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Misaghian K, Lugo JE, Faubert J. Immediate fall prevention: the missing key to a comprehensive solution for falling hazard in older adults. Front Aging Neurosci 2024; 16:1348712. [PMID: 38638191 PMCID: PMC11024377 DOI: 10.3389/fnagi.2024.1348712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
The world is witnessing an unprecedented demographic shift due to increased life expectancy and declining birth rates. By 2050, 20% of the global population will be over 60, presenting significant challenges like a shortage of caregivers, maintaining health and independence, and funding extended retirement. The technology that caters to the needs of older adults and their caregivers is the most promising candidate to tackle these issues. Although multiple companies and startups offer various aging solutions, preventive technology, which could prevent trauma, is not a big part of it. Trauma is the leading cause of morbidity, disability, and mortality in older adults, and statistics constitute traumatic fall accidents as its leading cause. Therefore, an immediate preventive technology that anticipates an accident on time and prevents it must be the first response to this hazard category to decrease the gap between life expectancy and the health/wellness expectancy of older adults. The article outlines the challenges of the upcoming aging crisis and introduces falls as one major challenge. After that, falls and their mechanisms are investigated, highlighting the cognitive functions and their relation to falls. Moreover, since understanding predictive cognitive mechanisms is critical to an effective prediction-interception design, they are discussed in more detail, signifying the role of cognitive decline in balance maintenance. Furthermore, the landscape of available solutions for falling and its shortcomings is inspected. Finally, immediate fall prevention, the missing part of a wholesome solution, and its barriers are introduced, and some promising methodologies are proposed.
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Affiliation(s)
- Khashayar Misaghian
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- OIST Innovation, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
| | - Jesus Eduardo Lugo
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Jocelyn Faubert
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
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Ruggiero C, Baroni M, Xenos D, Parretti L, Macchione IG, Bubba V, Laudisio A, Pedone C, Ferracci M, Magierski R, Boccardi V, Antonelli-Incalzi R, Mecocci P. Dementia, osteoporosis and fragility fractures: Intricate epidemiological relationships, plausible biological connections, and twisted clinical practices. Ageing Res Rev 2024; 93:102130. [PMID: 38030092 DOI: 10.1016/j.arr.2023.102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Dementia, osteoporosis, and fragility fractures are chronic diseases, often co-existing in older adults. These conditions pose severe morbidity, long-term disability, and mortality, with relevant socioeconomic implications. While in the research arena, the discussion remains on whether dementia is the cause or the consequence of fragility fractures, healthcare professionals need a better understanding of the interplay between such conditions from epidemiological and physiological standpoints. With this review, we summarized the available literature surrounding the relationship between cognitive impairment, dementia, and both low bone mineral density (BMD) and fragility fractures. Given the strength of the bi-directional associations and their impact on the quality of life, we shed light on the biological connections between brain and bone systems, presenting the main mediators, including gut microbioma, and pathological pathways leading to the dysregulation of bone and brain metabolism. Ultimately, we synthesized the evidence about the impact of available pharmacological treatments for the prevention of fragility fractures on cognitive functions and individuals' outcomes when dementia coexists. Vice versa, the effects of symptomatic treatments for dementia on the risk of falls and fragility fractures are explored. Combining evidence alongside clinical practice, we discuss challenges and opportunities related to the management of older adults affected by cognitive impairment or dementia and at high risk for fragility fracture prevention, which leads to not only an improvement in patient health-related outcomes and survival but also a reduction in healthcare cost and socio-economic burden.
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Affiliation(s)
- C Ruggiero
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy.
| | - M Baroni
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - D Xenos
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - L Parretti
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - I G Macchione
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - V Bubba
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - A Laudisio
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - C Pedone
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - M Ferracci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Magierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - V Boccardi
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Antonelli-Incalzi
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - P Mecocci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
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Minta K, Colombo G, Taylor WR, Schinazi VR. Differences in fall-related characteristics across cognitive disorders. Front Aging Neurosci 2023; 15:1171306. [PMID: 37358956 PMCID: PMC10289027 DOI: 10.3389/fnagi.2023.1171306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making.
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Affiliation(s)
- Karolina Minta
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Giorgio Colombo
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - William R. Taylor
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Victor R. Schinazi
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Psychology, Bond University, Gold Coast, QLD, Australia
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Toots A, Domellöf ME, Lundin-Olsson L, Gustafson Y, Rosendahl E. Backward relative to forward walking speed and falls in older adults with dementia. Gait Posture 2022; 96:60-66. [PMID: 35576668 DOI: 10.1016/j.gaitpost.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adults with dementia have a high risk of falls and fall-related injuries. A greater slowing of backward walking speed (BWS) relative to forward (FWS) has been indicated with older age, and slower BWS has been related to an increased risk of falls. Similarly, slow BWS relative to FWS has been observed in people with dementia. RESEARCH QUESTION Is slower BWS, and slower BWS relative to FWS associated with increased risk of prospective falls in older adults with dementia? METHODS In total, 52 women and 12 men with dementia living in nursing homes, mean age 86 years, and mean Mini-Mental State Examination score of 14.2 points were included. BWS and FWS was measured over 2.4 m, and the directional difference (DD) calculated (100*((FWS-BWS)/FWS)). Falls were followed for 6 months by review of fall incident reports in electronic medical records at nursing homes and the regional healthcare provider. RESULTS Altogether, 95 falls occurred with mean incidence rate 3.1 falls per person-years. Of included participants, 15 (23%) fell once, and 17 (27%) fell twice or more. In negative binomial regression analyses, greater DD was associated with lower prospective incidence fall rate ratio, IRR (IRR= 0.96, p < .001), while BWS was not (IRR= 0.04, p = .126). SIGNIFICANCE In this study of adults with dementia, slower BWS was not associated with prospective falls. However, slower BWS relative to forward (greater DD) was associated with fewer falls, and possibly a protective response. This is novel research, yet results are promising and indicate that assessing walking speed in multiple directions may inform fall risk in adults with dementia.
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Affiliation(s)
- Annika Toots
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden.
| | | | | | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
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Cognitive performances better identify fallers than mobility assessment among older adults with fear of falling. Aging Clin Exp Res 2021; 33:2709-2714. [PMID: 31576516 DOI: 10.1007/s40520-019-01338-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Half of the people with fear of falling (FoF) are non-fallers, and the reason why some people considered non-fallers are afraid of falling is unknown, but reduced mobility or cognition, or both concurrently must be considered as potential risk factors. AIM The study aimed to determine if mobility and/or cognitive abilities could identify people with a history of falls in older adults with FoF. METHODS Twenty-six older adults with FoF participated in this study. Full cognitive and mobility assessments were performed assessing global cognitive impairments (MoCA score < 26), executive functions, memory, processing speed, visuospatial skills, mobility impairment (TUG time > 13.5 s), gait, balance and physical capacity. Information about falls occurring during the year prior to the inclusion was collected. Logistic regression analyses were performed to explore the association between falls and cognitive and mobility abilities. RESULTS No significant differences in age, sex, level of education or body mass index were detected between fallers and non-fallers. Cognitive impairments (MoCA score < 26) distinguished between fallers and non-fallers (p = 0.038; R2 = 0.247). Among specific cognitive functions, visuospatial skills distinguished between fallers and non-fallers (p = 0.027; R2 = 0.258). Mobility impairments (TUG time > 13.5 s), gait, balance and physical capacity were not related to past falls. DISCUSSION/CONCLUSION In older adults with FoF, global cognitive deficits detected by the MoCA are important factors related to falls and more particularly visuospatial skills seem to be among the most implicated functions. These functions could be targeted in multifactorial interventions.
