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Guirguis-Blake JM, Perdue LA, Coppola EL, Bean SI. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2024:2819574. [PMID: 38833257 DOI: 10.1001/jama.2024.4166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Importance Falls are the most common cause of injury-related morbidity and mortality in older adults. Objective To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults. Data Sources MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024. Study Selection Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older. Data Extraction and Synthesis Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment. Main Outcomes and Measures Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms. Results Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise. Conclusions and Relevance Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.
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Affiliation(s)
- Janelle M Guirguis-Blake
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
- Department of Family Medicine, University of Washington, Tacoma
| | - Leslie A Perdue
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Lesch KJ, Tuomisto S, Tikkanen HO, Venojärvi M. Validity and Reliability of Dynamic and Functional Balance Tests in People Aged 19-54: A Systematic Review. Int J Sports Phys Ther 2024; 19:381-393. [PMID: 38699672 PMCID: PMC11065456 DOI: 10.26603/001c.94612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/28/2024] [Indexed: 05/05/2024] Open
Abstract
Evaluating an impairment in an individual's capacity to maintain, achieve, or restore balance suggests a deficiency in postural control. For effective identification of individuals at risk for falls, balance assessment should exhibit reliability, validity, and ease of use. This systematic review concentrated on dynamic and functional balance assessment methods and their validity in healthy adults aged 19-54. The objective was to clarify the tools that health professionals can utilize to assess balance in this healthy population. Methods A systematic literature search conducted in August 2019 yielded nine articles meeting predefined selection criteria. Inclusion criteria required studies featuring healthy adult participants aged 19-54, published in English, and focusing on dynamic and functional balance testing. Exclusion criteria excluded studies involving participants with chronic diseases or musculoskeletal disorders, systematic reviews, professional athletes, and those lacking specific participant age information. The quality of the studies was evaluated using a modified PEDro scale. Results This review analyzed ten distinct postural balance tests. The Star Excursion Balance Test and Y-Balance Test exhibited moderate to high reliability, establishing them as dependable measures of dynamic balance. The Nintendo Wii Balance Board, Clever Balance Board, and Posturomed device also displayed excellent reliability for assessing dynamic postural balance. Comparing one-arm and two-arm functional reach tests, the one-arm reach test emerged as a more suitable option for evaluating dynamic balance among young adults. Moreover, an investigation comparing three dynamic balance tests (one-leg jump landing, Posturomed device, and stimulated forward fall) revealed a low correlation among these tests, indicating a measurement of different balance constructs. Discussion In conclusion, the Y-Balance Test stands out as the most practical dynamic balance assessment for clinical use, characterized by a standardized protocol, good repeatability, affordability, and ease of application. The Nintendo Wii Balance Board also presents itself as a cost-effective and reliable tool for dynamic balance evaluation in clinical settings. It is crucial to recognize that these tests appraise discrete postural skills, preventing direct comparisons between test outcomes. This review equips healthcare professionals with valuable insights into optimal balance assessment methods for the healthy, 19 to 54 aged population. Levels of evidence Level 3.
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Affiliation(s)
- Kim J Lesch
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
| | - Sanni Tuomisto
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
| | - Heikki O Tikkanen
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
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3
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Camp K, Murphy S, Pate B. Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults. Clin Interv Aging 2024; 19:561-569. [PMID: 38533419 PMCID: PMC10964786 DOI: 10.2147/cia.s453961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes. Methods Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage. Results Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over $1 million with a per-patient enrolled savings of $19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of $4.95 million or $15,618 per enrolled patient. Conclusion Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.
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Affiliation(s)
- Kathlene Camp
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sara Murphy
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Brandon Pate
- Mobile Integrated Healthcare, MedStar Mobile Healthcare, Fort Worth, TX, USA
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Lahiani M, Ben Waer F, Chaari F, Rebai H, Sahli S. Effect of 12-Week-Zumba Training on Postural Balance, Lower Limb Strength, Mood and Quality of Life in Postmenopausal Women. Exp Aging Res 2024; 50:171-189. [PMID: 36726273 DOI: 10.1080/0361073x.2023.2172304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
We aimed to investigate 12-week-Zumba training effects on physical and psychological parameters, and quality of life (QoL) in postmenopausal women. Forty-two postmenopausal women were randomly allocated to a control group or a Zumba group (ZG). Postural balance, lower limb strength, mood level, and QoL were assessed before and after the 12-week-Zumba training. The ZG showed significantly better balance performances under all conditions such as on firm and foam surfaces with opened and closed eyes as well as improvements in limb strength, mood and QoL compared to their baselines. Thereby, 12-week-Zumba training was effective in improving postural balance, limb strength, mood and, QoL in postmenopausal women.
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Affiliation(s)
- Mariam Lahiani
- Research Laboratory: Education, Motricity, Sports and Health, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Ben Waer
- Research Laboratory: Education, Motricity, Sports and Health, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Chaari
- Research Laboratory: Education, Motricity, Sports and Health, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Research Laboratory: Education, Motricity, Sports and Health, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory: Education, Motricity, Sports and Health, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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Single M, Bruhin LC, Colombo A, Möri K, Gerber SM, Lahr J, Krack P, Klöppel S, Müri RM, Mosimann UP, Nef T. A Transferable Lidar-Based Method to Conduct Contactless Assessments of Gait Parameters in Diverse Home-like Environments. SENSORS (BASEL, SWITZERLAND) 2024; 24:1172. [PMID: 38400329 PMCID: PMC10893300 DOI: 10.3390/s24041172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
Gait abnormalities in older adults are linked to increased risks of falls, institutionalization, and mortality, necessitating accurate and frequent gait assessments beyond traditional clinical settings. Current methods, such as pressure-sensitive walkways, often lack the continuous natural environment monitoring needed to understand an individual's gait fully during their daily activities. To address this gap, we present a Lidar-based method capable of unobtrusively and continuously tracking human leg movements in diverse home-like environments, aiming to match the accuracy of a clinical reference measurement system. We developed a calibration-free step extraction algorithm based on mathematical morphology to realize Lidar-based gait analysis. Clinical gait parameters of 45 healthy individuals were measured using Lidar and reference systems (a pressure-sensitive walkway and a video recording system). Each participant participated in three predefined ambulation experiments by walking over the walkway. We observed linear relationships with strong positive correlations (R2>0.9) between the values of the gait parameters (step and stride length, step and stride time, cadence, and velocity) measured with the Lidar sensors and the pressure-sensitive walkway reference system. Moreover, the lower and upper 95% confidence intervals of all gait parameters were tight. The proposed algorithm can accurately derive gait parameters from Lidar data captured in home-like environments, with a performance not significantly less accurate than clinical reference systems.
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Affiliation(s)
- Michael Single
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
| | - Lena C. Bruhin
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
| | - Aaron Colombo
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
| | - Kevin Möri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
| | - Jacob Lahr
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3012 Bern, Switzerland; (J.L.); (S.K.)
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3012 Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3012 Bern, Switzerland; (J.L.); (S.K.)
| | - René M. Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
| | - Urs P. Mosimann
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland; (M.S.); (L.C.B.); (A.C.); (K.M.); (S.M.G.); (R.M.M.); (U.P.M.)
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, 3012 Bern, Switzerland
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Nakagawa Y, Goda A, Fujii K, Shimazaki R, Orita N, Yoshino D, Kawara T, Sakurai M, Ito Y, Maki Y. Factors Related to Favorable Outcomes in Older Adults Undergoing Home-Visit Rehabilitation Therapy. Cureus 2024; 16:e53740. [PMID: 38465166 PMCID: PMC10920404 DOI: 10.7759/cureus.53740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Increasing elderly population is a major health concern worldwide, requiring various at-home care services. The aim of home-visit rehabilitation therapy is to support at-home living of the elderly and to promote their participation in social activities. There is a paucity of data about the clinical conditions of this population that can contribute to the achievement of goals in-home visit rehabilitation therapy. AIM This study aimed to clarify clinical variables that could be related to the achievement of goals in-home visit rehabilitation therapy. METHODS We collected retrospective clinical data of the older adults who underwent home-visit rehabilitation therapy between July 2006 and June 2021. We searched the clinical variables of home-visit rehabilitation therapy users and their frequency of utilization of home-visit rehabilitation therapy services from the clinical record. The initial and final clinical variables evaluated in this study included the abilities of daily living, degree of being bedridden, dementia rating, and levels of support or long-term care. Those variables were evaluated by rehabilitation therapists and doctors. The users were divided into three groups according to the reason for terminating rehabilitation therapy: goal achievement (achieved group), aggravation of underlying disease (aggravated group), and treatment suspension because of their own/others' wish (suspended group). The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were evaluated among the groups. The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were statistically evaluated among those three groups, using the chi-square test and Kruskal-Wallis test. RESULTS In the achieved, aggravated, and suspended groups, 45, 190, and 38 users were respectively enrolled. The aggravated group showed significantly higher final care level (p = 0.002), degree of being bedridden (p=0.001), and dementia rating (p = 0.017) and significantly lower Barthel index scores (p < 0.001) and Frenchay Activities Index scores (p = 0.001) than the achieved group. Persons requesting the therapy were significantly older adults themselves in the achieved group (p = 0.018). The therapy was significantly performed more than once per week in the achieved group (p = 0.018). CONCLUSIONS Older adults undergoing self-motivated home-visit rehabilitation therapy more than once per week may contribute to the achievement of the goal.
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Affiliation(s)
| | - Akio Goda
- Physical Therapy, Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, JPN
| | | | | | | | | | | | | | | | - Yoshinori Maki
- Neurosurgery, Hikone Chuo Hospital, Hikone, JPN
- Rehabilitation, Hikari Hospital, Otsu, JPN
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O'Halloran AM, Cremers J, Vrangbæk K, Roe L, Bourke R, Mortensen LH, Westendorp RGJ, Kenny RA. Cardiovascular disease and the risk of incident falls and mortality among adults aged ≥ 65 years presenting to the emergency department: a cohort study from national registry data in Denmark. BMC Geriatr 2024; 24:93. [PMID: 38267873 PMCID: PMC10809657 DOI: 10.1186/s12877-023-04618-2] [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: 08/04/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Falls cause 58% of injury-related Emergency Department (ED) attendances. Previous research has highlighted the potential role of cardiovascular risk factors for falls. This study investigated the impact of cardiovascular disease (CVD) risk on three-year incident falls, with presentation to the ED, and mortality. METHODS A matched cohort study design was employed using national registry data from 82,292 adults (33% male) aged ≥ 65 years living in Denmark who attended the ED in 2013. We compared age and gender matched ED attendees presenting with a fall versus another reason. The cohort was followed for three-year incident falls, with presentation to the ED, and mortality. The impact of falls-related CVDs was also examined. RESULTS Three-year incident falls was twofold higher among age and gender matched ED attendees aged ≥ 65 years presenting with a fall versus another reason at baseline. A presentation of falls with hip fracture had the highest percentage of incident falls in the 65-74 age group (22%) and the highest percentage mortality in all age groups (27-62%). CVD was not a significant factor in presenting with a fall at the ED, nor did it contribute significantly to the prediction of three-year incident falls. CVD was strongly associated with mortality risk among the ED fall group (RR = 1.81, 95% CI: 1.67-1.97) and showed interactions with both age and fall history. CONCLUSION In this large study of adults aged ≥ 65 years attending the ED utilising data from national administrative registers in Denmark, we confirm that older adults attending the ED with a fall, including those with hip fracture, were at greatest risk for future falls. While CVD did not predict incident falls, it increased the risk of mortality in the three-year follow up with advancing age. This may be informative for the provision of care pathways for older adults attending the ED due to a fall.
