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Sebastiani C, Wong JYX, Litt A, Loewen J, Reece K, Conlin N, Dunand T, Montero Odasso M, D'Amore C, Saunders S, Beauchamp M. Mapping sex and gender differences in falls among older adults: A scoping review. J Am Geriatr Soc 2024; 72:903-915. [PMID: 38147460 DOI: 10.1111/jgs.18730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND There is growing recognition of the importance of sex and gender differences within falls literature, but the characterization of such literature is uncertain. The aim of this scoping review was to (1) map the nature and extent of falls literature examining sex or gender differences among older adults, and (2) identify gaps and opportunities for further research and practice. METHODS We used a scoping review methodology. Eligible studies included participants with a mean age of ≥ 60 years and study aims specifying falls and either sex or gender concepts. MEDLINE, Embase, CINAHL, Ageline, and Psychinfo databases were searched from inception to March 2, 2022. Records were screened and charted by six independent reviewers. Descriptive and narrative reports were generated. RESULTS A total of 15,266 records were screened and 74 studies were included. Most studies reported on sex and gender differences in fall risk factors (n = 52, 70%), incidence/prevalence (n = 26, 35%), fall consequences (n = 22, 30%), and fall characteristics (n = 15, 20%). The majority of studies (n = 70, 95%) found significant sex or gender differences in relation to falls, with 39 (53%) identifying significant sex differences and 31 (42%) identifying significant gender differences. However, only three (4%) studies defined sex or gender concepts and only nine (12%) studies used sex or gender terms appropriately. Fifty-six (76%) studies had more female participants than males. Four (5%) were intervention studies. Studies did not report falls in line with guidelines nor use common fall definitions. CONCLUSION Sex and gender differences are commonly reported in falls literature. It is critical for future research to use sex and gender terms appropriately and include similar sample sizes across all genders and sexes. In addition, there is a need to examine more gender-diverse populations and to develop interventions to prevent falls that address sex and gender differences among older adults.
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Affiliation(s)
- Crista Sebastiani
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jamie Yee Xin Wong
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Amandeep Litt
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julia Loewen
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Karly Reece
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Conlin
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tessa Dunand
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Manuel Montero Odasso
- Schulich School of Medicine and Dentistry, Department of Medicine, Western University, London, Ontario, Canada
| | - Cassandra D'Amore
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Saunders
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Wah W, Berecki-Gisolf J, Walker-Bone K. Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity. Occup Environ Med 2024; 81:66-73. [PMID: 38228388 DOI: 10.1136/oemed-2023-109079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Injuries at work are common and costly for individuals and employers. A common mechanism of workplace injury is through falls, but there have been few epidemiological studies of risk factors. This study aimed to identify patient, work and injury factors associated with injuries causing hospitalisation after falling at work in Victoria, Australia. METHODS Data came from work-related hospitalised injury admissions, identified by International Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification codes and compensation status, from Victorian Admitted Episodes Dataset between 1 July 2017 and 30 June 2022. Multivariate logistic regression analyses were conducted to identify factors associated with same-level falls and falls from height. RESULTS This study included 42 176 work-related injury admissions: 8669 (20.6%) fall injuries and 33 507 (79.4%) other injuries. Rates of high falls were more common in males than females (0.44 (95% CI: 0.43, 0.46) vs 0.08 (0.08, 0.09) admissions per 1000 employed), while same-level falls were more common in females than males (0.21 (0.20, 0.22) vs 0.18 (0.17, 0.18)). Patients with same-level fall injuries, relative to all other work injuries, were more likely to be older women, and have at least one chronic condition; falls from height were associated with male sex and construction work and more likely to result in intracranial, internal organ injuries and fractures and longer hospital stay than non-fall injuries. CONCLUSION Work-related falls were common and relatively severe. Same-level falls are relatively likely to occur in older women, the fastest-growing workplace demographic, and therefore the incidence is expected to increase. Comorbidities are an important fall risk factor. Employers could consider industry-relevant high and same-level fall prevention strategies for reducing the workplace injury burden.
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Affiliation(s)
- Win Wah
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Janneke Berecki-Gisolf
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Yu CH, Yeh CC, Lu YF, Lu YL, Wang TM, Lin FYS, Lu TW. Recurrent Neural Network Methods for Extracting Dynamic Balance Variables during Gait from a Single Inertial Measurement Unit. Sensors (Basel) 2023; 23:9040. [PMID: 38005428 PMCID: PMC10675772 DOI: 10.3390/s23229040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Monitoring dynamic balance during gait is critical for fall prevention in the elderly. The current study aimed to develop recurrent neural network models for extracting balance variables from a single inertial measurement unit (IMU) placed on the sacrum during walking. Thirteen healthy young and thirteen healthy older adults wore the IMU during walking and the ground truth of the inclination angles (IA) of the center of pressure to the center of mass vector and their rates of changes (RCIA) were measured simultaneously. The IA, RCIA, and IMU data were used to train four models (uni-LSTM, bi-LSTM, uni-GRU, and bi-GRU), with 10% of the data reserved to evaluate the model errors in terms of the root-mean-squared errors (RMSEs) and percentage relative RMSEs (rRMSEs). Independent t-tests were used for between-group comparisons. The sensitivity, specificity, and Pearson's r for the effect sizes between the model-predicted data and experimental ground truth were also obtained. The bi-GRU with the weighted MSE model was found to have the highest prediction accuracy, computational efficiency, and the best ability in identifying statistical between-group differences when compared with the ground truth, which would be the best choice for the prolonged real-life monitoring of gait balance for fall risk management in the elderly.
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Affiliation(s)
- Cheng-Hao Yu
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
| | - Chih-Ching Yeh
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
| | - Yi-Fu Lu
- Department of Information Management, National Taiwan University, Taipei 10617, Taiwan; (Y.-F.L.); (F.Y.-S.L.)
| | - Yi-Ling Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei 11220, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei 10051, Taiwan;
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Frank Yeong-Sung Lin
- Department of Information Management, National Taiwan University, Taipei 10617, Taiwan; (Y.-F.L.); (F.Y.-S.L.)
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei 10051, Taiwan;
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Edouard P, Reurink G, Mackey AL, Lieber RL, Pizzari T, Järvinen TAH, Gronwald T, Hollander K. Traumatic muscle injury. Nat Rev Dis Primers 2023; 9:56. [PMID: 37857686 DOI: 10.1038/s41572-023-00469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.
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Affiliation(s)
- Pascal Edouard
- Université Jean Monnet, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, Saint-Etienne, France.
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France.
| | - Gustaaf Reurink
- Department of Orthopedic Surgery and Sports Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, Netherlands
- The Sports Physicians Group, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Abigail L Mackey
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, USA
- Hines VA Medical Center, Maywood, IL, USA
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tero A H Järvinen
- Tampere University and Tampere University Hospital, Tampere, Finland
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Gigonzac M, Terrier P. Restoring walking ability in older adults with arm-in-arm gait training: study protocol for the AAGaTT randomized controlled trial. BMC Geriatr 2023; 23:542. [PMID: 37674129 PMCID: PMC10481504 DOI: 10.1186/s12877-023-04255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
CONTEXT Falls are a significant problem among older adults. While balance and functional exercises have been shown to be effective, it remains unclear whether regular walking has specific effects on reducing the risk of falls. RATIONALE Older people who fall frequently have impaired gait patterns. Recent studies have suggested using interpersonal synchronization: while walking arm-in-arm, an older person synchronizes steps with a younger person to reinstate a better gait pattern. This method of gait training may reduce the risk of falls. OBJECTIVE The aim is to assess the efficacy of an arm-in-arm gait-training program in older people. DESIGN The arm-in-arm gait training trial (AAGaTT) is a single-site, open label, two-arm, randomized controlled trial. PARTICIPANTS We will enroll 66 dyads of older people and their younger "gait instructors". The older participants must be > 70 years old with adequate walking ability. They must have experienced a fall in the year prior to study entry. INTERVENTION Dyads will walk an indoor course for 30 min either side-by-side without contact (control group) or arm-in-arm while synchronizing their gait (intervention group). The gait training will be repeated three times a week for four weeks. OUTCOMES The main outcome will be the walking speed measured in five-minute walking trials performed at baseline and at the end of each intervention week (week 1 - week 4), and at week 7. Gait quality will be assessed using accelerometers. We will also assess perceived physical activity and health using questionnaires. Finally, we will monitor fall incidence over 18 months. We will evaluate whether outcomes are more improved in the intervention group compared to the control group. In addition, interviews will be conducted to assess the perception of the gait training. EXPECTED RESULTS Recent advances in the neurophysiology of motor control have shown that synchronizing gait to external cues or to a human partner can increase the efficiency of gait training. The expected benefits of arm-in-arm gait training are: reduced risk of falls, safe treatment with no adverse effects, and high adherence. This gait training program could be a low-cost intervention with positive effects on the health and well-being of seniors. TRIAL REGISTRATION ClinicalTrials.gov NCT05627453. Date of registration: 11.25.2022.
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Affiliation(s)
- Mathilde Gigonzac
- Haute Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland
| | - Philippe Terrier
- Haute Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland.
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Lugade V, Torbitt M, O’Brien SR, Silsupadol P. Smartphone- and Paper-Based Delivery of Balance Intervention for Older Adults Are Equally Effective, Enjoyable, and of High Fidelity: A Randomized Controlled Trial. Sensors (Basel) 2023; 23:7451. [PMID: 37687907 PMCID: PMC10490587 DOI: 10.3390/s23177451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
Home-based rehabilitation programs for older adults have demonstrated effectiveness, desirability, and reduced burden. However, the feasibility and effectiveness of balance-intervention training delivered through traditional paper-versus novel smartphone-based methods is unknown. Therefore, the purpose of this study was to evaluate if a home-based balance-intervention program could equally improve balance performance when delivered via smartphone or paper among adults over the age of 65. A total of 31 older adults were randomized into either a paper or phone group and completed a 4-week asynchronous self-guided balance intervention across 12 sessions for approximately 30 min per session. Baseline, 4-week, and 8-week walking and standing balance evaluations were performed, with exercise duration and adherence recorded. Additional self-reported measures were collected regarding the enjoyment, usability, difficulty, and length of the exercise program. Twenty-nine participants completed the balance program and three assessments, with no group differences found for any outcome measure. Older adults demonstrated an approximately 0.06 m/s faster gait velocity and modified balance strategies during walking and standing conditions following the intervention protocol. Participants further self-reported similar enjoyment, difficulty, and exercise effectiveness. Results of this study demonstrated the potential to safely deliver home-based interventions as well as the feasibility and effectiveness of delivering balance intervention through a smartphone-based application.