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Lim Y, Ha J, Yoon KH, Baek KH, Kang MI. Measures of physical performance as a predictor of fracture risk independent of BMD: The Chungju metabolic disease cohort study. Bone 2021; 145:115878. [PMID: 33571697 DOI: 10.1016/j.bone.2021.115878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bone mineral density (BMD) assessments alone might not be sufficient for assessing fracture risk in the whole population, and decreased balance is an important risk factor for fracture. The aim of this study was to evaluate the association between baseline physical performance and fracture risk. METHODS This community-based cohort study was conducted in rural areas. The follow-up examination was performed in 4015 subjects for approximately 4 years. We used the one-leg standing time (OLST) to assess static balance and the timed up-and-go test (TUGT) to assess dynamic balance. Fractures were assessed during the medical interview. RESULTS The participants were divided into quartile groups according to their performance level, and the lowest baseline OLST performance was associated with a 2.1-fold increased risk of major osteoporotic fracture (MOF) independent of age, gender, hip BMD, fall incidence, and lifestyle factors. The participants in the low performance quartile of baseline OLST or TUGT performance had an increased incidence of osteoporosis and falling compared to that in the participants in the highest baseline performance quartile after adjusting for covariates. Among the participants with a femoral neck T-score above -2.5, the participants with an OLST below 14 s had a 1.7-fold higher risk of MOF than the participants with an OLST of 14 s or more. CONCLUSIONS The measurement of static balance by the OLST predicted the risk of fracture in Korean adults independent of BMD and fall history. Our results suggest that the OLST may have clinical utility in identifying individuals at risk of fracture, especially those who might not be adequately identified by BMD measurements alone.
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Affiliation(s)
- Yejee Lim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, Republic of Korea
| | - Kun Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, Republic of Korea
| | - Ki Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, Republic of Korea.
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, Republic of Korea.
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Sakurai R, Montero-Odasso M, Hiroyuki S, Ogawa S, Fujiwara Y. Motor Imagery Deficits in High-Functioning Older Adults and its Impact on Fear of Falling and Falls. J Gerontol A Biol Sci Med Sci 2021; 76:e228-e234. [PMID: 33693722 DOI: 10.1093/gerona/glab073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Older adults at risk of falling or who have fear of falling (FoF) present a discrepancy between "imagined" and "performed" actions. Using the gait-related motor imagery (MI) paradigm, we investigated whether prediction accuracy in motor execution is associated with the onset of FoF and with prospective falls among older adults with FoF. METHODS A cohort of 184 community-dwelling older adults was tested for imaginary and executed Timed Up and Go (TUG) tests at a fast pace at baseline. They were first asked to imagine performing TUG and estimate the time taken to complete it (iTUG), and then, to perform the actual trial (aTUG); the difference between the two times was calculated. Prospective falls were monitored between baseline and 2-year follow-up of FoF assessment. RESULTS At follow-up, 27 of 85 participants without FoF at baseline (31.8%) had developed FoF. Twenty-seven of 99 participants (27.2%) with FoF at baseline experienced falls. A significantly shorter iTUG duration, when compared with aTUG, was observed in those who developed FoF or experienced multiple prospective falls, indicating overestimation of their TUG performance. The adjusted logistic regression model showed that a greater ΔTUG (i.e., tendency to overestimate) at baseline was associated with an increased risk of new-onset FoF among those without FoF at baseline and multiple prospective falls among those with FoF at baseline. CONCLUSIONS Deficits in MI (i.e., overestimation of physical capabilities), reflecting impairment in motor planning, could provide an additional explanation of the high risk of FoF and recurrent falls among people with FoF.
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Affiliation(s)
- Ryota Sakurai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Suzuki Hiroyuki
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Susumu Ogawa
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
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Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clin Exp Res 2020; 32:1279-1287. [PMID: 31482296 DOI: 10.1007/s40520-019-01309-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/06/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite decades of research evaluating different predictive strategies to identify persons at risk for falls, nutritional issues have received little attention. Malnutrition leads to weight loss associated with muscle weakness and consequently increases the risk of falls. AIMS The current study assessed the association between nutritional state and fall risk scores in a geriatric in-patient unit in Ain Shams University Hospital, Cairo, Egypt. METHODS A cross-sectional study was conducted to assess the nutritional state of 190 older inpatients using a short form of the Mini-Nutritional Assessment (MNA-SF), and the risk of falls was assessed using the Morse Fall Scale (MFS), Johns Hopkins fall risk assessment tool (JH-FRAT), Schmid Fall Risk Assessment Tool (Schmid-FRAT), Hendrich II Fall Risk Model (HII-FRM) and Functional Assessment Instrument (FAI). The generalised linear models (GLM) and odds ratio (OR) were calculated to test the nutritional status as a risk factor for falls. RESULTS Malnutrition was significantly associated with high fall risk as assessed by MFS and HII-FRM (OR = 2.833, 95% CI 1.358-5.913, P = 0.006; OR = 3.477, 95% CI 1.822-6.636, P < 0.001), with the highest OR for JH-FRAT (OR = 5.455, 95% CI 1.548-19.214, P = 0.008). After adjusting for age, the adjusted Charlson Comorbidity Index (ACCI), number of fall risk-increasing drugs (FRIDs), risk of malnutrition or malnourished were significantly associated with high fall risk as assessed by MFS (OR = 2.761, 95% CI 1.306-5.836, P = 0.008), JH-FRAT (OR = 4.938, 95% CI 1.368-17.828, P = 0.015), and HII-FRM (OR = 3.486, 95% CI 1.783-6.815, P < 0.001). CONCLUSIONS This study demonstrated a significant association between malnutrition and fall risk assessment scores, especially JH-FRAT, in hospitalised older patients.
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Kim SJ, Yoo GE. Rhythm-Motor Dual Task Intervention for Fall Prevention in Healthy Older Adults. Front Psychol 2020; 10:3027. [PMID: 32010035 PMCID: PMC6978661 DOI: 10.3389/fpsyg.2019.03027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the effects of a rhythm-motor dual task intervention on cognitive and gait control for older adults in relation to fall prevention. Ten healthy older adults participated in a rhythm-motor dual task intervention and 10 participated in the control group. The intervention group received 16 30-min intervention sessions for 8 weeks. During the intervention sessions, participants engaged in walking or bimanual tapping as a primary motor task with concurrent rhythm tasks including playing instruments and rhythmic chanting or singing. At pretest and post-test, measures of cognition, balance/mobility, and gait were administered. A significant difference between groups was found for part B of the Trail Making Test (TMT-B) measure that involved executive control of attention. Also, changes in the gait ratio in the dual task condition of walking while playing an instrument were significantly different between groups. The findings in this study support the use of the rhythm-motor dual task intervention for increasing available cognitive resources and improving gait control, which are critical factors in fall prevention.
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Affiliation(s)
- Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, South Korea
| | - Ga Eul Yoo
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, South Korea
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Abstract
INTRODUCTION The purpose of this study was to evaluate the role of working memory (WM) training on walking patterns in elderly people. METHODS 20 elderly adults were selected and assigned randomly to two groups: WM training group and control group. WM training group received 6 weeks of computerized training on various spatial and verbal WM tasks. The spatial-temporal parameters, the ground reaction force and the timing activity of muscles in pre-posttest and in a follow-up were taken. RESULT The results indicated that a significant change in gait speed, double support time and stride time (p < 0.05). Alternations in ground reaction force (GRF) components were found significant. Timing of muscle activity also showed non-significant change after WM intervention. CONCLUSION Based on the results of this study, it can be concluded that WM intervention can be applied to improve gait parameters. The improvements in vertical ground reaction force after training may result in an increase upright stability and a decreased in rate falls.
