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Tang J, Wang B, Yuan Q, Li X. Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis. Ren Fail 2025; 47:2485375. [PMID: 40204427 PMCID: PMC11983538 DOI: 10.1080/0886022x.2025.2485375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 03/09/2025] [Accepted: 03/19/2025] [Indexed: 04/11/2025] Open
Abstract
OBJECTIVES This study aims to systematically quantify the prevalence of falls in people on hemodialysis and to assess risk factors associated with falls by synthesizing emerging best evidence. METHODS A comprehensive search was conducted across ten databases from their inception to February 27, 2025. The research team independently conducted study selection, quality assessments, data extraction, and analyses of all included studies. Meta-analysis was performed using random-effects and fixed-effects models. The PRISMA guidelines were used to report the systematic review and meta-analysis. RESULTS A total of 31 studies, comprising 191,800 individuals, were included in the analysis. The pooled prevalence of falls in people on hemodialysis was 27.1%. The meta-analysis of risk factors included 19 studies. After controlling for confounding variables, 12 risk factors were associated with falls, including older age, female gender, longer dialysis duration, diabetes mellitus, peripheral vascular disease, paralysis, antidepressant use, frailty, use of walking aids, malnutrition, intradialytic hypotension, and low hemoglobin levels. CONCLUSIONS This study provides an updated, evidence-based assessment of the prevalence and risk factors of falls in people on hemodialysis, confirming their multifactorial etiology. Screening and interventions should be implemented promptly to mitigate the adverse outcomes of falls in people on hemodialysis. REGISTRATION NUMBER PROSPERO CRD42024525375.
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Affiliation(s)
- Jiayi Tang
- The First Hospital of China Medical University, Shenyang, China
| | - Bei Wang
- Nursing School, China Medical University, Shenyang, China
| | - Qin Yuan
- Nursing School, China Medical University, Shenyang, China
| | - Xiaobo Li
- The First Hospital of China Medical University, Shenyang, China
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Nuesse T, Lemke U, Holube I. Associations of frailty, self-reported balance problems, hearing abilities, and posturography in a sample of older adults. Int J Audiol 2025; 64:509-517. [PMID: 39121026 DOI: 10.1080/14992027.2024.2383985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 08/11/2024]
Abstract
OBJECTIVE The aim of this study was to identify risk factors for self-reported balance problems, and to analyse associations between hearing and balance. DESIGN A battery of tests was administered to assess hearing and balance performance, as well as additional health-related factors indicative of frailty and fall risk. In a retrospective analysis, logistic regression was used to identify risk factors for self-reported balance problems and linear regression was used to identify associations between hearing ability and functional balance. STUDY SAMPLE For the risk factor analysis, 199 volunteers aged 55-81 years (mean:67) were divided into two groups according to their self-reported balance problems. Only participants lacking self-reported balance problems (n = 157) were included in the second analysis. RESULTS Female gender, frailty, and fine-motor skills were statistically significant predictors of self-reported balance problems. Functional balance performance was related to hearing impairment for dynamic, but not for static, balance tasks. CONCLUSION For a holistic approach to healthcare and regardless of age, individuals with multiple comorbidities and/or phenotypic signs of frailty should be considered at risk for falls. For further research, it was shown that dynamic, rather than static, balance tasks may be needed to gain deeper insights into the relationship between hearing and balance.