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Affiliation(s)
- Vipul Lugade
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
| | - Molly Torbitt
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Suzanne R. O’Brien
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
| | - Patima Silsupadol
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
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Al Mahrouqi MM, Vicenzino B, MacDonald DA, Smith MD. Falls and falls-related injuries in individuals with chronic ankle symptoms: a cross-sectional study. J Foot Ankle Res 2023; 16:49. [PMID: 37587537 PMCID: PMC10428594 DOI: 10.1186/s13047-023-00649-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Falls are a major public health concern globally. While falls are associated with osteoarthritis and persistent pain at the hip and knee, falls have not been investigated in people with chronic ankle symptoms. This study aimed to compare self-reported history of falls between adults with and without chronic ankle symptoms. Secondary aims were to compare concern about falling and balance confidence between groups, and to identify factors associated with falling. METHODS A total of 226 participants (134 with chronic ankle pain and/or stiffness and 92 controls) participated in this cross-sectional case-control study. Participants completed an online questionnaire about falls in the past 12 months, injuries associated with falling, concern about falling, balance confidence, function, pain and multimorbidity. RESULTS Eighty-six (64%) participants with chronic ankle symptoms and 24 (26%) controls reported at least one fall in the last 12 months (p < 0.001). Participants with chronic ankle symptoms reported more falls, more injurious falls, and more hospitalisations because of a fall than controls (p > 0.002). There was a small effect for lower balance confidence and higher concern about falling in symptomatic participants (standardised mean difference: 0.39-0.49; p > 0.017). Logistic regression analysis identified that falling was associated with the presence of ankle symptoms (3.08 (1.20, 7.92); p = 0.02) and concern about falling (odds ratio (95% confidence intervals): 1.13 (1.05, 1.23); p = 0.002). CONCLUSIONS Falls and falls-related injuries are a problem in individuals with chronic ankle symptoms. The high falls occurrence and concern about falling in individuals with chronic ankle symptoms suggest the need for clinicians to assess these factors in this population.
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Affiliation(s)
- Munira M Al Mahrouqi
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- Division of Physiotherapy, Oman College of Health Sciences, Ministry of Health, P.O. Box 3720, Muscat, PC, 112, Sultanate of Oman
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
| | - David A MacDonald
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- Physiotherapy, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
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Borrelli J, Creath R, Rogers MW. The timing and amplitude of the muscular activity of the arms preceding impact in a forward fall is modulated with fall velocity. J Biomech 2023; 150:111515. [PMID: 36867953 PMCID: PMC10257944 DOI: 10.1016/j.jbiomech.2023.111515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/16/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
Protective arm reactions have been shown to be an important injury avoidance mechanism in unavoidable falls. Protective arm reactions have been shown to be modulated with fall height, however it is not clear if they are modulated with impact velocity. The aim of this study was to determine if protective arm reactions are modulated in response to a forward fall with an initially unpredictable impact velocity. Forward falls were evoked via sudden release of a standing pendulum support frame with adjustable counterweight to control fall acceleration and impact velocity. Thirteen younger adults (1 female) participated in this study. Counterweight load explained more than 89% of the variation of impact velocity. Angular velocity at impact decreased (p < 0.001), drop duration increased from 601 ms to 816 ms (p < 0.001), and the maximum vertical ground reaction force decreased from 64%BW to 46%BW (p < 0.001) between the small and large counterweight. Elbow angle at impact (129 degrees extension), triceps (119 ms) and biceps (98 ms) pre-impact time, and co-activation (57%) were not significantly affected by counterweight load (p-values > 0.08). Average triceps and biceps EMG amplitude decreased from 0.26 V/V to 0.19 V/V (p = 0.004) and 0.24 V/V to 0.11 V/V (p = 0.002) with increasing counterweight respectively. Protective arm reactions were modulated with fall velocity by reducing EMG amplitude with decreasing impact velocity. This demonstrates a neuromotor control strategy for managing evolving fall conditions. Future work is needed to further understand how the CNS deals with additional unpredictability (e.g., fall direction, perturbation magnitude, etc.) when deploying protective arm reactions.
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Affiliation(s)
- James Borrelli
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA.
| | - Robert Creath
- Lebanon Valley College, Exercise Science Department, Annville, PA, USA
| | - Mark W Rogers
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA
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Rosenblatt TR, Vail D, Ludwig CA, Al-Moujahed A, Pasricha MV, Ji MH, Callaway NF, Moshfeghi DM. Fall risk in patients with pseudophakic monovision. Can J Ophthalmol 2023; 58:11-17. [PMID: 34419423 DOI: 10.1016/j.jcjo.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/12/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vision changes can precipitate falls in the elderly resulting in significant morbidity and mortality. We hypothesized that pseudophakic monovision and ensuing anisometropia and aniseikonia impact elderly fall risk. This study assessed fall risk in patients with pseudophakic monovision, pseudophakic single vision distance (classic cataract surgery), and cataracts with no surgery. DESIGN Retrospective single-institution cohort study PARTICIPANTS: Patients with bilateral cataracts diagnosed at 60 years of age or older who underwent bilateral cataract surgery (monovision or single vision distance) or did not undergo any cataract surgery (n = 13 385). Patients with unilateral surgery or a fall prior to cataract diagnosis were excluded. METHODS Data were obtained from the Stanford Research Repository. Time-to-fall analysis was performed across all 3 groups. Primary outcome was hazard ratio (HR) for fall after second eye cataract surgery or after bilateral cataract diagnosis. RESULTS Of 13 385 patients (241 pseudophakic monovision, 2809 pseudophakic single vision, 10 335 no surgery), 850 fell after cataract diagnosis. Pseudophakic monovision was not associated with fall risk after controlling for age, sex, and myopia. Pseudophakic single-vision patients had a decreased time to fall compared with no-surgery patients (log rank, p < 0.001). Older age at cataract diagnosis (HR =1.05, 95% confidence interval [CI] 1.04-1.06, p < 0.001) or at time of surgery (HR = 1.05, 95% CI 1.03-1.07, p < 0.001) increased fall risk, as did female sex (HR = 1.29, 95% CI 1.10-1.51, p = 0.002) and preexisting myopia (HR = 1.31, 95% CI 1.01-1.71, p = 0.046) among nonsurgical patients. CONCLUSIONS Pseudophakic monovision did not impact fall risk, but pseudophakic single vision may increase falls compared with patients without cataract surgery.
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Affiliation(s)
- Tatiana R Rosenblatt
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA.
| | - Daniel Vail
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | - Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Ahmad Al-Moujahed
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | | | - Marco H Ji
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia F Callaway
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
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Case SL, Frazier HN, Anderson KL, Lin R, Thibault O. Falling Short: The Contribution of Central Insulin Receptors to Gait Dysregulation in Brain Aging. Biomedicines 2022; 10:1923. [PMID: 36009470 PMCID: PMC9405648 DOI: 10.3390/biomedicines10081923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Insulin resistance, which manifests as a reduction of insulin receptor signaling, is known to correlate with pathological changes in peripheral tissues as well as in the brain. Central insulin resistance has been associated with impaired cognitive performance, decreased neuronal health, and reduced brain metabolism; however, the mechanisms underlying central insulin resistance and its impact on brain regions outside of those associated with cognition remain unclear. Falls are a leading cause of both fatal and non-fatal injuries in the older population. Despite this, there is a paucity of work focused on age-dependent alterations in brain regions associated with ambulatory control or potential therapeutic approaches to target these processes. Here, we discuss age-dependent alterations in central modalities that may contribute to gait dysregulation, summarize current data supporting the role of insulin signaling in the brain, and highlight key findings that suggest insulin receptor sensitivity may be preserved in the aged brain. Finally, we present novel results showing that administration of insulin to the somatosensory cortex of aged animals can alter neuronal communication, cerebral blood flow, and the motivation to ambulate, emphasizing the need for further investigations of intranasal insulin as a clinical management strategy in the older population.
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Philippe AG, Goncalves A, Martinez C, Deshayes M, Charbonnier E. Can an Eight-Session Multicomponent Physical Exercise Program Reduce Fall Risk and Fear of Falling among the Elderly? Int J Environ Res Public Health 2022; 19. [PMID: 35886109 DOI: 10.3390/ijerph19148262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
In older populations, falls are responsible for decrease autonomy and increased pain and injuries. With aging, fall risk is multifactorial and associated with sarcopenia, impaired balance, falls themselves and psychological factors such as fear of falling. The objectives of the present study were: (a) to test the effects of a short multicomponent physical exercise program on fall risk and fear of falling; and (b) to analyze the relationship between fall risk and fear of falling. The participants were thirty-five older persons who were engaged in an eight-session physical exercise program. Balance (i.e., One-leg Balance Test, and Functional Reach Test), lower-limb endurance (i.e., Wall-sit Test) and fear of falling were measured before and after the multicomponent physical exercise program. Results indicated an increase in balance and a diminution of fear of falling after the end of the physical exercise program (p < 0.05). The program has an effect on lower limb endurance (p > 0.05). Gains in balance were correlated to the diminution of fear of falling (p < 0.05). An 8-week multicomponent physical exercise program based on balance is efficient to reduce fall risk and fear of falling among the elderly.
