Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults

Associations of Usual and Fast Gait Speed With Physical Performance and Balance Confidence in Community-Dwelling Older Adults: Implications for Assessment

BACKGROUND AND PURPOSE

Gait speed is a robust measure that offers many advantages clinically. However, decisions concerning its utilization exist, including whether to assess usual or fast gait speed. The current study aimed to identify whether usual or fast gait speed was more strongly associated with physical performance measures and balance confidence. A secondary aim was to explore these relationships within subgroups based on fall risk status.

METHODS

This was an observational study with a cross-sectional design involving 57 community-dwelling older adults (77.2% female; mean age = 68.8, SD = 6.5 years, range = 60-87 years) who were assessed on the following variables: usual and fast gait speed, knee extension strength, step execution time, 6-minute walk test (6MWT), and Activities-specific Balance Confidence Scale (ABC-6). Spearman ρ correlations were computed to determine bivariate associations of usual and fast gait speed with physical performance measures and balance confidence for the whole sample and within subgroups based on fall risk [lower fall risk (n = 28) vs higher fall risk (n = 29)]. Multiple linear regression models were estimated with either usual or fast gait speed as key predictors of knee extension strength, step execution time, 6MWT, and ABC-6.

RESULTS AND DISCUSSION

Stronger correlations were observed for fast gait speed compared with usual gait speed with all physical performance measures and balance confidence for the entire sample and within the higher fall risk group. Multiple regression results indicated that models with fast rather than usual gait speed as the key predictor explained more of the variance in 6MWT ( R2 = 64.5% vs 45.6%), ABC-6 ( R2 = 28.5% vs 25.4%), step execution time ( R2 = 24.9% vs 19.0%), and knee extension strength ( R2 = 15.7% vs 7.2%).

CONCLUSIONS

Fast gait speed showed stronger associations and better predictive capabilities compared with usual gait speed with physical performance measures and balance confidence in older adults. Despite being measured less often than usual gait speed, fast gait speed assessment warrants additional consideration.

Development and validation of prediction model for fall accidents among chronic kidney disease in the community

Background

The population with chronic kidney disease (CKD) has significantly heightened risk of fall accidents. The aim of this study was to develop a validated risk prediction model for fall accidents among CKD in the community.

Methods

Participants with CKD from the China Health and Retirement Longitudinal Study (CHARLS) were included. The study cohort underwent a random split into a training set and a validation set at a ratio of 70 to 30%. Logistic regression and LASSO regression analyses were applied to screen variables for optimal predictors in the model. A predictive model was then constructed and visually represented in a nomogram. Subsequently, the predictive performance was assessed through ROC curves, calibration curves, and decision curve analysis.

Result

A total of 911 participants were included, and the prevalence of fall accidents was 30.0% (242/911). Fall down experience, BMI, mobility, dominant handgrip, and depression were chosen as predictor factors to formulate the predictive model, visually represented in a nomogram. The AUC value of the predictive model was 0.724 (95% CI 0.679-0.769). Calibration curves and DCA indicated that the model exhibited good predictive performance.

Conclusion

In this study, we constructed a predictive model to assess the risk of falls among individuals with CKD in the community, demonstrating good predictive capability.

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis

BACKGROUND

As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.

OBJECTIVES

To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.

DESIGN

A systematic review and meta-analysis was conducted by PRISMA guidelines.

METHODS

Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.

RESULTS

A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.

CONCLUSION

The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Fear of falling and associated factors in older adults with heart failure

BACKGROUND

This study aimed to evaluate the prevalence of fear of falling and associated factors in older adults with heart failure.

METHODS

A prospective, cross-sectional study. The study included 100 geriatric patients who were hospitalised and treated in the cardiology department of our hospital with ventricular ejection fraction (LVEF) lower than 50% for at least 1 year. A series of geriatric assessments were performed by face-to-face interview on the day of admission. Electrocardiography (ECG) and transthoracic echocardiography (TTE) were also performed on the day of admission.

