1
|
Chen Y, Du H, Song M, Liu T, Ge P, Xu Y, Pi H. Relationship between fear of falling and fall risk among older patients with stroke: a structural equation modeling. BMC Geriatr 2023; 23:647. [PMID: 37821821 PMCID: PMC10568824 DOI: 10.1186/s12877-023-04298-y] [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: 12/08/2022] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND With reduced balance and mobility, older patients with stroke are more susceptible to fear of falling (FOF). A maladaptive form of FOF can cause excessive activity restriction, poor balance, and recurrent falls, forming a self-reinforcing vicious cycle. This study applied and adapted the FOF model to investigate the interaction between FOF and fall risk in older stroke patients. METHODS A cross-sectional study was conducted among 302 older stroke patients aged 60 and over. All participants were invited to complete the FOF, fall risk, physical activity, and balance tests, which were measured by the Falls Efficacy Scale International (FES-I), Self-Rated Fall Risk Questionnaire (FRQ), the long-form International Physical Activity Questionnaire (IPAQ-LF) and the Four-Stage Balance Test (FSBT) respectively. Data were analyzed using structural equation modeling. RESULTS The mean age of the respondents was 68.62 ± 7.62 years; 8.94% reported a high level of FOF, and 18.21% reported a moderate level of FOF. The structural equation model showed that FOF was directly associated with fall risk (β=-0.38, p < 0.001), and was indirectly associated with fall risk via physical activity (β=-0.075, p < 0.05) and balance ability (β=-0.123, p < 0.05). Depression (β=-0.47, p < 0.001), fall history (β=-0.13, p < 0.05), and female sex (β=-0.16, p < 0.05) affected FOF, while anxiety was not associated with FOF. CONCLUSIONS The increased risk of falling in older stroke patients results from a maladaptive FOF affected by depression, fall history, poor balance ability, and limited physical activity. Our results suggest that greater attention should be paid to FOF during stroke recovery and fall prevention. A multifaced intervention program encompassing physiological and psychological factors should be designed to address FOF and prevent falls.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Medical School of Chinese PLA, Beijing, People's Republic of China
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hui Du
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mi Song
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Ting Liu
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Pei Ge
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Yue Xu
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongying Pi
- Medical Service Training Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, People's Republic of China.
| |
Collapse
|
2
|
Inoue S, Otaka Y, Horimoto Y, Shirooka H, Sugasawa M, Kondo K. Discrepancies in perception of fall risk between patients with subacute stroke and physical therapists in a rehabilitation hospital: a retrospective cohort study. FRONTIERS IN AGING 2023; 4:1204488. [PMID: 37342863 PMCID: PMC10277567 DOI: 10.3389/fragi.2023.1204488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization. Design: Retrospective cohort study. Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020. Methods: The Falls Efficacy Scale-International was used to assess both patients' and physical therapists' perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated. Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers. Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.
Collapse
Affiliation(s)
- Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yukari Horimoto
- Education and Management in Health and Welfare Section, Health Sciences Program, Graduate School of International University of Health and Welfare, Tokyo, Japan
| | - Hidehiko Shirooka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Masafumi Sugasawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| |
Collapse
|
3
|
The association between fatigue severity and risk of falls among middle-aged and older Australian stroke survivors. Aging Clin Exp Res 2022; 34:2457-2463. [PMID: 35796976 PMCID: PMC9637598 DOI: 10.1007/s40520-022-02179-9] [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: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022]
Abstract
Background Fatigue is a common and often debilitating symptom experienced by many stroke survivors. Significant post stroke fatigue may predispose individuals to other health complications, such as falls, which can lead to fractures and soft tissue injuries. Only limited research has examined the association between fatigue and falls in stroke survivors. Methods Data were obtained from the Sax Institute’s 45 and Up Study, from a subset of individuals who had experienced a stroke. The Modified Fatigue Impact Scale—5-item version (MFIS-5) was used to measure the level of fatigue. A logistic regression model, adjusted for stroke characteristics and comorbidities, was used to determine the magnitude of association between change in fatigue score and odds of having had a fall. Results A total of 576 participants completed the questionnaire. A total of 214 (37.2%) participants reported having had a fall in the previous 12 months. There was a statistically significant association between fatigue scores and fall status (p < 0.001). Specifically, for every 1-point increase in the fatigue score (MFIS-5) (i.e. higher level of fatigue), the odds of a person having a fall is 1.10 times greater (AOR = 1.10; 95% CI 1.05, 1.15; p < 0.001). Conclusion This study revealed an association between an increasing risk of falls with increasing severity of post stroke fatigue. Accurate detection and management of fatigue may help reduce the risk of falls and should be the focus of future research.
