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Hopkins J, Hill K, Jacques A, Burton E. Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis. Clin Rehabil 2022; 37:215-243. [PMID: 36189497 DOI: 10.1177/02692155221129832] [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: 11/15/2022]
Abstract
OBJECTIVES To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment. DATA SOURCES Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library. REVIEW METHODS All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures. RESULTS Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found. CONCLUSIONS Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.
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Affiliation(s)
- Jane Hopkins
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Angela Jacques
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,Institute for Health Research, 3431University of Notre Dame Australia, Fremantle, WA, Australia
| | - Elissa Burton
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,enAble Institute, 1649Curtin University, Perth, WA, Australia
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Hammouda N, Carpenter C, Hung W, Lesser A, Nyamu S, Liu S, Gettel C, Malsch A, Castillo E, Forrester S, Souffront K, Vargas S, Goldberg EM. Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1214-1227. [PMID: 33977589 PMCID: PMC8581064 DOI: 10.1111/acem.14279] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although falls are common, costly, and often preventable, emergency department (ED)-initiated fall screening and prevention efforts are rare. The Geriatric Emergency Medicine Applied Research Falls core (GEAR-Falls) was created to identify existing research gaps and to prioritize future fall research foci. METHODS GEAR's 49 transdisciplinary stakeholders included patients, geriatricians, ED physicians, epidemiologists, health services researchers, and nursing scientists. We derived relevant clinical fall ED questions and summarized the applicable research evidence, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The highest-priority research foci were identified at the GEAR Consensus Conference. RESULTS We identified two clinical questions for our review (1) fall prevention interventions (32 studies) and (2) risk stratification and falls care plan (19 studies). For (1) 21 of 32 (66%) of interventions were a falls risk screening assessment and 15 of 21 (71%) of these were combined with an exercise program or physical therapy. For (2) 11 fall screening tools were identified, but none were feasible and sufficiently accurate for ED patients. For both questions, the most frequently reported study outcome was recurrent falls, but various process and patient/clinician-centered outcomes were used. Outcome ascertainment relied on self-reported falls in 18 of 32 (56%) studies for (1) and nine of 19 (47%) studies for (2). CONCLUSION Harmonizing definitions, research methods, and outcomes is needed for direct comparison of studies. The need to identify ED-appropriate fall risk assessment tools and role of emergency medical services (EMS) personnel persists. Multifactorial interventions, especially involving exercise, are more efficacious in reducing recurrent falls, but more studies are needed to compare appropriate bundle combinations. GEAR prioritizes five research priorities: (1) EMS role in improving fall-related outcomes, (2) identifying optimal ED fall assessment tools, (3) clarifying patient-prioritized fall interventions and outcomes, (4) standardizing uniform fall ascertainment and measured outcomes, and (5) exploring ideal intervention components.
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Affiliation(s)
- Nada Hammouda
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, NY
| | | | - William Hung
- Department of Geriatrics and Palliative Care, Mount Sinai School of Medicine, New York City, NY
| | | | - Sylviah Nyamu
- Department of Emergency Medicine, Mount Sinai Hospital, New York City, NY
| | - Shan Liu
- Department of Emergency Medicine, Harvard School of Medicine, Boston, MA
| | - Cameron Gettel
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | | | - Edward Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, CA
| | - Savannah Forrester
- Department of Emergency Medicine, Queen’s University, Kingston, Ontario, CA
| | - Kimberly Souffront
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, NY
| | - Samuel Vargas
- Department of Emergency Medicine, Mount Sinai Hospital, New York City, NY
| | - Elizabeth M. Goldberg
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
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Kao PC, Pierro MA, Wu T, Gonzalez DM, Seeley R. Association between functional physical capacity and cognitive performance under destabilizing walking conditions in older adults. Exp Gerontol 2021; 155:111582. [PMID: 34637948 DOI: 10.1016/j.exger.2021.111582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive decline increases the risk of falls in older adults. Understanding the association between cognitive function, functional physical capacity, and falls may help identify targets for fall screening and intervention. This study examined (1) cognitive and functional physical capacity in community-dwelling older adults with and without a history of falls or the presence of brain-derived neurotrophic factor (BDNF) gene Val66Met polymorphism (Val/Met), and (2) the association between their cognitive and functional physical capacity, focusing on the cognitive performance during dual-task, challenging walking conditions. METHODS Twenty-nine healthy, community-dwelling older adults attended two testing sessions for (1) functional assessments of physical capacity and global cognitive status, and (2) performing four cognitive tasks (visual and auditory Stroop tasks, Clock task, and Paced Auditory Serial Addition Test) during standing and while walking on the treadmill with and without medio-lateral treadmill platform sways. RESULTS Participants with a fall history had reduced functional reach distance whereas individuals with Val/Met had reduced functional gait assessment (FGA) score compared to their controls. In addition, participants with a fall history or Val/Met showed reduced Clock task performance under dual-task conditions. Among all cognitive tasks, visual-Stroop performance, especially during the perturbed walking conditions, was significantly correlated with more physical capacity items. The performance of the other three cognitive tasks provided complementary information on those items not correlated with visual-Stroop performance. CONCLUSIONS Clock task performance can distinguish fallers from non-fallers as well as older adults with and without the BDNF gene polymorphism. Administering different types of cognitive tasks and under more challenging walking conditions can better reveal the association between cognitive and functional physical capacity in older adults. Fall screening and prevention intervention should integrate cognitive tasks into the functional physical capacity assessment and training regime, and progress to a more challenging condition such as introducing gait or balance perturbations during the assessment or training.