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Psomas CK, Hoover DR, Shi Q, Brown TT, Vance DE, Holman S, Plankey MW, Tien PC, Weber KM, Floris-Moore M, Bolivar HH, Golub ET, McDonnell Holstad M, Radtke KK, Tamraz B, Erlandson KM, Rubin LH, Sharma A. Polypharmacy Is Associated With Falls in Women With and Without HIV. J Acquir Immune Defic Syndr 2022; 90:351-359. [PMID: 35333216 PMCID: PMC9203977 DOI: 10.1097/qai.0000000000002955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aging in people with HIV is associated with increased risk of developing synergistic conditions such as neurocognitive impairment, polypharmacy, and falls. We assessed associations between polypharmacy (use of 5 or more non-ART medications), use of neurocognitive adverse effects (NCAE) medications, and odds of falls in women with HIV (WWH) and without HIV (HIV-). METHODS Self-reported falls and medication use data were contributed semiannually by 1872 (1315 WWH and 557 HIV-) Women's Interagency HIV Study participants between 2014 and 2016. Polypharmacy and NCAE medication use were evaluated separately and jointly in multivariable models to assess their independent contributions to single and multiple falls risk. RESULTS The proportion of women who reported any fall was similar by HIV status (19%). WWH reported both greater polypharmacy (51% vs. 41%; P < 0.001) and NCAE medication use (44% vs. 37%; P = 0.01) than HIV- women. Polypharmacy conferred elevated odds of single fall [adjusted odds ratio (aOR) 1.67, 95% CI: 1.36 to 2.06; P < 0.001] and multiple falls (aOR 2.31, 95% CI: 1.83 to 2.93; P < 0.001); the results for NCAE medications and falls were similar. Both polypharmacy and number of NCAE medications remained strongly and independently associated with falls in multivariable models adjusted for HIV serostatus, study site, sociodemographics, clinical characteristics, and substance use. CONCLUSIONS Polypharmacy and NCAE medication use were greater among WWH compared with HIV-, and both were independently and incrementally related to falls. Deprescribing and avoidance of medications with NCAEs may be an important consideration for reducing fall risk among WWH and sociodemographically similar women without HIV.
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Affiliation(s)
- Christina K Psomas
- Department of Infectious Diseases and Internal Medicine, European Hospital Marseille, Marseille, France
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Phyllis C Tien
- Department of VA Medical Center, San Fransisco, CA
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Kathleen M Weber
- Department of Medicine, Cook County Health/CORE Center and Hektoen Institute of Medicine, Chicago, IL
| | | | - Hector H Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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Legg HS, Arnold CM, Farthing JP, Lanovaz JL. Age differences in upper extremity joint moments and strength during a laboratory-based tether-release forward fall arrest in older women. J Biomech 2022; 138:111107. [DOI: 10.1016/j.jbiomech.2022.111107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/11/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
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Arnold CM, Lanovaz J, Farthing JP, Legg H, Weimer M, Kim S. Fall arrest strategy training improves upper body response time compared to standard fall prevention exercise in older women: A randomized trial. Clin Rehabil 2022; 36:940-951. [PMID: 35287479 PMCID: PMC9189718 DOI: 10.1177/02692155221087963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Exercise can decrease fall risk in older adults but less is known about training to reduce injury risk in the event a fall is unavoidable. The purpose of this study was to compare standard fall prevention exercises to novel Fall Arrest Strategy Training (FAST); exercises designed to improve upper body capacity to reduce fall-injury risk in older women. METHOD Forty women (mean age 74.5 years) participated in either Standard (n = 19) or FAST (n = 21) twice per week for 12 weeks. Both interventions included lower body strength, balance, walking practice, agility and education. FAST added exercises designed to enhance forward landing and descent control such as upper body strengthening, speed and practice of landing and descent on outstretched hands. RESULTS Both FAST and Standard significantly improved strength, mobility, balance, and fall risk factors from pre to post-intervention. There was a significant time by group interaction effect for upper body response time where FAST improved but Standard did not (p = 0.038). DISCUSSION FAST resulted in similar gains in factors that reduce fall risk as a standard fall prevention program; with the additional benefit of improving speed of arm protective responses; a factor that may help enhance landing position and reduce injury risks such as head impact during a forward fall.
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Affiliation(s)
- Catherine M Arnold
- School of Rehabilitation Science, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joel Lanovaz
- 70396College of Kinesiology, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jonathan P Farthing
- 70396College of Kinesiology, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hayley Legg
- 70396College of Kinesiology, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,62693St Mary's University, Twickenham, London, UK
| | - Melanie Weimer
- School of Rehabilitation Science, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Soo Kim
- School of Rehabilitation Science, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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15
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Williams JR, Muesch AJ, Svenson JE, Clegg AW, Patterson BW, Ward MA. Utility of bedside assessment to evaluate for cervical-spine fracture post ground-level fall for patients 65 years and older. Am J Emerg Med 2022; 53:208-214. [DOI: 10.1016/j.ajem.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022] Open
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Yoshii I, Chijiwa T, Sawada N, Kokei S. Musculoskeletal ambulation disability symptom complex as a risk factor of incident bone fragility fracture. Osteoporos Sarcopenia 2021; 7:115-120. [PMID: 34632115 PMCID: PMC8486644 DOI: 10.1016/j.afos.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives Influence of presenting musculoskeletal ambulation disability symptom complex (MADS) on occurrence of bone fragility fracture (BFF) is investigated with retrospective cohort study. Methods A total of 931 subjects joined in the study. Subjects were selected as bone fragility risk positive in the fracture assessment tool questionnaire. Their assumed risk factors were harvested from the medical records and X-ray pictures. They were followed up at least 8 years consecutively, and occurrence of incident BFF was set as primary endpoint. Each assumed risk factor including MADS was evaluated using Cox regression analysis. Subjects were divided into 2 groups according to presence of MADS (G-MADS and G-noMADS). Adjusted hazard ratios between the 2 groups was evaluated using Cox regression analysis. The statistical procedures were performed before and after propensity score matching (PSM) procedures in order to make parallel with assumed risk factors. Results Statistically significant risk factors within 5% were prevalent vertebral body fracture, disuse, MADS, cognitive disorder, hypertension, contracture, Parkinsonism, being female sex, hyperlipidemia, insomnia, T-score in the femoral neck ≤ −2.3, chronic kidney disease ≥ stage 2, chronic obstructive pulmonary diseases, glucocorticoid steroid administrated, and osteoarthritis in order of the adjusted hazard ratios (from highest to lowest). Adjusted hazard ratios between G-MADS and G-noMADS were 2.70 and 1.83 for before and after PSM, respectively. Conclusions MADS demonstrated as a significant risk factor of BFF occurrence. In treating osteoporosis, fall risk should be aware of as well as bone fragility risk.
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Affiliation(s)
- Ichiro Yoshii
- Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, Shimanto City, 787-0033, Kochi Prefecture, Japan
- Corresponding author. 6-7-5 Nakamura-Ohashidori, Shimanto City, 787-0033, Kochi Prefecture, Japan.
| | - Tatsumi Chijiwa
- Department of Rheumatology, Kochi Memorial Hospital, Kochi, 780-0824, Kochi Prefecture, Japan
| | - Naoya Sawada
- Department of Rheumatology, Dohgo Onsen Hospital, Matsuyama, 790-0858, Ehime Prefecture, Japan
| | - Shohei Kokei
- Department of Internal Medicine, Yoshii Hospital, Shimanto City, 787-0033, Kochi Prefecture, Japan
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Cheng Y, Li Y, Lee Smith M, Li C, Shen Y. Analyzing evidence-based falls prevention data with significant missing information using variable selection after multiple imputation. J Appl Stat 2021; 50:724-743. [PMID: 36819083 PMCID: PMC9930815 DOI: 10.1080/02664763.2021.1985090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Falls are the leading cause of fatal and non-fatal injuries among older adults. Evidence-based fall prevention programs are delivered nationwide, largely supported by funding from the Administration for Community Living (ACL), to mitigate fall-related risk. This study utilizes data from 39 ACL grantees in 22 states from 2014 to 2017. The large amount of missing values for falls efficacy in this national database may lead to potentially biased statistical results and make it challenging to implement reliable variable selection. Multiple imputation is used to deal with missing values. To obtain a consistent result of variable selection in multiply-imputed datasets, multiple imputation-stepwise regression (MI-stepwise) and multiple imputation-least absolute shrinkage and selection operator (MI-LASSO) methods are used. To compare the performances of MI-stepwise and MI-LASSO, simulation studies were conducted. In particular, we extended prior work by considering several circumstances not covered in previous studies, including an extensive investigation of data with different signal-to-noise ratios and various missing data patterns across predictors, as well as a data structure that allowed the missingness mechanism to be missing not at random (MNAR). In addition, we evaluated the performance of MI-LASSO method with varying tuning parameters to address the overselection issue in cross-validation (CV)-based LASSO.
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Affiliation(s)
| | - Yang Li
- Renmin University of China, Beijing, People's Republic of China
| | | | | | - Ye Shen
- The University of Georgia, Athens, GA, USA,Ye Shen
*Present address: Tulane University, New Orleans, LA, USA
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Legg HS, Arnold CM, Trask C, Lanovaz JL. Does functional performance and upper body strength predict upper extremity reaction and movement time in older women? Hum Mov Sci 2021; 77:102796. [PMID: 33862278 DOI: 10.1016/j.humov.2021.102796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/08/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reaction time to initiate upper limb movement and movement time to place hands on the landing surface may be important factors in forward fall landing and impact, contributing to injury reduction. The aim was to investigate the relationship of physical function and upper body strength to upper limb reaction and movement time in older female participants. METHODS 75 female participants (72 ± 8 yrs) performed 5 arm response trials. Reaction time (signal to initiation of movement), and movement time (initial movement to contact), were collected using 3D motion capture. Additional variables were: handgrip; sit-to-stand; shoulder flexion and elbow extension strength measured by hand-held dynamometry; one-legged balance; fall risk; and physical activity scores. Prediction variables for reaction and movement time were determined in separate backward selection multiple regression analyses. Significance was set at P < 0.05. FINDINGS Significant regression equations for RT (r2 = 0.08, P = 0.013) found a relationship between stronger handgrip (Beta = -0.002) and faster reaction time, accounting for 8% variance. For movement time (r2 = 0.06, P = 0.036) greater shoulder flexion strength (Beta = -0.04) was related to faster movement time, explaining 6% variance. Stronger SF strength was related to a decrease in MT by 4%. DISCUSSION A relationship between arm strength measures and faster upper body reaction and movement time was shown, with 10-20% higher strength associated with a 5% faster response time. Even though this was a relatively weak relationship, given that strength is a modifiable component this provides a potential avenue for future intervention efforts. This in turn could have an impact on forward fall landing and potential reduction of injury risk.