Collapse
|
4
|
Aihara S, Kitamura S, Dogan M, Sakata S, Kondo K, Otaka Y. Patients' thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke. BMC Geriatr 2021; 21:713. [PMID: 34922484 PMCID: PMC8684226 DOI: 10.1186/s12877-021-02649-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients' participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards. METHODS Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data. RESULTS Five themes surrounding fall events were extracted from the narratives: 'Psychological background before the action', 'Support for the action', 'Direct causes of the fall', 'Patients' awareness after the fall', and 'Changes in attitudes and behaviours after the fall'. 'Psychological background before the action' comprised hastiness or hesitation to call for help. Participants often took an action based on 'Support for the action' derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. 'Direct causes of the fall' consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. 'Patients' awareness after the fall' consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated 'Changes in attitudes and behaviours after the fall' such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling. CONCLUSIONS Comprehensive information on patients' perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients' views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.
Collapse
Affiliation(s)
- Saika Aihara
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan.,Department of Rehabilitation, Faculty of Health Science, Tohoku Fukushi University, Sendai, Miyagi, Japan
| | - Shin Kitamura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan.,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Dogan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Sachiko Sakata
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan. .,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| |
Collapse
|
5
|
Zaborova V, Fesyun A, Gurevich K, Oranskaya A, Rylsky A, Kryuchkova K, Malakhovskiy V, Shestakov D. Changes in kinesiostabilogram parameters and movement speed of stroke patients while increasing their physical activity due to the use of biofeedback method. Eur J Transl Myol 2021; 31. [PMID: 34595898 PMCID: PMC8758953 DOI: 10.4081/ejtm.2021.9360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Balance disorders are complications of stroke survivors. Aim of this study was the establish effectiveness of the biofeedback approach. In this intervention study 245 patients with early diagnosis of acute disturbance of cerebral circulation (ADCC) were examined. Patients able to move independently were treated by standard conservative ADCC therapy on an outpatient approach, but they continued to have problems with coordination of movement in upright position. Then they were submitted to an increasing physical activity based on five sessions of biofeedback, i.e., a complex rehabilitation of patients with motor pathology "Trust-M" according to TU 9442-001-63704475-2010. Mobility rates were assessed using a web camera. Patients' quality of life was evaluated by SF-36 questionnaire and the Hospital Anxiety and Depression Scale (HADS). All parameters were recorded before and after 5 sessions of biofeedback. After treatment, the stability indicators improved and all patients showed a significant increase in motion rate and quality of life. At the same time, the severity of pain and of depression and anxiety decreased. Negative correlations of average strength between the quadrant and patient HADS scaling rates were obtained. In conclusion, our work shows effectiveness of the biofeedback technique for correcting coordination in stroke survivors.
Collapse
Affiliation(s)
- Victoria Zaborova
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Sports Adaptology Laboratory, Moscow Institute of Physics and Technology (National Research University), Moscow Region, Dolgoprudniy.
| | - Anatoly Fesyun
- FSBI "National Medical Research Center for Rehabilitation and Resortology" Ministry of Public Health of Russia, Moscow.
| | - Konstantin Gurevich
- FSBI "National Medical Research Center for Rehabilitation and Resortology" Ministry of Public Health of Russia, Moscow, Russia; UNESCO chair "Healthy life style for sustainable development" "Moscow State University of Medicine and Dentistry. A.I. Evdokimov", Ministry of Health of the Russian Federation, Moscow, Russia; Research Institute of Healthcare Organization and Medical Management of the Moscow Department of Healthcare, Moscow .
| | - Alevtina Oranskaya
- UNESCO chair "Healthy life style for sustainable development" "Moscow State University of Medicine and Dentistry. A.I. Evdokimov", Ministry of Health of the Russian Federation, Moscow.
| | - Alexey Rylsky
- Moscow scientific and practical center for medical rehabilitation, rehabilitation and sports medicine, Department of Health of Moscow, Moscow.
| | - Kira Kryuchkova
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow.
| | - Vladimir Malakhovskiy
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow.
| | - Dmitry Shestakov
- Department of Orthopedics and Complex Trauma of the Moscow Clinical Research Center A.S. Loginov, Moscow.
| |
Collapse
|
6
|
Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
Collapse
Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| |
Collapse
|
7
|
Arvidsson Lindvall M, Forsberg A, Appelros P, Anderzén-Carlsson A. "I can manage the challenge" - a qualitative study describing experiences of living with balance limitations after first-ever stroke. Int J Qual Stud Health Well-being 2020; 16:1857044. [PMID: 33323049 PMCID: PMC7744151 DOI: 10.1080/17482631.2020.1857044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To describe experiences of living with balance limitations after first-ever stroke. Materials and methods: This study has a qualitative design, comprising interviews with 19 persons with first-ever stroke, ten women and nine men. Their mean age was 77 years and the mean time since stroke was 15 months. Stroke survivors who were able to walk outdoors with or without a walking aid and who were independent in toileting and dressing were invited to participate. Semi-structured individual interviews were performed. An inductive qualitative content analysis of the manifest and latent content was conducted. Results: The results are presented in two themes illustrating the latent content of the data, “Feeling dizzy and unstable is a continuous challenge” and “Feeling confidence despite dizziness and unsteadiness”, and seven categories illustrating the manifest content: Limitations in daily life; Being emotionally affected; The need for physical support; Everything takes time; I can still manage; Feelings of acceptance; and Finding individual solutions. Conclusions: All participants experienced the balance limitations as a continuous challenge in their everyday life, yet they also felt confidence. They had to some degree adapted their activities and were able to manage their daily life.