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Inderjeeth CA, Raymond WD, Briggs AM, Geelhoed E, Oldham D, Mountain D. Implementation of the Western Australian Osteoporosis Model of Care: a fracture liaison service utilising emergency department information systems to identify patients with fragility fracture to improve current practice and reduce re-fracture rates: a 12-month analysis. Osteoporos Int 2018; 29:1759-1770. [PMID: 29704027 DOI: 10.1007/s00198-018-4526-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED Fracture liaison service linked to an emergency department database effectively identifies patients with OP, improves best practice care, reduces recurrent fractures, and improves quality of life (QoL). The next step is to establish cost-effectiveness. This should be seen as the standard model of care. INTRODUCTION The Western Australian Osteoporosis Model of Care recommends implementation of a fracture liaison service (FLS) to manage patients with minimal trauma fractures (MTFs). This study evaluates the efficacy of a FLS linked to a tertiary hospital emergency department information system (EDIS) in reducing recurrent fractures. METHODS Patients aged ≥ 50 years with MTF identified from EDIS were invited to the FLS. Patient outcomes were compared to routine care (retrospective group-same hospital, and prospective group-other hospital) at 3- and 12-month follow-up. RESULTS Two hundred forty-one of 376 (64.1%) eligible patients participated in the FLS with 12 months of follow-up. Absolute risk of recurrent MTF at 12 months was reduced by 9.2 and 10.2% compared with the prospective and retrospective controls, respectively. After age/sex adjustment, FLS participants had less MTF at 12 months vs. the retrospective controls, OR 0.38 (95%CI 0.18-0.79), but not the prospective controls, OR 0.40 (95%CI 0.16-1.01). FLS patients were more likely to receive the 'best practice' care, i.e. awareness of osteoporosis, investigations, and treatment (all p < 0.05). 'Fallers' (OR 0.48 (95%CI 0.24, 0.96)) and fall rates were lower in the FLS (p = 0.001) compared to the prospective control. FLS experienced the largest improvement in QoL from 3 to 12 months as measured by the EuroQoL 5-domain (EQ-5D) UK weighted score (+ 15 vs. - 11 vs. - 16%, p < 0.001) and EQ-5D Health State visual analogue scale (+ 29 vs. - 2 vs. + 1%, p < 0.001). CONCLUSION Patients managed in a linked EDIS-FLS were more likely to receive the 'best practice' care and had lower recurrent MTF and improved QoL.
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Affiliation(s)
- C A Inderjeeth
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
- School of Medicine, The University of Western Australia, Perth, Australia.
- Arthritis and Osteoporosis Foundation of Western Australia, Shenton Park, Australia.
| | - W D Raymond
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | - A M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - E Geelhoed
- School of Population Health, The University of Western Australia, Perth, Australia
| | - D Oldham
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia
| | - D Mountain
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
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Lussier M, Lavoie M, Giroux S, Consel C, Guay M, Macoir J, Hudon C, Lorrain D, Talbot L, Langlois F, Pigot H, Bier N. Early Detection of Mild Cognitive Impairment With In-Home Monitoring Sensor Technologies Using Functional Measures: A Systematic Review. IEEE J Biomed Health Inform 2018; 23:838-847. [PMID: 29994013 DOI: 10.1109/jbhi.2018.2834317] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aging of the world population is accompanied by a substantial increase in neurodegenerative disorders, such as dementia. Early detection of mild cognitive impairment (MCI), a clinical diagnostic that comes with an increased chance to develop dementias, could be an essential condition for promoting quality of life and independent living, as it would provide a critical window for the implementation of early pharmacological and nonpharmacological interventions. This systematic review aims to investigate the current state of knowledge on the effectiveness of smart home sensors technologies for the early detection of MCI through the monitoring of everyday life activities. This approach offers many advantages, including the continuous measurement of functional abilities in ecological environments. A systematic search of publications in MEDLINE, EMBASE, and CINAHL, before November 2017, was conducted. Seventeen studies were included in this review. Thirteen studies were based on real-life monitoring, with several sensors installed in participants' actual homes, and four studies included scenario-based assessments, in which participants had to complete various tasks in a research lab apartment. In real-life monitoring, the most used indicators of MCI were walking speed and activity/motion in the house. In scenario-based assessment, time of completion, quality of activity completion, number of errors, amount of assistance needed, and task-irrelevant behaviors during the performance of everyday activities predicted MCI in participants. Despite technological limitations and the novelty of the field, smart home technologies represent a promising potential for the early screening of MCI and could support clinicians in geriatric care.
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Montero-Odasso M, Speechley M. Falls in Cognitively Impaired Older Adults: Implications for Risk Assessment And Prevention. J Am Geriatr Soc 2018; 66:367-375. [DOI: 10.1111/jgs.15219] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Laboratory; Parkwood Institute; Lawson Health Research Institute; London ON Canada
- Department of Medicine and Division of Geriatric Medicine; Schulich School of Medicine & Dentistry; University of Western Ontario; London ON Canada
- Department of Epidemiology and Biostatistics; Schulich Interfaculty Program in Public Health; University of Western Ontario; London ON Canada
| | - Mark Speechley
- Gait and Brain Laboratory; Parkwood Institute; Lawson Health Research Institute; London ON Canada
- Department of Epidemiology and Biostatistics; Schulich Interfaculty Program in Public Health; University of Western Ontario; London ON Canada
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Self-Selected and Maximal Walking Speeds Provide Greater Insight Into Fall Status Than Walking Speed Reserve Among Community-Dwelling Older Adults. Am J Phys Med Rehabil 2017; 95:475-82. [PMID: 27003205 DOI: 10.1097/phm.0000000000000488] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the degree to which self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) are associated with fall status among community-dwelling older adults. DESIGN WS and 1-year falls history data were collected on 217 community-dwelling older adults (median age = 82, range 65-93 years) at a local outpatient PT clinic and local retirement communities and senior centers. WSR was calculated as a difference (WSRdiff = MWS - SSWS) and ratio (WSRratio = MWS/SSWS). RESULTS SSWS (P < 0.001), MWS (P < 0.001), and WSRdiff (P < 0.01) were associated with fall status. The cutpoints identified were 0.76 m/s for SSWS (65.4% sensitivity, 70.9% specificity), 1.13 m/s for MWS (76.6% sensitivity, 60.0% specificity), and 0.24 m/s for WSRdiff (56.1% sensitivity, 70.9% specificity). SSWS and MWS better discriminated between fallers and non-fallers (SSWS: AUC = 0.69, MWS: AUC = 0.71) than WSRdiff (AUC = 0.64). CONCLUSIONS SSWS and MWS seem to be equally informative measures for assessing fall status in community-dwelling older adults. Older adults with SSWSs less than 0.76 m/s and those with MWSs less than 1.13 m/s may benefit from further fall risk assessment. Combining SSWS and MWS to calculate an individual's WSR does not provide additional insight into fall status in this population. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Describe the different methods for calculating walking speed reserve and discuss the potential of the metric as an outcome measure; (2) Explain the degree to which self-selected walking speed, maximal walking speed, and walking speed reserve are associated with fall status among community-dwelling older adults; and (3) Discuss potential limitations to using walking speed reserve to identify fall status in populations without mobility restrictions. LEVEL Advanced ACCREDITATION : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.