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Affiliation(s)
- Theresa Nuesse
- Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Oldenburg, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Ulrike Lemke
- Research and Development, Sonova AG, Stäfa, Switzerland
| | - Inga Holube
- Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Oldenburg, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
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Li M, Jing X, He Q. Risk of fall in middle-aged and older adult patients with chronic lung disease: evidence from the China Health and Retirement Longitudinal Study. Front Public Health 2025; 13:1547006. [PMID: 40331118 PMCID: PMC12052536 DOI: 10.3389/fpubh.2025.1547006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 04/07/2025] [Indexed: 05/08/2025] Open
Abstract
Background Chronic lung disease (CLD) not only manifests with respiratory symptoms but is often associated with various systemic conditions that may elevate the risk of falls. This study aimed to evaluate the independent association between chronic lung disease (CLD) and fall risk among middle-aged and older adult Chinese adults. Methods We enrolled participants aged over 45 years from the baseline wave of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and divided them into two groups based on the presence of CLD: the CLD group and the non-CLD group. Follow-up assessments were subsequently performed during the 2013, 2015, 2018, and 2020 survey waves to track longitudinal outcomes. The primary endpoint was the incidence of falls (≥1 fall event) during the entire follow-up period (2011-2020). To address potential confounding and strengthen causal inference, we employed a multivariable logistic regression model, conducted propensity score matching, and performed subgroup analyses. Results A total of 9,204 participants were included in the study, consisting of 940 patients with CLD and 8,264 individuals in the non-CLD group. The incidence of falls among patients with CKD was 33.5% (315/940), which was higher than the 27.5% (2,275/8264) observed in the non-CLD group (p < 0.001). After adjusting for confounding factors using logistic regression, the incidence of falls in the CLD group was found to be significantly higher compared to the non-CLD group (OR = 1.19, 95% CI: 1.02, 1.38, p = 0.02). Similar results were observed in the propensity score matching analysis and subgroup analyses. Conclusion Our study found that the risk of falls is significantly increased in middle-aged and older adult patients with CLD in China, highlighting the importance of fall screening and risk prevention programs for CLD patients.
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Affiliation(s)
- Min Li
- Department of Respiratory and Critical Care Medicine, Xishan People’s Hospital of Wuxi City, Wuxi, China
| | - Xushu Jing
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Qian He
- Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Soochow University, Changzhou, China
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Parry SM, Morris PE, Larkin J, Beach LJ, Mayer KP, Oliveira CC, McGinley J, Puthucheary ZA, Koye DN, Lamb KE, Denehy L, Granger CL. Incidence and Associated Risk Factors for Falls in Adults Following Critical Illness: An Observational Study. Crit Care Med 2025; 53:00003246-990000000-00513. [PMID: 40249231 PMCID: PMC12124207 DOI: 10.1097/ccm.0000000000006668] [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] [Indexed: 04/19/2025]
Abstract
OBJECTIVE To explore the incidence of falls and associated risk factors in the first year after hospital discharge in survivors of critical illness. DESIGN Prospective single-site observational study. SETTING University-affiliated mixed ICU. PATIENTS One hundred ICU adults who required invasive ventilation for 48 hours and in an ICU for at least 4 days. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Falls were monitored prospectively for 1 year with completion of monthly falls calendars. Falls data included the number of people who had falls/no falls/recurrent falls, falls rate per person per year, and time to first fall. Fall severity was classified according to the Schwenck classification scheme to examine injurious falls requiring medical intervention. Other outcomes considered included assessments of balance, strength, function, cognition, psychologic health, and health-related quality of life. One hundred participants (31% female) were recruited with a mean age of 58.3 ± 16.2 years, and a median ventilation duration of 6.3 days [4.0-9.1]. Sixty-one percent fell at least once in the first year with the majority sustaining two or more falls (81.4%) and one in four sustained an injurious fall requiring medical attention. The falls incidence rate was 4.4 falls per person-year (95% CI, 3.2-5.9), with the highest incidence occurring less than 3 months after hospital discharge (5.9 falls/person-year [95% CI, 4.4-7.8]). Time to first fall or injurious fall was 36 [11-66] and 95 (95% CI, 40-155) days, respectively. Key risk factors for falls at the time of hospital discharge include comorbidities, higher discharge medications, balance, and muscle strength. CONCLUSIONS There was a high falls incidence in ICU survivors. The study findings suggest a critical window may exist within the first 3 months after hospital discharge and the need for screening, pharmacological optimization, and exercise training in this patient group.
