.53-5.05), IRRwomen + 70 , 3.03 (2.59-3.55)) compared to the baseline (>1 year before initiation). The risk continued to be higher in the later treatment periods. Contrarily, in men and women aged 40-69 years, the risk was only higher in the 3-month pre-treatment period. The incidence of falls among young men and women was slightly lower after initiation of sedating medication (treatment period, IRRmen15-39 , 0.66 (0.50-0.86), IRRwomen15-39 , 0.65 (0.51-0.83)). Analyses with fractures as outcome yielded similar results. CONCLUSIONS Although falls and fractures occur more often in persons using sedative-hypnotic medication, the higher risk of falls and fractures in the pre-treatment period relative to the period directly after treatment, suggests that this association is better explained by other factors that elicited the prescription of this medication rather than the adverse effects of the sedative-hypnotic medication.
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Affiliation(s)
- Maarten Pieter Rozing
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
| | - Ida Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
| | - Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Kumar M, Orkaby A, Tighe C, Villareal DT, Billingsley H, Nanna MG, Kwak MJ, Rohant N, Patel S, Goyal P, Hummel S, Al-Malouf C, Kolimas A, Krishnaswami A, Rich MW, Kirkpatrick J, Damluji AA, Kuchel GA, Forman DE, Alexander KP. Life's Essential 8: Optimizing Health in Older Adults. JACC. ADVANCES 2023; 2:100560. [PMID: 37664644 PMCID: PMC10470487 DOI: 10.1016/j.jacadv.2023.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The population worldwide is getting older as a result of advances in public health, medicine, and technology. Older individuals are living longer with a higher prevalence of subclinical and clinical cardiovascular disease (CVD). In 2010, the American Heart Association introduced a list of key prevention targets, known as "Life's Simple 7" to increase CVD-free survival, longevity, and quality of life. In 2022, sleep health was added to expand the recommendations to "Life's Essential 8" (eat better, be more active, stop smoking, get adequate sleep, manage weight, manage cholesterol, manage blood pressure, and manage diabetes). These prevention targets are intended to apply regardless of chronologic age. During this same time, the understanding of aging biology and goals of care for older adults further enhanced the relevance of prevention across the range of functions. From a biological perspective, aging is a complex cellular process characterized by genomic instability, telomere attrition, loss of proteostasis, inflammation, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. These aging hallmarks are triggered by and enhanced by traditional CVD risk factors leading to geriatric syndromes (eg, frailty, sarcopenia, functional limitation, and cognitive impairment) which complicate efforts toward prevention. Therefore, we review Life's Essential 8 through the lens of aging biology, geroscience, and geriatric precepts to guide clinicians taking care of older adults.
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Affiliation(s)
- Manish Kumar
- Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Ariela Orkaby
- New England GRECC (Geriatric Research Education and Clinical Center), VA Boston HealthCare System, Boston, Massachusetts, USA
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caitlan Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Dennis T. Villareal
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | - Hayley Billingsley
- Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Min Ji Kwak
- Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Namit Rohant
- Department of Cardiology, University of Arizona, Tucson, Arizona, USA
| | - Shreya Patel
- Department of Pharmacy Practice, School of Pharmacy and Health Sciences, Fairleigh Dickinson University, Florham Park, New Jersey, USA
| | - Parag Goyal
- Program for the Care and Study of Aging Heart, Department of Medicine, Weill Cornell of Medicine, New York, New York, USA
| | - Scott Hummel
- Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Christina Al-Malouf
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amie Kolimas
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Mike W. Rich
- Department of Medicine, Washington University, St Louise, Missouri, USA
| | - James Kirkpatrick
- Department of Cardiology, University of Washington, Seattle, Washington, USA
| | - Abdulla A. Damluji
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - George A. Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Daniel E. Forman
- Divisions of Cardiology and Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh GRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Karen P. Alexander
- Division of Cardiology, Duke Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
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Welburn S, Fanning E, Cauley J, Brown P, Strotmeyer E, Boudreau R, Bear T, Moored K, Cawthon P, Stone K, Glynn N. Role of Perceived Physical and Mental Fatigability Severity on Prospective, Recurrent, and Injurious Fall Risk in Older Men. J Gerontol A Biol Sci Med Sci 2023; 78:1669-1676. [PMID: 36801938 PMCID: PMC10460552 DOI: 10.1093/gerona/glad061] [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: 04/19/2022] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Falls occur annually in 25% of adults aged ≥65 years. Fall-related injuries are increasing, highlighting the need to identify modifiable risk factors. METHODS Role of fatigability on prospective, recurrent, and injurious fall risk was examined in 1 740 men aged 77-101 years in the Osteoporotic Fractures in Men Study. The 10-item Pittsburgh Fatigability Scale measured perceived physical and mental fatigability (0-50/subscale) at Year 14 (2014-16); established cut-points identified men with more severe perceived physical (≥15, 55.7%), more severe mental (≥13, 23.7%) fatigability, or having both (22.8%). Prospective, recurrent (≥2), and injurious falls were captured by triannual questionnaires ≥1 year after fatigability assessment; risk of any fall was estimated with Poisson generalized estimating equations, and likelihood of recurrent/injurious falls with logistic regression. Models adjusted for age, health conditions, and other confounders. RESULTS Men with more severe physical fatigability had a 20% (p = .03) increased fall risk compared with men with less physical fatigability, with increased odds of recurrent and injurious falls, 37% (p = .04) and 35% (p = .035), respectively. Men with both more severe physical and mental fatigability had a 24% increased risk of a prospective fall (p = .026), and 44% (p = .045) increased odds of recurrent falling compared with men with less severe physical and mental fatigability. Mental fatigability alone was not associated with fall risk. Additional adjustment for previous fall history attenuated associations. CONCLUSIONS More severe fatigability may be an early indicator to identify men at high risk for falls. Our findings warrant replication in women, as they have higher rates of fatigability and prospective falls.
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Affiliation(s)
- Sharon C Welburn
- Department of Kinesiology and Health Sciences, Columbus State University, Columbus, Georgia,USA
| | - Erin E Fanning
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick J Brown
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, and The New York State Psychiatric Institute, New York, New York, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Todd M Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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8
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Zhou T, Dai X, Yuan Y, Xue Q, Li X, Wang M, Ma H, Heianza Y, Qi L. Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging. Front Immunol 2023; 14:1234102. [PMID: 37662961 PMCID: PMC10470625 DOI: 10.3389/fimmu.2023.1234102] [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: 06/03/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background Autoimmune diseases are more common among people with unhealthy sleep behaviors, and these conditions have been linked to aging-related bone health. However, there have been few studies that examined the correlation between recently developed sleep patterns based on sleep duration, sleepiness, chronotype, snoring, insomnia, and the incidence of falls and fractures. Methods We used a newly developed sleep pattern with components of sleep 7 to 8 h per day, absence of frequent excessive daytime sleepiness, early chronotype, no snoring, and no frequent insomnia as healthy factors to study their relationship with the incidence of falls and fractures. The analysis was conducted among 289,000 participants from the UK Biobank. Results The mean follow-up period was 12.3 years (3.5 million person-years of follow-up), and 12,967 cases of falls and 16,121 cases of all fractures were documented. Compared to participants exhibiting an unfavorable sleep pattern, those adhering to a healthy sleep pattern experienced a 17% and 28% reduction in the risks of incident falls (hazard ratio [HR], 0.83; 95% CI, 0.74-0.93) and all fractures (HR, 0.72; 95% CI, 0.66-0.79) during follow-up. In addition, participants exhibiting a healthy sleep pattern, together with a high genetically determined bone mineral density (BMD), showed the lowest risks of falls and fractures. Conclusion A healthy sleep pattern was significantly linked to decreased risks of incident falls and fractures. The protective association was not modified by genetically determined BMD.
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Affiliation(s)
- Tao Zhou
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xue Dai
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yu Yuan
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Mengying Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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9
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Wu JX, Deng FY, Lei SF. The Casual Association Inference for the Chain of Falls Risk Factors-Falls-Falls Outcomes: A Mendelian Randomization Study. Healthcare (Basel) 2023; 11:1889. [PMID: 37444723 DOI: 10.3390/healthcare11131889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Previous associations have been observed not only between risk factors and falls but also between falls and their clinical outcomes based on some cross-sectional designs, but their causal associations were still largely unclear. We performed Mendelian randomization (MR), multivariate Mendelian randomization (MVMR), and mediation analyses to explore the effects of falls. Our study data are mainly based on White European individuals (40-69 years) downloaded from the UK Biobank. MR analyses showed that osteoporosis (p = 0.006), BMI (p = 0.003), sleeplessness (p < 0.001), rheumatoid arthritis (p = 0.001), waist circumference (p < 0.001), and hip circumference (p < 0.001) have causal effects on falls. In addition, for every one standard deviation increase in fall risk, the risk of fracture increased by 1.148 (p < 0.001), the risk of stroke increased by 2.908 (p = 0.003), and a 1.016-fold risk increase in epilepsy (p = 0.009). The MVMR found that sleeplessness is an important risk factor for falls. Finally, our mediation analyses estimated the mediation effects of falls on the hip circumference and fracture (p < 0.001), waist circumference and epilepsy (p < 0.001), and sleeplessness and fracture (p = 0.005). Our study inferred the causal effects between risk factors and falls, falls, and outcomes, and also constructed three causal chains from risk factors → falls → falls outcomes.