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Affiliation(s)
- Hayley S Legg
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada; St Mary's University, London, UK.
| | - Cathy M Arnold
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada; School of Rehabilitation Science, University of Saskatchewan, Canada
| | - Catherine Trask
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada; Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Canada; Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Joel L Lanovaz
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada
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19
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Rinonapoli G, Ruggiero C, Meccariello L, Bisaccia M, Ceccarini P, Caraffa A. Osteoporosis in Men: A Review of an Underestimated Bone Condition. Int J Mol Sci 2021; 22:2105. [PMID: 33672656 PMCID: PMC7924179 DOI: 10.3390/ijms22042105] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is called the 'silent disease' because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.
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Affiliation(s)
- Giuseppe Rinonapoli
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio “Gaetano Rummo Hospital”, via R.Delcogliano, 82100 Benevento (BN), Italy;
| | - Michele Bisaccia
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Paolo Ceccarini
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Auro Caraffa
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
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20
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Richardson K, Savva GM, Boyd PJ, Aldus C, Maidment I, Pakpahan E, Loke YK, Arthur A, Steel N, Ballard C, Howard R, Fox C. Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies. Health Technol Assess 2021; 25:1-202. [PMID: 33410736 PMCID: PMC7812417 DOI: 10.3310/hta25010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sleep disturbance affects around 60% of people living with dementia and can negatively affect their quality of life and that of their carers. Hypnotic Z-drugs (zolpidem, zopiclone and zaleplon) are commonly used to treat insomnia, but their safety and efficacy have not been evaluated for people living with dementia. OBJECTIVES To estimate the benefits and harms of Z-drugs in people living with dementia with sleep disturbance. DESIGN A series of observational cohort studies using existing data from (1) primary care linked to hospital admission data and (2) clinical cohort studies of people living with dementia. DATA SOURCES Primary care study - Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data. Clinical cohort studies - the Resource Use and Disease Course in Dementia - Nursing Homes (REDIC) study, National Alzheimer's Coordinating Centre (NACC) clinical data set and the Improving Well-being and Health for People with Dementia (WHELD) in nursing homes randomised controlled trial. SETTING Primary care study - 371 primary care practices in England. Clinical cohort studies - 47 nursing homes in Norway, 34 Alzheimer's disease centres in the USA and 69 care homes in England. PARTICIPANTS Primary care study - NHS England primary care patients diagnosed with dementia and aged > 55 years, with sleep disturbance or prescribed Z-drugs or low-dose tricyclic antidepressants, followed over 2 years. Clinical cohort studies - people living with dementia consenting to participate, followed over 3 years, 12 years and 9 months, for REDIC, NACC and WHELD, respectively. INTERVENTIONS The primary exposure was prescription or use of Z-drugs. Secondary exposures included prescription or use of benzodiazepines, low-dose tricyclic antidepressants and antipsychotics. MAIN OUTCOME MEASURES Falls, fractures, infection, stroke, venous thromboembolism, mortality, cognitive function and quality of life. There were insufficient data to investigate sleep disturbance. RESULTS The primary care study and combined clinical cohort studies included 6809 and 18,659 people living with dementia, with 3089 and 914 taking Z-drugs, respectively. New Z-drug use was associated with a greater risk of fractures (hazard ratio 1.40, 95% confidence interval 1.01 to 1.94), with risk increasing with greater cumulative dose (p = 0.002). The hazard ratio for Z-drug use and hip fracture was 1.59 (95% confidence interval 1.00 to 2.53) and for mortality was 1.34 (95% confidence interval 1.10 to 1.64). No excess risks of falls, infections, stroke or venous thromboembolism were detected. Z-drug use also did not have an impact on cognition, neuropsychiatric symptoms, disability or quality of life. LIMITATIONS Primary care study - possible residual confounding because of difficulties in identifying patients with sleep disturbance and by dementia severity. Clinical cohort studies - the small numbers of people living with dementia taking Z-drugs and outcomes not necessarily being measured before Z-drug initiation restricted analyses. CONCLUSIONS We observed a dose-dependent increase in fracture risk, but no other harms, with Z-drug use in dementia. However, multiple outcomes were examined, increasing the risk of false-positive findings. The mortality association was unlikely to be causal. Further research is needed to confirm the increased fracture risk. Decisions to prescribe Z-drugs may need to consider the risk of fractures, balanced against the impact of improved sleep for people living with dementia and that of their carers. Our findings suggest that when Z-drugs are prescribed, falls prevention strategies may be needed, and that the prescription should be regularly reviewed. FUTURE WORK More research is needed on safe and effective management strategies for sleep disturbance in people living with dementia. STUDY REGISTRATION This study is registered as European Union electronic Register of Post-Authorisation Studies (EU PAS) 18006. 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. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
- Quadram Institute, Norwich, UK
| | - Penelope J Boyd
- School of Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Eduwin Pakpahan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
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Nicolini C, Fahnestock M, Gibala MJ, Nelson AJ. Understanding the Neurophysiological and Molecular Mechanisms of Exercise-Induced Neuroplasticity in Cortical and Descending Motor Pathways: Where Do We Stand? Neuroscience 2020; 457:259-282. [PMID: 33359477 DOI: 10.1016/j.neuroscience.2020.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
Exercise is a promising, cost-effective intervention to augment successful aging and neurorehabilitation. Decline of gray and white matter accompanies physiological aging and contributes to motor deficits in older adults. Exercise is believed to reduce atrophy within the motor system and induce neuroplasticity which, in turn, helps preserve motor function during aging and promote re-learning of motor skills, for example after stroke. To fully exploit the benefits of exercise, it is crucial to gain a greater understanding of the neurophysiological and molecular mechanisms underlying exercise-induced brain changes that prime neuroplasticity and thus contribute to postponing, slowing, and ameliorating age- and disease-related impairments in motor function. This knowledge will allow us to develop more effective, personalized exercise protocols that meet individual needs, thereby increasing the utility of exercise strategies in clinical and non-clinical settings. Here, we review findings from studies that investigated neurophysiological and molecular changes associated with acute or long-term exercise in healthy, young adults and in healthy, postmenopausal women.
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Affiliation(s)
- Chiara Nicolini
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Margaret Fahnestock
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
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22
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Gill TM, Bhasin S, Reuben DB, Latham NK, Araujo K, Ganz DA, Boult C, Wu AW, Magaziner J, Alexander N, Wallace RB, Miller ME, Travison TG, Greenspan SL, Gurwitz JH, Rich J, Volpi E, Waring SC, Manini TM, Min LC, Teresi J, Dykes PC, McMahon S, McGloin JM, Skokos EA, Charpentier P, Basaria S, Duncan PW, Storer TW, Gazarian P, Allore HG, Dziura J, Esserman D, Carnie MB, Hanson C, Ko F, Resnick NM, Wiggins J, Lu C, Meng C, Goehring L, Fagan M, Correa-de-Araujo R, Casteel C, Peduzzi P, Greene EJ. Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study. J Am Geriatr Soc 2020; 69:173-179. [PMID: 33037632 PMCID: PMC8178516 DOI: 10.1111/jgs.16854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVES In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability. DESIGN Pragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries. SETTING A total of 86 primary care practices within 10 U.S. healthcare systems. PARTICIPANTS A random subsample of 743 persons aged 75 and older. MEASUREMENTS The well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument. RESULTS Participants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference. CONCLUSIONS STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.
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Affiliation(s)
- Thomas M Gill
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nancy K Latham
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katy Araujo
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Chad Boult
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Albert W Wu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Michael E Miller
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thomas G Travison
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan L Greenspan
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of Reliant Medical Group, Fallon Health and University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jeremy Rich
- HealthCare Partners, El Segundo, California, USA
| | - Elena Volpi
- University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | | | - Jeanne Teresi
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | | | - Siobhan McMahon
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joanne M McGloin
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Eleni A Skokos
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Peter Charpentier
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Shehzad Basaria
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pamela W Duncan
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thomas W Storer
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Priscilla Gazarian
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of Massachusetts, Boston, Massachusetts, USA
| | - Heather G Allore
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - James Dziura
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Denise Esserman
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | | | | | - Fred Ko
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neil M Resnick
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Charles Lu
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Can Meng
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Lori Goehring
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maureen Fagan
- University of Miami Health System, Miami, Florida, USA
| | | | | | - Peter Peduzzi
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Erich J Greene
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
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Jyväkorpi SK, Urtamo A, Kivimäki M, Strandberg TE. Association of nutritional components with falls in oldest-old men: The Helsinki Businessmen Study (HBS). Exp Gerontol 2020; 142:111105. [PMID: 33031914 DOI: 10.1016/j.exger.2020.111105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Falls are associated with increased morbidity and mortality in older people. We examined how nutritional factors are associated with self-reported falls in the oldest-old community-dwelling men. METHODS Participants of the longitudinal and socioeconomically homogenous Helsinki Businessmen Study are men born in 1919-1934. A cross-sectional analysis from a random sample of 122 home-living oldest-old men who underwent medical examinations in 2017-2018 is reported here. Food and nutrient intakes were retrieved from 3-day food diaries, and the number of falls during past year was requested in the screening questionnaire. Nutritional status was assessed using Mini Nutritional Assessment Short Form (MNA-SF) and waist circumference was measured. Body composition was assessed with dual-energy X-ray absorptiometry (DXA)-scans, physical performance with short physical performance battery (SPPB), sarcopenia status using European Working Group on Sarcopenia in Older People's 2 (EWGSOP2) criteria, and frailty with phenotypic criteria. RESULTS Mean age of participants was 87 years (range 83-99 years) and 30% reported at least one fall during past year. Falls were associated with higher waist circumference (p = .031), frailty (p < .001) and sarcopenia (p = .002), and inversely associated with SPPB total score (p = .002). Of nutritional factors, intakes of fish (p = .016), fish protein (p = .039), berry (p = .027) and vitamin D (p = .041), and snacking more protein between breakfast and lunch (p = .017) were inversely associated with falls. Red meat intake was associated with higher frequency of falls (p = .044). CONCLUSION Higher waist circumference, but not body mass index, was associated with increased frequency of falls. Healthy dietary choices appeared protective from falls in these oldest-old men of similar socioeconomic status.