RESULTS

The median age of the patients was 72 years, and 72.0% were men. Falls Efficacy Scale scores indicated a fear of falling in 46 (46.0%) of the patients. Charlson Comorbidity Index (CCI) was significantly higher in patients with fear of falling (P < 0.001). Severe depression, severe clinical insomnia, daytime sleepiness, and malnutrition were significantly more frequent among patients with fear of falling. Fear of falling was associated with significantly lower LVEF (P = 0.001). The presence of severe depression increased the risk of fear of falling by 13.97 times (95% CI: 3.064-63.707; P = 0.001), and the presence of daytime sleepiness increased the risk by 3.49 times (95% CI: 1.012-12.037; P = 0.048). A one-unit increase in CCI increased the risk of fear of falling by 1.56 times (95% CI: 1.093-2.238; P = 0.014).

CONCLUSIONS

Heart failure patients with concomitant depression, sleep disorders, and high comorbidities have greater fear of falling.

Demographics moderated the association of symptom burden with falls and fall-related outcomes

OBJECTIVES

To examine whether (1) prior-year symptom burden predicted later-year falls and fall-related outcomes and (2) demographics moderated the longitudinal effects of symptom burden on falls and fall-related outcomes among community-dwelling older adults.

METHODS

We used 2011-2018 National Health and Aging Trends Study data that included 9,060 community-dwelling older adults (contributed 34,327 observations). Falls and fall-related outcomes included self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. Symptom burden was defined as the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue, and calculated the number of symptoms (range from 0 to 6). Binomial logistic regression was used to examine the associations between symptom burden and falls and fall-related outcomes and the moderation effects of demographic factors.

RESULTS

The majority of the sample were aged between 65 and 79 years old (57.7%), non-Hispanic White (70.5%), and female (58.4%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.10-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.20, 95% CI: 1.18-1.23), and FOF limiting activity (AOR: 1.24, 95% CI: 1.20-1.28). Age, race/ethnicity, education, and living arrangement statistically significantly moderated the relationships between symptom burden and falls and fall-related outcomes.

CONCLUSIONS

Symptom burden predicted falls, multiple falls, FOF and FOF limiting activity, and demographics may differentially modify this risk. Individually tailored symptom assessment and management plans should be incorporated into fall risk assessment and interventions for community-dwelling older adults living.

Associations of EWGSOP1 and EWGSOP2 probable sarcopenia definitions with mortality: A comparative study

BACKGROUND & AIMS

Sarcopenia is a well-defined geriatric syndrome and a major cause of disability and mortality. We investigate the associations of alternative sarcopenia definitions with mortality in community-dwelling older adults.

METHODS

Sarcopenia was defined based on the EWGSOP1 and EWGSOP2 probable sarcopenia criteria, with standard handgrip strength (HGS) cut-offs of 30/20 kg for an EWGSOP1 definition and 27/16 kg for an EWGSOP2 definition, or alternatively, population-specific cut-offs of 35/20 kg for a EWGSOP2 definition. The 5-year mortality rate was assessed in the accessible cases.

RESULTS

The prevalence of sarcopenia among 204 older adults [53.9% female; aged 74.5 ± 7.0] was 4.9% based on the EWGSOP1 criterion, 23.5% according to the EWGSOP2-suggested standard (British) HGS cut-offs and 50.0% based on the EWGSOP2 population-specific cut-offs. In the 103 accessible patients, the mortality rate was 30.1%. Cox-regression analyses adjusted for parameters determined through univariate analyses [age and sarcopenia definitions (in 3 different models)], showed that the EWGSOP1 definition (HR = 4.26, 95% CI = 1.45-12.42, p = 0.008) and EWGSOP2 probable sarcopenia definition with population-specific cut-offs (HR = 2.58, 95% CI = 1.12-5.93, p = 0.03) were associated with a greater mortality risk, while the EWGSOP2 probable sarcopenia definition with standard-cut offs was not (p = 0.09).

CONCLUSIONS

This is the first study to investigate the associations of EWGSOP2-defined probable sarcopenia with mortality based on standard vs. population-specific HGS cut-offs. The results suggest that population-specific cut-offs should be used when available. We suggest that conducted in community-dwelling older adults, our results have implications for most of older adults.

Prevalence of cognitive frailty among older adults in China: a systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the prevalence of cognitive frailty among older adults in China.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure(CNKI), Wanfang, Chinese Biomedical Literature and Weipu (VIP) databases to collect information on the epidemiology of cognitive frailty among older adults in China. The study period was from the establishment of the database to March 2022. Two researchers independently screened the literature, extracted the data and assessed the risk of bias in the included studies. All statistical analyses were performed using Stata V.15.0.