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Affiliation(s)
- Jia-Xin Wu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
- Collaborative Innovation Center of Bone and Immunology between Sihong Hospital and Soochow University, Suzhou 215123, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou 215123, China
| | - Fei-Yan Deng
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
- Collaborative Innovation Center of Bone and Immunology between Sihong Hospital and Soochow University, Suzhou 215123, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou 215123, China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
- Collaborative Innovation Center of Bone and Immunology between Sihong Hospital and Soochow University, Suzhou 215123, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou 215123, China
- Changzhou Geriatric Hospital, Soochow University, Changzhou 213000, China
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10
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Katz P, Pedro S, Michaud K. Sleep Disorders Among Individuals With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:1250-1260. [PMID: 35997482 DOI: 10.1002/acr.24999] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Self-reported sleep problems are common in rheumatoid arthritis (RA), with potential negative health implications, yet relatively little research has focused on sleep in RA. We examined the prevalence of obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS) symptoms, and short sleep (SS) in a large RA cohort (n = 4,200) and factors associated with each. METHODS Data are from FORWARD, The National Databank for Rheumatic Diseases. Validated screening measures assessed OSA risk and RLS symptoms. SS was based on self-reported average sleep time (<6 hours). The Medical Outcomes Study Sleep Problems Index I measured self-reported sleep quality. Multivariable logistic regression models identified independent predictors of sleep disorders and sleep quality and the independent association of OSA risk, RLS symptoms, and SS with self-reported poor sleep quality. RESULTS Twenty-one percent (n = 899) had OSA diagnosis or risk, 30% (n = 1,272) had RLS symptoms or diagnosis, and 43% (n = 1,737) reported SS, and RA disease activity was associated with each sleep disorder. Abatacept use was associated with lower odds of RLS and SS. Use of conventional disease-modifying antirheumatic drugs or abatacept was less frequent in the SS group. No medications were associated with OSA in multivariable analyses. Both RLS and SS was associated with worse perceived sleep quality. DISCUSSION Almost two-thirds met criteria for at least one sleep disorder. RA disease activity and pain were significantly associated with each sleep condition. Additional research is needed to identify the causal pathway between sleep disorders and RA disease activity and pain and the long-term consequences of sleep disorders in RA.
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Affiliation(s)
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
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11
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Zhang YW, Lu PP, Li YJ, Wang H, Zhao YK, Chen H, Rui YF. Short report: relationship between self-reported sleep characteristics and falls-associated fractures in elderly individuals: a population-based study. PSYCHOL HEALTH MED 2023; 28:946-954. [PMID: 36050909 DOI: 10.1080/13548506.2022.2119482] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Currently, the data for effect of sleep on falls-associated fractures in elderly individuals are still limited. This current study was aimed to assess the link between self-reported sleep characteristics and falls-associated fractures in elderly individuals. This study included a total of 20,497 participants from National Health and Nutritional Examination Survey (NHANES) 2005-2008, and 6,174 participants aged 45 years and older were identified. Self-reported sleep characteristics and conditions of falls-associated fractures of individuals were obtained via the method of personal questionnaires. In a total of 610 participants with exact history of fractures, 168 individuals with falls-associated fractures were identified, and the prevalence was 27.5%. The mean age of falls-associated fractures group was (72.1 ± 8.8) years, and the female (P < 0.001) occupied a higher proportion. Factors of living alone (P = 0.003), combined with hypertension (P = 0.003) and osteoporosis (P < 0.001), sleeping less or more (P = 0.009), and frequent snoring (P = 0.007) were linked to falls-associated fractures. Compared with sleep duration of 6 to 8 h/night, sleep duration of ≤4 h/night (odds ratio [OR] 1.858, 95% confidence interval [CI] 1.115-3.094) and of ≥9 h/night (OR 1.932, 95% CI 1.195-3.123) were related to an increased risk of falls-associated fractures. Collectively, our nationwide data noted that sleep characteristics were closely related to falls-associated fractures in elderly individuals, and a longer sleep duration may exhibit a protective effect against the falls-associated fractures, but it should be limited within 9 h/night.
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Affiliation(s)
- Yuan-Wei Zhang
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pan-Pan Lu
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ying-Juan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hao Wang
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ya-Kuan Zhao
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hui Chen
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yun-Feng Rui
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, China.,Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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12
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Hypnotic Medications as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2023; 18:95-111. [PMID: 36764791 DOI: 10.1016/j.jsmc.2022.10.004] [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: 02/10/2023]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the universally recommended treatment of choice for insomnia disorder based on its safety and posttreatment durability of benefit. However, CBT-I does not help all patients achieve remission. The second most evidence-based treatment, hypnotic pharmacotherapy (PCT), does not resolve perpetuating factors of insomnia, resulting in potential waning of benefit and dependence. This article presents a rationale that supports consideration of hypnotic augmentation of CBT-I (COMB), along with a review of select randomized controlled trials relevant to clinical decision-making.
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13
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National incidence of joint dislocation in China: a retrospective survey of 512,187 individuals. Chin Med J (Engl) 2022; 135:1742-1749. [PMID: 35984105 PMCID: PMC9509134 DOI: 10.1097/cm9.0000000000002253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Joint dislocations significantly impact public health. However, a comprehensive study on the incidence, distribution, and risk factors for joint dislocations in China is lacking. We conducted the China National Joint Dislocation Study, which is a part of the China National Fracture Study conducted to obtain the national incidence and risk factors for traumatic fractures, and to investigate the incidence and risk factors for joint dislocations. METHODS For this national retrospective epidemiological study, 512,187 participants were recruited using stratified random sampling and probability-proportional-to-size method from January 19 to May 16, 2015. Participants who sustained joint dislocations of the trunk, arms, or legs (skull, sternum, and ribs being excluded) in 2014 were personally interviewed to obtain data on age, educational background, ethnic origin, occupation, geographic region, and urbanization degree. The joint-dislocation incidence was calculated based on age, sex, body site, and demographic factors. The risk factors for different groups were examined using multiple logistic regression. RESULTS One hundred and nineteen participants sustained 121 joint dislocations in 2014. The population-weighted incidence rate of joint dislocations of the trunk, arms, or legs was 0.22 (95% confidence interval [CI]: 0.16, 0.27) per 1000 population in 2014 (men, 0.27 [0.20, 0.34]; women, 0.16 [0.10, 0.23]). For all ages, previous dislocation history (male: OR 42.33, 95% confidence interval [CI]: 12.03-148.90; female: OR 54.43, 95% CI: 17.37-170.50) and alcohol consumption (male: OR 3.50, 95% CI: 1.49-8.22; female: OR 2.65, 95% CI: 1.08-6.50) were risk factors for joint dislocation. Sleeping less than 7 h/day was a risk factor for men. Compared with children, women aged ≥15 years (female 15-64 years: OR 0.16, 95% CI: 0.04-0.61; female ≥65 years: OR 0.06, 95% CI: 0.01-0.41) were less likely to sustain joint dislocations. Women with more than three children were at higher dislocation risk than women without children (OR 6.92, 95% CI: 1.18-40.78). CONCLUSIONS The up-to-date data on joint dislocation incidence, distribution, and risk factors can be used as a reference for national healthcare, prevention, and management in China. Specific strategies for decreasing alcohol consumption and encouraging adequate sleeping hours should be developed to prevent or reduce dislocation incidents. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-EPR-15005878.
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14
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Abstract
With aging, there are normative changes to sleep physiology and circadian rhythmicity that may predispose older adults to sleep deficiency, whereas many health-related and psychosocial/behavioral factors may precipitate sleep deficiency. In this article, we describe age-related changes to sleep and describe how the health-related and psychosocial/behavioral factors typical of aging may converge in older adults to increase the risk for sleep deficiency. Next, we review the consequences of sleep deficiency in older adults, focusing specifically on important age-related outcomes, including mortality, cognition, depression, and physical function. Finally, we review treatments for sleep deficiency, highlighting safe and effective nonpharmacologic interventions.