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Affiliation(s)
- Selina M. Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Peter E. Morris
- Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jane Larkin
- Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Lisa J. Beach
- Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kirby P. Mayer
- Department of Physical Therapy, The University of Kentucky, Lexington, KY
| | - Cristino C. Oliveira
- Department of Physiotherapy, Federal University of Espírito Santo, Vitória, Brazil
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jennifer McGinley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Zudin A. Puthucheary
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute Queen Mary University of London, London, United Kingdom
- Adult Critical Care Unit, Royal London Hospital Barts Health NHS Trust, London, United Kingdom
| | - Digsu N. Koye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karen E. Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Health Services, Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Catherine L. Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC, Australia
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Wen MH, Chen PY, Lin S, Lien CW, Tu SH, Chueh CY, Wu YF, Tan Cheng Kian K, Hsu YL, Bai D. Enhancing Patient Safety Through an Integrated Internet of Things Patient Care System: Large Quasi-Experimental Study on Fall Prevention. J Med Internet Res 2024; 26:e58380. [PMID: 39361417 PMCID: PMC11487210 DOI: 10.2196/58380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/17/2024] [Accepted: 08/23/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND The challenge of preventing in-patient falls remains one of the most critical concerns in health care. OBJECTIVE This study aims to investigate the effect of an integrated Internet of Things (IoT) smart patient care system on fall prevention. METHODS A quasi-experimental study design is used. The smart patient care system is an integrated IoT system combining a motion-sensing mattress for bed-exit detection, specifying different types of patient calls, integrating a health care staff scheduling system, and allowing health care staff to receive and respond to alarms via mobile devices. Unadjusted and adjusted logistic regression models were used to investigate the relationship between the use of the IoT system and bedside falls compared with a traditional patient care system. RESULTS In total, 1300 patients were recruited from a medical center in Taiwan. The IoT patient care system detected an average of 13.5 potential falls per day without any false alarms, whereas the traditional system issued about 11 bed-exit alarms daily, with approximately 4 being false, effectively identifying 7 potential falls. The bedside fall incidence during hospitalization was 1.2% (n=8) in the traditional patient care system ward and 0.1% (n=1) in the smart ward. We found that the likelihood of bedside falls in wards with the IoT system was reduced by 88% (odds ratio 0.12, 95% CI 0.01-0.97; P=.047). CONCLUSIONS The integrated IoT smart patient care system might prevent falls by assisting health care staff with efficient and resilient responses to bed-exit detection. Future product development and research are recommended to introduce IoT into patient care systems combining bed-exit alerts to prevent inpatient falls and address challenges in patient safety.
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Affiliation(s)
- Ming-Huan Wen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shirling Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Wen Lien
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Hsiang Tu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Yi Chueh
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Fang Wu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kelvin Tan Cheng Kian
- S R Nathan School of Human Development, Singapore University of Social Sciences, Singapore, Singapore
| | - Yeh-Liang Hsu
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
| | - Dorothy Bai
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Ashizawa R, Honda H, Kameyama Y, Yoshimoto Y. Effect of Pre-Hospitalization Fall History on Physical Activity and Sedentary Behavior After the Implementation of a Behavioral Change Approach in Patients with Minor Ischemic Stroke: A Secondary Analysis of a Randomized Controlled Trial. Int J Behav Med 2024; 31:649-658. [PMID: 37587353 DOI: 10.1007/s12529-023-10202-0] [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] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We aimed to determine whether a history of falls before admission affected physical activity levels and sedentary behavior negatively after implementing a behavior modification approach in patients with minor ischemic stroke. METHODS This study constituted a secondary analysis of an intervention trial. In the intervention study, patients with minor ischemic stroke were randomly assigned to two groups: intervention and control groups. The intervention group was encouraged to reduce sedentary behavior during hospitalization and after discharge, while the control group was encouraged to increase physical activity levels solely during hospitalization. The study included 52 patients who completed the intervention trial. The exposure factor examined was a history of falls. Upon admission, patients were queried about any falls experienced in the year preceding admission and subsequently classified into fall and non-fall groups based on their responses. The primary outcome of interest focused on changes in physical activity levels (step count, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity) and sedentary behavior. Measurements were obtained at two time points: before the intervention, during hospitalization (baseline), and 3 months after discharge (post-intervention). RESULTS Only a significantly lower change in the number of steps taken in the fall group than in the non-fall group was found. CONCLUSION Those with a history of falls showed a lesser change in the number of steps taken before and after implementing a behavior change approach compared with those without a history of falls. Those with a history of falls may have engaged in activities other than walking.
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Affiliation(s)
- Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, 3453 Mikatahara-Cho, Kita-Ku, Hamamatsu-Shi, Shizuoka, 433-8558, Japan.