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Affiliation(s)
- S K Jyväkorpi
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland.
| | - A Urtamo
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - M Kivimäki
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - T E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland; University of Oulu, Center for Life Course Health Research, Oulu, Finland
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24
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Pan J, Liu C, Li L, Zhang S. The effect of Tai Chi exercise on postural time-to-contact in manual fitting task among older adults. Gait Posture 2020; 82:61-67. [PMID: 32896796 DOI: 10.1016/j.gaitpost.2020.08.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A fall would impact elderly population's quality of life, which associate with diminished physical and psychological function, and can even be life-threatening. Tai Chi has been used to improve age-related postural instability in locomotion. However, it does not fully explain the mechanism of a lower risk of falling among the Tai Chi population compared to other healthy older adults. RESEARCH QUESTION The maintenance of postural stability is more complicated than minimizing postural movements. Postural time to contact is an important temporal measure of postural stability under fitting tasks, which might further clarify the benefits of long term Tai Chi exercise. METHODS Participants were required to fit a block (90 × 90 mm) through two different openings (130 × 130 mm and 100 × 100 mm) at two different distances (arm's length or 130 % of arm's length). Kistler forceplate and Vicon system were used to collect center of pressure and kinematic data, respectively. Postural time to contact was used to assess instantaneous perturbation for postural system. RESULTS Tai Chi group exhibited significant longer postural time to contact in quiet standing and shorter postural time to contact in fitting tasks, expecting for close-small condition, compared to the brisk walking and sedentary groups (p < .05). In addition, both large and small opening condition, Tai Chi group showed a shorter postural time to contact than brisk walking and sedentary groups (p < .0001). SIGNIFICANCE Long term Tai Chi exercise would promote the regulation of posture and decrease the postural constrain to increase the overall stability when performing fitting tasks. Therefore, Tai Chi exercise can be considered as a feasible method to enhance postural control and stability in older adult.
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Affiliation(s)
- Jiahao Pan
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, 200438, China; Center for Orthopaedic & Biomechanics Research, Boise State University, Boise, ID, 83725, USA
| | - Cuixian Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, 200438, China
| | - Li Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, 200438, China; School of Health & Kinesiology, Georgia Southern University, Statesboro, GA, 30460, USA
| | - Shuqi Zhang
- Center for Orthopaedic & Biomechanics Research, Boise State University, Boise, ID, 83725, USA.
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25
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Sharma A, Vance DE, Hoover DR, Shi Q, Yin MT, Holman S, Plankey MW, Tien PC, Weber KM, Floris-Moore M, Bolivar HH, Golub ET, McDonnell Holstad M, Rubin LH. Impaired Cognition Predicts Falls Among Women With and Without HIV Infection. J Acquir Immune Defic Syndr 2020; 83:301-9. [PMID: 31913989 DOI: 10.1097/QAI.0000000000002262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared with HIV- women. DESIGN Cross-sectional data analysis from 825 HIV+ and 392 HIV- women in the Women's Interagency HIV Study with NC testing within 2 years before falls surveys. METHODS NC impairment (T score <40) was assessed in 7 domains: executive function, psychomotor speed, attention, learning, memory, fluency, and fine motor function. For domains associated with any fall within 6 months in simple logistic regression (P < 0.05), hierarchical regression models evaluated associations between NC impairment and odds of falling, adjusting for: (1) study site and HIV, (2) demographics, (3) comorbid conditions, (4) substance use/central nervous system active medications, and HIV-specific factors. RESULTS Median age was higher in HIV+ than HIV- women (51 vs. 48 yrs); prevalence of falls was similar (19% HIV+, 16% HIV-). Overall, executive function [OR (odds ratio) = 1.82, 95% CI (confidence interval): 1.21 to 2.74; P = 0.004], psychomotor speed (OR = 1.59, 95% CI: 1.05 to 2.42, P = 0.03), and fine motor (OR 1.70, 95% CI: 1.11 to 2.61, P = 0.02) impairments were associated with greater odds of falls in fully adjusted models. In fully adjusted models, associations of executive function, psychomotor speed, and fine motor were nonsignificant among HIV+ women; conversely, among HIV- women, associations with impaired executive and fine motor functions were strengthened and remained significant. CONCLUSIONS Cognitive impairment was associated with falls among middle-aged HIV- but not HIV+ women. Additional studies should elucidate mechanisms by which domain-specific NC impairment impacts fall risk among older HIV+ and HIV- women and how different factors modify relationships between cognition and falls.
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26
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Orssatto LBR, Wiest MJ, Moura BM, Collins DF, Diefenthaeler F. Neuromuscular determinants of explosive torque: Differences among strength-trained and untrained young and older men. Scand J Med Sci Sports 2020; 30:2092-2100. [PMID: 32749004 DOI: 10.1111/sms.13788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 02/03/2023]
Abstract
This study compared the differences in neural and muscular mechanisms related to explosive torque in chronically strength-trained young and older men (>5 years). Fifty-four participants were allocated into four groups according to age and strength training level: older untrained (n = 14; 65.6 ± 2.9 years), older trained (n = 12; 63.6 ± 3.8 years), young untrained (n = 14; 26.2 ± 3.7 years), and young trained (n = 14; 26.7 ± 3.4 years). Knee extension isometric voluntary explosive torque (absolute and normalized as a percentage of maximal voluntary torque) was assessed at the beginning of the contraction (ie, 50, 100, and 150 ms-T50, T100, and T150, respectively), and surface electromyogram (sEMG) amplitude (normalized as a percentage of sEMG recorded during maximal voluntary isometric contraction) at 0-50, 50-100, and 100-150 time windows. Supramaximal electrically evoked T50 was assessed with octet trains delivered to the femoral nerve (8 pulses at 300 Hz). Voluntary T50, T100, and T150 were higher for trained than untrained in absolute (P < 0.001) and normalized (P < 0.030) terms, accompanied by higher sEMG at 0-50, 50-100, and 100-150 ms (P < 0.001), and voluntary T50/octet T50 ratio for trained. Greater octet T50 was observed for the young trained (P < 0.001) but not for the older trained (P = 0.273) compared to their untrained counterparts. Age effect was observed for voluntary T50, T100, and T150 (P < 0.050), but normalization removed these differences (P > 0.417). Chronically strength-trained young and older men presented a greater explosive torque than their untrained pairs. In young trained, the greater explosive performance was attributed to enhanced muscular and neural mechanisms, while in older trained to neural mechanisms only.
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Affiliation(s)
- Lucas B R Orssatto
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Matheus J Wiest
- Neural Engineering & Therapeutic Team, KITE, Toronto Rehab, University Health Network, Toronto, ON, Canada
| | - Bruno M Moura
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil
| | - David F Collins
- Human Neurophysiology Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
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27
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Yu G, Fan Y, Fan Y, Li R, Liu Y, Antonijevic D, Milovanovic P, Zhang B, Li Z, Djuric M, Fan Y. The Role of Footwear in the Pathogenesis of Hallux Valgus: A Proof-of-Concept Finite Element Analysis in Recent Humans and Homo naledi. Front Bioeng Biotechnol 2020; 8:648. [PMID: 32714903 PMCID: PMC7343976 DOI: 10.3389/fbioe.2020.00648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022] Open
Abstract
Hallux valgus (HV), the bunion of the first metatarsophalangeal joint (MTPJ), bothers many adults. No consensus has been reached about the causes of HV, be it a hereditary, or acquired, or multifactorial disease. Nor has agreement been reached using MTPJ angle to assess HV based on X-ray because in most cases the assessment of MTPJ is not reliable as it depends on the posture during scanning. In this study, we assume that HV is predominately acquired and that shoe wearing per se is an important player in HV pathogenesis. To verify our hypothesis, a CT-based finite element (FE) model of the first MTPJ of fossil remains of bear-footed Homo naledi was created and compared to that of five contemporary shoe-wearing wrestlers (10 models from two scans at an interval of about 18 months) because Homo naledi's first MTPJ is an ideal model for non-shoe wearing with parallel sesamoid grooves. We developed the first MTPJ structure transformation method and created MTPJ joint capsule model for both Homo naledi and wrestlers. Constraint on the medial side of the first MTPJ capsule was set to simulate shoe-wearing conditions compared to the lack of medial constraint for barefooted conditions. Analysis of eight FE models of different angles for the first MTPJ of Homo naledi was performed by the first MTPJ transformation method and results showed that stress concentrated on the medial capsule of the first MTPJ in simulated shoe-wearing conditions, even at MTPJ angle of 0°. Increase in the first MTPJ angle further increased stress concentration on the medial side, and stress-growth relationship might reveal the causes of HV. We further developed a method to position the first MTPJ in wrestlers and created CT-based models at two time points. It was evident that the first MTPJ angle increased in all but one athlete, with a maximal increase of 4.03 degrees. This verifies our hypothesis that HV might be developed by wearing shoes. Further longitudinal studies with larger sample sizes are needed to additionally validate our results and determine the magnitude of the effects of shoe wearing on development and progression of HV.