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Affiliation(s)
- Jane Alexandra Pappas
- San Juan Bautista School of Medicine, Salida 21 Carr. 172 Urb. Turabo Gardens, Caguas 00726, Puerto Rico
| | - Brienne Miner
- Section of Geriatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
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15
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Abstract
PURPOSE OF REVIEW Review recent literature investigating the relationship between bone health and sleep/circadian disruptions (e.g., abnormal sleep duration, night shift work). RECENT FINDINGS Short and long sleep are associated with low bone mineral density (BMD). Recent data from observational studies identified an increased risk of fracture in women with short sleep. Studies suggest that age, sex, weight change, and concurrent circadian misalignment may modify the effects of sleep restriction on bone metabolism. Interventional studies demonstrate alterations in bone metabolism and structure in response to circadian disruption that could underlie the increased fracture risk seen with night shift work. The effects of sleep and circadian disruption during adolescence may have lifelong skeletal consequences if they adversely impact bone modeling. Data suggest that short sleep and night shift work negatively impact bone metabolism and health. Rigorous studies of prevalent sleep and circadian disruptions are needed to determine mechanisms and develop prevention strategies to optimize lifelong skeletal health.
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Affiliation(s)
- Christine Swanson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave., Mail Stop 8106, Aurora, CO, 80045, USA.
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16
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Tian F, Zhao M, Chen Z, Yang R. Prescription of Potentially Inappropriate Medication Use in Older Cancer Outpatients With Multimorbidity: Concordance Among the Chinese, AGS/Beers, and STOPP Criteria. Front Pharmacol 2022; 13:857811. [PMID: 35496292 PMCID: PMC9039126 DOI: 10.3389/fphar.2022.857811] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/18/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives: Age-related multimorbidity is a general problem in older patients, which increases the prevalence of potentially inappropriate medication (PIM) use. This study aimed to examine the prevalence and predictors of PIM use in older Chinese cancer outpatients with multimorbidity based on the 2017 Chinese criteria, 2019 AGS/Beers criteria, and 2014 STOPP criteria. Methods: A cross-sectional study was conducted using electronic medical data from nine tertiary hospitals in Chengdu from January 2018 to December 2018. The 2017 Chinese criteria, 2019 AGS/Beers criteria, and 2014 STOPP criteria were used to evaluate the PIM status of older cancer outpatients (age ≥65 years), the concordance among the three PIM criteria was calculated using kappa tests, and multivariate logistic regression was used to identify the risk factors associated with PIM use. Results: A total of 6,160 cancer outpatient prescriptions were included in the study. The prevalence of PIM use was 34.37, 32.65, and 15.96%, according to the 2017 Chinese criteria, 2019 AGS/Beers criteria, and 2014 STOPP criteria, respectively. Furthermore, 62.43% of PIMs met table 2, 0.27% of PIMs met table 3, 34.68% of PIMs met table 4, 2.62% of PIMs met table 5 of 2019 AGS/Beers criteria, respectively. According to the three criteria, 84.93%, 82.25%, and 94.61% of older cancer outpatients had one PIM. The most frequently used PIM in cancer outpatients was estazolam. The Chinese criteria and the STOPP criteria indicated poor concordance, whereas the 2019 AGS/Beers criteria showed moderate concordance with the other two criteria. Logistic regression demonstrated that age ≥ 80, more diseases, polypharmacy, irrational use of drugs, and lung cancer were positively associated with PIM use in older cancer outpatients. Conclusion: The prevalence of PIM use in Chinese older cancer outpatients with multimorbidity is high in China, and poor-to-moderate concordance among the three criteria was observed. Research on building PIM criteria for the older cancer population is necessary in the future.
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Affiliation(s)
- Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- *Correspondence: Fangyuan Tian, , orcid.org/0000-0002-5187-0386
| | - Mengnan Zhao
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Ruonan Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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18
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Kirshner D, Spiegelhalder K, Shahar RT, Shochat T, Agmon M. The association between objective measurements of sleep quality and postural control in adults: A systematic review. Sleep Med Rev 2022; 63:101633. [DOI: 10.1016/j.smrv.2022.101633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/18/2022] [Accepted: 04/03/2022] [Indexed: 01/31/2023]
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19
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Knechel NA, Chang PS. The relationships between sleep disturbance and falls: A systematic review. J Sleep Res 2022; 31:e13580. [PMID: 35288982 DOI: 10.1111/jsr.13580] [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: 10/28/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this systematic review was to examine critically the literature that addresses the association between sleep disturbance and falls. Electronic databases OVID MEDLINE, PubMed, and CINAHL were searched using MeSH terms "sleep" and "accidental falls." Search limits included adults, humans, and English. The articles selected for the final sample were assessed for methodological quality. Eleven key attributes of sleep disturbance were extracted. The search yielded 177 articles from OVID MEDLINE, 124 from PubMed, and 46 from CINAHL. The final sample included 42 papers. The mean methodological quality score was 7.5 (range 2-10). Those who self-report >11 h or ≤5 h of nocturnal sleep duration may have a greater fall risk, but variations in cutoff points, study designs, and data collection methods contribute to difficulty in comparing study results. Subjective sleep fragmentation is associated with falls. The few studies on obstructive sleep apnea and insomnia demonstrate evidence of an increased risk for falls. It remains unclear whether daytime sleepiness, self-reported sleep quality, snoring, or napping are associated with falls, since some but not all studies demonstrate an association and the study quality did not differ.
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20
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Tian F, Yang R, Chen Z, Duan X, Yuan P. The prevalence and factors associated with potentially inappropriate medication use in Chinese older outpatients with cancer with multimorbidity. J Geriatr Oncol 2022; 13:629-634. [DOI: 10.1016/j.jgo.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023]
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21
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Stewart NH, Arora VM. Sleep in Hospitalized Patients. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Taani MH, Kovach CR. Do Daytime Activity, Mood and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents? Healthcare (Basel) 2021; 10:healthcare10010022. [PMID: 35052186 PMCID: PMC8775539 DOI: 10.3390/healthcare10010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, unit tumult, and mood were associated with sleep quality. A convenience sample of 53 long-term care (LTC) residents participated in this correlational study. Objective sleep quality was measured using actigraphy, and comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than 80% and was awake for more than 90 min at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor sleep. Findings suggest daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality.
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Imaginário C, Martins T, Araújo F, Rocha M, Machado P. Risk Factors Associated with Falls among Nursing Home Residents: A Case-Control Study. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000520491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand the behaviour and health conditions of older adults living in nursing homes. Objective: This study had two main objectives. The first was to find significant predictors for falls in older adults living in nursing homes. The second main goal was to build a predictive model to find the best predictors for falls. Methods: Out of 56 nursing homes with the same legal statute, 25 agreed to participate. The sample was randomly selected and only the independent or slight/moderately dependent participants were included in the study (n = 325). Results: There was a mean of 1.47 ± 0.99 falls (range from 1 to 7) per resident in nursing homes. By using the t test and odds ratio analysis, ten factors related to falls were identified. Through the binary logistic regression, a model was tested identifying four robust predictors: static balance, resorting to emergency services, polypharmacy, and an independent self-care profile. Conclusions: The present study replicated the main results of contemporary research on the risk factors of falls. More importantly, it suggests that the self-care profile model should be taken into account in future studies and early interventions. It is crucial to implement preventive measures consistent with safer environments and to establish an individual plan for integrated activities according to older adults’ health needs.
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24
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Lee S, Chung JH, Kim JH. Association Between Sleep Quality and Falls: A Nationwide Population-Based Study from South Korea. Int J Gen Med 2021; 14:7423-7433. [PMID: 34744453 PMCID: PMC8566001 DOI: 10.2147/ijgm.s331103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/05/2021] [Indexed: 01/06/2023] Open
Abstract
Purpose There are few large studies evaluating the association between sleep quality and the risk of falls. We aimed to determine the independent effect of poor sleep quality on an increased risk of falls using a large-sample dataset. Methods We conducted a retrospective, cross-sectional study using population-based data from the 2018 Korean Community Health Survey on 201,700 participants. Sociodemographic, mental health-related, and physical health-related variables as well as sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) were compared between 2499 fallers who have experienced at least one fall during the past 12 months and 199,201 non-fallers. Multivariable logistic regression was performed to identify sleep quality variables significantly associated with an increased risk of falls. Results Fallers had poorer sleep quality (PSQI score >5) and higher scores for global PSQI and individual PSQI components than did non-fallers (all p < 0.001). Multivariable logistic regression adjusted for potential confounders including socioeconomic, physical health-related, and mental health-related variables showed that an increased risk of falls was associated with poor sleep quality (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.19–1.42). Subgroup analyses by age revealed that poor sleep quality was significantly associated with an increased risk of falls in all three adult age groups. Multivariable logistic regression using the seven PSQI components revealed that an increased risk of falls was associated with short sleep duration (OR 1.14, CI 1.09–1.20), increased sleep disturbances (OR 1.30, CI 1.16–1.46), and increased daytime dysfunctions (OR 1.21, CI 1.08–1.13). Conclusion Poor sleep quality caused by short sleep duration may be a principal risk factor of falls in adult populations. Increased sleep disturbances and daytime dysfunctions may also contribute to an increased risk of falls. Our results have clinical and public health perspectives that increasing sleep duration and reducing daytime dysfunctions and sleep disturbances could mitigate unintentional falls.