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hanadaira Care Center, Hamamatsu, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
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Qian XX, Chau PH, Fong DYT, Ho M, Woo J. Identifying factors associated with post-hospital falls in older patients: a territory-wide cohort study. Public Health 2024; 235:1-7. [PMID: 39032191 DOI: 10.1016/j.puhe.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/07/2024] [Accepted: 06/15/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES Post-hospital falls impose a substantial healthcare burden on older adults, yet contributing factors remain inadequately examined. This study aimed to investigate underinvestigated factors associated with post-hospital falls. STUDY DESIGN Retrospective territory-wide cohort study. METHODS We examined the electronic medical records of patients aged ≥65 who were discharged from public hospitals in Hong Kong (2007-2018). During the 12 months following discharge, participants were monitored to identify falls based on diagnosis codes or clinical notes from inpatient episodes, the emergency department (ED) visits, and death records. Falls were categorized into two groups: those only requiring ED visits and those requiring hospitalizations. Binary logistic and multinomial logistic regressions examined the associated factors for post-hospital falls and subcategories of falls, respectively. RESULTS Among 606,392 older patients, 28,593 (4.71%; 95% CI = 4.66%-4.77%) experienced falls within 12 months after discharge. Of those, 8438 (29.5%) only required ED visits, and 20,147 (70.5%) required hospitalizations. Discharge from non-surgical wards, length of stay over two weeks, receiving the Geriatric Day Hospital and Rehabilitation Day Program, advancing age, being female, having more comorbidities, taking more fall risk increasing drugs, previous admission for falls, and living in Hong Kong Island were associated with increased fall risk. Receiving allied health service or nurse service was associated with reduced risk. The same factors were more associated with falls requiring hospitalizations rather than falls only requiring ED visits. CONCLUSIONS Older patients with identified factors were particularly vulnerable to post-hospital falls leading to rehospitalizations. Fall risk assessment and tailored prevention should prioritize this group.
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Affiliation(s)
- X X Qian
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - P H Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - D Y T Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - J Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Sadlonova M, Hansen N, Esselmann H, Celano CM, Derad C, Asendorf T, Chebbok M, Heinemann S, Wiesent A, Schmitz J, Bauer FE, Ehrentraut J, Kutschka I, Wiltfang J, Baraki H, von Arnim CAF. Preoperative Delirium Risk Screening in Patients Undergoing a Cardiac Surgery: Results from the Prospective Observational FINDERI Study. Am J Geriatr Psychiatry 2024; 32:835-851. [PMID: 38228452 DOI: 10.1016/j.jagp.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Postoperative delirium (POD) is a common complication of cardiac surgery that is associated with higher morbidity, longer hospital stay, cognitive decline, and mortality. Preoperative assessments may help to identify patients´ POD risk. However, a standardized screening assessment for POD risk has not been established. DESIGN Prospective observational FINd DElirium RIsk factors (FINDERI) study. PARTICIPANTS Patients aged ≥50 years undergoing cardiac surgery. MEASUREMENTS The primary aim was to analyze the predictive value of the Delirium Risk Screening Questionnaire (DRSQ) prior to cardiac surgery. Secondary aims are to investigate cognitive, frailty, and geriatric assessments, and to use data-driven machine learning (ML) in predicting POD. Predictive properties were assessed using receiver operating characteristics analysis and multivariate approaches (regularized LASSO regression and decision trees). RESULTS We analyzed a data set of 504 patients (68.3 ± 8.2 years, 21.4% women) who underwent cardiac surgery. The incidence of POD was 21%. The preoperatively administered DRSQ showed an area under the curve (AUC) of 0.68 (95% CI 0.62, 0.73), and the predictive OR was 1.25 (95% CI 1.15, 1.35, p <0.001). Using a ML approach, a three-rule decision tree prediction model including DRSQ (score>7), Trail Making Test B (time>118), and Montreal Cognitive Assessment (score ≤ 22) was identified. The AUC of the three-rule decision tree on the training set was 0.69 (95% CI 0.63, 0.75) and 0.62 (95% CI 0.51, 0.73) on the validation set. CONCLUSION Both the DRSQ and the three-rule decision tree might be helpful in predicting POD risk before cardiac surgery.
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Affiliation(s)
- Monika Sadlonova
- Department of Cardiovascular and Thoracic Surgery (MS, IK, HB), University of Göttingen Medical Center, Göttingen, Germany; Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany; Department of Psychosomatic Medicine and Psychotherapy (MS,), University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research) (MS, IK, HB, CAFA), Göttingen, Germany; Department of Psychiatry (MS, CMC), Massachusetts General Hospital, Boston, MA.