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Affiliation(s)
- Genyu Yu
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Yuzhou Fan
- Shenzhen Tourism College, Jinan University, Shenzhen, China
| | - Yuxuan Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Ruining Li
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Yaming Liu
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Djordje Antonijevic
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China.,Laboratory for Atomics Physics, Institute for Nuclear Sciences "Vinca", University of Belgrade, Belgrade, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology, School of Medicine, Institute of Anatomy, University of Belgrade, Belgrade, Serbia
| | - Bo Zhang
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Zhiyu Li
- College of Foreign Studies, Jinan University, Guangzhou, China
| | - Marija Djuric
- Laboratory for Anthropology, School of Medicine, Institute of Anatomy, University of Belgrade, Belgrade, Serbia
| | - Yifang Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
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28
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Singh T, Bélanger E, Thomas K. Is Fear of Falling the Missing Link to Explain Racial Disparities in Fall Risk? Data from the National Health and Aging Trends Study. Clin Gerontol 2020; 43:465-470. [PMID: 29764333 PMCID: PMC6202265 DOI: 10.1080/07317115.2018.1468377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Emerging research suggests Black older adults experience a 30% decreased risk for falls compared with their White U.S. counterparts, and this is mediated neither by physical performance nor activity. Fear of falling (FOF) is a significant risk factor for falls, yet we know little about how FOF varies by race/ethnicity. The purpose of this original research brief was to investigate the relationship between race/ethnicity and FOF among older adults. METHODS 4,981 community-dwelling Medicare beneficiaries from the National Health and Aging Trends Study (NHATS) who had not self-reported a fall in the past 12 months were analyzed. Logistic regression analyses were conducted to examine the association between race/ethnicity and fear of falling, controlling for sex, age, total annual income, and mobility assistance. RESULTS FOF differed significantly across racial groups. Black, non-Hispanic older adults were less likely to have FOF (OR = .87, 95% CI = .71,1.07) compared with their White, non-Hispanic counterparts. In the fully adjusted model, this difference persisted and became stronger (adjusted OR = .75, 95%CI = .61, .93). CONCLUSION The decreased risk for falls in Black older adults could be explained by lower FOF in this group. CLINICAL IMPLICATIONS These findings should inform public health fall prevention initiatives among community-dwelling older adults.
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Affiliation(s)
- Tanvee Singh
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy, and Practice, School of Public Health, Brown University , Providence, Rhode Island, USA
| | - Emmanuelle Bélanger
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy, and Practice, School of Public Health, Brown University , Providence, Rhode Island, USA
| | - Kali Thomas
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy, and Practice, School of Public Health, Brown University , Providence, Rhode Island, USA.,Center of Innovation for Long-term Services and Supports at the Providence VA Medical Center, Brown University , Providence, Rhode Island, USA
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Torii H, Ando M, Tomita H, Kobaru T, Tanaka M, Fujimoto K, Shimizu R, Ikesue H, Okusada S, Hashida T, Kume N. Association of Hypnotic Drug Use with Fall Incidents in Hospitalized Elderly Patients: A Case-Crossover Study. Biol Pharm Bull 2020; 43:925-931. [DOI: 10.1248/bpb.b19-00684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Haruki Torii
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
| | - Motozumi Ando
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
| | - Hideaki Tomita
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Tomoko Kobaru
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
| | - Mahoko Tanaka
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
| | - Kazuhide Fujimoto
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
| | - Rumiko Shimizu
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
| | - Hiroaki Ikesue
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Satoshi Okusada
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Tohru Hashida
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Noriaki Kume
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University
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Abstract
Multisensory integration is essential for maintenance of motor and cognitive abilities, thereby ensuring normal function and personal autonomy. Balance control is challenged during senescence or in motor disorders, leading to potential falls. Increased uncertainty in sensory signals is caused by a number of factors including noise, defined as a random and persistent disturbance that reduces the clarity of information. Counter-intuitively, noise can be beneficial in some conditions. Stochastic resonance is a mechanism whereby a particular level of noise actually enhances the response of non-linear systems to weak sensory signals. Here we review the effects of stochastic resonance on sensory modalities and systems directly involved in balance control. We highlight its potential for improving sensorimotor performance as well as cognitive and autonomic functions. These promising results demonstrate that stochastic resonance represents a flexible and non-invasive technique that can be applied to different modalities simultaneously. Finally we point out its benefits for a variety of scenarios including in ambulant elderly, skilled movements, sports and to patients with sensorimotor or autonomic dysfunctions.
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Affiliation(s)
- Olivier White
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France.,Acquired Brain Injury Rehabilitation, Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Jan Babič
- Laboratory for Neuromechanics and Biorobotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Carlos Trenado
- Leibniz Research Centre for Working Environment and Human Factors TU Dortmund (ifADO), Institute of Clinical Neuroscience and Medical Psychology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Leif Johannsen
- Acquired Brain Injury Rehabilitation, Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Nandu Goswami
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
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Peitgen DS, Innmann MM, Merle C, Gotterbarm T, Moradi B, Streit MR. Cumulative Long-Term Incidence of Postoperative Periprosthetic Femoral Fractures Using an Uncemented Tapered Titanium Hip Stem: 26- to 32-Year Results. J Arthroplasty 2019; 34:77-81. [PMID: 30274947 DOI: 10.1016/j.arth.2018.08.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/12/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although falling is becoming a major problem in the elderly, little is known about the long-term incidence of postoperative periprosthetic femoral fractures (PFF) after total hip arthroplasty (THA) using uncemented stems with a minimum follow-up of 26 years postoperatively. METHODS In a consecutive series, the cumulative incidence of PFF after uncemented THA using a straight, collarless, tapered titanium stem was retrospectively reviewed in 354 hips (326 patients). After a mean follow-up of 28 (26-32) years postoperatively, 179 hips had died and 5 hips had been lost to follow-up. Kaplan-Meier survival analysis was used to estimate cumulative percentage probability of PFF. RESULTS At final follow-up, a total of 27 fractures in 27 patients had occurred. In 15 hips, the stem had to be revised, and in 10 the fracture was treated by open reduction and internal fixation. Two patients declined further surgery. The cumulative percentage probability of PFF was 1.6% (95% confidence interval, 0.7 to 3.8) at 10 years and 13.2% (95% confidence interval, 8.5 to 20.2) at 29 years after primary THA. There was no association between the occurrence of fracture and gender, age at primary THA, cup revision, or canal fill index. CONCLUSION Our findings indicate that PFF is the major mode of failure in the long term after uncemented THA using a tapered titanium stem. More research is needed to evaluate the reasons and risk factors for PFF after THA, thus providing better prophylaxis for those at risk and to compare the long-term incidence using different fixation methods and implants. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David S Peitgen
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Moritz M Innmann
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Tobias Gotterbarm
- Department of Orthopedics, Kepler University Hospital, Linz, Austria
| | - Babak Moradi
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Marcus R Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
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Sandoval-Insausti H, Pérez-Tasigchana RF, López-García E, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. Protein Intake and Risk of Falls: A Prospective Analysis in Older Adults. J Am Geriatr Soc 2018; 67:329-335. [DOI: 10.1111/jgs.15681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Helena Sandoval-Insausti
- Department of Preventive Medicine and Public Health; School of Medicine, Universidad Autónoma de Madrid-IdiPaz; Madrid Spain
- CIBER of Epidemiology and Public Health (CIBERESP); Madrid Spain
- Service of Preventive Medicine; Hospital Universitario de La Princesa; Madrid Spain
| | - Raúl F. Pérez-Tasigchana
- Department of Preventive Medicine and Public Health; School of Medicine, Universidad Autónoma de Madrid-IdiPaz; Madrid Spain
- CIBER of Epidemiology and Public Health (CIBERESP); Madrid Spain
- School of Medicine, Universidad San Francisco de Quito; Quito Ecuador
| | - Esther López-García
- Department of Preventive Medicine and Public Health; School of Medicine, Universidad Autónoma de Madrid-IdiPaz; Madrid Spain
- CIBER of Epidemiology and Public Health (CIBERESP); Madrid Spain
- IMDEA-Food Institute, CEI UAM+CSIC; Madrid Spain
| | - José R. Banegas
- Department of Preventive Medicine and Public Health; School of Medicine, Universidad Autónoma de Madrid-IdiPaz; Madrid Spain
- CIBER of Epidemiology and Public Health (CIBERESP); Madrid Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health; School of Medicine, Universidad Autónoma de Madrid-IdiPaz; Madrid Spain
- CIBER of Epidemiology and Public Health (CIBERESP); Madrid Spain
- IMDEA-Food Institute, CEI UAM+CSIC; Madrid Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health; School of Medicine, Universidad Autónoma de Madrid-IdiPaz; Madrid Spain
- CIBER of Epidemiology and Public Health (CIBERESP); Madrid Spain
- IMDEA-Food Institute, CEI UAM+CSIC; Madrid Spain
- Welch Center for Prevention; Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland
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Gill TM, Williams CS. Likelihood of Sustaining an Injury in the Setting of Multiple Falls. J Am Geriatr Soc 2018; 67:119-123. [PMID: 30325022 DOI: 10.1111/jgs.15639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/01/2018] [Accepted: 09/01/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the relationship between number of falls and risk of injury after a specific fall. DESIGN Prospective cohort study. SETTING Greater New Haven, Connecticut. PARTICIPANTS Probability sample of 1,103 community-living persons aged 72 and older. MEASUREMENTS Falls and fall-related injuries were ascertained monthly for 3 years using a fall calendar and follow-up telephone interviews. RESULTS Of 606 participants with a fall, 164 (27.0%) had at least 1 fall with a serious injury, and 455 (75.1%) had at least 1 fall with any injury; mean number of falls was 2.6±2.3 (range 1-18), of falls with serious injury was 0.3±0.6 (range 0-4), and of falls with any injury was 1.4±1.4 (range 0-9). On a per-participant basis, risk of serious injury and any injury increased progressively as the number of falls increased (P < .001). On a per-fall basis, risk of serious injury and any injury increased from 1 to 2 falls but then decreased from 2 to 3 or 4 falls and from 3 or 4 to 5 or more falls, although these differences were not statistically significant. The results were consistent for women and men and for analyses that evaluated the proportion of falls with injuries. CONCLUSION In community-living older persons, risk of injury from a specific fall did not differ as the number of falls increased. Falls appear to operate independently in terms of conferring risk of injury in the setting of multiple falls. J Am Geriatr Soc 67:119-123, 2019.