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15
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Higuma M, Sanjo N, Mitoma H, Yoneyama M, Yokota T. Whole-Day Gait Monitoring in Patients with Alzheimer's Disease: A Relationship between Attention and Gait Cycle. J Alzheimers Dis Rep 2017; 1:1-8. [PMID: 30480224 PMCID: PMC6159725 DOI: 10.3233/adr-170001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Gait impairment in patients with Alzheimer's disease (AD) and its relationship with cognitive function has been described, but reports of gait analysis in AD in daily living are limited. Objective: To investigate whether gait pattern of patients with AD in daily living is associated with cognitive function. Methods: Gait was recorded in 24 patients with AD and 9 healthy controls (HC) for 24 hours by using a portable gait rhythmogram. Mean gait cycle and gait acceleration were compared between the AD and HC groups. For the AD group, these gait metrics were assessed for correlations with cognitive function, as determined by the Mini Mental State Examination and Wechsler Memory Scale-Revised (WMS-R). Results: Although both gait parameters were not different between the patients with AD and HC, gait cycle in patients with AD was positively correlated with attention/concentration scores on the WMS-R (r = 0.578), and not with memory function. Patients with AD with attention scores as high as HC displayed a longer gait cycle than both HC (p = 0.048) and patients with AD with lower attention scores (p = 0.011). The patients with AD with lower attention scores showed a similar gait cycle with HC (p = 0.994). Conclusion: Patients with AD with impaired attentional function walk with faster gait cycle comparable to HC in daily living walking, which was unexpected based on previous gait analysis in clinical settings. This result probably reflects diminished consciousness to either the environment or instability of gait in the patients with AD with impaired attention.
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Affiliation(s)
- Maya Higuma
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | | | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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16
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Snowden MB, Steinman LE, Bryant LL, Cherrier MM, Greenlund KJ, Leith KH, Levy C, Logsdon RG, Copeland C, Vogel M, Anderson LA, Atkins DC, Bell JF, Fitzpatrick AL. Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence? Int J Geriatr Psychiatry 2017; 32:357-371. [PMID: 28146334 PMCID: PMC5962963 DOI: 10.1002/gps.4652] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality. METHODS This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study. RESULTS Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions. CONCLUSIONS This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Lesley E. Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Lucinda L. Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Monique M. Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kurt J. Greenlund
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine H. Leith
- College of Social Work, Hamilton College, University of South Carolina, Columbia, SC, USA
| | - Cari Levy
- Division of Health Care Policy and Research, School of Medicine, University of Colorado and the Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Rebecca G. Logsdon
- UW School of Nursing, Northwest Research Group on Aging, Seattle, WA, USA
| | - Catherine Copeland
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Mia Vogel
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Lynda A. Anderson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Janice F. Bell
- Betty Irene Moore School of Nursing, University of California, Davis, CA, USA
| | - Annette L. Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, School of Medicine and School of Public Health, University of Washington, Seattle, WA, USA
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17
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The Association of Judgment and Related Factors That Affect Fall Risk in Older Adults. TOPICS IN GERIATRIC REHABILITATION 2017. [DOI: 10.1097/tgr.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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What can gait tell us about dementia? Review of epidemiological and neuropsychological evidence. Gait Posture 2017; 53:215-223. [PMID: 28222369 DOI: 10.1016/j.gaitpost.2017.01.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 01/22/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cognitive impairment and gait disorders in people over the age of 65 represent major public health issues because of their high frequency, their link to poor outcomes and high costs. Research has demonstrated that these two geriatric syndromes are closely related. METHODS AND RESULTS We aim to review the evidence supporting the relationship between gait and cognitive impairment, particularly focusing on epidemiological and neuropsychological studies in patients with Mild cognitive impairment, Alzheimer's disease and Vascular dementia. The review demonstrates that gait and cognition are closely related, but our knowledge of their interrelationship is limited. Emerging evidence shows that gait analysis has the potential to contribute to diagnosis and prognosis of cognitive impairment. CONCLUSIONS An integrated approach for evaluating these major geriatric syndromes, based on their close relationship, will not only increase our understanding of cognitive-motor interactions, but most importantly may be used to aid early diagnosis, prognosis and the development of new interventions.
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Kedia SK, Chavan PP, Boop SE, Yu X. Health Care Utilization Among Elderly Medicare Beneficiaries With Coexisting Dementia and Cancer. Gerontol Geriatr Med 2017; 3:2333721416689042. [PMID: 31508440 PMCID: PMC5308432 DOI: 10.1177/2333721416689042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/03/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
Objective: The goal of this research is to delineate health care utilization among elderly Medicare beneficiaries with coexisting dementia and cancer compared with those with dementia alone, cancer alone, or neither condition. Method: The study cohort included 96,124 elderly patients aged 65 years and older who resided in the Mid-South region of the United States and were enrolled in Medicare during 2009. Multivariate regression analyses were used to examine health care utilizations while adjusting for sociodemographic characteristics. Results: Those with coexisting dementia and cancer diagnoses had higher rates of hospitalizations, hospital readmissions within 30 days, intensive care unit use, and emergency department visits compared with those with dementia only, cancer only, and those with neither condition. Patients with coexisting dementia and cancer also had a higher number of primary care visits and specialist visits. Conclusion: There is a greater need for developing tailored care plans for elderly with these two degenerative health conditions to address their unique health care needs and to reduce financial burden on the patients and the health care system.
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20
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Pirker W, Katzenschlager R. Gait disorders in adults and the elderly : A clinical guide. Wien Klin Wochenschr 2016; 129:81-95. [PMID: 27770207 PMCID: PMC5318488 DOI: 10.1007/s00508-016-1096-4] [Citation(s) in RCA: 231] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/14/2016] [Indexed: 01/22/2023]
Abstract
Human gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems. The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives. The prevalence of gait disorders increases from 10 % in people aged 60–69 years to more than 60 % in community dwelling subjects aged over 80 years. Sensory ataxia due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait disorders. With advancing age the proportion of patients with multiple causes or combinations of neurological and non-neurological gait disorders increases. Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions. This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.
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Affiliation(s)
- Walter Pirker
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Department of Neurology, Wilhelminenspital, Vienna, Austria.
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Conditions, Donauspital, Vienna, Austria
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21
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Panza F, Seripa D, Solfrizzi V, Tortelli R, Greco A, Pilotto A, Logroscino G. Targeting Cognitive Frailty: Clinical and Neurobiological Roadmap for a Single Complex Phenotype. J Alzheimers Dis 2016; 47:793-813. [PMID: 26401761 DOI: 10.3233/jad-150358] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Late-life cognitive disorders may be prevented by influencing age-related conditions such as frailty, characterized by decreased resistance to stressors and increased risk for adverse health outcomes. In the present review article, we examined clinical and epidemiological studies investigating the possible role of different frailty models in modulating the risk of Alzheimer's disease (AD), dementia, vascular dementia (VaD), mild cognitive impairment (MCI), and late-life cognitive impairment/decline that have been published over the past 3 years. Both deficit accumulation and physical frailty models were associated with late-life cognitive impairment/decline, incident dementia, AD, MCI, VaD, non-AD dementias, and AD pathology, proposing cognitive frailty as a new clinical construct with coexisting physical frailty and cognitive impairment in nondemented older subjects. Two subtypes of this new clinical condition have been recently proposed: "potentially reversible" cognitive frailty and "reversible" cognitive frailty. The physical factors should be physical prefrailty and frailty, while the cognitive impairment of potentially reversible cognitive frailty should be MCI (Clinical Dementia rating Scale = 0.5), while the cognitive impairment of reversible cognitive frailty should be pre-MCI Subjective Cognitive Decline (SCD), as recently proposed by the SCD Initiative Working Group. The mechanisms underlying the cognitive-frailty link are multifactorial and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. Considering both physical frailty and cognition as a single complex phenotype may be crucial in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects.