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Affiliation(s)
- Aisling M O'Halloran
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland.
| | - Jolien Cremers
- Data Science Lab, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Centre for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark
- Department of Political Science, University of Copenhagen, Copenhagen, Denmark
| | - Lorna Roe
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Robert Bourke
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Laust H Mortensen
- Data Science Lab, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rose Anne Kenny
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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8
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Dashner J, Espín-Tello SM, Chen SW, Hollingsworth H, Bollinger R, Morgan KA, Stark S. Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: a cross-sectional study. Disabil Rehabil 2023:1-9. [PMID: 38108275 DOI: 10.1080/09638288.2023.2293990] [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: 04/12/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD). MATERIALS AND METHODS A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45-65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected. RESULTS Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls. CONCLUSIONS PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.
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Affiliation(s)
- Jessica Dashner
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Sandra M Espín-Tello
- Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Szu-Wei Chen
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Holly Hollingsworth
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Rebecca Bollinger
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Kerri A Morgan
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Susan Stark
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
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Shankar KN, Li A. Older Adult Falls in Emergency Medicine, 2023 Update. Clin Geriatr Med 2023; 39:503-518. [PMID: 37798062 DOI: 10.1016/j.cger.2023.05.010] [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] [Indexed: 10/07/2023]
Abstract
Of 4 older adults, 1 will fall each year in the United States. Based on 2020 data from the Centers of Disease Control, about 36 million older adults fall each year, resulting in 32,000 deaths. Emergency departments see about 3 million older adults for fall-related injuries with falls having the ability to cause serious injury such as catastrophic head injuries and hip fractures. One-third of older fall patients discharged from the ED experience one of these outcomes at 3 months.
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Affiliation(s)
- Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA.
| | - Angel Li
- Department of Emergency Medicine, The Ohio State University, 376 West 10th Avenue, Columbus, OH 43210, USA
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Pambet M, Gauvain JB, Valery A, Annweiler C, Mandigout S, Fougere B, Puisieux F. Use of a clustering method to describe the clinical profiles of older fallers: the value of a multidisciplinary consultation. Eur Geriatr Med 2023; 14:1097-1104. [PMID: 37597075 DOI: 10.1007/s41999-023-00829-3] [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: 12/21/2022] [Accepted: 06/26/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES The population of older adults is particularly heterogeneous with regard to frailty and the risk of falling, the two of which are linked. We conducted an exploratory, analysis (with no preconceived ideas) of data collected during multidisciplinary falls consultations (MFCs), to identify people with similar profiles. MATERIALS AND METHODS We performed an observational, multicentre study of older patients (aged 75 and over) having been evaluated in an MFC. We excluded adults with a Mini Mental State Examination score < 14/30, an activities of daily living score < 4/6, or an unstable medical condition. Each participant underwent a clinical interview, impedancemetry, and a physical activity assessment (a questionnaire, and use of an activity tracker on 5 consecutive days). The K-means method and ascending hierarchical clustering were used to identify clusters of people with common characteristics. RESULTS Of the 106 participants, the median [IQR] mean number of falls in the previous 6 months was 1 [2]. Three functional clusters were identified: (i) fallers with poor mobility, difficulty getting up off the ground after a fall, and using a mobility aid for walking; (ii) an intermediate sedentary group with a gait speed of ~ 0.6 m s-1, and (iii) active people with a timed "up and go" test time below 15 s and a gait speed above 0.8 m s-1. CONCLUSIONS The population of older fallers referred for an MFC is heterogeneous. The presence of certain clinical characteristics enabled the definition of three patient clusters, which might help physicians to determine the most appropriate care objectives and pathways.
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Affiliation(s)
- M Pambet
- Court Séjour Gériatrique, Department of Medicine, CHR d'Orléans, 14 Av. de l'Hôpital, 45067, Orleans, France
| | - J B Gauvain
- Court Séjour Gériatrique, Department of Medicine, CHR d'Orléans, 14 Av. de l'Hôpital, 45067, Orleans, France
| | - A Valery
- Court Séjour Gériatrique, Department of Medicine, CHR d'Orléans, 14 Av. de l'Hôpital, 45067, Orleans, France
| | - C Annweiler
- Department of Geriatric Medicine, Centre de Recherche sur l'Autonomie et la Longévité (CeRAL), UPRES EA 4638, UNAM, Université d'Angers, 4 rue Larrey, 49933, Angers, France
| | - S Mandigout
- HAVAE, UR20217, University of Limoges, F-87000, Limoges, France.
| | - B Fougere
- Department of Geriatric Medicine and Pôle Vieillissement, Université de Tours, 2 boulevard tonnellé, 37044, Tours, France
| | - F Puisieux
- Clinique de gérontologie et service de médecine interne et gériatrie, Hôpital gériatrique les Bateliers, Université de Lille, 23 Rue des Bateliers, 59037, Lille, France
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11
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Eveld ME, King ST, Zelik KE, Goldfarb M. Efficacy of stumble recovery assistance in a knee exoskeleton for individuals with simulated mobility impairment: A pilot study. WEARABLE TECHNOLOGIES 2023; 4:e22. [PMID: 38510587 PMCID: PMC10952054 DOI: 10.1017/wtc.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/05/2023] [Accepted: 06/06/2023] [Indexed: 03/22/2024]
Abstract
Falls due to stumbles are a major cause of injury for many populations, and as such interventions to reduce fall risk have been a key focus of rehabilitation research. However, dedicated stumble recovery assistance in a powered lower-limb exoskeleton has yet to be explored as a fall mitigation intervention. Thus young, healthy adults () were recruited for a stumble recovery experiment to test the efficacy of knee exoskeleton stumble recovery assistance in improving an impaired stumble recovery response (i.e., the elevating strategy response). Leg weights were attached unilaterally to each participant's shank to simulate walking and stumble recovery impairment, and a unilateral powered knee exoskeleton was worn on the same leg for walking and stumble recovery assistance. Ultimately, knee exoskeleton stumble recovery assistance served to improve participants' elevating limb kinematics (i.e., increase thigh and knee motion) and reduce overall fall risk (i.e., reduce trunk motion and improve foot placement) during responses relative to their impaired response (i.e., with the leg weights and no assistance), and relative to their response while receiving only walking assistance. This initial exploration provides a first indication that knee exoskeleton stumble recovery assistance is a viable approach to improving an impaired stumble recovery response, which could serve two important use cases: (1) a safety mechanism for existing exoskeleton wearers, who may be less capable of recovering from stumbles due to the added weight or joint impedance of the device; (2) an external stumble recovery aid for fall-prone populations, such as the elderly or stroke survivors.
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Affiliation(s)
- Maura E. Eveld
- Department of Mechanical Engineering, Vanderbilt University, TN, USA
| | - Shane T. King
- Department of Mechanical Engineering, Vanderbilt University, TN, USA
| | - Karl E. Zelik
- Department of Mechanical Engineering, Vanderbilt University, TN, USA
- Department of Physical Medicine & Rehabilitation, Vanderbilt University, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, TN, USA
| | - Michael Goldfarb
- Department of Mechanical Engineering, Vanderbilt University, TN, USA
- Department of Physical Medicine & Rehabilitation, Vanderbilt University, TN, USA
- Department of Electrical Engineering, Vanderbilt University, TN, USA
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12
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Nertinger S, Das N, Satoshi E, Naceri A, Hirche S, Haddadin S. Assessing Human-Human Kinematics for the Implementation of Robot-Assisted Physical Therapy in Humanoids: A Pilot Study. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941169 DOI: 10.1109/icorr58425.2023.10304778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The development of humanoids with bimanual manipulator arms may facilitate assistive robots to perform physical therapy with older adults living at home. As we assume the human-human interaction to be the gold standard of physical therapy, we propose a kinematics analysis to derive guidelines for implementing physical therapy assisted by humanoids. Therefore, a pilot study was carried out involving three physical therapists and two participants acting as exemplary patients. The study analyzes the therapists' movement strategy, including the position and orientation of the therapists' bodies in relation to the participants and the placement of the therapists' hands on the upper limb segment of the participants, as well as the inter- and intravariability during the performance of a ROM (range of motion) assessment. The results demonstrate that while physical therapists exhibit variation in their interaction strategies, they still achieve a consistently low level of variability in their manipulation space.
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13
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Cai Y, Leveille SG, Andreeva O, Shi L, Chen P, You T. Characterizing Fall Circumstances in Community-Dwelling Older Adults: A Mixed Methods Approach. J Gerontol A Biol Sci Med Sci 2023; 78:1683-1691. [PMID: 37210687 PMCID: PMC10460549 DOI: 10.1093/gerona/glad130] [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: 11/18/2022] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach. METHODS The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, MA. Occurrence and circumstances of falls (ie, locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions. RESULTS During the 4-year follow-up, 490 participants (64%) had at least 1 fall. Among 1 829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as "lost my balance and fell." CONCLUSIONS Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.
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Affiliation(s)
- Yurun Cai
- Department of Community and Health Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
- Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Suzanne G Leveille
- Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Olga Andreeva
- Department of Computer Science and Engineering, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Ling Shi
- Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Ping Chen
- Department of Computer Science and Engineering, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Tongjian You
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
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14
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Cuvelier C, Hars M, Zamorani-Bianchi MP, Herrmann FR, Wieczorkiewicz CD, Zekry D, Gold G, Trombetti A. Hypnosis to reduce fear of falling in hospitalized older adults: a feasibility randomized controlled trial. Pilot Feasibility Stud 2023; 9:139. [PMID: 37559112 PMCID: PMC10410891 DOI: 10.1186/s40814-023-01366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Fear of falling is associated with numerous negative health outcomes in older adults and can limit the rehabilitation process. Hypnosis is now recognized as an effective treatment for a variety of conditions, especially anxiety and pain, which can be integrated safely with conventional medicine. The objective of this study was to assess the feasibility and acceptability of a hypnosis intervention in hospitalized older adults to reduce fear of falling. METHODS In this feasibility randomized controlled trial, 32 older patients, hospitalized in geriatric rehabilitation wards, were randomly allocated (1:1 ratio) to either an intervention group (hypnosis, 2 sessions, one per week, plus usual rehabilitation program) or a control group (usual rehabilitation program only). Clinical assessors and statistician were blinded to group allocation. Primary outcomes were recruitment rate, retention rate, and adherence to the intervention. Exploratory outcomes, analyzed according to the intention-to-treat principle, included impact of hypnosis on fear of falling (assessed by a new scale perform-FES), functional status, in-hospital falls, and length of hospital stay. RESULTS Recruitment rate was 1.3 patients per week. The recruitment of the population sample was achieved in 5.5 months. The retention rate did not differ significantly between groups and a good adherence to the hypnosis intervention was achieved (77% of patients received the full intervention). No adverse event related to the hypnosis intervention was observed. Regarding exploratory clinical outcomes, no differences were found between groups on any outcome. CONCLUSION Hypnosis is feasible and well accepted in a geriatric hospitalized population undergoing rehabilitation. Further pilot work should be conducted, with an increased number of hypnosis sessions, before conducting a full-scale trial to conclude whether, or not, hypnosis is effective to reduce fear of falling. TRIAL REGISTRATION NCT04726774.