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Affiliation(s)
- Sujin Lee
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Jae Ho Chung
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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25
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Beetz G, Herrero Babiloni A, Jodoin M, Charlebois-Plante C, Lavigne GJ, De Beaumont L, Rouleau DM. Relevance of Sleep Disturbances to Orthopaedic Surgery: A Current Concepts Narrative and Practical Review. J Bone Joint Surg Am 2021; 103:2045-2056. [PMID: 34478407 DOI: 10.2106/jbjs.21.00176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Sleep disturbances can increase the risk of falls and motor vehicle accidents and may reduce bone density. ➤ Poor sleep can lead to worse outcomes after fracture, such as chronic pain and delayed recovery. ➤ Orthopaedic surgeons can play an important role in the screening of sleep disorders among their patients.
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Affiliation(s)
- Gabrielle Beetz
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alberto Herrero Babiloni
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Marianne Jodoin
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | | | - Gilles J Lavigne
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Dominique M Rouleau
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
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Seol J, Lee J, Nagata K, Fujii Y, Joho K, Tateoka K, Inoue T, Liu J, Okura T. Combined effect of daily physical activity and social relationships on sleep disorder among older adults: cross-sectional and longitudinal study based on data from the Kasama study. BMC Geriatr 2021; 21:623. [PMID: 34732144 PMCID: PMC8565015 DOI: 10.1186/s12877-021-02589-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study investigated whether daily physical activity of older adults, combined with social relationships, is associated with the risk of sleep disorder. Further, it determined whether a high level of one variable with a low level of the other, leads to a significantly lower risk of sleep disorder than low levels of both. Methods The sample comprised 1339 community-dwelling older Japanese adults: 988 in Study 1 and 351 in Study 2. The level of daily physical activity and range of social relationships were assessed using the Physical Activity Scale for the Elderly and the Lubben Social Network Scale, respectively. The Pittsburgh Sleep Quality Index was used to assess sleep disorder. To test the combined relationships and effects in Studies 1 and 2, the medians for the respective scores of each of the following four groups that the participants were categorized into, were calculated: (1) low activity group with low social relationships, (2) low activity group with high social relationships, (3) high activity group with low social relationships, and (4) high activity group with high social relationships. After adjusting for potential confounders, a logistic regression analysis was conducted in Study 1. After adjusting for potential confounders, a Cox proportional hazards regression analysis was conducted in Study 2. Results Study 1 revealed that the high activity group with high social relationships showed a significantly lower risk of sleep disorder (ORs: 0.585, 95% CI: 0.404–0.847) than the low activity group with low social relationships. Study 2 also revealed that the high activity group with high social relationships showed a significantly lower prevalence of sleep disorder (HRs: 0.564, 95% CI: 0.327–0.974) than the low activity group with low social relationships. Conclusions Our findings suggest that for older adults with high social relationships, being physically active is favorably associated with sleep quality. However, a high level of one variable with a low level of the other has not been confirmed in improving sleep quality among older adults.
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Affiliation(s)
- Jaehoon Seol
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan. .,International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. .,Japan Society for the Promotion of Sciences, 5-3-1 Kojimachi, Chiyoda, Tokyo, 102-0083, Japan.
| | - Jaehee Lee
- Master's Program in Physical Education, Health and Sports Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Koki Nagata
- Doctoral Program in Public Health, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Yuya Fujii
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, 150 Tobukimachi, Hachioji, Tokyo, 192-0001, Japan
| | - Kaya Joho
- Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan.,J-Stretch Association, 1132-1-504 Ochikawa, Hino-city, Tokyo, 191-0034, Japan
| | - Korin Tateoka
- Doctoral Program in Physical Education, Health and Sports Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Taiki Inoue
- Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Jue Liu
- Doctoral Program in Physical Education, Health and Sports Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Tomohiro Okura
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan.,R&D Center for Tailor-Made QOL, University of Tsukuba, 1-2 Kasuga, Tsukuba, Ibaraki, 305-8550, Japan
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27
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Lujan MR, Perez-Pozuelo I, Grandner MA. Past, Present, and Future of Multisensory Wearable Technology to Monitor Sleep and Circadian Rhythms. Front Digit Health 2021; 3:721919. [PMID: 34713186 PMCID: PMC8521807 DOI: 10.3389/fdgth.2021.721919] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022] Open
Abstract
Movement-based sleep-wake detection devices (i.e., actigraphy devices) were first developed in the early 1970s and have repeatedly been validated against polysomnography, which is considered the “gold-standard” of sleep measurement. Indeed, they have become important tools for objectively inferring sleep in free-living conditions. Standard actigraphy devices are rooted in accelerometry to measure movement and make predictions, via scoring algorithms, as to whether the wearer is in a state of wakefulness or sleep. Two important developments have become incorporated in newer devices. First, additional sensors, including measures of heart rate and heart rate variability and higher resolution movement sensing through triaxial accelerometers, have been introduced to improve upon traditional, movement-based scoring algorithms. Second, these devices have transcended scientific utility and are now being manufactured and distributed to the general public. This review will provide an overview of: (1) the history of actigraphic sleep measurement, (2) the physiological underpinnings of heart rate and heart rate variability measurement in wearables, (3) the refinement and validation of both standard actigraphy and newer, multisensory devices for real-world sleep-wake detection, (4) the practical applications of actigraphy, (5) important limitations of actigraphic measurement, and lastly (6) future directions within the field.
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Affiliation(s)
- Matthew R Lujan
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Ignacio Perez-Pozuelo
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.,Department of Medicine, The Alan Turing Institute, London, United Kingdom
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
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Han C, An J, Chan P. The influence of probable rapid eye movement sleep behavior disorder and sleep insufficiency on fall risk in a community-dwelling elderly population. BMC Geriatr 2021; 21:606. [PMID: 34702166 PMCID: PMC8549138 DOI: 10.1186/s12877-021-02513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022] Open
Abstract
Background The objective was to investigate the individual effect and potential interactions of probable rapid eye movement sleep behavior disorder (pRBD) and sleep insufficiency on fall risk among a Chinese elderly population. Methods Community-dwelling population aged 55 years or above were recruited from the Beijing Longitudinal Study on Aging II cohort from 2010 to 2011. Odds ratio (ORs) and 95% confidence intervals (CIs) were estimated using multivariate logistic regression models. Multiplicative and additive interactions between pRBD and sleep insufficiency were examined using likelihood ratio tests and relative excess risk due to interaction (RERI), respectively. Results Among 6891 included participants, 479 experienced at least once fall. pRBD and sleep insufficiency were both independently associated with elevated fall risk. Compared to the elderly without pRBD or sleep insufficiency, pRBD and sleep insufficiency was each associated with a 2.57-fold (OR = 2.57, 95%CI: 1.46–4.31) and 1.45-fold (OR = 1.45, 95%CI: 1.11–1.88) risk of falls individually, while their coexistence was associated with a less-than-additive 17% (OR = 1.17, 95%CI: 0.43–2.63) increased risk of falls. The combination of these two factors demonstrated evidence of a negative interaction on both multiplicative (ratio of ORs = 0.31, 95%CI: 0.10, 0.86) and additive (RERI = − 1.85, 95%CI: − 3.61, − 0.09) scale. Conclusions Our study has provided robust evidence for the adverse effect of pRBD and sleep insufficiency, as well as their negative interaction on increasing fall risk in a Chinese elderly population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02513-2.
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Affiliation(s)
- Chao Han
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jing An
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, China. .,Department of Neurobiology, Neurology and Geriatrics, Clinical Center for Parkinson's Disease, Key Laboratories for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Advanced Innovative Center for Human Brain Protection, Beijing Institute of Geriatrics, Parkinson Disease Center of Beijing Institute for Brain Disorders, Xuanwu Hospital of Capital Medical University, 45 Changchun Road, Beijing, 100053, China.