RESULTS

We screened 522 records, of which 28 met the inclusion criteria. The results of the meta-analysis showed that the prevalence of cognitive frailty among older adults in China was 15%(95%CI (0.13%,0.17%)). The prevalence of cognitive frailty was higher in hospitals and nursing homes than in communities. Moreover, the prevalence of cognitive frailty was higher in women than in men. Furthermore, the prevalence rates of cognitive frailty in North China Hospital, older adults aged≥80 years, and illiterate individuals were 25%, 29%, and 55%, respectively.

CONCLUSIONS

In conclusion, in China, the prevalence of cognitive frailty is higher among older adults, is higher in women than in men, is higher in hospitals and nursing homes than in communities, and is higher in North China than other regions. Moreover, the higher the educational level, the lower the prevalence of cognitive frailty. Multimodal interventions for cognitive frailty, including increased exercise, nutritional support, increased socialisation opportunities and multifactorial strategies, may be effective in preventing cognitive frailty. These findings have important implications for adjusting healthcare and social care systems.

PROSPERO REGISTRATION NUMBER

CRD42023390486.

Effect of ukemi practice in judo on fear of falling and mobility skills in healthy older adults

[Purpose] To examine whether fear of falling and mobility skills improved after judo ukemi practice in healthy older adults, and whether a relationship exists between improvements in fear of falling and changes in mobility skills. [Participants and Methods] Ten healthy older adults who participated in exercise classes for middle-aged and elderly people to promote health performed ukemi practice three times in total, increasing the degree of difficulty every week. [Results] No significant differences in fear of falling or 10-m walking times were noted in Steps 1, 2, and 3. A significant reduction in timed up and go test results was observed in Steps 2 and 3. No correlation was found between change in fear of falling and change in mobility skills before and after ukemi practice for all combinations. [Conclusion] The results suggest that judo ukemi practice improves mobility skills in healthy older individuals with relatively high physical ability. These changes may not be due to a reduced fear of falling but rather to quicker physical reactivity and other psychological factors.

Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey

AIMS

In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition.

METHODS

The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis.

RESULTS

In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21-3.51, p:0.007).

CONCLUSION

While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.

Investigating Factors Associated with Fear of Falling in Community-Dwelling Older Adults through Structural Equation Modeling Analysis: A Cross-Sectional Study

The scientific literature mentions the existence of factors associated with fear of falling in older adults. However, the direct and indirect paths of its predictors have not yet been fully explored. This study aimed to analyze the socioeconomic, clinical, and health factors directly and indirectly associated with fear of falling in community-dwelling older adults. This is a cross-sectional study conducted in older adults (n = 410 - 70.11 ± 7.22 years). Clinical and health-condition data were collected, as were data on fear of falling using the Falls Efficacy Scale International-Brazil (FES-I Brazil). It was found that being female and having a higher number of self-reported morbidities, worse physical performance, and a higher number of depressive symptoms were directly associated with greater fear of falling. Regarding indirect associations, physical inactivity, mediated by a greater number of morbidities, worse physical performance, and a greater number of depressive symptoms, was associated with greater fear of falling. In addition, worse self-rated health, mediated by a greater number of depressive symptoms, as well as older age, mediated by worse physical performance, were associated with the outcome. This study provides information on the predictors directly and indirectly associated with fear of falling, expanding current understanding of this relationship.

Foot and ankle characteristics associated with fear of falling and mobility in community-dwelling older people: a cross-sectional study

BACKGROUND

Fear of falling is multifactorial in etiology and is associated with falls. It has been demonstrated that foot problems increase the risk of falls in older people. Therefore, the objective of this study was to investigate the associations of foot and ankle characteristics with fear of falling and mobility in community-dwelling older people.

METHOD

One hundred and eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran, were recruited. Foot and ankle characteristics (including foot posture, range of motion, muscle strength, deformity, tactile sensation, pain and dynamic function), fear of falling (Fall Efficacy Scale International) and mobility (Timed Up and Go Test) were measured. Two multivariate linear regression analyses identified variables independently associated with fear of falling and mobility.

RESULTS

Linear regression analysis revealed that less ankle plantarflexor muscle strength, greater pressure-time integral, foot pain, and reduced tactile sensitivity of the ankle were significantly and independently associated with increased fear of falling. The total variance explained by the model was 59%. Less ankle plantarflexor muscle strength, greater pressure-time integral, and slower centre of pressure velocity were significantly and independently associated with poorer mobility. The total variance explained by the model was 48%.