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Affiliation(s)
- Clémence Cuvelier
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Mélany Hars
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Maria Pia Zamorani-Bianchi
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Catherine Ducharne Wieczorkiewicz
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gabriel Gold
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Andrea Trombetti
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland.
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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15
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Womack JA, Murphy TE, Leo-Summers L, Bates J, Jarad S, Gill TM, Hsieh E, Rodriguez-Barradas MC, Tien PC, Yin MT, Brandt CA, Justice AC. Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV. J Am Geriatr Soc 2023; 71:1891-1901. [PMID: 36912153 PMCID: PMC10258163 DOI: 10.1111/jgs.18304] [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: 10/26/2022] [Revised: 01/14/2023] [Accepted: 01/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Although 50 years represents middle age among uninfected individuals, studies have shown that persons living with HIV (PWH) begin to demonstrate elevated risk for serious falls and fragility fractures in the sixth decade; the proportions of these outcomes attributable to modifiable factors are unknown. METHODS We analyzed 21,041 older PWH on antiretroviral therapy (ART) from the Veterans Aging Cohort Study from 01/01/2010 through 09/30/2015. Serious falls were identified by Ecodes and a machine-learning algorithm applied to radiology reports. Fragility fractures (hip, vertebral, and upper arm) were identified using ICD9 codes. Predictors for both models included a serious fall within the past 12 months, body mass index, physiologic frailty (VACS Index 2.0), illicit substance and alcohol use disorders, and measures of multimorbidity and polypharmacy. We separately fit multivariable logistic models to each outcome using generalized estimating equations. From these models, the longitudinal extensions of average attributable fraction (LE-AAF) for modifiable risk factors were estimated. RESULTS Key risk factors for both outcomes included physiologic frailty (VACS Index 2.0) (serious falls [15%; 95% CI 14%-15%]; fractures [13%; 95% CI 12%-14%]), a serious fall in the past year (serious falls [7%; 95% CI 7%-7%]; fractures [5%; 95% CI 4%-5%]), polypharmacy (serious falls [5%; 95% CI 4%-5%]; fractures [5%; 95% CI 4%-5%]), an opioid prescription in the past month (serious falls [7%; 95% CI 6%-7%]; fractures [9%; 95% CI 8%-9%]), and diagnosis of alcohol use disorder (serious falls [4%; 95% CI 4%-5%]; fractures [8%; 95% CI 7%-8%]). CONCLUSIONS This study confirms the contributions of risk factors important in the general population to both serious falls and fragility fractures among older PWH. Successful prevention programs for these outcomes should build on existing prevention efforts while including risk factors specific to PWH.
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Affiliation(s)
- Julie A. Womack
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Nursing, West Haven, CT
| | | | | | - Jonathan Bates
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | | | - Evelyn Hsieh
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Maria C. Rodriguez-Barradas
- Infectious Diseases Section, Michael E DeBakey VA Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Phyllis C. Tien
- University of California, San Francisco, and Department of Veterans Affairs, San Francisco, CA
| | | | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
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16
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Huang Y, Li C, Lu X, Wang Y. The geographic environment and the frequency of falling: a study of mortality outcomes in elderly people in China. GEOSPATIAL HEALTH 2023; 18. [PMID: 37246537 DOI: 10.4081/gh.2023.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 05/30/2023]
Abstract
Falling has become the first and second cause of death due to injury among urban and rural residents in China. This mortality is considerably higher in the southern part of the country than in the North. We collected the rate of mortality due to falling for 2013 and 2017 by province, age structure and population density, taking topography, precipitation and temperature into account. 2013 was used as the first year of the study since this year marks the expansion of the mortality surveillance system from 161 counties to 605 counties making available data more representative. A geographically weighted regression was used to evaluate the relationship between mortality and the geographic risk factors. High levels of precipitation, steep topography and uneven land surfaces as well as a higher quantile of the population aged above 80 years in southern China are believed to have led to the significantly higher number of falling compared with that in the North. Indeed, when evaluated by geographically weighted regression, the factors mentioned found a difference between the South and the North with regard to falling of 81% and 76% for the years 2013 and 2017, respectively. Interaction effects were observed between geographic risk factors and falling that, apart from the age factor, could be explained by topographic and climatic differences. The roads in the South are more difficult to negotiate on foot, particularly when it rains, which increases the probability of falling. In summary, the higher mortality due to falling in southern China emphasizes the need to apply more adaptive and effective measures in rainy and mountainous region to reduce this kind of risk.
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Affiliation(s)
- Yi Huang
- School of Geographic Sciences, Nantong University, Nantong.
| | - Chen Li
- School of Management, Shanghai University of Engineering Science, Shanghai.
| | - Xianjing Lu
- School of Geographic Sciences, Nantong University, Nantong.
| | - Yue Wang
- School of Geographic Sciences, Nantong University, Nantong.
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17
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Teggi R, Familiari M, Battista RA, Gatti O, Cangiano I, Bussi M, Bubbico L. The social problem of presbystasis and the role of vestibular rehabilitation in elderly patients: a review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023:1-8. [PMID: 37224169 PMCID: PMC10366565 DOI: 10.14639/0392-100x-n1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 10/17/2022] [Indexed: 05/26/2023]
Affiliation(s)
- Roberto Teggi
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Marco Familiari
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Rosa Alessia Battista
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Omar Gatti
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Iacopo Cangiano
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Luciano Bubbico
- Department of Sensorineural Disabilities, INAPP/Italian Institute of Social Medicine, Rome, Italy
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18
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Osuka Y, Okubo Y, Nofuji Y, Maruo K, Fujiwara Y, Oka H, Shinkai S, Lord SR, Sasai H. Occupational Fall Risk Assessment Tool for older workers. Occup Med (Lond) 2023; 73:161-166. [PMID: 36893360 DOI: 10.1093/occmed/kqad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND No easy-to-use fall risk assessment tools have been devised to assess occupational fall risk in older workers. AIMS To develop an Occupational Fall Risk Assessment Tool (OFRAT) and report its predictive validity and reliability in older workers. METHODS The baseline fall risk assessment was completed by 1113 participants aged ≥60 years who worked ≥4 days/month in Saitama, Japan. Participants were followed up for falls during occupational activities for 1 year, and 30 participants were assessed twice for test-retest reliability. The following assessment measures were summed to form the OFRAT risk score: older age, male sex, history of falls, physical work participation, diabetes, use of medications increasing fall risk, reduced vision, poor hearing, executive dysfunction and slow stepping. The scores were then classified into four grades (0-2 points: very low, 3 points: low, 4 points: moderate and ≥5 points: high). RESULTS During follow-up, 112 participants fell 214 times during work. The negative binomial regression model showed that participants with higher grades had a higher incidence rate ratio [95% confidence interval] for falls than those with very low grades (low: 1.64 [1.08-2.47], moderate: 4.23 [2.82-6.34] and high: 6.12 [3.83-9.76]). The intraclass correlation coefficient for risk score was 0.86 [0.72-0.93], and the weighted kappa coefficient for grade assessment was 0.74 [0.52-0.95]. CONCLUSIONS The OFRAT is a valid and reliable tool for estimating the occupational fall risk in older workers. It may assist occupational physicians implement strategies to prevent falls in this group.
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Affiliation(s)
- Y Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Y Okubo
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Sydney 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, Australia
| | - Y Nofuji
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
| | - K Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Y Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
| | - H Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - S Shinkai
- Graduate School of Nutrition and Health Science, Kagawa Nutrition University, Saitama 350-0214, Japan
| | - S R Lord
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Sydney 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, Australia
| | - H Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
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19
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Mahoney JR, Blumen HM, De Sanctis P, Fleysher R, Frankini C, Hoang A, Hoptman MJ, Jin R, Lipton M, Nunez V, Twizer L, Uy N, Valdivia A, Verghese T, Wang C, Weiss EF, Zwerling J, Verghese J. Visual-somatosensory integration (VSI) as a novel marker of Alzheimer’s disease: A comprehensive overview of the VSI study. Front Aging Neurosci 2023; 15:1125114. [PMID: 37065459 PMCID: PMC10098130 DOI: 10.3389/fnagi.2023.1125114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
Identification of novel, non-invasive, non-cognitive based markers of Alzheimer’s disease (AD) and related dementias are a global priority. Growing evidence suggests that Alzheimer’s pathology manifests in sensory association areas well before appearing in neural regions involved in higher-order cognitive functions, such as memory. Previous investigations have not comprehensively examined the interplay of sensory, cognitive, and motor dysfunction with relation to AD progression. The ability to successfully integrate multisensory information across multiple sensory modalities is a vital aspect of everyday functioning and mobility. Our research suggests that multisensory integration, specifically visual-somatosensory integration (VSI), could be used as a novel marker for preclinical AD given previously reported associations with important motor (balance, gait, and falls) and cognitive (attention) outcomes in aging. While the adverse effect of dementia and cognitive impairment on the relationship between multisensory functioning and motor outcomes has been highlighted, the underlying functional and neuroanatomical networks are still unknown. In what follows we detail the protocol for our study, named The VSI Study, which is strategically designed to determine whether preclinical AD is associated with neural disruptions in subcortical and cortical areas that concurrently modulate multisensory, cognitive, and motor functions resulting in mobility decline. In this longitudinal observational study, a total of 208 community-dwelling older adults with and without preclinical AD will be recruited and monitored yearly. Our experimental design affords assessment of multisensory integration as a new behavioral marker for preclinical AD; identification of functional neural networks involved in the intersection of sensory, motor, and cognitive functioning; and determination of the impact of early AD on future mobility declines, including incident falls. Results of The VSI Study will guide future development of innovative multisensory-based interventions aimed at preventing disability and optimizing independence in pathological aging.