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Affiliation(s)
- Pei-Chun Kao
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States; New England Robotics Validation and Experimentation (NERVE) Center, University of Massachusetts Lowell, Lowell, MA, United States.
| | - Michaela A Pierro
- Biomedical Engineering and Biotechnology Program, University of Massachusetts Lowell, Lowell, MA, United States
| | - Tong Wu
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Daniela M Gonzalez
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, United States
| | - Rachel Seeley
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
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Baixinho CRSL, Dixe MDACR, Madeira C, Alves S, Henriques MA. Interobserver analysis of safety practices and behaviors adopted by elderly people to prevent falls. Rev Lat Am Enfermagem 2020; 28:e3268. [PMID: 32491125 PMCID: PMC7266635 DOI: 10.1590/1518-8345.3209.3268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/07/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: determine the psychometric properties of the safety practices and behaviors
dimension of the Scale of Practices and Behaviors of Institutionalized
Elderly People to Prevent Falls in a sample of elderly people with cognitive
decline. Method: methodological study, with a quantitative approach, to assess the
psychometric properties of the mentioned scale in a sample with 102 elderly
people with cognitive decline who lived in two long-term care institutions
for the public in this age group. Internal consistency evaluation was
carried out by calculating the Cronbach’s alpha coefficient; interobserver
reliability was expressed by Cohen’s kappa coefficient; and temporal
stability, by obtaining Spearman correlation. Compliance with all ethical
procedures was observed. Results: the dimension of safety practices and behaviors showed α = 0.895 for its 11
items. Seven out of the 11 items reached good to excellent agreement among
the experts for interobserver reliability. Kappa index values indicated that
the instrument is valid and reliable. Safety practices and behaviors were
influenced by institutionalization time, being at least 85 years old, and
gait skills. Conclusion: the results pointed out that the instrument has good reproducibility and is
valid and reliable, which allows its use in clinical practice in elderly
people with cognitive decline as well as in research.
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Affiliation(s)
| | | | - Carla Madeira
- Medicina, Hospital de VIla Franca de Xira, Vila Franca de Xira, VFX, Portugal
| | - Silvia Alves
- Unidade de Cuidados Intensivos, Hospital de VIla Franca de Xira, Vila Franca de Xira, VFX, Portugal
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Mier N, Ory MG, Towne SD, Smith ML. Relative Association of Multi-Level Supportive Environments on Poor Health among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040387. [PMID: 28383513 PMCID: PMC5409588 DOI: 10.3390/ijerph14040387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 12/14/2022]
Abstract
Background: The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older persons. The purpose of this study was to investigate personal characteristics and supportive environments associated with poor health among older individuals aged 65 and over. Methods: This study used a cross-sectional design and was guided by a conceptual framework developed by the authors to depict the relationship between personal characteristics and environments associated with poor health status. Environment types included in this study were family, home, financial, neighborhood, and healthcare. The sample was comprised of 1319 adults aged 65 years and older residing in Central Texas. From a random selection of households, participants were administered a mail-based survey created by a community collaborative effort. Descriptive statistics and three binary logistic regression models were fitted to examine associations with poor health status (i.e., physical, mental, and combined physical/mental). Results: Two personal characteristics (number of chronic conditions and educational level) were consistently related (p < 0.05) to health outcomes. Supportive family, home, financial, neighborhood, and health care environmental factors were shown to be related (p < 0.05) to various aspects of physical or mental health outcomes. Conclusions: Multidimensional factors including personal characteristics and protective environments are related to health status among older individuals. The unique roles of each environment can help inform public health interventions to create and enhance support for older adults to engage in healthful activities and improve their physical and mental health.
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Affiliation(s)
- Nelda Mier
- Department of Public Health Studies, Texas A&M School of Public Health, McAllen Campus, McAllen, TX 78503, USA.
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
| | - Samuel D Towne
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
| | - Matthew Lee Smith
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
- Institute of Gerontology, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
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