CONCLUSION

Several foot and ankle characteristics are associated with fear of falling and mobility in older people. Targeting these modifiable risk factors may play a role in reducing fear of falling and enhancing mobility performance in this population.

Utility of performance-based outcome measures (PBOMs) used in fall risk assessment tools for older adults

This study investigated the diagnostic accuracy of different clusters of performance based outcome measures (PBOMs) recommended by two consensus-based guidelines: Stopping Elderly Accidents, Deaths, and Injuries (STEADI), and those recommended by a systematic review completed by the American Physical Therapy Association and Academy of Geriatric Physical Therapy (APTA-SR, APTA-SR3). 33 community-dwelling older adults (25 females, 8 males) aged mean 79.45 ± 7.64 years participated in this study. Participants completed a fall history questionnaire and were evaluated via a battery of PBOMs for comparative analysis. The diagnostic accuracy of each PBOM cluster was analyzed retrospectively (previous 1 year fall history) and prospectively (6 month follow up). Retrospective analysis revealed the APTA-SR3 had the highest clinical utility and diagnostic accuracy: Sp 88.24% (63.56-98.54), Sn 62.5% (35.43-84.8), LR+ 2.35 (1.22-4.53), LR- 0.19 (0.05-0.73), accuracy 70.22% (51.83-84.81). Prospective analysis revealed the cluster of the APTA-SR and APTA-SR3 had identical diagnostic accuracy: Sn 100% (39.76-100), Sp 43.75% (19.75-70.12), LR+ 1.78 (1.15-2.74), LR- 0 (0), accuracy 60.62% (36.63-81.36). The APTA-SR 3 cluster demonstrated the highest diagnostic accuracy and in this study was the most effective and efficient group of PBOMs to identify fall risk in community dwelling older adults.

Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study

Background

Anxiety and depressive symptoms are associated with fear of falling and fear of falling-related activity restrictions. However, it remains unknown whether anxiety or depressive symptoms alone could predict fear of falling and activity restrictions in older adults. We sought to determine if anxiety and depressive symptoms alone could be an independent predictor of fear of falling and activity restrictions in community-dwelling older adults.

Methods

This longitudinal analysis used waves 5 (time 1, [T1]) and 6 (time 2, [T2], 1 year from T1) data (N = 6376) from the National Health and Aging Trends Study. The Generalized Anxiety Disorder Scale 2 and Patient Health Questionnaire 2 were used to assess anxiety and depressive symptoms, respectively. Interview questions included demographics, health-related data, and fall worry levels (no fear of falling, fear of falling but no activity restrictions, and activity restrictions). Using multinomial logistic regression models, we examined whether anxiety and depressive symptoms (T1) predicted fear of falling and activity restrictions (T2).

Results

In wave 5 (T1, mean age: 78 years, 58.1% female), 10 and 13% of participants reported anxiety and depressive symptoms. About 19% of participants experienced fear of falling but not activity restrictions, and 10% of participants developed activity restrictions in wave 6 (T2), respectively. Participants with anxiety symptoms at T1 had a 1.33 times higher risk of fear of falling (95% CI = 1.02–1.72) and 1.41 times higher risk of activity restrictions (95% CI = 1.04–1.90) at T2. However, having depressive symptoms did not show any significance after adjusting for anxiety symptoms.

Conclusions

Anxiety symptoms seemed to be an independent risk factor for future fear of falling and activity restrictions, while depressive symptoms were not. To prevent future fear of falling and activity restrictions, we should pay special attention to older individuals with anxiety symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03406-8.

Fear of Falling, Cognition, and Physical Function in Community-Dwelling Older Adult

BACKGROUND

Fear of falling (FOF) might be associated with physical and cognitive function, but there is a lack of understanding of the specific relationship between the three variables.

OBJECTIVES

To accurately investigate the association of FOF with cognitive and physical function in community-dwelling older adults.

METHODS

A total of 669 older adults (> 60 years) participated in this study. A self-report questionnaire collected information about demographic characteristics, lifestyle, and behavioral habits. FOF was evaluated through the Shortened Version of the Falls Efficacy Scale International. Global cognitive function and the subdomains of cognitive function (including memory, visual-spatial, language, attention, and executive function) were assessed using the Montreal Cognitive Assessment (MoCA) scale, the Auditory Verbal Learning Test (AVLT), the Clock-Drawing Test (CDT), the Verbal Fluency Test, and the Trail Making Test. Subjective memory complaints were assessed using the Subjective Memory Complaints Questionnaire (SMCQ). Physical function was evaluated by measuring muscle strength and balance ability, and muscle strength was indicated by hand grip strength. In contrast, balance was assessed using the Timed Up and Go (TUG) Test.