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Affiliation(s)
- Jeannette R. Mahoney
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- *Correspondence: Jeannette R. Mahoney,
| | - Helena M. Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Pierfilippo De Sanctis
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Roman Fleysher
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Carolina Frankini
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Alexandria Hoang
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Matthew J. Hoptman
- Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Runqiu Jin
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Michael Lipton
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Valerie Nunez
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Lital Twizer
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Naomi Uy
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ana Valdivia
- Department of Radiology, Division of Nuclear Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Tanya Verghese
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Cuiling Wang
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Erica F. Weiss
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Center of Aging Brain, Montefiore Medical Center, Yonkers, NY, United States
| | - Jessica Zwerling
- Center of Aging Brain, Montefiore Medical Center, Yonkers, NY, United States
| | - Joe Verghese
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Bronx, NY, United States
- Center of Aging Brain, Montefiore Medical Center, Yonkers, NY, United States
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20
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Lee J, Goldfarb M. The effects of swing assistance in a microprocessor-controlled transfemoral prosthesis on walking at varying speeds and grades. WEARABLE TECHNOLOGIES 2023; 4:e9. [PMID: 38487774 PMCID: PMC10936271 DOI: 10.1017/wtc.2023.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 03/17/2024]
Abstract
This article proposes, describes, and tests a swing-assist walking controller for a stance-controlled, swing-assisted knee prosthesis that aims to combine benefits of passive swing mechanics (e.g., quiet operation, biomimetic function, and low power requirements) with benefits of powered swing assistance (e.g., increased robustness of swing-phase motion and specifically increased toe clearance). A three-participant, multislope, multispeed treadmill walking study was performed using the swing-assist prosthesis and controller, as well as using the participants' prescribed microprocessor knee devices. The swing-assist device and approach were found to improve user minimum foot clearance during walking at slopes and speeds, and also to improve symmetry of knee motion. Hip power inputs from stance knee release to heel strike indicated that, on average, less hip power was required when using the swing-assist prosthesis, indicating that the observed benefits were likely the result of the knee device and its control methodology, rather than a result of increased hip joint effort.
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Affiliation(s)
- Jantzen Lee
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Michael Goldfarb
- Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Reyes-Ortiz CA, Pacheco S, Slovacek CA, Jiang M, Salinas-Fernandez IC, Ocampo-Chaparro JM. Medical falls among older adults in Latin American cities. Rev Salud Publica (Bogota) 2023; 22:527-532. [PMID: 36753221 DOI: 10.15446/rsap.v22n5.84883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/30/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and risk factors for falls requiring medical attention, referred as medical falls, in community-dwelling persons aged >60 years. Methods A cross-sectional analysis was conducted using information from the Health, Well-Being, and Aging ("SABE") Study in Latin America and the Caribbean (7 cities), as well as from the SABE Bogota study (pooled sample of 8 cities n=12,487). Falls that occurred during a past 12-month period were considered and then noted if required medical treatment because of the fall. RESULTS The weighted prevalence of medical falls across the eight surveys ranged from 6.0% to 11.3%. In weighted multivariate logistic regression analyses, potentially modifiable risk factors for medical falls include urinary incontinence (OR=1.51 95% CI 1.18-1.92), high depressive symptomatology (OR=1.53 95% CI 1.24-1.91), poor self-rated health (OR=1.35 95% CI 1.10-1.66) and activities of daily living limitations (OR=1.48 95% CI 1.16-1.87). CONCLUSIONS Based on our results, preventive measures targeting these risk factors may help to decrease the risk for medical falls among older adults in Latin America.
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Affiliation(s)
- Carlos A Reyes-Ortiz
- CR: MD. Ph. D. Associate Professor and Researcher. Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences. Florida A&M University, Tallahassee. Florida, USA.
| | - Soraira Pacheco
- SP: MD. Assistant Professor in Geriatric and Palliative Medicine. Division of Geriatric and Palliative Medicine. McGovern Medical School, Houston. Texas, USA.
| | - Cedar A Slovacek
- CS: MD. Physician. McGovern Medical School, Houston. Texas, USA.
| | - Meng Jiang
- MJ: Gerontological Nurse Practitioner. Division of Geriatric and Palliative Medicine, McGovern Medical School, Houston. Texas, USA.
| | | | - Jose M Ocampo-Chaparro
- JO: MD. M. Sc. Associate Professor and Researcher. Department of Internal Medicine, Universidad Libre. Department of Family Medicine, Universidad del Valle. Cali, Colombia.
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22
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Xuan C, Zhang B, Jia X. The Effect of Human Settlement Pedestrian Environment on Gait of Older People: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1567. [PMID: 36674319 PMCID: PMC9865741 DOI: 10.3390/ijerph20021567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Older people are limited by the pedestrian environment in human settlements and are prone to travel difficulties, falls, and stumbles. Furthermore, we still lack systematic knowledge of the pedestrian environment affecting the gait of older people. The purpose of this review is to synthesize current evidence of effective human settlement pedestrian environments interfering with gait in older people. The systematic effects of the human settlement pedestrian environment on gait in older people are discussed. Databases such as Web of Science, Medline (via PubMed), Scopus, and Embase were searched for relevant studies up to June 2022. The literature was screened to extract relevant evidence from the included literature, assess the quality of the evidence, and analyze the systematic effects of the pedestrian environment on gait in older people. From the 4297 studies identified in the initial search, 11 systematic reviews or meta-analysis studies were screened, from which 18 environmental factors and 60 gait changes were extracted. After removing duplicate elements and merging synonymous features, a total of 53 relationships between environmental factors and gait change in older people were extracted: the main human settlement pedestrian environmental factors affecting gait change in older people in existing studies were indoor and outdoor stairs/steps, uneven and irregular ground, obstacles, walking path turns, vibration interventions, mechanical perturbation during gait, and auditory sound cues. Under the influence of these factors, older people may experience changes in the degree of cautiousness and conservatism of gait and stability, and their body posture performance and control, and muscle activation may also be affected. Factors such as ground texture or material, mechanical perturbations during gait, and vibration interventions stimulate older people's understanding and perception of their environment, but there is controversy over the results of specific gait parameters. The results support that human settlements' pedestrian environment affects the gait changes of older people in a positive or negative way. This review may likely contribute evidence-based information to aid communication among practitioners in public health, healthcare, and environmental construction. The above findings are expected to provide useful preference for associated interdisciplinary researchers to understand the interactions among pedestrian environments, human behavior, and physiological characteristics.
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Affiliation(s)
- Changzheng Xuan
- Architecture College, Inner Mongolia University of Technology (IMUT), Hohhot 010051, China
- Inner Mongolia Key Laboratory of Green Building, Hohhot 010051, China
| | - Bo Zhang
- Architecture College, Inner Mongolia University of Technology (IMUT), Hohhot 010051, China
- Inner Mongolia Key Laboratory of Green Building, Hohhot 010051, China
| | - Xiaohu Jia
- Architecture College, Inner Mongolia University of Technology (IMUT), Hohhot 010051, China
- Inner Mongolia Key Laboratory of Green Building, Hohhot 010051, China
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Silva SDO, Barbosa JB, Lemos T, Oliveira LAS, Ferreira ADS. Agreement and predictive performance of fall risk assessment methods and factors associated with falls in hospitalized older adults: A longitudinal study. Geriatr Nurs 2023; 49:109-114. [PMID: 36495792 DOI: 10.1016/j.gerinurse.2022.11.016] [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: 09/10/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Falls in hospitalized older adults are of concern and, despite the availability of fall risk assessment methods and knowledge about factors associated with falls, their validity and agreement remain poorly investigated. In a prospective study, we enrolled 102 hospitalized older adults (median [P25-P75]) 67 (64-73) years, 52 [51%] men, length of stay 20 [8-41] days). Fall risk was assessed at hospital admission using the Functional Independence Measure; Morse Fall Scale; St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients; Johns Hopkins Fall Risk Assessment Tool; and polypharmacy. The St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients method showed the highest predictive performance (accuracy 92%) for the identification of fallers during hospitalization. A slightly better-then-chance agreement was estimated between all methods (Light's κ = 0.120). Fall risk assessment methods and factors associated with falls should not be used interchangeably as their overall and pairwise agreement are fair at best.
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Affiliation(s)
| | | | - Thiago Lemos
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Brazil.
| | | | - Arthur de Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Brazil.
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Quatman CE, Wiseman JM, Sheridan E, Caterino JM, Weade M, Wisner D, Leyshon C, Quatman-Yates C. Automated referral to community paramedicine during 9-1-1 fall calls for resource activation. J Am Geriatr Soc 2022; 70:3578-3584. [PMID: 36039856 PMCID: PMC9771950 DOI: 10.1111/jgs.18011] [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: 10/08/2021] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We sought to improve the referral process to a community paramedicine (CP) program following a 9-1-1 encounter. METHODS An electronic health record (EHR) for CP records with the ability to link to emergency EHR was identified and implemented with a single-click referral to the CP program. Referrals were tracked for 15 months before and after implementation. RESULTS Referral capacity increased from an average of 14.2 referrals per month to 44.9 referrals per month. CONCLUSION The results of this study suggest an EHR is a useful investment for CP programs and may be integral to efficient program operations.
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Affiliation(s)
- Carmen E Quatman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jessica M Wiseman
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elizabeth Sheridan
- Division of Trauma, Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Weade
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - David Wisner
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - Christine Leyshon
- Upper Arlington Community Assistance, Referrals, and Education Services (UA CARES), Upper Arlington Fire Division, Upper Arlington, OH
| | - Catherine Quatman-Yates
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA, Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA, Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA, The Ohio State University Sports Medicine Research Institute, Columbus, OH, USA
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25
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Lage I, Braga F, Almendra M, Meneses F, Teixeira L, Araujo O. Falls in older persons living alone: the role of individual, social and environmental factors. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:396-404. [PMID: 35533981 DOI: 10.1016/j.enfcle.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To identify the prevalence and the risk factors of falling in older people (65+) living alone. METHOD This is a descriptive and transversal study which included 186 participants, aged 65+ living alone in community-dwelling. RESULTS The prevalence of falls was 80.1% (95% CI 74.1-85.8). Considering the last 3 months, the prevalence of falls reduced to 22.2% (95% CI 17.5-29.9) and the number of falls reported was 2.4 (sd = 2.1). Most falls were accidental (n = 74, 59.7%), followed by dizziness (n = 15, 12.1%) and almost 50% occurred in the morning (n = 53, 45.3%). Considering the local where the falls occurred, 70 (57.4%) were at home (36.1% inside and 21.3% outside), 41 on the street (33.6%) and only 11 (9.0%) in a public place (4.1% inside and 4.9% outside). After the fall, 30.9% of the participants changed daily life after an event. CONCLUSIONS Falls among older adults is a multifactorial problem that requires integrated and multiprofessional interventions. Older age, living alone in an urban area, with insufficient resources, reduced physical activity and a poor self-perception are factors associated with a higher risk of falling. Similarly, older people who have difficulty standing, sitting and rising from a chair, as well as being hypertensive and taking a high number of medications are associated with a high risk of falling. Future research should develop and emphasize more national studies to confirm these results.