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy (NH, HE, JW), University of Göttingen Medical Center, Göttingen, Germany
| | - Hermann Esselmann
- Department of Psychiatry and Psychotherapy (NH, HE, JW), University of Göttingen Medical Center, Göttingen, Germany
| | - Christopher M Celano
- Department of Psychiatry (MS, CMC), Massachusetts General Hospital, Boston, MA; Department of Psychiatry (CMC), Harvard Medical Schol, Boston, MA
| | - Carlotta Derad
- Department of Medical Statistics (CD, TA), University of Göttingen Medical Center, Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics (CD, TA), University of Göttingen Medical Center, Göttingen, Germany
| | - Mohammed Chebbok
- Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany; Department of Cardiology and Pneumology (MC), University of Göttingen Medical Center, Göttingen, Germany
| | - Stephanie Heinemann
- Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany
| | - Adriana Wiesent
- Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany
| | - Jessica Schmitz
- Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany
| | - Frederike E Bauer
- Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany
| | - Julia Ehrentraut
- Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany
| | - Ingo Kutschka
- Department of Cardiovascular and Thoracic Surgery (MS, IK, HB), University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research) (MS, IK, HB, CAFA), Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy (NH, HE, JW), University of Göttingen Medical Center, Göttingen, Germany; German Center for Neurodegenerative Diseases (DZNE) (JW), Göttingen, Germany; Neurosciences and Signaling Group (JW), Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Hassina Baraki
- Department of Cardiovascular and Thoracic Surgery (MS, IK, HB), University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research) (MS, IK, HB, CAFA), Göttingen, Germany
| | - Christine A F von Arnim
- Department of Geriatrics (MS, MC, SH, AW, JS, FEB, JE, CAFA), University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research) (MS, IK, HB, CAFA), Göttingen, Germany
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9
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Ritchey KC, Yohannes AM, Locke ER, Chen S, Simpson T, Battaglia C, Trivedi RB, Swenson ER, Edelman J, Fan VS. Association between self-reported falling risk and risk of hospitalization for patients with chronic obstructive pulmonary disease. Respir Med 2023; 220:107466. [PMID: 37981244 DOI: 10.1016/j.rmed.2023.107466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
RATIONALE The association between self-report falling risk in persons with COPD and hospitalization has not been previously explored. OBJECTIVE To examine whether self-reported risk is associated with hospitalizations in patients with COPD. METHODS A secondary analysis from a prospective observational cohort study of veterans with COPD. Participants completed questions from the Stopping Elderly Accidents, Deaths and Injuries (STEADI) tool kit at either baseline or at the end of the 12-month study. A prospective or cross-sectional analysis examined the association between responses to the STEADI questions and risk of all-cause or COPD hospitalizations. RESULTS Participants (N = 388) had a mean age of 69.6 ± 7.5 years, predominately male (96 %), and 144 (37.1 %) reported having fallen in the last year. More than half reported feeling unsteady with walking (52.6 %) or needing to use their arms to stand up from a chair (61.1 %). A third were concerned about falling (33.3 %). Three questions were associated with all-cause (not COPD) hospitalization in both unadjusted and adjusted cross-sectional analysis (N = 213): "fallen in the past year" (IRR 1.77, 95 % CI 1.10 to 2.86); "unsteady when walking" (IRR 1.88, 95 % CI 1.14 to 3.10); "advised to use a cane or walker" (IRR 1.89, 95 % CI 1.16 to 3.08). CONCLUSIONS The prevalence of self-reported falling risk was high in this sample of veterans with COPD. The association between falling risk and all-cause hospitalization suggests that non-COPD hospitalizations can negatively impact intrinsic risk factors for falling. Further research is needed to clarify the effects of all-cause hospitalization on falling risk in persons with COPD.