Collapse
Affiliation(s)
- Mialinn Arvidsson Lindvall
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Peter Appelros
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Agneta Anderzén-Carlsson
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| |
Collapse
|
8
|
Walsh ME, Sorensen J, Galvin R, Williams DJP, Harbison JA, Murphy S, Collins R, McCabe DJH, Crowe M, Horgan NF. First year post-stroke healthcare costs and fall-status among those discharged to the community. Eur Stroke J 2018; 3:254-262. [PMID: 31008356 PMCID: PMC6453204 DOI: 10.1177/2396987318764954] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/19/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Falls are common post-stroke events but their relationship with healthcare costs is unclear. The aim of this study was to examine the relationship between healthcare costs in the first year after stroke and falls among survivors discharged to the community. PATIENTS AND METHODS Survivors of acute stroke with planned home discharges from five large hospitals in Ireland were recruited. Falls and healthcare utilisation data were recorded using inpatient records, monthly calendars and post-discharge interviews. Cost of stroke was estimated for each participant from hospital admission for one year. The association of fall-status with overall cost was tested with multivariable linear regression analysis adjusting for pre-stroke function, stroke severity, age and living situation. RESULTS A total of 109 stroke survivors with complete follow-up data (mean age = 68.5 years (SD = 13.5 years)) were included. Fifty-three participants (49%) fell following stroke, of whom 28 (26%) had recurrent falls. Estimated mean total healthcare cost was €20,244 (SD=€23,456). The experience of one fall and recurrent falls was independently associated with higher costs of care (p = 0.02 and p < 0.01, respectively). DISCUSSION The observed relationship between falls and cost is likely to be underestimated as aids and adaptions, productivity losses, and nursing home care were not included. CONCLUSION This study points at differences across fall-status in several healthcare costs categories, namely the index admission, secondary/tertiary care (including inpatient re-admissions) and allied healthcare. Future research could compare the cost-effectiveness of inpatient versus community-based fall-prevention after stroke. Further studies are also required to inform post-stroke bone-health management and fracture-risk reduction.
Collapse
Affiliation(s)
- Mary E Walsh
- School of Physiotherapy,
Royal
College of Surgeons in Ireland, Dublin,
Ireland
- HRB Centre for Primary Care Research, Department of General
Practice,
Royal
College of Surgeons in Ireland, Dublin,
Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre,
Royal
College of Surgeons in Ireland, Dublin,
Ireland
| | - Rose Galvin
- Department of Clinical Therapies, Faculty of Education and
Health Sciences, Health Research Institute,
University
of Limerick, Limerick, Ireland
| | - David JP Williams
- School of Medicine,
Royal
College of Surgeons in Ireland, Dublin,
Ireland
- Department of Geriatric and Stroke Medicine,
Beaumont
Hospital, Dublin, Ireland
| | - Joseph A Harbison
- Department of Medicine for the Elderly, St James’s Hospital,
Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity
College Dublin, Dublin, Ireland
| | - Sean Murphy
- School of Medicine,
Royal
College of Surgeons in Ireland, Dublin,
Ireland
- Department of Medicine for the Older Person and Stroke Service,
Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin,
Ireland
| | - Ronan Collins
- Discipline of Medical Gerontology, School of Medicine, Trinity
College Dublin, Dublin, Ireland
- Department of Age-related Healthcare, The
Adelaide
and Meath Hospital, Dublin,
incorporating the National Children’s Hospital, Dublin, Ireland
| | - Dominick JH McCabe
- Department of Neurology, Vascular Neurology Research Foundation
and Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the
National Children’s Hospital, Dublin, Ireland
- Department of Clinical Neurosciences, Royal Free Campus, UCL
Institute of Neurology, London, UK
- Academic Unit of Neurology, School of Medicine, Trinity College
Dublin, Dublin, Ireland
| | - Morgan Crowe
- Department of Medicine for the Elderly, St Vincent’s University
Hospital, Dublin, Ireland
| | - N Frances Horgan
- School of Physiotherapy,
Royal
College of Surgeons in Ireland, Dublin,
Ireland
| |
Collapse
|