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Affiliation(s)
- Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Davide Seripa
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Rosanna Tortelli
- Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Antonio Greco
- Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- Geriatrics Unit, Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, Galliera Hospital NR-HS, Genova, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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22
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Azadian E, Torbati HRT, Kakhki ARS, Farahpour N. The effect of dual task and executive training on pattern of gait in older adults with balance impairment: A Randomized controlled trial. Arch Gerontol Geriatr 2015; 62:83-9. [PMID: 26508098 DOI: 10.1016/j.archger.2015.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effect of two different approaches of dual-task training and executive training on pattern of gait in older adults with balance impairment. METHODS Thirty older adults with the mean age of 73.8 participated in the study. They scored 52 or less on the Berg Balance Scale (BBS), and walked with a self-selected gait speed of 1.1m/s or less. Participants were randomly assigned to one of the three groups: experimental group one (cognitive dual-task (CDT) training) that focused on gait performance under dual task condition; experimental group two (executive function (EF) training) who underwent 3 types of training on working memory, inhibition, speed of processing; and a control group. Subjects walked 10 m, under single-task and dual-task (DT) conditions where kinematics parameters were recorded. Participants in experimental groups received 45-min training sessions, 3 times a week for 8 weeks. The data obtained was analyzed using repeated measure at a criterion p-value of 0.05. RESULTS The results showed that after training, changes of walking speed, length of stride and step, times of stride, step, single support, and double support, were significant at p<0.05. Asymmetry index in walking with dual task condition increased significantly, but after training asymmetry in DT condition decreased significantly in EF group. CONCLUSIONS Both training groups showed improvements in gait parameters in the post test compared with that in the control group; however, in EF training group, symmetry of limbs and inter-coordination, improved more than that in CDT group.
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Affiliation(s)
- Elaheh Azadian
- Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad-International Campus, Mashhad, Iran
| | - Hamid Reza Taheri Torbati
- Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Ali Reza Saberi Kakhki
- Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Nader Farahpour
- Department of Sport Biomechanics, Faculty of Physical Education and Sport Sciences, Bu Ali Sina University, Hamedan, Iran
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23
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Panza F, Solfrizzi V, Barulli MR, Santamato A, Seripa D, Pilotto A, Logroscino G. Cognitive Frailty: A Systematic Review of Epidemiological and Neurobiological Evidence of an Age-Related Clinical Condition. Rejuvenation Res 2015; 18:389-412. [PMID: 25808052 DOI: 10.1089/rej.2014.1637] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Advancing age is the focus of recent studies on familial and sporadic Alzheimer's disease (AD), suggesting a prolonged pre-clinical phase several decades before the onset of dementia symptoms. Influencing some age-related conditions, such as frailty, may have an impact on the prevention of late-life cognitive disorders. Frailty reflects a nonspecific state of vulnerability and a multi-system physiological change with increased risk for adverse health outcomes in older age. In this systematic review, frailty indexes based on a deficit accumulation model were associated with late life cognitive impairment and decline, incident dementia, and AD. Physical frailty constructs were associated with late-life cognitive impairment and decline, incident AD and mild cognitive impairment, vascular dementia, non-AD dementias, and AD pathology in older persons with and without dementia, thus also proposing cognitive frailty as a new clinical condition with co-existing physical frailty and cognitive impairment in non-demented older subjects. Considering both physical frailty and cognitive impairment as a single complex phenotype may be central in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects. The mechanisms underlying the cognitive-frailty link are multi-factorial, and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. There is a critical need for randomized controlled trials of intervention investigating the role of nutrition and/or physical exercise on cognitive frail subjects with the progression to dementia as primary outcome. These preventive trials and larger longitudinal population-based studies targeting cognitive outcomes could be useful in further understanding the cognitive-frailty interplay in older age.
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Affiliation(s)
- Francesco Panza
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- 2 Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro , Bari, Italy
| | - Maria Rosaria Barulli
- 3 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,4 Department of Clinical Research in Neurology, University of Bari Aldo Moro , "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Andrea Santamato
- 5 Department of Physical Medicine and Rehabilitation,"OORR Hospital", University of Foggia , Italy
| | - Davide Seripa
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy .,6 Geriatric Unit, Azienda ULSS 16 Padova, Hospital S. Antonio , Padova, Italy
| | - Giancarlo Logroscino
- 3 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,4 Department of Clinical Research in Neurology, University of Bari Aldo Moro , "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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van het Reve E, de Bruin ED. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC Geriatr 2014; 14:134. [PMID: 25511081 PMCID: PMC4293005 DOI: 10.1186/1471-2318-14-134] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/09/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Exercise interventions often do not combine physical and cognitive training. However, this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training. METHODS A multicenter parallel randomized controlled trial was conducted to compare a motor to a cognitive-motor exercise program. A total of 182 eligible residents of homes-for-the-aged (n = 159) or elderly living in the vicinity of the homes (n = 23) were randomly assigned to either strength-balance (SB) or strength-balance-cognitive (SBC) training. Both groups conducted similar strength-balance training during 12 weeks. SBC additionally absolved computerized cognitive training. Outcomes were dual task costs of walking, physical performance, simple reaction time, executive functions, divided attention, fear of falling and fall rate. Participants were analysed with an intention to treat approach. RESULTS The 182 participants (mean age ± SD: 81.5 ± 7.3 years) were allocated to either SB (n = 98) or SBC (n = 84). The attrition rate was 14.3%. Interaction effects were observed for dual task costs of step length (preferred walking speed: F(1,174) = 4.94, p = 0.028, η2 = 0.027, fast walking speed: F(1,166) = 6.14, p = 0.009, η2 = 0.040) and dual task costs of the standard deviation of step length (F(1,166) = 6.14, p = 0.014, η2 = 0.036), in favor of SBC. Significant interactions in favor of SBC revealed for in gait initiation (F(1,166) = 9.16, p = 0.003, η2 = 0.052), 'reaction time' (F(1,180) = 5.243, p = 0.023, η² = 0.028) & 'missed answers' (F(1,180) = 11.839, p = 0.001, η² = 0.062) as part of the test for divided attention. Within-group comparison revealed significant improvements in dual task costs of walking (preferred speed; velocity (p = 0.002), step time (p = 0.018), step length (p = 0.028), fast speed; velocity (p < 0.001), step time (p = 0.035), step length (p = 0.001)), simple reaction time (p < 0.001), executive functioning (Trail making test B; p < 0.001), divided attention (p < 0.001), fear of falling (p < 0.001), and fall rate (p < 0.001). CONCLUSIONS Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking, gait initiation, and divided attention. The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls. TRIAL REGISTRATION This trial has been registered under ISRCTN75134517.