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Affiliation(s)
- Katherine C Ritchey
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, USA; Division of Geriatrics and Gerontology, Department of Medicine, University of Washington School of Medicine, 325 9th Ave, Box 359755, Seattle, WA, 98104-2499, USA.
| | - Abebaw M Yohannes
- Department of Physical Therapy, School of Health Professions Building, University of Alabama at Birmingham, 1716 9th Avenue South, Birmingham, AL, 35233, USA.
| | - Emily R Locke
- Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, USA.
| | - Sunny Chen
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, USA
| | - Tracy Simpson
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA; Department of Psychiatry, University of Washington School of Medicine, 959 NE Pacific Street Box 356560, Seattle, WA, 98195-6560, USA.
| | - Catherine Battaglia
- Eastern Colorado VA Health Care System, 1700 N. Wheeling, Aurora, CO, 80045, USA; University of Colorado Anschutz Medical Campus, 13001 E. 17th Pl, Aurora, CO, 80045, USA.
| | - Ranak B Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795. Willow Road, Menlo Park, CA, 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Erik R Swenson
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington School of Medicine, Seattle, WA 1959 NE Pacific Street, Seattle, WA, 98159, USA; Pulmonary and Critical Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
| | - Jeff Edelman
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington School of Medicine, Seattle, WA 1959 NE Pacific Street, Seattle, WA, 98159, USA; Pulmonary and Critical Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
| | - Vincent S Fan
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington School of Medicine, Seattle, WA 1959 NE Pacific Street, Seattle, WA, 98159, USA; Pulmonary and Critical Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
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10
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Qian XX, Chau PH, Fong DYT, Ho M, Woo J. Post-Hospital Falls Among the Older Population: The Temporal Pattern in Risk and Healthcare Burden. J Am Med Dir Assoc 2023; 24:1478-1483.e2. [PMID: 37591487 DOI: 10.1016/j.jamda.2023.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES Older adults are prone to falls following hospital discharge, resulting in healthcare utilization and costs. The fall risk might change over time after discharge. To fill research gaps in this area, this study examined the temporal pattern in incidence and healthcare burden of post-hospital falls in older adults. DESIGN A territory-wide retrospective cohort study was conducted. SETTING AND PARTICIPANTS Participants were Hong Kong adults aged ≥65 years and discharged from hospitals between January 2007 and December 2017. METHODS The participants were followed for 12 months to identify fall-related inpatient episodes, accident and emergency department (AED) visits, and mortality after discharge. The post-hospital falls were further analyzed in 2 subcategories (1) only requiring AED visits and (2) requiring hospitalization. The incidence rate and faller incidence proportion for total falls and subcategories during the different periods were examined. The corresponding healthcare utilization and costs were calculated. RESULTS Among the 606,392 older adults discharged from hospitals during the study period, 28,593 individuals (4.7%) experienced at least 1 post-hospital fall within 12 months, resulting in a total of 33,158 falls (57 per 1000 person-years). Out of post-hospital falls presenting to hospitals, one-third only required AED visits, and two-thirds required hospitalization. The fall incidence rate peaked in the first 3 weeks after discharge and gradually decreased to a stable level from the fourth to ninth week. The annual healthcare costs related to post-hospital falls exceeded USD 28.9 million in older adults, with the mean cost per faller and fall being USD 11,129 and USD 9596. CONCLUSIONS AND IMPLICATIONS The fall-related healthcare utilizations after discharge impose a substantial economic burden on older adults. During the first 9 weeks, particularly the first 3 weeks, older adults were at high risk of falling. The efforts on resource allocation for fall prevention are suggested to prioritize this period.
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Affiliation(s)
- Xing Xing Qian
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Daniel Y T Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mandy Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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11
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Wright JR, D'Ausilio J, Holmberg JM, Timpson M, Preston T, Woodfield D, Snow GL. Using Quality Indicator Codes to Identify Patients' Fall Risk in Inpatient Rehabilitation Facilities. Arch Phys Med Rehabil 2023; 104:1394-1401. [PMID: 37024006 DOI: 10.1016/j.apmr.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To discover if quality indicator (QI) codes are associated with patient falls in inpatient rehabilitation facilities (IRFs). DESIGN This retrospective cohort study explored differences between patients who fell and those who did not fall. We analyzed potential associations between QI codes and falls using univariable and multivariable logistic regression models. SETTING We collected data from electronic medical records at 4 IRFs. PARTICIPANTS In 2020, our 4 data collection sites admitted and discharged a total of 1742 patients older than 14 years . We only excluded patients (N=43) from statistical analysis if they were discharged before admission data had been assigned. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Using a data extraction report, we collected age, sex, race and ethnicity, diagnosis, falls, and QI codes for communication, self-care, and mobility performance. Staff documented communication codes on a 1-4 scale and self-care and mobility codes on a 1-6 scale, with higher codes representing greater independence. RESULTS Ninety-seven patients (5.71%) fell in the 4 IRFs over a 12-month period. The group who fell had lower QI codes for communication, self-care, and mobility. When adjusting for bed mobility, transfer, and stair-climbing ability, low performance with understanding, walking 10 feet, and toileting were significantly associated with falls. Patients with admission QI codes below 4 for understanding had 78% higher odds of falling. If they were assigned admission QI codes below 3 for walking 10 feet or toileting, they had 2 times greater odds of falling. We did not find a significant association between falls and patients' diagnosis, age, sex, or race and ethnicity in our sample. CONCLUSIONS Communication, self-care, and mobility QI codes appear to be significantly associated with falls. Future research should explore how to use these required codes to better identify patients likely to fall in IRFs.