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Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Christianna S Williams
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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Gell NM, Patel KV. Rehabilitation Services Use of Older Adults According to Fall-Risk Screening Guidelines. J Am Geriatr Soc 2018; 67:100-107. [PMID: 30295320 DOI: 10.1111/jgs.15625] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To characterize rehabilitation services use of older adults according to fall-risk classification based on screening guidelines. DESIGN Cross-sectional analysis of 2015 National Health and Aging Trends Study. SETTING Study participants' homes. PARTICIPANTS National sample of 7,440 community-dwelling Medicare beneficiaries. MEASUREMENTS In-person interviews and functional assessments. Based on Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths and Injuries criteria, participants were classified as low, moderate, or high fall risk. RESULTS Twenty-three percent of older adults classified as moderate fall-risk (n = 2602) and 40.6% of those at high fall-risk (n = 940) reported rehabilitation services use in the past year. Among older adults who reported rehabilitation services in the past year (n = 1,505), treatment to address falls was reported by 2.8%, 12.6%, and 34.7% of those classified with low, moderate, and high fall-risk, respectively (p < 0.001). Older adults with high fall-risk who did not receive rehabilitation services had significantly better self-reported physical capacity (p = 0.02) but comparable physical performance (all p's > 0.05) relative to those who received rehabilitation. CONCLUSION Older adults at high risk for falls were significantly more likely to report rehabilitation services use compared to those with low and moderate risk of falling. The findings also indicate that there is low adherence to national clinical recommendations for rehabilitation services use in older adults vulnerable to falls-related injury. Among the high fall-risk group, those who did not receive rehabilitation services had similarly low physical function as compared with those who received rehabilitation, indicating potential unmet need to address physical impairments related to fall-risk. J Am Geriatr Soc 67:100-107, 2019.
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Affiliation(s)
- Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.,Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington
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Giboin LS, Gruber M, Kramer A. Additional Intra- or Inter-session Balance Tasks Do Not Interfere With the Learning of a Novel Balance Task. Front Physiol 2018; 9:1319. [PMID: 30283361 PMCID: PMC6157309 DOI: 10.3389/fphys.2018.01319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/31/2018] [Indexed: 11/23/2022] Open
Abstract
Background: It has been shown that balance training induces task-specific performance improvements with very limited transfer to untrained tasks. Thus, regarding fall prevention, one strategy is to practice as many tasks as possible to be prepared for a multitude of situations with increased fall risk. However, it is not clear whether the learning of several different balance tasks interfere with each other. A positive influence could be possible via the contextual interference (CI) effect, a negative influence could be induced by the disruption of motor memory during consolidation or retrieval. Methods: In two 3-week training experiments, we tested: (1) whether adding an additional balance task in the same training session would influence the learning of a balance task [first task: one-leg stance on a tilt-board (TB), six sessions, 15 × 20 s per session; additional task: one-leg stance on a slack line (SL), same amount of additional training]; (2) whether performing a different balance task (SL) in between training sessions of the first task (TB) would influence the learning of the first task. Twenty-six healthy subjects participated in the first experiment, 40 in the second experiment. In both experiments the participants were divided into three groups, TB only, TB and SL, and control. Before and after the training period, performance during the TB task (3 × 20 s) was recorded with a Vicon motion capturing system to assess the time in equilibrium. Results: Analyses of variance revealed that neither the additional intra-session balance task in experiment 1 nor the inter-session task in experiment 2 had a significant effect on balance performance improvement in the first task (no significant group × time interaction effect for the training groups, p = 0.83 and p = 0.82, respectively, only main effects of time). Conclusion: We could not find that additional intra- or intersession balance tasks interfere with the learning of a balance task, neither impairing it nor having a significant positive effect. This can also be interpreted as further evidence for the specificity of balance training effects, as different balance tasks do not seem to elicit interacting adaptations.
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Affiliation(s)
| | - Markus Gruber
- Sensorimotor Performance Lab, University of Konstanz, Konstanz, Germany
| | - Andreas Kramer
- Sensorimotor Performance Lab, University of Konstanz, Konstanz, Germany
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Khorgami Z, Fleischer WJ, Chen YJA, Mushtaq N, Charles MS, Howard CA. Ten-year trends in traumatic injury mechanisms and outcomes: A trauma registry analysis. Am J Surg 2018; 215:727-734. [DOI: 10.1016/j.amjsurg.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/05/2018] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
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Abstract
Gait control challenges commonly coincide with vestibular dysfunction and there is a long history in using balance and gait activities to enhance functional mobility in this population. While much has been learned using traditional rehabilitation exercises, there is a new line of research emerging that is using visual stimuli in a very specific way to enhance gait control. For example, avatars can be created in an individualized manner to incorporate specific gait characteristics. The avatar could then be used as a visual stimulus to which the patient can synchronize their own gait cycle. This line of research builds upon the rich history of sensorimotor control research in which augmented sensory information (visual, haptic, or auditory) is used to probe, and even enhance, human motor control. This review paper focuses on gait control challenges in patients with vestibular dysfunction, provides a brief historical perspective on how various visual displays have been used to probe sensorimotor and gait control, and offers some recommendations for future research.
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Faure AM, Fischer K, Dawson-Hughes B, Egli A, Bischoff-Ferrari HA. Gender-specific association between dietary acid load and total lean body mass and its dependency on protein intake in seniors. Osteoporos Int 2017; 28:3451-3462. [PMID: 28971236 DOI: 10.1007/s00198-017-4220-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/06/2017] [Indexed: 01/08/2023]
Abstract
UNLABELLED Diet-related mild metabolic acidosis may play a role in the development of sarcopenia. We investigated the relationship between dietary acid load and total lean body mass in male and female seniors age ≥ 60 years. We found that a more alkaline diet was associated with a higher %TLM only among senior women. INTRODUCTION The aim of this study was to determine if dietary acid load is associated with total lean body mass in male and female seniors age ≥ 60 years. METHODS We investigated 243 seniors (mean age 70.3 ± 6.3; 53% women) age ≥ 60 years who participated in the baseline assessment of a clinical trial on vitamin D treatment and rehabilitation after unilateral knee replacement due to severe knee osteoarthritis. The potential renal acid load (PRAL) was assessed based on individual nutrient intakes derived from a food frequency questionnaire. Body composition including percentage of total lean body mass (%TLM) was determined using dual-energy X-ray absorptiometry. Cross-sectional analyses were performed for men and women separately using multivariable regression models controlling for age, physical activity, smoking status, protein intake (g/kg BW per day), energy intake (kcal), and serum 25-hydroxyvitamin D concentration. We included a pre-defined subgroup analysis by protein intake (< 1 g/kg BW day, > 1 g/kg BW day) and by age group (< 70 years, ≥ 70 years). RESULTS Adjusted %TLM decreased significantly across PRAL quartiles only among women (P trend = 0.004). Moreover, in subgroup analysis, the negative association between the PRAL and %TLM was most pronounced among women with low protein intake (< 1 g/kg BW per day) and age below 70 years (P = 0.002). Among men, there was no association between the PRAL and %TLM. CONCLUSION The association between dietary acid load and %TLM seems to be gender-specific, with a negative impact on total lean mass only among senior women. Therefore, an alkaline diet may be beneficial for preserving total lean mass in senior women, especially in those with low protein intake.
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Affiliation(s)
- A M Faure
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - K Fischer
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - A Egli
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - H A Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland.
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland.
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland.
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Sanders KM, Lim K, Stuart AL, Macleod A, Scott D, Nicholson GC, Busija L. Diversity in fall characteristics hampers effective prevention: the precipitants, the environment, the fall and the injury. Osteoporos Int 2017; 28:3005-3015. [PMID: 28725985 PMCID: PMC5624977 DOI: 10.1007/s00198-017-4145-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/04/2017] [Indexed: 01/19/2023]
Abstract
UNLABELLED Falls among the elderly are common and characteristics may differ between injurious and non-injurious falls. Among 887 older Australian women followed for 1.6 years, 32% fell annually. Only 8.5% resulted in fracture and/or hospital admission. The characteristics of those falls are indistinguishable from those not coming to medical attention. INTRODUCTION The precipitants and environment of all falls occurring among a large cohort of older Caucasian women were categorised by injury status to determine if the characteristics differed between injurious and non-injurious falls. METHODS Among 887 Australian women (70+ years), falls were ascertained using monthly postcard calendars and a questionnaire was administered for each fall. Hospital admissions and fractures were independently confirmed. RESULTS All falls were reported for a mean observation time of 577 (IQR 546-607) days per participant, equating to a total 1400 person-years. Thirty-two percent fell at least once per year. The most common features of a fall were that the faller was walking (61%) at home (61%) during the day (88%) and lost balance (32%). Only 12% of all falls occurred at night. Despite no difference in the type of injury between day and night, the likelihood of being hospitalised from a fall at night was 4.5 times greater than that of a daytime fall with adjustment for injury type and participant age (OR 4.5, 95% CI 2.1, 9.5; p < 0.001). Of all falls, approximately one third were associated with no injury to the faller (31%), one third reported a single injury (37%) and one third reported more than one injury (32%). In 95% of falls, the faller was not admitted to hospital. Only 5% of falls resulted in fracture(s). CONCLUSIONS Our findings demonstrate the significant diversity of precipitants and environment where falls commonly occur among older community-dwelling women. Falls resulting in fracture and/or hospital admission collectively represent 8.5% of all falls and their characteristics are indistinguishable from falls not coming to medical attention and incurring no apparent cost to the health system.
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Affiliation(s)
- K M Sanders
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia.
| | - K Lim
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia
| | | | - A Macleod
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia
| | - D Scott
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - G C Nicholson
- Rural Clinical School, School of Medicine, The University of Queensland, Toowoomba, Australia
| | - L Busija
- Institute for Health & Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, Australia
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Taylor-Piliae RE, Peterson R, Mohler MJ. Clinical and Community Strategies to Prevent Falls and Fall-Related Injuries Among Community-Dwelling Older Adults. Nurs Clin North Am 2017; 52:489-497. [PMID: 28779828 DOI: 10.1016/j.cnur.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Falls in older adults are the result of several risk factors across biological and behavioral aspects of the person, along with environmental factors. Falls can trigger a downward spiral in activities of daily living, independence, and overall health outcomes. Clinicians who care for older adults should screen them annually for falls. A multifactorial comprehensive clinical fall assessment coupled with tailored interventions can result in a dramatic public health impact, while improving older adult quality of life. For community-dwelling older adults, effective fall prevention has the potential to reduce serious fall-related injuries, emergency room visits, hospitalizations, institutionalization, and functional decline.