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Affiliation(s)
- Eva van het Reve
- />Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Wolfgang-Pauli-Str. 27, 8093 Zürich, Switzerland
| | - Eling D de Bruin
- />Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Wolfgang-Pauli-Str. 27, 8093 Zürich, Switzerland
- />Department of Epidemiology, CAPHRI School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, Netherlands
- />Department of Epidemiology, Centre for Evidence Based Physiotherapy, PO Box 616, 6200 MD Maastricht, Netherlands
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25
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Cedervall Y, Halvorsen K, Aberg AC. A longitudinal study of gait function and characteristics of gait disturbance in individuals with Alzheimer's disease. Gait Posture 2014; 39:1022-7. [PMID: 24491520 DOI: 10.1016/j.gaitpost.2013.12.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 12/16/2013] [Accepted: 12/30/2013] [Indexed: 02/02/2023]
Abstract
Walking in daily life places high demands on the interplay between cognitive and motor functions. A well-functioning dual-tasking ability is thus essential for walking safely. The aims were to study longitudinal changes in gait function during single- and dual-tasking over a period of two years among people with initially mild AD (n=21). Data were collected on three occasions, twelve months apart. An optical motion capture system was used for three-dimensional gait analysis. Gait parameters were examined at comfortable gait speed during single-tasking, dual-tasking naming names, and naming animals. The dual-task cost for gait speed was pronounced at baseline (names 26%, animals 35%), and remained so during the study period. A significant (p<0.05) longitudinal decline in gait speed and step length during single- and dual-tasking was observed, whereas double support time, step width and step height showed inconsistent results. Systematic visual examination of the motion capture files revealed that dual-tasking frequently resulted in gait disturbances. Three main characteristics of such disturbances were identified: Temporal disturbance, Spatial disturbance and Instability in single stance. These aberrant gait performances may affect gait stability and increase the risk of falling. Furthermore, the observed gait disturbances can contribute to understanding and explaining previous reported gait variability among individuals with AD. However, the role that dual-task testing and aberrant dual-task gait performance play in the identification of individuals with early signs of cognitive impairment and in predicting fall risk in AD remains to be studied.
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Affiliation(s)
- Ylva Cedervall
- Department of Public Health and Caring Science/Geriatrics, Uppsala University, Uppsala Science Park, SE-751 85 Uppsala, Sweden.
| | - Kjartan Halvorsen
- Department of Information Technology, Uppsala University, Box 337, SE-751 05 Uppsala, Sweden.
| | - Anna Cristina Aberg
- Department of Public Health and Caring Science/Geriatrics, Uppsala University, Uppsala Science Park, SE-751 85 Uppsala, Sweden.
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Lee T, Lipnicki DM, Crawford JD, Henry JD, Trollor JN, Ames D, Wright MJ, Sachdev PS. Leisure activity, health, and medical correlates of neurocognitive performance among monozygotic twins: the Older Australian Twins Study. J Gerontol B Psychol Sci Soc Sci 2013; 69:514-22. [PMID: 23668997 DOI: 10.1093/geronb/gbt031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We aimed to examine associations between each of three leisure activities (Cognitive, Physical, and Social) and performance in selected cognitive domains (Speed, Memory, Verbal ability, and Executive functions) and global cognition. We also aimed to explore associations between medical and health factors and late-life cognition. METHOD Our sample comprised 119 pairs of monozygotic twins from the Older Australian Twins Study. Their mean age was 71 years and 66% were women. We used a discordant co-twin design, with cognitive performance measures as dependent variables and leisure activities as independent variables. Multiple regression analyses were performed, adjusting for potentially relevant medical and health factors. RESULTS Discordance in Cognitive Activity and Social Activity participation was positively associated with discordance in performance on some cognitive domains. There were no associations between Physical Activity participation and cognition. Discordance in several cardiovascular, frailty, and sensory variables was associated with discordance in cognitive performance measures. DISCUSSION This study identified lifestyle and health-related influences on late-life cognition. Our findings not only help in understanding the neurobiological mechanisms, they also have practical implications for interventions to prevent or slow age-related cognitive decline.
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Affiliation(s)
- Teresa Lee
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Sydney, Australia. Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia.
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Sydney, Australia
| | - Julie D Henry
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Sydney, Australia. Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Sydney, Australia
| | - David Ames
- National Ageing Research Institute, University of Melbourne, Victoria, Australia. University of Melbourne Academic Unit for Psychiatry of Old Age, St. George's Hospital, Melbourne, Australia
| | - Margaret J Wright
- School of Psychology, University of Queensland, Brisbane, Australia. Genetic Epidemiology Unit, Queensland Institute of Medical Research, Brisbane, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Sydney, Australia. Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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Tolppanen AM, Lavikainen P, Soininen H, Hartikainen S. Incident hip fractures among community dwelling persons with Alzheimer's disease in a Finnish nationwide register-based cohort. PLoS One 2013; 8:e59124. [PMID: 23527106 PMCID: PMC3601105 DOI: 10.1371/journal.pone.0059124] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 02/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous cohort studies have shown that persons with Alzheimer's disease (AD) have a higher risk of hip fractures but recent data from large representative cohorts is scarce. METHODS We investigated the association between AD and prevalent and incident hip fractures in an exposure-matched cohort study conducted in Finland 2002-2009 (the Medication and Alzheimer's disease in 2005 study; MEDALZ-2005). The study population included all community-dwelling persons with verified AD diagnosis in Finland on December 31, 2005 and one matched comparison person per AD case (N = 56,186, mean age 79.9 (SD 6.8) years, range 42-101 years). The diagnosis of AD was extracted from a special reimbursement register. Data on hip fractures during 2002-2009 was extracted from the Finnish National hospital discharge register. Analyses of incident hip fractures (n = 2,861) were restricted to years 2006-2009. RESULTS Persons with AD were twice as likely to have previous hip fracture in 2005 (odds ratio, 95% confidence interval 2.00, 1.82-2.20) than matched aged population without AD. They were also more likely to experience incident hip fracture during the four-year follow-up (hazard ratio, 95% confidence interval 2.57, 2.32-2.84, adjusted for health status, psychotropic drug and bisphosphonate use). The AD-associated risk increase decreased linearly across age groups. Although people with AD had higher risk of hip fractures regardless of sex, the risk increase was larger in men than women. CONCLUSION Findings from our nationwide study are in line with previous studies showing that persons with AD, regardless of sex or age, have higher risk of hip fracture in comparison to general population. Although there was some suggestion of effect modification by age or sex, AD was consistently associated with doubling of the risk of incident hip fracture.
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Affiliation(s)
- Anna-Maija Tolppanen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.
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Influence of the cognitive impairment level on the performance of the Timed “Up & Go” Test (TUG) in elderly institutionalized people. Arch Gerontol Geriatr 2013; 56:44-9. [DOI: 10.1016/j.archger.2012.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/31/2012] [Accepted: 06/02/2012] [Indexed: 11/18/2022]
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Taylor ME, Delbaere K, Mikolaizak AS, Lord SR, Close JCT. Gait parameter risk factors for falls under simple and dual task conditions in cognitively impaired older people. Gait Posture 2013; 37:126-30. [PMID: 22832468 DOI: 10.1016/j.gaitpost.2012.06.024] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 05/25/2012] [Accepted: 06/26/2012] [Indexed: 02/02/2023]
Abstract
Impaired gait may contribute to the increased rate of falls in cognitively impaired older people. We investigated whether gait under simple and dual task conditions could predict falls in this group. The study sample consisted of 64 community dwelling older people with mild to moderate cognitive impairment. Participants walked at their preferred speed under three conditions: (a) simple walking, (b) walking while carrying a glass of water and (c) walking while counting backwards from 30. Spatiotemporal gait parameters were measured using the GAITRite(®) mat. Falls were recorded prospectively for 12months with the assistance of carers. Twenty-two (35%) people fell two or more times in the 12month follow-up period. There was a significant main effect of gait condition and a significant main effect of faller status for mean value measures (velocity, stride length, double support time and stride width) and for variability measures (swing time variability and stride length variability). Examination of individual gait parameters indicated that the multiple fallers walked more slowly, had shorter stride length, spent longer time in double support, had a wider support width and showed more variability in stride length and swing time (p<0.05). There was no significant interaction between gait condition and faller status for any of the gait variables. In conclusion, dual task activities adversely affect gait in cognitively impaired older people. Multiple fallers performed worse in each gait condition but the addition of a functional or cognitive secondary task provided no added benefit in discriminating fallers from non-fallers with cognitive impairment.