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Affiliation(s)
- Jonathan R Wright
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah; Doctor of Physical Therapy Department, Rocky Mountain University, Provo, Utah.
| | - Jamie D'Ausilio
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah
| | - Janene M Holmberg
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah
| | - Misti Timpson
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah; Doctor of Physical Therapy Department, Rocky Mountain University, Provo, Utah
| | - Trevor Preston
- Enterprise Analytics, Intermountain Medical Center, Murray, Utah
| | - Devyn Woodfield
- Enterprise Analytics, Intermountain Medical Center, Murray, Utah
| | - Gregory L Snow
- Statistical Data Center, Intermountain Medical Center, Murray, Utah
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12
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Xu S, Qian L, Hao J, Wang J, Qiu Y. Balance-Associated Tests Contribute to Predicting the Need for Ambulatory Assistive Devices (AAD) among Community-Dwelling Older Adults. Healthcare (Basel) 2023; 11:2405. [PMID: 37685439 PMCID: PMC10487081 DOI: 10.3390/healthcare11172405] [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: 07/25/2023] [Revised: 08/20/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
This study aims to analyze the use of ambulatory assistive devices (AAD) in relation to balance-associated tests and assist medical staff in providing professional objective reference values for older adults on whether to use AAD. Older adults (n = 228) were recruited from the local community to participate in this study. Participants were divided into the AAD-use group and the non-AAD-use group. Four balance-associated tests and scales were applied to predict the relationship between balance function and the use of AAD in older adults. They were used to assess the participant's balance function and confidence in maintaining balance and were considered the most reliable measures of balance. There were significant differences in the Berg Balance Scale (BBS) score and Timed Up and Go Test (TUGT) among the subjects in the AAD-use group and non-AAD-use group (p < 0.001). The ROC curve analysis presented the following cut-off values for balance tests and scales: 23.62 s for the TUGT test and 41.5 points for the BBS score. For example, if the TUGT score is greater than 23.62 s and the BBS score is below 41.5 points, AAD is recommended for older adults to maintain balance and prevent falls. These objective reference standards may be useful in guiding medical personnel to determine whether older adults need to use AAD. In future studies, we hope to include more participants for subgroup analysis, investigating different types of AAD and their effects on older adults.
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Affiliation(s)
- Shiqi Xu
- Wuxi School of Medicine, Jiangnan University, Wuxi 214126, China; (S.X.); (J.H.)
| | - Lei Qian
- Department of Rehabilitation, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi 214023, China;
| | - Jianru Hao
- Wuxi School of Medicine, Jiangnan University, Wuxi 214126, China; (S.X.); (J.H.)
| | - Jun Wang
- Department of Rehabilitation, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi 214023, China;
| | - Yuyu Qiu
- Wuxi School of Medicine, Jiangnan University, Wuxi 214126, China; (S.X.); (J.H.)