RESULTS

After adjustment for potential confounding factors, the linear or ordinal regression analysis showed that the values of hand grip strength, MoCA, AVLT, and CDT were significantly and negatively correlated with the score of FOF. On the other hand, SMCQ and TUG Test values showed significant positive correlations with FOF scores. Moreover, compared with other cognitive or physical measures, the CDT and TUG Test values showed a greater association with the FOF scores.

DISCUSSION

Low subjective or objective cognitive ability and low physical function, especially low visuospatial and balance ability, were positively associated with the risk of FOF in a community-dwelling older population.

Factors associated with and 1-year outcomes of fear of falling in a geriatric post-hip fracture assessment

Background

Hip fracture causes not only physical injury but also psychological trauma. Fear of falling (FoF) is related to poor recovery, loss of mobility and mortality. There is limited data on the clinical factors affecting post-hip fracture FoF and its consequences.

Objective

To investigate the factors associated with and 1-year outcomes of post-hip fracture FoF.

Methods

An observational prospective cohort study. Data were collected on hospital admission, at a geriatric outpatient assessment 4–6 months post-hip fracture and by telephone interviews 1 year after the index fracture. FoF was assessed with a dichotomous single-item question. Logistic regression analyses were conducted to examine the age, gender and multivariable-adjusted association between baseline and the geriatric assessment domains with FoF. Follow-up outcomes included changes in mobility, living arrangements and mortality.

Results

Of the 916 patients included, 425 (49%) had FoF at the time of their geriatric assessment. These patients were predominantly female and were living alone in their own homes with supportive home care. They scored lower on tests of physical performance. Less FoF was documented in patients with diagnosed cognitive disorders before the index fracture and in those with Clinical Dementia Rating ≥ 1. After adjusting for age and gender, no association was observed between FoF and any of the 1-year follow-up outcomes.

Conclusion

Post-hip fracture FoF is common and associated with female gender, polypharmacy, poor daily functioning, poor physical performance and depressive mood. Patients with cognitive disorders have less FoF than those without. FoF appears to have no impact on the follow-up outcomes.

Management of chronic non-cancer pain: a framework

Aim: Since publication of the CDC 2016 Guideline, opioid-related mortality in the USA has doubled and a crisis has developed among the 15-20 million Americans with chronic, moderate-to-severe, noncancer pain. Our aim was to develop a comprehensive alternative approach to management of chronic pain. Methods: Analytic review of the clinical literature. Results: Published science provides a solid framework for the management of chronic non-cancer pain, detailed here, even as it leaves many knowledge gaps, which we fill with insights from clinical experience. Conclusion: There is a sufficient basis in science and in clinical experience to achieve adequate control of chronic pain in nearly all patients in a way that adequately balances benefits and potential harms.

Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review

BACKGROUND/OBJECTIVE

Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and frailty.

METHODS

All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age ≥60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies, respectively.

RESULTS

The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89).

CONCLUSION

FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty.

PROSPERO

CRD42021276775.

Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study

OBJECTIVES

Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients.

DESIGN

In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given.

PARTICIPANTS

Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients.

MEASUREMENTS

Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group.

RESULTS

The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both).

CONCLUSION

Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.

The current situation in the approach to osteoporosis in older adults in Turkey: areas in need of improvement with a model for other populations

PURPOSE

The total number of older adults in Turkey is striking, amounting to around 8 million, and this translates into considerably higher numbers of cases of osteoporosis (OP) and fractures in older adults. In this article, we outlined the current situation of OP in older adults in Turkey and investigated the differences between Turkey and a representative developed European country (Belgium), in terms of the screening, diagnosis, and treatment of OP. Our intention in this regard was to identify areas in need of improvement and subsequently to make a clear call for action to address these issues.

METHODS

Herein, considering the steps related to the OP approach, we made a complete review of the studies conducted in Turkey and compared with the literature recommendations.