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Affiliation(s)
- Morag E Taylor
- Falls and Balance Research Group, Neuroscience Research Australia, Sydney, Australia.
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Risk of falls in older people during fast-walking--the TASCOG study. Gait Posture 2012; 36:510-5. [PMID: 22682610 DOI: 10.1016/j.gaitpost.2012.05.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 04/26/2012] [Accepted: 05/07/2012] [Indexed: 02/02/2023]
Abstract
AIMS To investigate the relationship between fast-walking and falls in older people. METHODS Individuals aged 60-86 years were randomly selected from the electoral roll (n=176). Gait speed, step length, cadence and a walk ratio were recorded during preferred- and fast-walking using an instrumented walkway. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait variables during fast-walking and change between preferred- and fast-walking. Covariates included age, sex, mood, physical activity, sensorimotor and cognitive measures. RESULTS The risk of multiple falls was increased for those with a smaller walk ratio (shorter steps, faster cadence) during fast-walking (RR 0.92, CI 0.87, 0.97) and greater reduction in the walk ratio (smaller increase in step length, larger increase in cadence) when changing to fast-walking (RR 0.73, CI 0.63, 0.85). These gait patterns were associated with poorer physiological and cognitive function (p<0.05). A higher risk of multiple falls was also seen for those in the fastest quarter of gait speed (p=0.01) at fast-walking. A trend for better reaction time, balance, memory and physical activity for higher categories of gait speed was stronger for fallers than non-fallers (p<0.05). CONCLUSION Tests of fast-walking may be useful in identifying older individuals at risk of multiple falls. There may be two distinct groups at risk--the frail person with short shuffling steps, and the healthy person exposed to greater risk.
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Yogev-Seligmann G, Hausdorff JM, Giladi N. Do we always prioritize balance when walking? Towards an integrated model of task prioritization. Mov Disord 2012; 27:765-70. [DOI: 10.1002/mds.24963] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 01/16/2012] [Accepted: 02/01/2012] [Indexed: 12/17/2022] Open
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van der Jagt-Willems HC, van Hengel M, Vis M, van Munster BC, van Campen JPCM, Tulner LR, Lems WF. Why do geriatric outpatients have so many moderate and severe vertebral fractures? Exploring prevalence and risk factors. Age Ageing 2012; 41:200-6. [PMID: 22217460 DOI: 10.1093/ageing/afr174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES to determine the prevalence of vertebral fractures and their risk factors in geriatric patients. DESIGN prospective cohort study. SETTING teaching hospital in Amsterdam, The Netherlands. SUBJECTS three hundred and three geriatric patients, who had their first visit at a diagnostic day hospital between April and August 2007. MEASUREMENTS lateral X-rays of the lumbar spine and chest were performed; vertebral fractures were scored according to the semi-quantitative method of Genant by trained observers and compared with the official report of radiologists. Co-morbidity, reported falls, mobility and cognitive function were scored. RESULTS vertebral fractures were observed in 51% (156/303) of geriatric patients. Sixty-nine per cent (107/156) of these fractures were moderate to severe. In 21% (33/156) of the patients with a fracture, vertebral fractures were diagnosed on the lumbar spine X-ray alone. Patients with vertebral fractures had more previous non-vertebral fractures (odds ratio: 2.40 95% CI: 1.40-4.10), had lower serum albumin levels (OR: 0.92 95% CI: 0.87-0.97) and more current prednisone use (OR: 8.94 95% CI: 1.12-71.45). Co-morbidity and cognitive decline were not identified as risk factors. Radiologists reported vertebral fractures in 53% (82/156) of the cases. CONCLUSION this study showed a very high prevalence of vertebral fractures in geriatric patients; particularly the high prevalence of moderate and severe fractures is remarkable. Because of this high prevalence, the routinely performed lateral X-ray of the chest should be used to look for vertebral fractures. An additional X-ray of the lumbar spine might be useful in patients without vertebral fractures on the chest X-ray.
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Bryant M, Rintala D, Hou J, Rivas S, Fernandez A, Lai E, Protas E. The Relation of Falls to Fatigue, Depression and Daytime Sleepiness in Parkinsons Disease. Eur Neurol 2012; 67:326-30. [DOI: 10.1159/000335877] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/11/2011] [Indexed: 11/19/2022]
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Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff JM. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Rev Neurother 2011; 11:1057-75. [PMID: 21721921 DOI: 10.1586/ern.11.69] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this article, we briefly summarize the incidence and significant consequences of falls among older adults, the insufficient effectiveness of commonly used multifactorial interventions and the evidence linking falls and cognitive function. Recent pharmacologic and nonpharmacologic studies that evaluated the effects of cognitive therapy on fall risk are reviewed. The results of this article illustrate the potential utility of multiple, diverse forms of cognitive therapy for reducing fall risk. The article also indicates that large-scale, randomized controlled trials are warranted and that additional research is needed to better understand the pathophysiologic mechanisms underlying the interplay between human mobility, fall risk and cognitive function. Nonetheless, we suggest that multimodality interventions that combine motor and cognitive therapy should, eventually, be incorporated into clinical practice to enable older adults and patients to move safer and with a reduced fall risk.
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Affiliation(s)
- Orit Segev-Jacubovski
- Beit Rivka Geriatric Rehabilitation Center, Department of Occupational Therapy, Faculty of Social Welfare & Health, University of Haifa, Israel
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Callisaya ML, Blizzard L, Schmidt MD, Martin KL, McGinley JL, Sanders LM, Srikanth VK. Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. Age Ageing 2011; 40:481-7. [PMID: 21628390 DOI: 10.1093/ageing/afr055] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND it is uncertain as to which measures of gait best predict those who are likely to fall. Our aim was to investigate the associations of gait and gait variability measures with incident falls risk. METHODS individuals aged 60-86 years (n = 412) were randomly selected from the Tasmanian electoral roll. Average gait and gait variability measures were collected on a computerised walkway. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait measures. Covariates included age, sex, sensorimotor and cognitive measures, mood and medications. RESULTS in this population-based study greater intra-individual variability in step length and double-support phase were linearly associated with increased risk of multiple falls (P = 0.04). Non-linear associations with multiple falls were found for gait speed P = 0.002, cadence P = 0.004 and step time variability P = 0.03. None of the gait measures predicted risk of single falls. CONCLUSION there is an increased risk of multiple falls, but not single falls, in older people with poorer gait. Specific measures of gait and gait variability seem to confer this risk and may be amenable to interventions designed to reduce the risk of multiple falls in older people.
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Affiliation(s)
- Michele L Callisaya
- Department of Medicine, Monash Medical Centre, Monash University, Clayton, VIC, Australia.