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Affiliation(s)
- Isabel Lage
- School of Nursing, University of Minho, Portugal
| | - Fátima Braga
- School of Nursing, University of Minho, Portugal
| | | | - Filipe Meneses
- School of Nursing, University of Minho, Portugal; School of Engineering, University of Minho, Portugal; Centro de Computação Gráfica, Guimarães, Portugal
| | - Laetitia Teixeira
- Algoritmi Research Centre, University of Minho, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Odete Araujo
- School of Nursing, University of Minho, Portugal; CINTESIS-Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal; Health Sciences Research Unit, Nursing (UICISA E: UMinho), Portugal.
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26
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Tsang C, Leung J, Kwok T. Self-perceived balance confidence is independently associated with any subsequent falls and injurious falls among community-dwelling older fallers: A prospective cohort study. Arch Gerontol Geriatr 2022; 103:104776. [PMID: 35870272 DOI: 10.1016/j.archger.2022.104776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/26/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Balance confidence contributes to activity restriction, decline in physical function, and falls, potentially. This study aimed at examining whether balance confidence is a significant fall predictor independent of physical function measures in community-dwelling older adults. METHODS This was an observational cohort study. Self-perceived balance confidence was measured by the Activities-specific Balance Confidence scale (ABC) and the short form of it, ABC-6. Other potential predictors included gait speed, Five Times Sit-to-Stand Test, Physiological Profile Assessment (PPA), age, sex, cognition, depression, arthritis, body mass index, recurrent fall history, number of comorbidities, number of prescribed medications, and the use of walking aids. Fall occurrence and subsequent injuries were followed up trimonthly for 12 months. The association of the potential predictors with falls was examined with multivariable logistic regression analyses. Sensitivity analysis for their association with injurious falls in a year was performed. RESULTS 461 community-dwelling older adults with a fall history in the past year completed the 12-month follow-up (mean age 70.6±7.1 years, range 60-92 years; 81% females). Participants with high balance confidence (ABC score ≥76 and ABC-6 score ≥64) were less likely to fall in the subsequent year, independently of the physical function measures and other covariates (adjusted OR 0.51-0.57, 95%CI 0.30-0.97, p<0.05). CONCLUSION Balance confidence is a significant fall predictor independent of physical function measures and other covariates in community-dwelling older adults with a history of falls. Future studies might investigate the causal effects of balance confidence on the risk of falling with randomized controlled trials.
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Affiliation(s)
- Charlotte Tsang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong
| | - Jason Leung
- The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong
| | - Timothy Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong.
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Womack JA, Murphy TE, Leo-Summers L, Bates J, Jarad S, Smith AC, Gill TM, Hsieh E, Rodriguez-Barradas MC, Tien PC, Yin MT, Brandt CA, Justice AC. Predictive Risk Model for Serious Falls Among Older Persons Living With HIV. J Acquir Immune Defic Syndr 2022; 91:168-174. [PMID: 36094483 PMCID: PMC9470988 DOI: 10.1097/qai.0000000000003030] [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: 01/27/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older (older than 50 years) persons living with HIV (PWH) are at elevated risk for falls. We explored how well our algorithm for predicting falls in a general population of middle-aged Veterans (age 45-65 years) worked among older PWH who use antiretroviral therapy (ART) and whether model fit improved with inclusion of specific ART classes. METHODS This analysis included 304,951 six-month person-intervals over a 15-year period (2001-2015) contributed by 26,373 older PWH from the Veterans Aging Cohort Study who were taking ART. Serious falls (those falls warranting a visit to a health care provider) were identified by external cause of injury codes and a machine-learning algorithm applied to radiology reports. Potential predictors included a fall within the past 12 months, demographics, body mass index, Veterans Aging Cohort Study Index 2.0 score, substance use, and measures of multimorbidity and polypharmacy. We assessed discrimination and calibration from application of the original coefficients (model derived from middle-aged Veterans) to older PWH and then reassessed by refitting the model using multivariable logistic regression with generalized estimating equations. We also explored whether model performance improved with indicators of ART classes. RESULTS With application of the original coefficients, discrimination was good (C-statistic 0.725; 95% CI: 0.719 to 0.730) but calibration was poor. After refitting the model, both discrimination (C-statistic 0.732; 95% CI: 0.727 to 0.734) and calibration were good. Including ART classes did not improve model performance. CONCLUSIONS After refitting their coefficients, the same variables predicted risk of serious falls among older PWH nearly and they had among middle-aged Veterans.
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Affiliation(s)
- Julie A Womack
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Nursing, West Haven, CT
| | | | | | - Jonathan Bates
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | | | | | - Evelyn Hsieh
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Maria C Rodriguez-Barradas
- Michael E DeBakey VA Medical Center, Infectious Diseases Section and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Phyllis C Tien
- University of California, San Francisco, CA
- Department of Veterans Affairs, San Francisco, CA
| | | | - Cynthia A Brandt
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
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28
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Yesantharao LV, Rosenberg P, Oh E, Leoutsakos J, Munro CA, Agrawal Y. Vestibular therapy to reduce falls in people with Alzheimer's disease: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2022; 8:167. [PMID: 35918757 PMCID: PMC9344717 DOI: 10.1186/s40814-022-01133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Falls are highly common in patients with Alzheimer's disease (AD); around two-thirds of AD patients fall annually. Fall events are major drivers of injury, early institutionalization, and shorter survival. Balance and mobility impairment are among the most important fall risk factors in AD patients. Vestibular therapy (VT) is an effective rehabilitation intervention in improving balance and fall risk through vestibular function, but not often used in AD. We want to evaluate the feasibility of using VT to reduce falls and improve balance function in patients with AD and drive use of an existing, potentially beneficial therapy in a patient population whose high level of vestibular deficits is currently unaddressed. METHODS The proposed pilot clinical trial will be a parallel-group randomized controlled trial. Patients with a diagnosis of mild-moderate AD, age ≥ 60, and the presence of a caregiver will be recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Eligible patients will be offered vestibular testing. Patients with vestibular loss will be offered participation in the VT trial. One-hundred AD patients with vestibular loss will be enrolled and randomized 1:1 into the control and intervention arms of the trial. All patients will undergo baseline balance and cognitive assessment, followed by 8 weeks of active control therapy or VT, consisting of ~25-min office sessions with a vestibular therapist. Patients will be tracked for falls and undergo follow-up balance and cognitive assessment at 8 and 52 weeks (1 year) to assess the potential short-term and longer-term effects, respectively, of VT on balance and cognition. The main outcomes of this trial are falls, balance (using the Berg Balance Scale and the Timed Up and Go test), and cognition (using the clock drawing test, the Card Rotations test, the Money Road Map test, and the triangle completion task). DISCUSSION As the population ages and the number of individuals with AD in the US grows to a projected 14 million in 2050, managing falls in AD will continue to grow as a critical public health concern; this trial assesses feasibility of a potential solution. TRIAL REGISTRATION ClinicalTrial.Gov identifier - NCT03799991 . Registered 01 August 2019.
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Affiliation(s)
- Lekha V Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Esther Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Impact of Upgraded Lighting on Falls in Care Home Residents. J Am Med Dir Assoc 2022; 23:1698-1704.e2. [PMID: 35850166 DOI: 10.1016/j.jamda.2022.06.013] [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: 02/24/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Falls in care home residents have major health and economic implications. Given the impact of lighting on visual acuity, alertness, and sleep and their potential influence on falls, we aimed to assess the impact of upgraded lighting on the rate of falls in long-term care home residents. DESIGN An observational study of 2 pairs of care homes (4 sites total). One site from each pair was selected for solid-state lighting upgrade, and the other site served as a control. SETTING AND PARTICIPANTS Two pairs of care homes with 758 residents (126,479 resident-days; mean age (±SD) 81.0 ± 11.7 years; 57% female; 31% with dementia). METHODS One "experimental" site from each pair had solid-state lighting installed throughout the facility that changed in intensity and spectrum to increase short-wavelength (blue light) exposure during the day (6 am-6 pm) and decrease it overnight (6 pm-6 am). The control sites retained standard lighting with no change in intensity or spectrum throughout the day. The number of falls aggregated from medical records were assessed over an approximately 24-month interval. The primary comparison between the sites was the rate of falls per 1000 resident-days. RESULTS Before the lighting upgrade, the rate of falls was similar between experimental and control sites (6.94 vs 6.62 falls per 1000 resident-days, respectively; rate ratio [RR] 1.05; 95% CI 0.70-1.58; P = .82). Following the upgrade, falls were reduced by 43% at experimental sites compared with control sites (4.82 vs 8.44 falls per 1000 resident-days, respectively; RR 0.57; 95% CI 0.39-0.84; P = .004). CONCLUSIONS AND IMPLICATIONS Upgrading ambient lighting to incorporate higher intensity blue-enriched white light during the daytime and lower intensity overnight represents an effective, passive, low-cost, low-burden addition to current preventive strategies to reduce fall risk in long-term care settings.
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Lage I, Braga F, Almendra M, Meneses F, Teixeira L, Araujo O. Caídas en personas mayores que viven solas: el papel de los factores individuales, sociales y medioambientales. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kim KM, Lui LY, Cummings SR. Recent fall and high imminent risk of fracture in older men and women. Age Ageing 2022; 51:6618058. [PMID: 35753766 DOI: 10.1093/ageing/afac141] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND despite fall history being a well-known risk factor for falls and fractures, the association between very recent falls and imminent fracture risk is not clearly elucidated. OBJECTIVE to study the very recent (<4 months) fall-related absolute risk of fractures in the following year. METHODS two large prospective cohort studies of women (Study of Osteoporotic Fractures [SOF]) and men (Osteoporotic Fractures in Men Study [MrOS]) aged 65 years or older were included. Data on falls were collected every 4 months, and the primary outcomes were any non-spine and hip fractures in the next 12 months. RESULTS a total of 9,704 women contributed 419,149, and 5,994 men contributed 223,885 four-monthly periods of observations during the 14.8-year SOF and 12.6-year MrOS follow-up. Falls within 4 months indicated a high risk of non-spine and hip fractures in the following year for both sexes; in women, a recent fall indicated an 8.1% absolute risk of a non-spine fracture within 1 year, a 2.5-fold higher risk than that in women without falls, a 2.5% absolute risk of hip fracture, and a 3.1-fold increased risk. Falls increased the risk of fractures regardless of whether a fracture occurred or not. Men had similar risk patterns, albeit with a lower absolute risk of fracture. CONCLUSIONS in older people, a fall within 4 months indicates a high risk of fracture in the next year, regardless of fracture occurrence. A recent fall warrants urgent evaluation and consideration of treatments to reduce the imminent risk of fractures.