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29
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Pan F, Tian J, Cicuttini F, Jones G. Sleep disturbance and bone mineral density, risk of falls and fracture: Results from a 10.7-year prospective cohort study. Bone 2021; 147:115938. [PMID: 33766805 DOI: 10.1016/j.bone.2021.115938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
Sleep problems are common in the general population and have been linked to bone health, falls risk and fracture. However, longitudinal studies on sleep-bone health outcomes are lacking and no study has investigated whether an increased risk of fracture is attributable to sleep-related low bone mineral density (BMD) and an increased risk of falls. This study was designed to examine the associations of sleep disturbance with bone mineral density (BMD), risk of falls and fractures over 10.7 years. The analyses were performed in a population-based cohort study with 1099 participants (mean age 62.9 years) enrolled at baseline, and 875, 768 and 563 participants traced at a mean follow-up of 2.6, 5.1 and 10.7 years, respectively. At each visit, self-reported sleep disturbance was recorded. BMD (by dual-energy x-ray absorptiometry), falls risk score and fracture were measured at each visit. The short-form Physiological Profile Assessment was used to measure falls risk score expressed as Z-score. Fractures were self-reported. Mixed-effects model and generalized estimating equations were used for the analyses. In multivariable analysis, there was a dose-response relationship between the extent of sleep disturbance and falls risk score with the strongest association in those reporting the worst sleep disturbance (β = 0.15/unit; 95%CI 0.02-0.28). The worst sleep disturbance was associated with an increased risk of any (relative risk [RR] 1.30/unit; 95%CI 1.01-1.67) and vertebral fracture (RR 2.41/unit; 95%CI 1.00-5.80) compared with those reporting no interrupted sleep. Women but not men with sleep disturbance had a higher risk of vertebral fracture (RR: 2.07 to 6.02, P < 0.05). These were independent of covariates, hip BMD and falls risk. There was no statistically significant association between sleep disturbance and BMD at the hip, spine or total body. Sleep disturbance was independently associated with a greater falls risk score and an increased risk of fractures. Further research is needed to confirm and identify underlying mechanisms for these associations.
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Affiliation(s)
- Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne, Victoria 3181, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia
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30
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Hjetland GJ, Kolberg E, Pallesen S, Thun E, Nordhus IH, Bjorvatn B, Flo-Groeneboom E. Ambient bright light treatment improved proxy-rated sleep but not sleep measured by actigraphy in nursing home patients with dementia: a placebo-controlled randomised trial. BMC Geriatr 2021; 21:312. [PMID: 34001024 PMCID: PMC8127192 DOI: 10.1186/s12877-021-02236-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 04/20/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Up to 70% of nursing home patients with dementia suffer from sleep problems. Light is the main zeitgeber to the circadian system and thus has a fundamental impact on sleep-wake behaviour. Low indoor light levels in nursing homes have been reported, and in combination with age-related reductions in light sensitivity, insufficient light exposure is likely to contribute to sleep problems in this population. Increasing daytime light exposure using bright light treatment (BLT) may represent a feasible non-pharmacological treatment for sleep problems in nursing home patients with dementia. METHODS The present study reports on sleep outcomes, which are the primary outcomes of the DEM.LIGHT trial (Therapy Light Rooms for Nursing Home Patients with Dementia- Designing Diurnal Conditions for Improved Sleep, Mood and Behavioural Problems), a 24-week cluster-randomised placebo-controlled trial including 8 nursing home units and 69 resident patients. The intervention comprised ambient light of 1000 lx and 6000 K from 10:00 to 15:00, with gradually increasing and decreasing light levels prior to and following this interval, using ceiling mounted light-fixtures and light emitting diode technology. The placebo condition had continuous standard light levels (150-300 lx, ~ 3000 K). Sleep was assessed at baseline and follow-up at week 8, 16, and 24, using the proxy-rated Sleep Disorder Inventory (SDI) and actigraphy (Actiwatch II, Philips Respironics). Mixed linear models were used to evaluate intervention effects, adjusting for relevant covariates such as age, gender, number of drugs, severity of dementia, eye disease, and estimated light exposure. RESULTS Sleep as measured by the SDI was significantly improved in the intervention group compared to the control group from baseline to week 16 (B = - 0.06, 95% CI -0.11 - -0.01, p < .05) and from baseline to week 24 (B = - 0.05, 95% CI -0.10 - -0.01, p < .05). There was no effect according to the SDI at week 8 and no significant effects in terms of actigraphically measured sleep. CONCLUSIONS Proxy-rated sleep improved among nursing home patients with dementia following 16 and 24 weeks of BLT. These improvements were not corroborated by actigraphy recordings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03357328 . Registered 29 November 2017 - Retrospectively registered.
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Affiliation(s)
- Gunnhild J Hjetland
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
- City Department of Health and Care, City of Bergen, Norway.
- Norwegian Institute of Public Health, Bergen, Norway.
| | - Eirin Kolberg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Eirunn Thun
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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31
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Meyer BM, Tulipani LJ, Gurchiek RD, Allen DA, Adamowicz L, Larie D, Solomon AJ, Cheney N, McGinnis RS. Wearables and Deep Learning Classify Fall Risk From Gait in Multiple Sclerosis. IEEE J Biomed Health Inform 2021; 25:1824-1831. [PMID: 32946403 DOI: 10.1109/jbhi.2020.3025049] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Falls are a significant problem for persons with multiple sclerosis (PwMS). Yet fall prevention interventions are not often prescribed until after a fall has been reported to a healthcare provider. While still nascent, objective fall risk assessments could help in prescribing preventative interventions. To this end, retrospective fall status classification commonly serves as an intermediate step in developing prospective fall risk assessments. Previous research has identified measures of gait biomechanics that differ between PwMS who have fallen and those who have not, but these biomechanical indices have not yet been leveraged to detect PwMS who have fallen. Moreover, they require the use of laboratory-based measurement technologies, which prevent clinical deployment. Here we demonstrate that a bidirectional long short-term (BiLSTM) memory deep neural network was able to identify PwMS who have recently fallen with good performance (AUC of 0.88) based on accelerometer data recorded from two wearable sensors during a one-minute walking task. These results provide substantial improvements over machine learning models trained on spatiotemporal gait parameters (21% improvement in AUC), statistical features from the wearable sensor data (16%), and patient-reported (19%) and neurologist-administered (24%) measures in this sample. The success and simplicity (two wearable sensors, only one-minute of walking) of this approach indicates the promise of inexpensive wearable sensors for capturing fall risk in PwMS.
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32
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Song Y, Kelly MR, Fung CH, Dzierzewski JM, Grinberg AM, Mitchell MN, Josephson K, Martin JL, Alessi CA. Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial. Ann Behav Med 2021; 56:35-49. [PMID: 33944909 DOI: 10.1093/abm/kaab030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy for insomnia (CBTI) targets changing dysfunctional sleep-related beliefs. The impact of these changes on daytime functioning in older adults is unknown. PURPOSE We examined whether changes in sleep-related beliefs from pre- to post-CBTI predicted changes in sleep and other outcomes in older adults. METHOD Data included 144 older veterans with insomnia from a randomized controlled trial testing CBTI. Sleep-related beliefs were assessed with the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16, subscales: Consequences, Worry/Helplessness, Sleep Expectations, Medication). Outcomes included sleep diary variables, actigraphy-measured sleep efficiency, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient Health Questionnaire-9, and health-related quality of life. Analyses compared slope of change in DBAS subscales from baseline to posttreatment between CBTI and control, and assessed the relationship between DBAS change and the slope of change in outcomes from baseline to 6 months. RESULTS Compared to controls, the CBTI group demonstrated stronger associations between improvement in DBAS-Consequences and subsequent improvement in PSQI, ISI, ESS, and FFS. The CBTI group also demonstrated stronger associations between improvement in DBAS-Worry/Helplessness and subsequent improvements in PSQI, ISI, and FFS; improvements in DBAS-Medication and PSQI; and improvements in DBAS-Sleep Expectations and wake after sleep onset (sleep diary) and FFS (all p < .05). CONCLUSIONS Significant reduction in dysfunctional sleep-related beliefs following CBTI in older adults predicted improvement in several outcomes of sleep and daytime functioning. This suggests the importance of addressing sleep-related beliefs for sustained improvement with CBTI in older veterans. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00781963.
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Affiliation(s)
- Yeonsu Song
- School of Nursing, University of California, Los Angeles, CA, USA.,Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Monica R Kelly
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA
| | - Constance H Fung
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Austin M Grinberg
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA
| | - Michael N Mitchell
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA
| | - Karen Josephson
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA
| | - Jennifer L Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Cathy A Alessi
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Seol J, Fujii Y, Inoue T, Kitano N, Tsunoda K, Okura T. Effects of Morning Versus Evening Home-Based Exercise on Subjective and Objective Sleep Parameters in Older Adults: A Randomized Controlled Trial. J Geriatr Psychiatry Neurol 2021; 34:232-242. [PMID: 32431208 DOI: 10.1177/0891988720924709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to determine whether the timing of exercise influenced the effects of home-based low-intensity stepping exercises on the sleep parameters of older adults. METHOD For 8 weeks, 60 healthy older adults participated in a randomized controlled trial, performing low-intensity aerobic exercise (70-80 bpm) for about 30 minutes every day at home, either in the morning (from waking until 12:00) or evening (18:00 to bedtime). RESULTS In the evening exercise group, both subjectively and objectively measured sleep latency significantly improved throughout the intervention. Further, postintervention subjective sleep satisfaction was significantly higher in the evening group (6.2 ± 1.3 points) than in the morning group (5.2 ± 1.4 points; P = .006). Additionally, sleep variables related to evening exercise had larger effect sizes (Cohen d) than those performed in the morning. CONCLUSION Engaging in low-intensity stepping exercises during the evening is potentially a useful nonpharmacological approach to improving sleep quality among older adults.