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Affiliation(s)
- Ruth E Taylor-Piliae
- College of Nursing, University of Arizona, 1305 North Martin Avenue, PO Box 210203, Tucson, AZ 85721-0203, USA.
| | - Rachel Peterson
- Arizona Center on Aging, College of Medicine, University of Arizona, 1807 East Elm Street, Tucson, AZ 85719, USA
| | - Martha Jane Mohler
- Arizona Center on Aging, College of Medicine, University of Arizona, 1807 East Elm Street, Tucson, AZ 85719, USA; Division of Geriatrics, General Internal Medicine, and Palliative Medicine, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA; Mel and Enid Zuckerman College of Public Health, University of Arizona, 295 N. Martin Avenue, Tucson, AZ 85724, USA
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Abstract
Osteoporosis is a growing health concern worldwide and its complications are as prevalent as other common chronic disease complications such as hypertension and diabetes. In this review, we will discuss the role of gender in osteoporosis, especially related to peak bone mass and maturation, rate of annual bone loss, screening, prevalence of osteoporosis and its related fractures, mortality after osteoporosis-related fracture, fracture risk predication using different technologies and the impact of gender on osteoporosis management.
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Affiliation(s)
- Khaled A Alswat
- Department of Internal Medicine, Taif University School of Medicine, Taif, Saudi Arabia.
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Huang S, Duong T, Ieong L, Quach T. Understanding Falls Risk and Impacts in Chinese American Older Patients at a Community Health Center. J Community Health 2017; 42:763-769. [PMID: 28168394 DOI: 10.1007/s10900-017-0315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While falls are highly prevalent and costly for older adults, little is known about falls for Asian Americans. Using a custom, evidence-based, bilingual fall risk assessment and management tool, our study examined the prevalence of falls among older Chinese-speaking patients at a community health center. We identified the risks for falls and explored an association of fall risk with emergency room (ER) and hospital use in this population. The setting was at a community health center in Oakland, CA. Participants included 839 older Asian American adults (ages 65-80 years) who spoke Cantonese/Mandarin. Primary care clinic staff administered a fall risk assessment and management tool at the time of clinic visits to assess patients' risk factors for falls. Of the total, 173 (20.6%) reported having fallen in the past year, with women comprising a majority (71.7%). 362 patients in the cohort (43.1%) reported fear of falling. For the subset of Medicaid managed care patients (n = 455, 54.3% of total) for whom we were able to obtain ER and hospital utilization data, 31 patients (14.5%) who reported a fall risk had an ER/hospital episode compared to 15 (6.2%) of those who did not self-report fall risks (statistically significant, p < 0.05). A targeted fall risk assessment and management tool designed by community-based primary care practitioners and utilized with linguistic and cultural competence to focus on Asian American older adults, can help establish the prevalence of falls in this understudied population and effectively identify those at higher risk for falls and subsequent ER/hospital utilization. More research is needed to understand the risk and impacts of falls in understudied populations and identify ways to prevent these costly falls.
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Affiliation(s)
- Susan Huang
- Asian Health Services, 818 Webster Street, Oakland, CA, 94607, USA
| | - Thomas Duong
- Asian Health Services, 818 Webster Street, Oakland, CA, 94607, USA
| | - Liss Ieong
- Asian Health Services, 818 Webster Street, Oakland, CA, 94607, USA
| | - Thu Quach
- Asian Health Services, 818 Webster Street, Oakland, CA, 94607, USA.
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Lupo J, Barnett-Cowan M. Perceived timing of a postural perturbation. Neurosci Lett 2017; 639:167-172. [DOI: 10.1016/j.neulet.2016.12.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/03/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
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Aitken G, Murphy B, Pilgrim J, Bugeja L, Ranson D, Ibrahim JE. Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends. Forensic Sci Med Pathol 2017; 13:52-57. [PMID: 28091985 DOI: 10.1007/s12024-016-9830-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2016] [Indexed: 11/28/2022]
Abstract
There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS). The variables examined comprised: sex, age group, year-of-death, cause and manner of death. One-third of deaths among nursing home residents in Victoria resulted from external causes (n = 1296, 33.3%) of which just over one-quarter (361, 27.9%) underwent toxicological analysis as part of the medical death investigation. The use of toxicological analysis varied by cause of death with a relatively low proportion conducted in deaths from unintentional falls (n = 286, 24.9%) and choking (n = 36, 40.4%). The use of toxicological analysis decreased as the decedents age increased. Forensic toxicology has the potential to contribute to improving our understanding of premature deaths in nursing home residents however it remains under used and is possibly undervalued.
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Affiliation(s)
- Georgia Aitken
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. .,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Briony Murphy
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia. .,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Jennifer Pilgrim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - David Ranson
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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Schlenstedt C, Arnold M, Mancini M, Deuschl G, Weisser B. The effect of unilateral balance training on postural control of the contralateral limb. J Sports Sci 2016; 35:2265-2271. [DOI: 10.1080/02640414.2016.1265660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Christian Schlenstedt
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
- Department of Sport Science, Christian-Albrechts-University, Kiel, Germany
| | - Michel Arnold
- Department of Sport Science, Christian-Albrechts-University, Kiel, Germany
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Burkhard Weisser
- Department of Sport Science, Christian-Albrechts-University, Kiel, Germany
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Abstract
The Home Falls and Accidents Screening Tool (HOME FAST) was developed as a screening instrument for use in a community preventive care trial for older people. This paper describes the first stage of the development of this screening tool. The objectives of the study were (i) to review existing home safety measures, (ii) to field test an instrument containing a pool of home safety items with the goal of identifying those hazards associated with falls in the home and (iii) to select the items for inclusion in a 25-item tool using an expert panel. The field testing took place in a rural area of Australia, where the pooled checklist was used to evaluate hazards within the homes of 83 older people. No individual hazards were associated with the risk of falls at home and, although participants who had experienced falls had a higher mean number of home hazards (mean = 13.7, SD 8.2), the differences between fallers and non-fallers was not significant. Items relevant to a rural population were indicated through field testing. Further psychometric testing of the HOME FAST and a meaningful method of scoring the checklist are now warranted.
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48
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Maher L, Jayathissa S. Blunt chest trauma in a non-specialist centre: Right treatment, right place? Emerg Med Australas 2016; 28:725-729. [DOI: 10.1111/1742-6723.12680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/25/2016] [Accepted: 07/31/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Lesley Maher
- Intensive Care Unit; North Shore Hospital; Auckland New Zealand
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49
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Audiffren J, Contal E. Preprocessing the Nintendo Wii Board Signal to Derive More Accurate Descriptors of Statokinesigrams. Sensors (Basel) 2016; 16:E1208. [PMID: 27490545 DOI: 10.3390/s16081208] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/16/2022]
Abstract
During the past few years, the Nintendo Wii Balance Board (WBB) has been used in postural control research as an affordable but less reliable replacement for laboratory grade force platforms. However, the WBB suffers some limitations, such as a lower accuracy and an inconsistent sampling rate. In this study, we focus on the latter, namely the non uniform acquisition frequency. We show that this problem, combined with the poor signal to noise ratio of the WBB, can drastically decrease the quality of the obtained information if not handled properly. We propose a new resampling method, Sliding Window Average with Relevance Interval Interpolation (SWARII), specifically designed with the WBB in mind, for which we provide an open source implementation. We compare it with several existing methods commonly used in postural control, both on synthetic and experimental data. The results show that some methods, such as linear and piecewise constant interpolations should definitely be avoided, particularly when the resulting signal is differentiated, which is necessary to estimate speed, an important feature in postural control. Other methods, such as averaging on sliding windows or SWARII, perform significantly better on synthetic dataset, and produce results more similar to the laboratory-grade AMTI force plate (AFP) during experiments. Those methods should be preferred when resampling data collected from a WBB.
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50
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Özdemir AT. An Analysis on Sensor Locations of the Human Body for Wearable Fall Detection Devices: Principles and Practice. Sensors (Basel) 2016; 16:s16081161. [PMID: 27463719 PMCID: PMC5017327 DOI: 10.3390/s16081161] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/03/2016] [Accepted: 07/20/2016] [Indexed: 12/03/2022]
Abstract
Wearable devices for fall detection have received attention in academia and industry, because falls are very dangerous, especially for elderly people, and if immediate aid is not provided, it may result in death. However, some predictive devices are not easily worn by elderly people. In this work, a huge dataset, including 2520 tests, is employed to determine the best sensor placement location on the body and to reduce the number of sensor nodes for device ergonomics. During the tests, the volunteer’s movements are recorded with six groups of sensors each with a triaxial (accelerometer, gyroscope and magnetometer) sensor, which is placed tightly on different parts of the body with special straps: head, chest, waist, right-wrist, right-thigh and right-ankle. The accuracy of individual sensor groups with their location is investigated with six machine learning techniques, namely the k-nearest neighbor (k-NN) classifier, Bayesian decision making (BDM), support vector machines (SVM), least squares method (LSM), dynamic time warping (DTW) and artificial neural networks (ANNs). Each technique is applied to single, double, triple, quadruple, quintuple and sextuple sensor configurations. These configurations create 63 different combinations, and for six machine learning techniques, a total of 63 × 6 = 378 combinations is investigated. As a result, the waist region is found to be the most suitable location for sensor placement on the body with 99.96% fall detection sensitivity by using the k-NN classifier, whereas the best sensitivity achieved by the wrist sensor is 97.37%, despite this location being highly preferred for today’s wearable applications.
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Affiliation(s)
- Ahmet Turan Özdemir
- Department of Electrical and Electronics Engineering, Erciyes University, Kayseri 38039, Turkey.
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