RESULTS

There is a need for a national osteoporotic fracture registry; measures should be taken to improve the screening and treatment of OP in older males, such as educational activities; technicians involved in dual-energy X-ray absorptiometry (DXA) scanning should undergo routine periodic training; all DXA centers should identify center-specific least significant change values; all older adults should be considered for routine lateral dorsolumbar X-ray imaging for the screening of vertebral fractures while ordering DXA scans; the inclusion of vertebral fracture assessment (VFA) software in DXA assessments should be considered; screening using a fracture risk assessment tool (FRAX) algorithm that is specific to Turkey should be integrated; the fortification of foods with vitamin D is required; the high fracture risk by country-specific FRAX algorithm and the presence of falls/high fall risk should be integrated in reimbursement terms; and finally, more "fracture liaison services" should be established.

CONCLUSION

We suggest that the practical consideration of our suggestions will provide considerable support to the efforts for combating with the adverse consequences of OP in society. This approach can be subsequently modeled for other populations to improve the management of OP globally.

SARC-F and the Risk of Falling in Middle-Aged and Older Community-Dwelling Postmenopausal Women

(1) Background: The objective of the present study was to determine the ability of the SARC-F questionnaire to identify individuals at risk of falling among middle-aged and older community-dwelling postmenopausal women. (2) Methods: An analytical cross-sectional study was conducted on 157 women (70.80 ± 8.37 years). The SARC-F questionnaire was used to screen for risk of sarcopenia. Fear of falling and balance confidence, as measured by the Falls Efficacy Scale-International (FES-I) and the Activities-Specific balance Scale-16 items (ABC-16) respectively, were used to assess risk of falling. Anxiety and depression (Hospital Anxiety and Depression Scale), fatigue (Fatigue Severity Scale), body mass index, waist-to-hip ratio, and sleep duration were also determined. (3) Results: Logistic regression showed that higher risk of falling as assessed by FES-I was associated with higher SARC-F scores (OR = 1.656), anxiety levels (OR = 1.147), and age (OR = 1.060), while increased SARC-F scores (OR = 1.612), fatigue (OR = 1.044), and shorter sleep duration (OR = 0.75) were related to ABC-16 scores. In addition, a SARC-F cutoff of 1.50 (83.33% sensitivity and 59.13% specificity) and 3.50 (44.44% sensitivity and 89.26% specificity) were shown to be able to discriminate participants at risk of falling according to the FES-I and the ABC-16, respectively. (4) Conclusions: our results show that SARC-F is an independent predictor of the risk of falling among middle-aged and older community-dwelling postmenopausal women.

Factors associated with fear of falling among frail older adults

Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.

A Propensity Score Matched Approach to Assess the Associations of Commonly Prescribed Medications with Fall Risk in a Large Harmonized Cohort of Older Ambulatory Persons

Introduction

Several medication classes are considered to present risk factors for falls. However, the evidence is mainly based on observational studies that often lack adequate adjustment for confounders. Therefore, we aimed to assess the associations of medication classes with fall risk by carefully selecting confounders and by applying propensity score matching (PSM).

Methods

Data from several European cohorts, harmonized into the ADFICE_IT cohort, was used. Our primary outcome was time until the first fall within 1-year follow-up. The secondary outcome was a fall in the past year. Our exposure variables were commonly prescribed medications. We used 1:1 PSM to match the participants with reported intake of specific medication classes with participants without. We constructed Cox regression models stratified by the pairs matched on the propensity score for our primary outcome and conditional logistic regression models for our secondary outcome.

Results

In total, 32.6% of participants fell in the 1-year follow-up and 24.4% reported falling in the past year. ACE inhibitor users (prevalence of use 15.3%) had a lower fall risk during follow-up when matched to non-users, with a hazard ratio (HR) of 0.82 (95% CI 0.68–0.98). Also, statin users (prevalence of use 20.1%) had a lower risk, with an HR of 0.76 (95% CI 0.65–0.90). Other medication classes showed no association with risk of first fall. Also, in our secondary outcome analyses, statin users had a significantly lower risk. Furthermore, β-blocker users had a lower fall risk and proton pump inhibitor use was associated with a higher risk in our secondary outcome analysis.

Conclusion

Many commonly prescribed medication classes showed no associations with fall risk in a relatively healthy population of community-dwelling older persons. However, the treatment effects and risks can be heterogeneous between individuals. Therefore, focusing on identification of individuals at risk is warranted to optimize personalized falls prevention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40266-021-00876-0.