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Affiliation(s)
- Jaehoon Seol
- Doctoral Program in Physical Education, Health and Sport Sciences, 13121University of Tsukuba, Ibaraki, Japan
| | - Yuya Fujii
- Doctoral Program in Physical Education, Health and Sport Sciences, 13121University of Tsukuba, Ibaraki, Japan
| | - Taiki Inoue
- Master's Program in Physical Education, Health and Sport Sciences, 13121University of Tsukuba, Ibaraki, Japan
| | - Naruki Kitano
- Physical Fitness Research Institute, 68376Meiji Yasuda Life Foundation of Health and Welfare, Shinjuku-ku, Tokyo, Japan
| | - Kenji Tsunoda
- Faculty of Social Welfare, 57951Yamaguchi Prefectural University, Yamaguchi, Japan
| | - Tomohiro Okura
- Faculty of Health and Sport Sciences, 13121University of Tsukuba, Ibaraki, Japan
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34
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Ensrud KE, Kats AM, Schousboe JT, Langsetmo L, Vo TN, Blackwell TL, Buysse DJ, Ancoli-Israel S, Stone KL. Multidimensional sleep health and subsequent health-care costs and utilization in older women. Sleep 2021; 43:5637931. [PMID: 31755954 DOI: 10.1093/sleep/zsz230] [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: 04/02/2019] [Revised: 07/31/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Determine the association of poor multidimensional sleep health with health-care costs and utilization. METHODS We linked 1,459 community-dwelling women (mean age 83.6 years) participating in the Study of Osteoporotic Fractures Year 16 visit (2002-2004) with their Medicare claims. Five dimensions of sleep health (satisfaction, daytime sleepiness, timing, latency, and duration) were assessed by self-report. The number of impaired dimensions was expressed as a score (range 0-5). Total direct health-care costs and utilization were ascertained during the subsequent 36 months. RESULTS Mean (SD) total health-care costs/year (2017 dollars) increased in a graded manner across the sleep health score ranging from $10,745 ($15,795) among women with no impairment to up to $15,332 ($22,810) in women with impairment in three to five dimensions (p = 0.01). After adjustment for age, race, and enrollment site, women with impairment in three to five dimensions vs. no impairment had greater mean total costs (cost ratio [CR] 1.34 [95% CI = 1.13 to 1.60]) and appeared to be at higher risk of hospitalization (odds ratio (OR) 1.31 [95% CI = 0.96 to 1.81]). After further accounting for number of medical conditions, functional limitations, and depressive symptoms, impairment in three to five sleep health dimensions was not associated with total costs (CR 1.02 [95% CI = 0.86 to 1.22]) or hospitalization (OR 0.91 [95% CI = 0.65 to 1.28]). Poor multidimensional sleep health was not related to outpatient costs or risk of skilled nursing facility stay. CONCLUSIONS Older women with poor sleep health have higher subsequent total health-care costs largely attributable to their greater burden of medical conditions, functional limitations, and depressive symptoms.
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Affiliation(s)
- Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.,Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
| | - Allyson M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - John T Schousboe
- HealthPartners Institute, Bloomington, MN.,Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Tien N Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | | | | | | | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco
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35
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Song Y, Martin JL, Lee D, Kramer BJ, Ryan GW, Hays RD, Choi SE. Associations of Self-Reported Sleep Quality with Demographic and Other Characteristics in Older Korean Immigrants. J Immigr Minor Health 2021; 24:403-411. [PMID: 33751360 PMCID: PMC7942980 DOI: 10.1007/s10903-021-01174-y] [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] [Accepted: 02/22/2021] [Indexed: 11/02/2022]
Abstract
Poor sleep is common among older adults, affecting a wide range of health outcomes. However, little is known about sleep issues among older Korean immigrants, the fastest growing Asian American subgroup in the United States. We aimed to explore multiple factors associated with sleep among this group. We analyzed cross-sectional survey data from 43 older immigrants living in two large Korean communities in Southern California. Perceived sleep quality was significantly associated with gender, living arrangement, employment status, mental health, and sleep-related beliefs (all p-values < 0.05). Living with someone and being employed for wages were significantly uniquely associated with better sleep quality, accounting for demographic and health-related factors (R2 = 51.8%, adjusted R2 = 38.7%, p = 0.002). These findings suggest a potential role of sociocultural factors on sleep. Further studies are needed to confirm these findings and to inform a sleep intervention program tailored to the characteristics of older Korean immigrants.
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Affiliation(s)
- Yeonsu Song
- School of Nursing, University of California Los Angeles, 700 Tiverton Avenue, 3-242 Factor, Los Angeles, CA, 90095, USA. .,Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Jennifer L Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Diane Lee
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - B Josea Kramer
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gery W Ryan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA
| | - Ron D Hays
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Sarah E Choi
- School of Nursing, University of California Los Angeles, 700 Tiverton Avenue, 3-242 Factor, Los Angeles, CA, 90095, USA
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36
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Jiménez-García JD, Hita-Contreras F, de la Torre-Cruz MJ, Aibar-Almazán A, Achalandabaso-Ochoa A, Fábrega-Cuadros R, Martínez-Amat A. Effects of HIIT and MIIT Suspension Training Programs on Sleep Quality and Fatigue in Older Adults: Randomized Controlled Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1211. [PMID: 33572909 PMCID: PMC7908512 DOI: 10.3390/ijerph18031211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
Poor sleep quality lessens general health quality and is related to physical and mental problems. Moreover, fatigue is one of the foremost common complaints in medical care and plays a role in the decreasing quality of life of the older population. For these reasons, the objective of this study was to examine the effect of high- and moderate-intensity interval training programs (HIIT vs. MIIT)-both consisting of twelve weeks of TRX training-on the sleep quality and fatigue levels of the elderly. A randomized controlled clinical trial (NCT03404830) was conducted. A total of 82 subjects were randomized to either a HIIT group (n = 28) that performed a main squat activity with a suspension system, comprising four four-minute intervals between 90-95% of the maximum heart rate (HR), an MIIT group (n = 27) with an intensity of 70% of the maximum HR, and a control group (CG) (n = 27) that continued their daily lifestyle. The two exercise groups trained twice a week for 12 weeks, with each session lasting 45 min. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI), and fatigue was assessed using the fatigue severity scale (FSS). Outcomes were measured before the intervention and after the intervention period. Post-intervention sleep quality measurements revealed a statistically significant interaction regarding group × time (p < 0.005) and fatigue (p = 0.002). Specifically, fatigue decreased in the HIIT group between both measurement moments (p = 0.003). In addition, differences were obtained in the post-intervention measure between the HIIT and MIIT groups (p = 0.013) and HIIT and control (p = 0.029). Our analysis indicates that a population of the elderly showed improvements in sleep quality and fatigue after performing a high-intensity intervention using suspension training (TRX), with markedly better results in the HIIT group.
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Affiliation(s)
- José Daniel Jiménez-García
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, 11003 Cádiz, Spain;
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, 11003 Cádiz, Spain
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (F.H.-C.); (A.A.-O.); (R.F.-C.); (A.M.-A.)
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (F.H.-C.); (A.A.-O.); (R.F.-C.); (A.M.-A.)
| | - Alexander Achalandabaso-Ochoa
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (F.H.-C.); (A.A.-O.); (R.F.-C.); (A.M.-A.)
| | - Raquel Fábrega-Cuadros
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (F.H.-C.); (A.A.-O.); (R.F.-C.); (A.M.-A.)
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (F.H.-C.); (A.A.-O.); (R.F.-C.); (A.M.-A.)