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Affiliation(s)
- Kyoung Min Kim
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.,Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Li-Yung Lui
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Close JCT, Lord SR. Fall prevention in older people: past, present and future. Age Ageing 2022; 51:6618056. [PMID: 35754196 DOI: 10.1093/ageing/afac105] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Indexed: 11/12/2022] Open
Abstract
Over the past 50 years we have transitioned from accepting falls as an inevitable consequence of ageing to something that can and should be prevented. Numerous studies have elucidated the contributors to falls and how to assess a person's risk of falling. There are many effective approaches to preventing falls in older people including those with cognitive and physical impairments. Exercise is the most tried and tested approach with good evidence that moderate to high intensity balance training is an effective fall prevention strategy. Other successful single modality interventions include enhanced podiatry, home safety interventions, expedited cataract extraction, cardiac pacing for people with carotid sinus hypersensitivity and vitamin D supplementation in people living in care homes. Multiple interventions (everyone receives the same intervention package) and multifactorial interventions (interventions tailored to identified risk factors) are effective particularly in high-risk populations. In more recent years we have seen the emergence of new technologies such as devices and software programs that can offer low-cost interventions which may be more sustainable than our traditional time- and resource-limited approach to prevention. There is still more to be done and a translational focus is needed to ensure that effective interventions are scaled up and delivered to more people while at the same time maximising adherence and maintaining the fidelity of the interventions.
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Affiliation(s)
- Jacqueline C T Close
- School of Population Health, University of New South Wales, Sydney, Australia.,Prince of Wales Clinical School, UNSW, Sydney, Australia
| | - Stephen R Lord
- School of Population Health, University of New South Wales, Sydney, Australia
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Tago M, Katsuki NE, Nakatani E, Tokushima M, Dogomori A, Mori K, Yamashita S, Oda Y, Yamashita SI. External validation of a new predictive model for falls among inpatients using the official Japanese ADL scale, Bedriddenness ranks: a double-centered prospective cohort study. BMC Geriatr 2022; 22:331. [PMID: 35428196 PMCID: PMC9013105 DOI: 10.1186/s12877-022-02871-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
Background Several reliable predictive models for falls have been reported, but are too complicated and time-consuming to evaluate. We recently developed a new predictive model using just eight easily-available parameters including the official Japanese activities of daily living scale, Bedriddenness ranks, from the Ministry of Health, Labour and Welfare. This model has not yet been prospectively validated. This study aims to prospectively validate our new predictive model for falls among inpatients admitted to two different hospitals. Methods A double-centered prospective cohort study was performed from October 1, 2018, to September 30, 2019 in an acute care hospital and a chronic care hospital. We analyzed data from all adult inpatients, for whom all data required by the predictive model were evaluated and recorded. The eight items required by the predictive model were age, gender, emergency admission, department of admission, use of hypnotic medications, previous falls, independence of eating, and Bedriddenness ranks. The main outcome is in-hospital falls among adult inpatients, and the model was assessed by area under the curve. Results A total of 3,551 adult participants were available, who experienced 125 falls (3.5%). The median age (interquartile range) was 78 (66–87) years, 1,701 (47.9%) were men, and the incidence of falls was 2.25 per 1,000 patient-days and 2.06 per 1,000 occupied bed days. The area under the curve of the model was 0.793 (95% confidence interval: 0.761–0.825). The cutoff value was set as − 2.18, making the specificity 90% with the positive predictive value and negative predictive value at 11.4% and 97%. Conclusions This double-centered prospective cohort external validation study showed that the new predictive model had excellent validity for falls among inpatients. This reliable and easy-to-use model is therefore recommended for prediction of falls among inpatients, to improve preventive interventions. Trial registration UMIN000040103 (2020/04/08) Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02871-5.
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Palmisano C, Kullmann P, Hanafi I, Verrecchia M, Latoschik ME, Canessa A, Fischbach M, Isaias IU. A Fully-Immersive Virtual Reality Setup to Study Gait Modulation. Front Hum Neurosci 2022; 16:783452. [PMID: 35399359 PMCID: PMC8983870 DOI: 10.3389/fnhum.2022.783452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
Objective: Gait adaptation to environmental challenges is fundamental for independent and safe community ambulation. The possibility of precisely studying gait modulation using standardized protocols of gait analysis closely resembling everyday life scenarios is still an unmet need. Methods: We have developed a fully-immersive virtual reality (VR) environment where subjects have to adjust their walking pattern to avoid collision with a virtual agent (VA) crossing their gait trajectory. We collected kinematic data of 12 healthy young subjects walking in real world (RW) and in the VR environment, both with (VR/A+) and without (VR/A-) the VA perturbation. The VR environment closely resembled the RW scenario of the gait laboratory. To ensure standardization of the obstacle presentation the starting time speed and trajectory of the VA were defined using the kinematics of the participant as detected online during each walking trial. Results: We did not observe kinematic differences between walking in RW and VR/A-, suggesting that our VR environment per se might not induce significant changes in the locomotor pattern. When facing the VA all subjects consistently reduced stride length and velocity while increasing stride duration. Trunk inclination and mediolateral trajectory deviation also facilitated avoidance of the obstacle. Conclusions: This proof-of-concept study shows that our VR/A+ paradigm effectively induced a timely gait modulation in a standardized immersive and realistic scenario. This protocol could be a powerful research tool to study gait modulation and its derangements in relation to aging and clinical conditions.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- *Correspondence: Chiara Palmisano
| | - Peter Kullmann
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marta Verrecchia
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marc Erich Latoschik
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Andrea Canessa
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genova, Italy
| | - Martin Fischbach
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Pini-CTO, Milano, Italy
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Fall determinants in hospitalised older patients: a nested case control design - incidence, extrinsic and intrinsic risk in Malaysia. BMC Geriatr 2022; 22:179. [PMID: 35236280 PMCID: PMC8892728 DOI: 10.1186/s12877-022-02846-6] [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] [Received: 02/27/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The older person is at greater risk of falls due to multiple intrinsic and extrinsic factors. This is compounded when the elderly is admitted to hospitals, as they are acutely ill and placed in an unfamiliar environment. Delirium and polypharmacy further complicate these problems. As falls reflect quality of care with potential for grave outcomes, this study aimed to identify the extent and risk of falls in public hospitals. Methods We conducted a nested case control study in 12 public hospitals in Malaysia. In the cohort section, we screened all inpatients 60 years of age and above daily until discharge, or the end of the study period. Daily, we identified those who fell, inclusive of near falls, in the preceding 24 h. Our enumerators interviewed patients on experience of fall, and supplemented data from the nurses and caregivers. For each case, ten controls were chosen. Results The incidence of falls/near falls was 1.0 per 1000 patient days (95% CI: 0.9, 1.1). Intrinsic risk factors found to be significant included patients who were not from a nursing home or not cared for by a domestic helper prior to admission, had prior history of indoor fall either in home or hospital, had four or more clinical diagnoses or exited from the bed on the weak side. Significant extrinsic factors were the absence of transfer bar in toilet, call bells, light switches or walking aids that were not within reach, as well as not having a walking aid. Non-sturdy chair was associated with lesser falls than when sturdy chairs with armrests were present. Conclusion Querying patients for falls produced better results than incident reporting. Several intrinsic factors such as history of indoor or in-hospital fall, having four or more clinical diagnoses or exiting from weaker side and residence history may help to identify those at higher risk. Addressing significant extrinsic factors such as transfer bars and the identification of switches may help in reducing falls risk in hospitals. Trial registration This study was registered in National Medical Research Register of Malaysia (NMRR-07-772-1044; date 26/05/2008) with Ethics Approval from Medical Research and Ethics Committee (MREC: MRG-07-LOI-HSR-1).
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Mitchell A, Martin AE. Quantifying the effect of sagittal plane joint angle variability on bipedal fall risk. PLoS One 2022; 17:e0262749. [PMID: 35081142 PMCID: PMC8791504 DOI: 10.1371/journal.pone.0262749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022] Open
Abstract
Falls are a major issue for bipeds. For elderly adults, falls can have a negative impact on their quality of life and lead to increased medical costs. Fortunately, interventional methods are effective at reducing falls assuming they are prescribed. For biped robots, falls prevent them from completing required tasks. Thus, it is important to understand what aspects of gait increase fall risk. Gait variability may be associated with increased fall risk; however, previous studies have not investigated the variation in the movement of the legs. The purpose of this study was to determine the effect of joint angle variability on falling to determine which component(s) of variability were statistically significant. In order to investigate joint angle variability, a physics-based simulation model that captured joint angle variability as a function of time through Fourier series was used. This allowed the magnitude, the frequency mean, and the frequency standard deviation of the variability to be altered. For the values tested, results indicated that the magnitude of the variability had the most significant impact on falling, and specifically that the stance knee flexion variability magnitude was the most significant factor. This suggests that increasing the joint variability magnitude may increase fall risk, particularly if the controller is not able to actively compensate. Altering the variability frequency had little to no effect on falling.
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Affiliation(s)
- Amy Mitchell
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - Anne E. Martin
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
- * E-mail:
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Feng C, Adebero T, DePaul VG, Vafaei A, Norman KE, Auais M. A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults. Phys Ther 2022; 102:6383647. [PMID: 34636923 DOI: 10.1093/ptj/pzab236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.
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Affiliation(s)
- Chengying Feng
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Tony Adebero
- Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Afshin Vafaei
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
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Kuo CC, Chen SC, Wang JY, Ho TJ, Lu TW. Best-Compromise Control Strategy Between Mechanical Energy Expenditure and Foot Clearance for Obstacle-Crossing in Older Adults: Effects of Tai-Chi Chuan Practice. Front Bioeng Biotechnol 2021; 9:774771. [PMID: 34926422 PMCID: PMC8675231 DOI: 10.3389/fbioe.2021.774771] [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: 09/13/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Obstacle-crossing increases the risk of falls in older people. This study aimed to identify the effects of long-term Tai-Chi Chuan (TCC) practice on the control strategies for obstacle-crossing in older people. Methods: A multi-objective optimal control technique with measured gait data was used to identify the control strategies adopted by 15 long-term TCC practitioners and 15 healthy controls when crossing obstacles of different heights, in terms of the best-compromise weighting sets for the conflicting objectives of minimizing energy expenditure and maximizing the toe-obstacle and heel-obstacle clearances. Results and Conclusions: The long-term TCC older practitioners adopted a best-compromise control strategy similar to those adopted by young adults, with greater weightings on the minimization of the mechanical energy expenditure and smaller weightings on foot-clearance as compared to non-TCC controls (TCC: 0.72, 0.14, 0.14; Control: 0.55, 0.225, 0.225). This strategy enabled the long-term TCC older practitioners to cross obstacles with significantly greater leading-toe clearances but with relatively less mechanical energy expenditure. With the current approach, further simulations of obstacle-crossing mechanics with a given weighting set will be useful for answering clinically relevant what-if questions, such as what abilities would be needed if the non-TCC older people were to cross obstacles using the crossing strategy of the TCC people.