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13
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Wang K, Chen M, Zhang X, Zhang L, Chang C, Tian Y, Wang X, Li Z, Ji Y. The Incidence of Falls and Related Factors among Chinese Elderly Community Residents in Six Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14843. [PMID: 36429561 PMCID: PMC9690932 DOI: 10.3390/ijerph192214843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
This cross-sectional study classified the factors related to falls among residents ≥ 60 years old in China in order to provide evidence for the prevention of falls in the elderly. A total of 2994 participants were enrolled, and the correlations between social demography, physical health, self-health management awareness, family support, and fall risk were analyzed. Factors influencing falls were classified by location, cause, and the activity during falls. Suffering from osteoarthropathy (OR = 1.761, 95% CI: 1.234-2.513, p < 0.05), depression or anxiety (OR = 1.896, 95% CI: 1.331-2.700, p < 0.001), household size > 2 (OR = 1.806, 95% CI: 1.042-3.130, p < 0.05), and poor self-assessed health (OR = 1.478, 95% CI: 1.107-1.972, p < 0.01) were risk factors. Higher participation in community health programs (OR = 0.522, 95% CI: 0.298-0.912, p < 0.05) and spousal support (OR = 0.909, 95% CI: 0.841-0.981, p < 0.05) were protective factors. Falls were divided into the following categories: stairs/hallway (vision, attention problems), bath/toilet (vision, attention problems, slipping), indoor housework (dizziness, leg weakness), and outdoor activities (attention, surface problems). While acknowledging that the personal physical and mental health of the elderly may lead to falls, community support, accelerated transformation of housing, and the construction of barrier-free environments play an important role in reducing the risk of falls.
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Affiliation(s)
- Kun Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Meijun Chen
- School of Public Health, The University of Hong Kong, Hong Kong 999077, China
| | - Xiaoyue Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Lanchao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Yu Tian
- Xinjiekou Community Health Service Center of Xicheng District, Beijing 100035, China
| | - Xiaofeng Wang
- Ronghua Community Health Service Center of Beijing Economic-Technological Development Area, Beijing 100176, China
| | - Zhijing Li
- School of Health Humanities, Peking University Health Science Center, Beijing 100191, China
| | - Ying Ji
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
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14
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Takase R, Nakata T, Aoki K, Okamoto M, Fukuda A, Fukunaga N, Goto K, Masaki T, Shibata H. The Relationship Between Edema and Body Functions in Patients With Chronic Kidney Disease: A Preliminary Study. Cureus 2022; 14:e27118. [PMID: 36000120 PMCID: PMC9391615 DOI: 10.7759/cureus.27118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Chronic kidney disease (CKD) is known to be a risk factor for falls. In addition, numerous factors such as impaired body balance and loss of muscle mass were reported as risk factors for falls. Patients with CKD often have edema in their lower extremes. In Japan, edema, as well as physical factors, are listed as fall assessment items. Little is known about the relation between body functions and edema in patients with CKD. Thus, we conducted a multivariate regression analysis to investigate the factors related to knee extension muscle strength and dynamic balance in motion (TUG). Materials and methods: Thirty patients with CKD participated in this study. The basic characteristics were sex, age, blood pressure, body mass index (BMI), and medications. The laboratory data were estimated glomerular filtration rate (eGFR), hemoglobin (Hb), and C-reactive protein (CRP). Edema and muscle mass was measured by using InBody S10 (Inbody Japan Inc., Tokyo, Japan). The balance function while standing at rest and motion was measured as the total trajectory length of the center of gravity and the index of postural stability (IPS) using a kinetogravicorder 7100 (Anima Inc., Tokyo, Japan). Dynamic balance was assessed by the timed up & go (TUG) test. Knee extension muscle strength was measured by the Micro Total Analysis System (μ-Tas) F-1 (Anima Inc., Tokyo, Japan) test. Nutritional assessment was measured by the geriatric nutritional risk index (GNRI). Activities of daily living were measured using the functional independence measure (FIM). We conducted a multivariate regression analysis to investigate the factors related to knee extension muscle strength and dynamic balance in motion. Results: Extracellular water/total body water (ECW/TBW) was not significantly correlated with balance at rest and IPS. The ECW/TBW was associated with knee extension muscle strength, TUG, albumin (Alb), Hb, and GNRI with statistical significance. After adjusting for sex and age, knee extension muscle strength was associated with ECW/TBW and TUG (p=0.044). The TUG was also associated with ECW/TBW after being adjusted for age and sex (p=0.046). Conclusion: Patients with CKD who have edema may have decreased knee extensor strength and body balance function. Investigation of knee extension muscle strength and the body balance test in addition to the presence of leg edema at the time of physical examination may help predict a functional decline in CKD patients.
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