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Dietary variety is associated with sleep efficiency in urban-dwelling older adults: A longitudinal study. Clin Nutr ESPEN 2021; 41:391-397. [PMID: 33487295 DOI: 10.1016/j.clnesp.2020.10.013] [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: 09/19/2020] [Accepted: 10/19/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Improving sleep quality is important for an aging society. However, no study has been conducted on the association between dietary variety and sleep efficiency among older Japanese adults using longitudinal data. The current study is a longitudinal study that aimed to elucidate the association between dietary variety and sleep efficiency in older Japanese adults. METHODS This study was conducted among older adults (≥70 years old in 2016) in the metropolitan area of Tokyo, Japan, between 2016 and 2018. Dietary variety score (DVS) and sleep efficiency were determined for all participants and were used to assess dietary habits and sleep quality, respectively. A cross-lagged panel analysis was used to consider the prospective associations between DVS and sleep efficiency, and this analysis was performed before and after adjusting for possible covariates in the 2016 data. RESULTS After adjusting for age, sex, body mass index, current drinking status, current smoking status, exercise habits, living (alone or with others) style, the Japanese version of the Geriatric Depression Scale (Short Form), sleep duration and retiring time the DVS in 2016 predicted the sleep efficiency in 2018 (β = 0.130, p < 0.05). CONCLUSION The possibility that DVS can predict sleep efficiency 2 years later was demonstrated.
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Associations between sleep duration, midday napping, depression, and falls among postmenopausal women in China: a population-based nationwide study. ACTA ACUST UNITED AC 2021; 28:554-563. [PMID: 33438896 DOI: 10.1097/gme.0000000000001732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore the independent and joint associations of sleep duration, midday napping, and depression with fall accidents in Chinese postmenopausal women. METHODS A total of 2,378 postmenopausal women aged ≥ 45 years from the baseline survey of the China Health and Retirement Longitudinal Study were enrolled in the study. Each participant provided data on falls, sleep duration, midday napping by a self-reporting approach. We employed the Chinese version of the Center for Epidemiologic Studies Depression Scale to assess depression. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to estimate the associations of predictor variables with falls using multivariate logistic regression. RESULTS Of the 2,378 postmenopausal women, 478 (20.10%) reported falls in the preceding 2 years. Compared with sleep duration of 7 to 8 h/night, sleep duration of 5 to 6 h/night (OR, 1.49; 95% CI, 1.03-2.15) and of ≤ 5 h/night (OR, 1.63; 95% CI, 1.18-2.25) were associated with a higher fall prevalence. However, no significant correlation was found between sleep duration of > 8 h/night and falls. Furthermore, participants with depression were more likely to report falls (OR, 1.78; 95% CI, 1.41-2.25) than their depression-free counterparts. The duration of midday napping was not independently associated with falls, but significant joint associations of sleeping ≤ 6 h/night and no napping (OR, 1.72; 95% CI, 1.07-2.76) or napping > 60 minutes (OR, 2.14; 95% CI, 1.18-3.89) with more falls were found. Similarly, a combined status of sleeping ≤ 6 h/night and depression was related to more falls (OR, 2.97; 95% CI, 1.86-4.74). CONCLUSION The present study demonstrates that short sleep duration and depression are independently associated with more falls among postmenopausal women in China. Moreover, short sleep duration combined with no or long napping, short sleep duration combined with depression are jointly correlated with more falls. Future longitudinal studies are warranted to confirm these findings.
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Kirshner D, Kizony R, Gil E, Asraf K, Krasovsky T, Haimov I, Shochat T, Agmon M. Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study. Nat Sci Sleep 2021; 13:329-338. [PMID: 33727875 PMCID: PMC7955755 DOI: 10.2147/nss.s299833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/16/2021] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia. METHODS Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann-Whitney U-tests. RESULTS Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p<0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p<0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48-30.93 vs 7.81% IQR: 4.43-14.82, p<0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: -0.89-38.84 vs 15%, IQR: -0.89-38.84%, p=0.599). CONCLUSION Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.
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Affiliation(s)
- Dani Kirshner
- Clalit Health Services; Faculty of Medicine, Technion, Haifa, Israel
| | - Rachel Kizony
- Occupational Therapy Department, University of Haifa, Haifa, Israel.,Occupational Therapy Department, Sheba Medical Center, Tel- Hashomer, Tel-Aviv, Israel
| | - Efrat Gil
- Clalit Health Services; Faculty of Medicine, Technion, Haifa, Israel
| | - Kfir Asraf
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Tal Krasovsky
- Physical Therapy Department, University of Haifa, Haifa, Israel.,Pediatric Rehabilitation Department, Sheba Medical Center, Tel- Hashomer, Tel-Aviv, Israel
| | - Iris Haimov
- The Center for Psychobiological Research, Department of Psychology, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Tamar Shochat
- School of Nursing, Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
| | - Maayan Agmon
- School of Nursing, Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
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Jin Z, Lv H, Li M, Hou Z, Lian X, Chen W, Zhang Y. Epidemiological investigation of hospitalized patients with traumatic fractures: a cross-sectional study. J Int Med Res 2021; 49:300060520979854. [PMID: 33435782 PMCID: PMC7809307 DOI: 10.1177/0300060520979854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study was performed to explore major risk factors for traumatic fracture by comparing related data of hospitalized patients with traumatic fracture and patients with lumbar disc herniation. METHODS Patients with traumatic fracture and patients with lumbar disc herniation requiring surgical treatment in the orthopedics department of our hospital from March to May 2018 were divided into a fracture group and a non-fracture group. Clinical data were collected from the two groups by questionnaires. Major risk factors for traumatic fracture were analyzed using multivariate logistic regression. RESULTS Univariate analysis showed statistically significant differences in family history of fracture, smoking history, drinking history, sex, sleep duration, chronic disease history, osteoporosis history, age, body mass index, occupation, and education level between the two groups. Multivariate logistic regression analysis showed that patients aged 25 to 44 years were more prone to traumatic fracture than patients aged ≥65 years, male patients were more prone to fracture than female patients, drinking alcohol was a risk factor for traumatic fracture, and sufficient sleep duration (>7 hours/night) was a protective factor for traumatic fracture. CONCLUSION Young age, male sex, and drinking are risk factors for traumatic fracture, whereas sufficient sleep duration is a protective factor.
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Affiliation(s)
- Zeyue Jin
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Hongzhi Lv
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Ming Li
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Zhiyong Hou
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Xiaodong Lian
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Wei Chen
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Yingze Zhang
- Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
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Desjardins S, Lapierre S, Vasiliadis HM, Hudon C. Evaluation of the Effects of an Intervention Intended to Optimize the Sleep Environment Among the Elderly: An Exploratory Study. Clin Interv Aging 2020; 15:2117-2127. [PMID: 33204077 PMCID: PMC7665518 DOI: 10.2147/cia.s277252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose The objective of this exploratory study was to evaluate the effects of a brief intervention intended to optimize the sleep environment in older people living in the community and to examine the way these effects change over time. Methods The sample was made up of 44 participants (19 men and 25 women) aged 65-85 years, with a mean age of 71.4. The intervention consisted in a group training session that covered the reasons for and ways to ("why" and "how") optimize a sleep environment. It comprises six themes: air quality and odors, luminosity, noises and sounds, comfort of the mattress, comfort of the pillow, and temperature. Participants completed a set of questionnaires before the intervention, and one month and four months later. Results Four months after the intervention, the replies to the questionnaires showed that the participants experienced reduced severity of insomnia, sleep latency and anxiety. The subjective quality of the participants' sleep along with their sleep efficacy also increased significantly during the same period. Conclusion A brief intervention intended to optimize the sleep environment appears promising as an addition or alternative to the two other sleep improvement options generally offered to older people: medication and cognitive behavioral therapy.
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Affiliation(s)
- Sophie Desjardins
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Carol Hudon
- School of Psychology, Université Laval, Québec, Québec, Canada
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Schousboe JT, Kats AM, Stone KL, Langsetmo L, Vo TN, Blackwell TL, Buysse DJ, Ancoli-Israel S, Ensrud KE. Self-reported poor sleep on multiple dimensions is associated with higher total health care costs in older men. Sleep 2020; 43:5819391. [PMID: 32280977 DOI: 10.1093/sleep/zsaa073] [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] [Received: 11/13/2019] [Revised: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To estimate the association of self-reported poor sleep in multiple dimensions with health care costs in older men. METHODS Participants were 1,413 men (mean [SD] age 76.5 [5.7] years) enrolled in both the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study and Medicare Fee-for-Service. Poor sleep was characterized at the baseline MrOS Sleep visit on five dimensions (satisfaction, daytime sleepiness, timing, latency, and duration). Health care costs and utilization were ascertained over 3 years of follow-up using Medicare Claims. RESULTS Median (interquartile range [IQR]) annualized total health care costs (2018 US dollars) rose from $3,616 (IQR 1,523-7,875) for those with no impaired sleep dimensions to $4,416 (IQR 1,854-11,343) for men with two impaired sleep dimensions and $5,819 (IQR 1,936-15,569) for those with at least three impaired sleep dimensions. After multivariable adjustment, the ratio of total health care costs (CR) was significantly higher for men with two (1.24, 95% confidence interval [CI] 1.03- to 1.48) and men with at least three impaired sleep dimensions (1.78, 95% CI 1.42 to 2.23) vs. those with no impaired sleep dimensions. After excluding 101 men who died during the 3-year follow-up period, these associations were attenuated and not significant (CR 1.22, 95% CI 0.98 to 1.53 for men ≥3 impaired sleep dimensions vs. none). CONCLUSIONS Self-reported poor sleep on multiple dimensions is associated with higher subsequent total health care costs in older men, but this may be due to higher mortality and increased health care costs toward the end of life among those with poor sleep health.