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Affiliation(s)
- Chien-Chung Kuo
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.,Department of Orthopedics, School of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Chang Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jr-Yi Wang
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Jung Ho
- Integration Center of Traditional Chinese and Modern Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Department of Chinese Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
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Rosengren BE, Rempe J, Jehpsson L, Dencker M, Karlsson MK. Physical Activity at Growth Induces Bone Mass Benefits Into Adulthood – A Fifteen‐Year Prospective Controlled Study. JBMR Plus 2021; 6:e10566. [PMID: 35079677 PMCID: PMC8770997 DOI: 10.1002/jbm4.10566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022] Open
Abstract
Daily school physical activity (PA) improves musculoskeletal traits. Whether or not benefits remain in adulthood is debated. We included in this study 131 children that took part in an intervention with 40 minutes of PA per school day (200 minutes per week) from age 6 to 9 years (grade one) to age 14 to 16 years (grade nine), whereas 78 children continued with national recommended school physical education of 60 minutes per week. Measurements were done with dual‐energy X‐ray absorptiometry (bone mineral content [BMC], bone mineral density [BMD], and bone area), and a computerized knee dynamometer (peak torque muscle strength) at study start, at the end of the intervention, and 7 years after the intervention. Group differences from study start and end of the intervention to 7 years thereafter were estimated by analyses of covariance (adjusted for sex and follow‐up time). Musculoskeletal gains from study start to 7 years after termination of the intervention were higher in the intervention group (total body less head BMC +182.5 g [95% confidence interval {CI}, 55.1–309.9] and BMD +0.03 g/cm2 [95% CI, 0.003–0.05], femoral neck area + 0.2 cm2 [95% CI, 0.1–0.4], and knee flexion peak torque muscle strength at 60 degrees per second +9.2 Nm [95% CI, 2.9–15.5]). There was no attenuation during the 7 years that followed termination of the intervention (all group comparisons p > 0.05). Benefits in musculoskeletal gains remain 7 years after termination of a daily school‐based PA program, without attenuation after termination of the program. Daily school PA may counteract low bone mass and inferior muscle strength in adulthood. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Jakob Rempe
- Department of Orthopedics, Helsingborg Hospital Lund University Helsingborg Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Magnus Dencker
- Department of Physiology and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
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Calvert GHM, Carson RG. Neural mechanisms mediating cross education: With additional considerations for the ageing brain. Neurosci Biobehav Rev 2021; 132:260-288. [PMID: 34801578 DOI: 10.1016/j.neubiorev.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
CALVERT, G.H.M., and CARSON, R.G. Neural mechanisms mediating cross education: With additional considerations for the ageing brain. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2021. - Cross education (CE) is the process whereby a regimen of unilateral limb training engenders bilateral improvements in motor function. The contralateral gains thus derived may impart therapeutic benefits for patients with unilateral deficits arising from orthopaedic injury or stroke. Despite this prospective therapeutic utility, there is little consensus concerning its mechanistic basis. The precise means through which the neuroanatomical structures and cellular processes that mediate CE may be influenced by age-related neurodegeneration are also almost entirely unknown. Notwithstanding the increased incidence of unilateral impairment in later life, age-related variations in the expression of CE have been examined only infrequently. In this narrative review, we consider several mechanisms which may mediate the expression of CE with specific reference to the ageing CNS. We focus on the adaptive potential of cellular processes that are subserved by a specific set of neuroanatomical pathways including: the corticospinal tract, corticoreticulospinal projections, transcallosal fibres, and thalamocortical radiations. This analysis may inform the development of interventions that exploit the therapeutic utility of CE training in older persons.
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Affiliation(s)
- Glenn H M Calvert
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland; School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
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Alipour V, Azami-Aghdash S, Rezapour A, Derakhshani N, Ghiasi A, Yusefzadeh N, Taghizade S, Amuzadeh S. Cost-Effectiveness of Multifactorial Interventions in Preventing Falls among Elderly Population: A Systematic Review. Bull Emerg Trauma 2021; 9:159-168. [PMID: 34692866 PMCID: PMC8525694 DOI: 10.30476/beat.2021.84375.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/25/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective: To review the cost-effectiveness of multifactorial interventions to prevent falls in elderly people. Methods: In this systematic review, the databases including PubMed via MEDLINE, Web of Science, Embase, Scopus, Cochrane Library and Google Scholar (from 1st January 2000 to 30th February) were used. All pre-reviewed articles related to cost-effectiveness analysis of multifactorial interventions to prevent falls in elderly were included in this paper and congresses abstracts were excluded. Descriptive statistics were used for quantitative data and content-analysis method to analyze qualitative data. Results: Out of the 456 articles, 19 were finally included in the study. Eighteen articles were conducted in High-Income Countries (HICs) and 16 were at the community level. Medical visits consultation and education were the most common interventions. Most studies were cost-effectiveness and using the Randomized Control Trial (RCT) methods. A fall of prevention costs ranged from $ 272 to $ 987. Incremental Cost-Effectiveness Ratio (ICER) interventions also ranged from the US $ 120,667 to the US $ 4280.9. Conclusion: The results show that despite the high effectiveness of multifactorial interventions to prevent elderly falls, the cost of the interventions are high and they are not very cost-effective. It would be better to design and implement multifactorial interventions with low cost and high effectiveness that are appropriate for each country.
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Affiliation(s)
- Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Derakhshani
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Akbar Ghiasi
- Health Administration HEB School of Business & Administration, University of the Incarnate Word, Texas, USA
| | - Neghar Yusefzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Taghizade
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Reliability and Fall-Risk Predictability of the Short Form of the Fullerton Advanced Balance Scale in Iranian Older Adults. J Aging Phys Act 2021; 30:590-597. [PMID: 34564067 DOI: 10.1123/japa.2021-0137] [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: 04/21/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
Recently, a short form of the Fullerton Advanced Balance (SF-FAB) scale was reported as a good predictor of falls in older adults. However, we found no evidence regarding its reliability in non-American older adults. Therefore, we aimed to analyze the reliability and homogeneity of the SF-FAB scale to measure postural balance in Iranian older adults. Eighty-five community-dwelling older adults (70.75 ± 4.97 years) performed the SF-FAB test on two occasions 1 week apart. In both instances, four raters assessed the performance on the test. The SF-FAB scale (mean total score: 12.46 ± 3.53) revealed acceptable internal consistency (Cronbach's α = .77), excellent intrarater reliability (intraclass correlation coefficient = .94-.99), and excellent interrater reliability (intraclass correlation coefficient = .92-.99). The overall prediction success rate was 83.5% with correctly classifying 95.6% of nonfallers and 35.3% of fallers. The SF-FAB scale can provide a quick screen of balance status in older adults to trigger referral to clinicians for a more comprehensive assessment.
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Contactless Gait Assessment in Home-like Environments. SENSORS 2021; 21:s21186205. [PMID: 34577412 PMCID: PMC8473097 DOI: 10.3390/s21186205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
Gait analysis is an important part of assessments for a variety of health conditions, specifically neurodegenerative diseases. Currently, most methods for gait assessment are based on manual scoring of certain tasks or restrictive technologies. We present an unobtrusive sensor system based on light detection and ranging sensor technology for use in home-like environments. In our evaluation, we compared six different gait parameters, based on recordings from 25 different people performing eight different walks each, resulting in 200 unique measurements. We compared the proposed sensor system against two state-of-the art technologies, a pressure mat and a set of inertial measurement unit sensors. In addition to test usability and long-term measurement, multi-hour recordings were conducted. Our evaluation showed very high correlation (r>0.95) with the gold standards across all assessed gait parameters except for cycle time (r=0.91). Similarly, the coefficient of determination was high (R2>0.9) for all gait parameters except cycle time. The highest correlation was achieved for stride length and velocity (r≥0.98,R2≥0.95). Furthermore, the multi-hour recordings did not show the systematic drift of measurements over time. Overall, the unobtrusive gait measurement system allows for contactless, highly accurate long- and short-term assessments of gait in home-like environments.
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Mueller Y, Schwarz J, Monod S, Locatelli I, Senn N. Use of standardized brief geriatric evaluation compared with routine care in general practice for preventing functional decline: a pragmatic cluster-randomized trial. CMAJ 2021; 193:E1289-E1299. [PMID: 34426445 PMCID: PMC8412422 DOI: 10.1503/cmaj.202887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although assessment of geriatric syndromes is increasingly encouraged in older adults, little evidence exists to support its systematic use by general practitioners (GPs). The aim of this study was to determine whether a systematic geriatric evaluation performed by GPs can prevent functional decline. METHODS We conducted a controlled, open-label, pragmatic cluster-randomized trial in 42 general practices in Switzerland. Participating GPs were expected to enrol an average of 10 community-dwelling adults (aged ≥ 75 yr) who understood French, and had visited their GP at least twice in the previous year. The intervention consisted of yearly assessment by the GP of 8 geriatric syndromes with an associated tailored management plan according to assessment results, compared with routine care. Our primary outcomes were the proportion of patients who lost at least 1 instrumental activity of daily living (ADL) and the proportion who lost at least 1 basic ADL, over 2 years. Our secondary outcomes were quality-of-life scores, measured using the older adult module of the World Health Organization Quality of Life Instrument, and health care use. RESULTS Forty-two GPs recruited 429 participants (63% women) with a mean age of 82.5 years (standard deviation 4.8 yr) at time of recruitment. Of these, we randomly assigned 217 participants to the intervention and 212 to the control arm. The proportion of patients who lost at least 1 instrumental ADL in the intervention and control arms during the course of the study was 43.6% and 47.6%, respectively (risk difference -4.0%, 95% confidence interval [CI] -14.9% to 6.7%, p = 0.5). The proportion of patients who lost at least 1 basic ADL was 12.4% in the intervention arm and 16.9% in the control arm (risk difference -5.1%, 95% CI -14.3% to 4.1%, p = 0.3). INTERPRETATION A yearly geriatric evaluation with an associated management plan, conducted systematically in GP practices, does not significantly lessen functional decline among community-dwelling, older adult patients, compared with routine care. TRIAL REGISTRATION ClinicalTrials.gov, NCT02618291.
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Affiliation(s)
- Yolanda Mueller
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Joëlle Schwarz
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Stéfanie Monod
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Stark S, Keglovits M, Somerville E, Hu YL, Barker A, Sykora D, Yan Y. Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2122044. [PMID: 34463746 PMCID: PMC8408671 DOI: 10.1001/jamanetworkopen.2021.22044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults. OBJECTIVE To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021. INTERVENTIONS The intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral. MAIN OUTCOMES AND MEASURES The primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life. RESULTS A total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02392013.
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Affiliation(s)
- Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Yi-Ling Hu
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Abigail Barker
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Dave Sykora
- St Louis Area Agency on Aging, St Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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46
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Vieira ER, Cavalcanti FADC, Civitella F, Hollifield M, Caceres S, Carreno J, Gaillard T, Huffman FG, Mora JC, Queiroga MR. Effects of Exercise and Diet on Body Composition and Physical Function in Older Hispanics with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158019. [PMID: 34360312 PMCID: PMC8345658 DOI: 10.3390/ijerph18158019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022]
Abstract
Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.