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Affiliation(s)
- John T Schousboe
- HealthPartners Institute, Bloomington, MN.,Division of Health Policy & Management, University of Minnesota, Minneapolis, MN
| | - Allyson M Kats
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Lisa Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Tien N Vo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Terri L Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Kristine E Ensrud
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, University of Minnesota, Minneapolis, MN.,Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN
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Turner K, Bjarnadottir R, Jo A, Repique RJR, Thomas J, Green JF, Staggs VS. Patient Falls and Injuries in U.S. Psychiatric Care: Incidence and Trends. Psychiatr Serv 2020; 71:899-905. [PMID: 32600184 DOI: 10.1176/appi.ps.202000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this study was to estimate the incidence of falls (total, injurious, and assisted) in U.S. psychiatric care across 6 years (April 2013-March 2019). METHODS Data on falls among patients of adult and geriatric psychiatric units of general, acute care, and psychiatric hospital inpatient units from the National Database of Nursing Quality Indicators were used for this 6-year study. Total falls, assisted falls (i.e., falls broken or slowed by staff), and injurious falls were calculated, along with trends in total and injurious fall rates. RESULTS The sample included 1,159 units in 720 hospitals. Of the 119,246 falls reported, 25,807 (21.6%) resulted in injury. Only 7.0% of the total falls in psychiatric units were assisted by a staff member. Falling unassisted was associated with a higher likelihood of fall-related injury (adjusted odds ratio=1.69, 95% confidence interval=1.59 to 1.80). The total fall rate (8.55 per 1,000 patient-days) and injurious fall rate (1.97 per 1,000 patient-days) were highest for geriatric psychiatric units in general hospitals. Total and injurious fall rates in psychiatric units in general hospitals declined during the study (total fall rate declined by 10% for adult psychiatric units in general hospitals). There was no clear trend in total or injurious fall rates for units in psychiatric hospitals. CONCLUSIONS Falls are a persistent problem in psychiatric care settings. Few fall-prevention programs have been tested in these settings, which have unique risk factors for falls. Additional research is needed to develop fall-prevention interventions in psychiatric care.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Ragnhildur Bjarnadottir
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Ara Jo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Renee John R Repique
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Jamie Thomas
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Jeanette F Green
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Vincent S Staggs
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
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Jehu DA, Davis JC, Liu-Ambrose T. Risk factors for recurrent falls in older adults: a study protocol for a systematic review with meta-analysis. BMJ Open 2020; 10:e033602. [PMID: 32376749 PMCID: PMC7223009 DOI: 10.1136/bmjopen-2019-033602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Older adults who fall recurrently (i.e., >1 fall/year) are at risk for functional decline and mortality. Key risk factors for recurrent falls in community-dwelling older adults are not well established due to methodological limitations, such as recall bias. A better understanding of the risk factors for recurrent falls will aid in refining clinical practice guidelines for secondary fall prevention strategies. The primary objective of this systematic review with meta-analysis is to examine the risk factors for recurrent falls in prospective studies among community-dwelling older adults. METHODS AND ANALYSIS A comprehensive search for articles indexed in MEDLINE, EMBASE, PsycINFO and CINAHL databases as well as grey literature was conducted on April 25, 2019. We will use MeSH and keyword search terms around the following topics: falls, recurrence, fall-risk, ageing and prospective studies. Prospective studies with monthly falls monitoring for 12 months, investigating risk factors for recurrent falls in older adults will be included. One author will complete the search. Two authors will remove duplicates and screen the titles and abstracts for their potential inclusion against the eligibility criteria. Two authors will screen the full texts and extract the data using a piloted extraction sheet. Included studies will be evaluated for the risk of bias with the Joanna Briggs Institute Prevalence Critical Appraisal tools. The quality of reporting will be determined with the Strengthening the Reporting of OBservational studies in Epidemiology. The data extraction will include study characteristics as well as sociodemographic, balance and mobility, sensory and neuromuscular, psychological, medical, medication and environmental factors. The results will be presented via figures, summary tables, meta-analysis (when possible) and narrative summaries. ETHICS AND DISSEMINATION No ethics approval will be required. Findings will be disseminated through publication and media. PROSPERO REGISTRATION NUMBER CRD42019118888; Pre-results.
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Affiliation(s)
- Deborah A Jehu
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Suchy Y. Introduction to special issue: Contextually valid assessment of executive functions in the era of personalized medicine. Clin Neuropsychol 2020; 34:613-618. [PMID: 32295481 DOI: 10.1080/13854046.2020.1748827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Epidemiology of low-energy fracture in Chinese postmenopausal women: changing trend of incidence since menopause and associated risk factors, a national population-based survey. Menopause 2020; 26:286-292. [PMID: 30325792 DOI: 10.1097/gme.0000000000001211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to report the incidence of low-energy fracture since menopause in postmenopausal women ≤70 years and to explore associated risk factors METHODS:: This was a part of the Chinese National Fracture Survey (CNFS), which was carried out in eight provinces of China mainland between January and May 2015. Data on 68,783 postmenopausal women ≤70 years were extracted from the CNFS database for calculations and analyses. RESULTS A total of 309 women were confirmed to have low-energy fractures in 2014, indicating the incidence of 449.2 (95% CI, 399.3-499.2) per 100,000 women. There were two obvious peaks of fracture incidence at the 4th year and the 9th year since menopause. From the 10th year on, the fracture incidence rate presented the relatively steady trends over years, only with slight interannual fluctuation. After adjustment for confounding variables, advanced age, higher latitude, milk intake ≥1/d, residence ≥2nd floor without elevator, alcohol consumption, sleep duration <7 h/d, history of past fracture, and more births were identified as significant risk factors. Supplementation of calcium or vitamin D or both was associated with 44% of fracture reduction (OR, 0.56; 95% CI, 0.37-0.84). CONCLUSIONS These data on low-energy fractures in postmenopausal women provided an updated clinical evidence base for better national healthcare planning and preventive efforts in China.
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Chung JH, Kim JB, Kim JH. Effects of sleep duration and weekend catch-up sleep on falling injury in adolescents: a population-based study. Sleep Med 2020; 68:138-145. [DOI: 10.1016/j.sleep.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022]
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Cattelani L, Chesani F, Palmerini L, Palumbo P, Chiari L, Bandinelli S. A rule-based framework for risk assessment in the health domain. Int J Approx Reason 2020. [DOI: 10.1016/j.ijar.2019.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Li N, Xu G, Chen G, Zheng X. Sleep quality among Chinese elderly people: A population-based study. Arch Gerontol Geriatr 2020; 87:103968. [DOI: 10.1016/j.archger.2019.103968] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/06/2019] [Accepted: 10/21/2019] [Indexed: 11/16/2022]
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Abstract
Sleep disturbances are common sequelae of traumatic brain injury (TBI) that are associated with poorer recovery. This is important among older adults, who fare worse following TBI relative to younger adults and have a higher prevalence of sleep disorders. The objective of this study was to assess the risk of newly-diagnosed sleep disorders following TBI among adults ≥65 years. Using a large commercial insurance database, older adults diagnosed with TBI between 2008-2014 (n = 78,044) and non-TBI controls (n = 76,107) were identified. The first dates of diagnosis of four common sleep disorders (hypersomnia, insomnia, obstructive sleep apnea, and restless legs syndrome) and a composite of any sleep disorder were identified. To compare groups, this study used a difference-in-differences (DID) approach, accounting for pre-index differences between cohorts and the trends in sleep diagnoses over time. Individuals with TBI were more likely to have any newly-diagnosed sleep disorder before (14.1% vs 9.4%, p < 0.001) and after (22.7% vs 14.1%, p < 0.001) the index date. In fully adjusted DID models, TBI was associated with an increased risk of insomnia (rate ratio (RR) = 1.17; 95% confidence interval (CI) = 1.08-1.26) and any sleep disorder (RR = 1.13; 95% CI = 1.08-1.19). Following TBI among older adults, screening and education on sleep disorders should be considered.
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Affiliation(s)
- Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA,OptumLabs, Visiting Fellow, Cambridge, MA, 02142
| | - Emerson M. Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD,Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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