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Affiliation(s)
- Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
- Correspondence:
| | | | - Fernanda Civitella
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Monica Hollifield
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Stephanie Caceres
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Jorge Carreno
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Trudy Gaillard
- Department of Undergraduate Nursing, Florida International University, Miami, FL 33179, USA;
| | - Fatma G. Huffman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Jorge Camilo Mora
- Department of Humanities, Health and Society, Florida International University, Miami, FL 33179, USA;
| | - Marcos Roberto Queiroga
- Department of Physical Education, Midwestern Parana State University, Guarapuava 85040-167, PR, Brazil;
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47
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Balance Measurement Using Microsoft Kinect v2: Towards Remote Evaluation of Patient with the Functional Reach Test. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11136073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To prevent falls, it is important to measure periodically the balance ability of an individual using reliable clinical tests. As Red Green Blue Depth (RGBD) devices have been increasingly used for balance rehabilitation at home, they may also be used to assess objectively the balance ability and determine the effectiveness of a therapy. For this, we developed a system based on the Microsoft Kinect v2 for measuring the Functional Reach Test (FRT); one of the most used balance clinical tools to predict falls. Two experiments were conducted to compare the FRT measures computed by our system using the Microsoft Kinect v2 with those obtained by the standard method, i.e., manually. In terms of validity, we found a very strong correlation between the two methods (r = 0.97 and r = 0.99 (p < 0.05), for experiments 1 and 2, respectively). However, we needed to correct the measurements using a linear model to fit the data obtained by the Kinect system. Consequently, a linear regression model has been applied and examining the regression assumptions showed that the model works well for the data. Applying the paired t-test to the data after correction indicated that there is no statistically significant difference between the measurements obtained by both methods. As for the reliability of the test, we obtained good to excellent within repeatability of the FRT measurements tracked by Kinect (ICC = 0.86 and ICC = 0.99, for experiments 1 and 2, respectively). These results suggested that the Microsoft Kinect v2 device is reliable and adequate to calculate the standard FRT.
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48
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Legrand R, Nuemi G, Poulain M, Manckoundia P. Description of Lifestyle, Including Social Life, Diet and Physical Activity, of People ≥90 years Living in Ikaria, a Longevity Blue Zone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126602. [PMID: 34205297 PMCID: PMC8296328 DOI: 10.3390/ijerph18126602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/16/2022]
Abstract
A cross-sectional observational study was conducted to describe the lifestyle of people ≥90 years, living in Evdilos or Raches, two municipalities of the Greek island of Ikaria, classified a longevity blue zone. The 71 participants were interviewed and underwent the Mediterranean Islands study food frequency questionnaire (MEDIS-FFQ) and the international physical activity questionnaire (IPAQ). The frequency of social contacts was daily for 77.9% of participants, weekly for 16.1%, and monthly for 5.9%. Most participants (90.0%) believed in God, and 81.4% took part in religious events. A total of 62.0% attended Panigiria festivals. Access to primary health care was considered difficult in the past for 66.2% of participants, while 22.1% felt that it remained difficult at the time of the survey. The level of adherence to the Mediterranean diet was 62.7% (61.6% in women and 64.0% in men). Physical activity levels were moderate or high for 71.8% of participants (59.5% of women and 85.3% of men). In conclusion, the participants had a very high level of family solidarity, social interaction and physical activity. The results concerning the Mediterranean diet are less convincing. It would be interesting to study the impact of these factors on the longevity of the oldest old aged people living in Ikaria.
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Affiliation(s)
- Romain Legrand
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France;
| | - Gilles Nuemi
- Department of Biostatistics and Bioinformatics, François Mitterrand Hospital, University Hospital, 21079 Dijon, France;
| | - Michel Poulain
- Institute for the Analysis of Change in Historical and Contemporary Societies (IACCHOS), Université Catholique de Louvain, 1348 Ottignies-Louvain-la-Neuve, Belgium;
- Estonian Institute for Population Studies, Tallinn University, 10120 Tallinn, Estonia
| | - Patrick Manckoundia
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France;
- INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-3-80-29-39-70; Fax: +33-3-80-29-36-21
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49
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Crockett RA, Falck RS, Dao E, Hsu CL, Tam R, Alkeridy W, Liu-Ambrose T. Sweat the Fall Stuff: Physical Activity Moderates the Association of White Matter Hyperintensities With Falls Risk in Older Adults. Front Hum Neurosci 2021; 15:671464. [PMID: 34093153 PMCID: PMC8175638 DOI: 10.3389/fnhum.2021.671464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Falls in older adults are a major public health problem. White matter hyperintensities (WMHs) are highly prevalent in older adults and are a risk factor for falls. In the absence of a cure for WMHs, identifying potential strategies to counteract the risk of WMHs on falls are of great importance. Physical activity (PA) is a promising countermeasure to reduce both WMHs and falls risk. However, no study has yet investigated whether PA attenuates the association of WMHs with falls risk. We hypothesized that PA moderates the association between WMHs and falls risk. Methods: Seventy-six community-dwelling older adults aged 70–80 years old were included in this cross-sectional study. We indexed PA using the Physical Activity Score for the Elderly (PASE) Questionnaire. Falls risk was assessed using the Physiological Profile Assessment (PPA), and WMH volume (mm3) was determined by an experienced radiologist on T2-weighted and PD-weighted MRI scans. We first examined the independent associations of WMH volume and PASE score with PPA. Subsequently, we examined whether PASE moderated the relationship between WMH volume and PPA. We plotted simple slopes to interpret the interaction effects. Age, sex, and Montreal Cognitive Assessment (MoCA) score were included as covariates in all models. Results: Participants had a mean age of 74 years (SD = 3 years) and 54 (74%) were female. Forty-nine participants (66%) had a Fazekas score of 1, 19 (26%) had a score of 2, and 6 (8%) a score of 3. Both PASE (β = −0.26 ± 0.11; p = 0.022) and WMH volume (β = 0.23 ± 0.11; p = 0.043) were each independently associated with PPA score. The interaction model indicated that PASE score moderated the association between WMH volume and PPA (β = −0.27 ± 0.12; p = 0.030), whereby higher PASE score attenuated the association between WMHs and falls risk. Conclusion: PA is an important moderator of falls risk. Importantly, older adults with WMH can reduce their risk of falls by increasing their PA.
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Affiliation(s)
- Rachel A Crockett
- Aging, Mobility, and Cognitive Neuroscience Laboratory, The University of British Columbia, Vancouver, BC, Canada.,Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Ryan S Falck
- Aging, Mobility, and Cognitive Neuroscience Laboratory, The University of British Columbia, Vancouver, BC, Canada.,Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Elizabeth Dao
- Aging, Mobility, and Cognitive Neuroscience Laboratory, The University of British Columbia, Vancouver, BC, Canada.,Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
| | - Chun Liang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Roger Tam
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada.,School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Walid Alkeridy
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Division of Geriatrics, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, The University of British Columbia, Vancouver, BC, Canada.,Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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50
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Bruce J, Hossain A, Lall R, Withers EJ, Finnegan S, Underwood M, Ji C, Bojke C, Longo R, Hulme C, Hennings S, Sheridan R, Westacott K, Ralhan S, Martin F, Davison J, Shaw F, Skelton DA, Treml J, Willett K, Lamb SE. Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT. Health Technol Assess 2021; 25:1-114. [PMID: 34075875 DOI: 10.3310/hta25340] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Falls and fractures are a major problem. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of alternative falls prevention interventions. DESIGN Three-arm, pragmatic, cluster randomised controlled trial with parallel economic analysis. The unit of randomisation was the general practice. SETTING Primary care. PARTICIPANTS People aged ≥ 70 years. INTERVENTIONS All practices posted an advice leaflet to each participant. Practices randomised to active intervention arms (exercise and multifactorial falls prevention) screened participants for falls risk using a postal questionnaire. Active treatments were delivered to participants at higher risk of falling. MAIN OUTCOME MEASURES The primary outcome was fracture rate over 18 months, captured from Hospital Episode Statistics, general practice records and self-report. Secondary outcomes were falls rate, health-related quality of life, mortality, frailty and health service resource use. Economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit. RESULTS Between 2011 and 2014, we randomised 63 general practices (9803 participants): 21 practices (3223 participants) to advice only, 21 practices (3279 participants) to exercise and 21 practices (3301 participants) to multifactorial falls prevention. In the active intervention arms, 5779 out of 6580 (87.8%) participants responded to the postal fall risk screener, of whom 2153 (37.3%) were classed as being at higher risk of falling and invited for treatment. The rate of intervention uptake was 65% (697 out of 1079) in the exercise arm and 71% (762 out of 1074) in the multifactorial falls prevention arm. Overall, 379 out of 9803 (3.9%) participants sustained a fracture. There was no difference in the fracture rate between the advice and exercise arms (rate ratio 1.20, 95% confidence interval 0.91 to 1.59) or between the advice and multifactorial falls prevention arms (rate ratio 1.30, 95% confidence interval 0.99 to 1.71). There was no difference in falls rate over 18 months (exercise arm: rate ratio 0.99, 95% confidence interval 0.86 to 1.14; multifactorial falls prevention arm: rate ratio 1.13, 95% confidence interval 0.98 to 1.30). A lower rate of falls was observed in the exercise arm at 8 months (rate ratio 0.78, 95% confidence interval 0.64 to 0.96), but not at other time points. There were 289 (2.9%) deaths, with no differences by treatment arm. There was no evidence of effects in prespecified subgroup comparisons, nor in nested intention-to-treat analyses that considered only those at higher risk of falling. Exercise provided the highest expected quality-adjusted life-years (1.120), followed by advice and multifactorial falls prevention, with 1.106 and 1.114 quality-adjusted life-years, respectively. NHS costs associated with exercise (£3720) were lower than the costs of advice (£3737) or of multifactorial falls prevention (£3941). Although incremental differences between treatment arms were small, exercise dominated advice, which in turn dominated multifactorial falls prevention. The incremental net monetary benefit of exercise relative to treatment valued at £30,000 per quality-adjusted life-year is modest, at £191, and for multifactorial falls prevention is £613. Exercise is the most cost-effective treatment. No serious adverse events were reported. LIMITATIONS The rate of fractures was lower than anticipated. CONCLUSIONS Screen-and-treat falls prevention strategies in primary care did not reduce fractures. Exercise resulted in a short-term reduction in falls and was cost-effective. FUTURE WORK Exercise is the most promising intervention for primary care. Work is needed to ensure adequate uptake and sustained effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN71002650. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Emma J Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ray Sheridan
- General Medicine/Care of the Elderly, Royal Devon and Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Katharine Westacott
- Elderly Care Department, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Shvaita Ralhan
- Gerontology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Finbarr Martin
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Davison
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fiona Shaw
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn A Skelton
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Treml
- Geriatric Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,College of Medicine and Health, University of Exeter, Exeter, UK.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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