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Ryan JJ, McCloy C, Rundquist P, Srinivasan V, Laird R. Fall Risk Assessment Among Older Adults With Mild Alzheimer Disease. J Geriatr Phys Ther 2011; 34:19-27. [DOI: 10.1519/jpt.0b013e31820aa829] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brown NA, Zenilman ME. The impact of frailty in the elderly on the outcome of surgery in the aged. Adv Surg 2010; 44:229-49. [PMID: 20919524 DOI: 10.1016/j.yasu.2010.05.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
As the population continues to age, we will continue to encounter issues involving aging and the elderly. Despite these issues, knowledge is expanding and evolving with new solutions to ongoing problems. Mechanistically, frailty at its root is a symptom of growing old, with cascades and circuitous feedback between organ systems at all levels. Clinically, frailty is as equally dynamic and its multifactorial nature represents a unique challenge to the surgical community and warrants the integration of geriatric assessment into clinical practice. Integration within clinical practice includes using an interdisciplinary approach, where surgeons work with anesthesiologists, geriatricians, nursing, rehabilitation, nutritionists, and other support staff to provide holistic assessment, efficient delivery, and higher quality of care. This in hand, recognition of frailty can occur in a timely fashion to initiate treatment, decreasing the risk of morbidity and mortality for improved surgical outcomes.
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Affiliation(s)
- Nefertiti A Brown
- Department of Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 40, Brooklyn, NY 11203, USA.
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Faes MC, Reelick MF, Esselink RA, Rikkert MGO. Developing and evaluating complex healthcare interventions in geriatrics: the use of the medical research council framework exemplified on a complex fall prevention intervention. J Am Geriatr Soc 2010; 58:2212-21. [PMID: 21039367 DOI: 10.1111/j.1532-5415.2010.03108.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Geriatrics focuses on a variety of multiorgan problems in a heterogeneous older population. Therefore, most geriatric healthcare interventions are complex interventions. The UK Medical Research Council (MRC) has developed a framework to systematically design, evaluate, and implement complex interventions. This article provides an overview of this framework and illustrates its use in geriatrics by showing how it was used to develop and evaluate a fall prevention intervention. The consecutive phases of the framework are described: Phase I: Development. This phase began with a literature review, which provided the existing evidence and the theoretical understanding of the process of change. This understanding was further developed through focus groups with experts and interviews with patients and caregivers. The intervention was modeled using qualitative testing of the preliminary intervention through focus groups and through the completion of Delphi surveys by independent specialists. Phase II: Feasibility and piloting. In this phase, a pilot study was conducted in a group of patients and caregivers. The feasibility of the intervention and evaluation was also discussed in focus groups of participants and instructors. Phase III: Evaluation. The information from phases I and II shaped the design of a randomized controlled trial to test the effectiveness of the intervention. Phase IV: Dissemination. The purpose of the final phase is to examine the implementation of the intervention into practice. The MRC framework provides an innovative and useful methodology for the development and evaluation of complex geriatric interventions that deserves greater dissemination and implementation.
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Affiliation(s)
- Miriam C Faes
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Eggermont LH, Gavett BE, Volkers KM, Blankevoort CG, Scherder EJ, Jefferson AL, Steinberg E, Nair A, Green RC, Stern RA. Lower-extremity function in cognitively healthy aging, mild cognitive impairment, and Alzheimer's disease. Arch Phys Med Rehabil 2010; 91:584-8. [PMID: 20382291 DOI: 10.1016/j.apmr.2009.11.020] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/18/2009] [Accepted: 11/18/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine differences in lower-extremity function in cognitive healthy older persons, older persons with mild cognitive impairment (MCI), and older persons with Alzheimer's disease (AD). DESIGN Descriptive study. SETTING University Alzheimer's disease clinical and research program. PARTICIPANTS Older persons (N=66) were studied (mean age, 76.7y); 22 were cognitively normal, 22 were diagnosed with probable MCI, 22 were diagnosed with probable AD. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Lower-extremity function was assessed by the four-meter walk test (4MWT), Timed Up & Go (TUG) test, and sit-to-stand (STS) test. RESULTS Analysis of variance, adjusting for covariates, revealed that performance on the 4MWT was significantly lower in the MCI and AD groups as compared with controls. TUG test performance was worse in the AD group compared with controls. No significant group differences were found for STS performance. CONCLUSIONS These results suggest an association between cognitive impairment and lower-limb function in older persons. Walking speed could be evaluated for its possible utility in screening older persons at risk for cognitive impairment and falls.
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Affiliation(s)
- Laura H Eggermont
- Alzheimer's Disease Clinical and Research Program, Boston University School of Medicine, Boston, MA 02118-2526, USA
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Härlein J, Dassen T, Halfens RJG, Heinze C. Fall risk factors in older people with dementia or cognitive impairment: a systematic review. J Adv Nurs 2009; 65:922-33. [PMID: 19291191 DOI: 10.1111/j.1365-2648.2008.04950.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rochester L, Burn DJ, Woods G, Godwin J, Nieuwboer A. Does auditory rhythmical cueing improve gait in people with Parkinson's disease and cognitive impairment? A Feasibility study. Mov Disord 2009; 24:839-45. [DOI: 10.1002/mds.22400] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rochester L, Nieuwboer A, Baker K, Hetherington V, Willems AM, Kwakkel G, Van Wegen E, Lim I, Jones D. Walking speed during single and dual tasks in Parkinson's disease: which characteristics are important? Mov Disord 2009; 23:2312-8. [PMID: 18816800 DOI: 10.1002/mds.22219] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The impact of dual tasks on gait in Parkinson's disease (PD) reveals lack of automaticity and increased cognitive demands. We explored which characteristics explained walking speed with and without dual task interference and if they reflected the cognitive demands of the task. In 130 people with PD, gait performance was quantified in the home using accelerometers allowing estimates of single and dual task walking speed and interference (difference between dual and single task). Multiple regression analysis was used to explore the effect of 12 characteristics representing four domains (personal, motor symptoms, cognitive, affective) on gait outcomes. Thirty-seven percent of variance in single task speed was explained by increased fear of falling, sex, age, disease severity, and depression; 34% of variance in dual task speed was explained by increased fear of falling, disease severity, medication, and depression; 12% of variance in interference scores was explained by greater disease severity and impaired executive function. Personal, motor, affective, and cognitive characteristics contribute to walking speed and interference, highlighting the multifactorial nature of gait. Different patterns of characteristics for each outcome indicates the impact of cognitive demand and task complexity, providing cautious support for dual task speed and interference as valid proxy measures of cognitive demand in PD gait.
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Affiliation(s)
- Lynn Rochester
- School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom.
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van Iersel MB, Kessels RPC, Bloem BR, Verbeek ALM, Olde Rikkert MGM. Executive functions are associated with gait and balance in community-living elderly people. J Gerontol A Biol Sci Med Sci 2009; 63:1344-9. [PMID: 19126847 DOI: 10.1093/gerona/63.12.1344] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognition influences gait and balance in elderly people. Executive functions seem to play a key role in this mechanism. Previous studies used only a single test to probe executive functions, and outcome measures were restricted to gait variables. We extend this prior work by examining the association between two different executive functions and measures of both gait and balance, with and without two different cognitive dual tasks. METHODS This is a cross-sectional study with randomly selected community-living elderly people. Executive functions were tested with the Trail Making Test Parts A and B and the Stroop Color Word Test; memory with Cambridge Neuropsychological Test Automated Battery (CANTAB) subtests. Patients walked without and with two dual tasks (subtracting serial sevens and animal naming). Main outcomes focused on gait (velocity, stride length, and stride time variability), measured on an electronic walkway, and balance, measured as trunk movements during walking. Associations were assessed with multiple regression models. RESULTS One hundred elderly people, with a mean age 80.6 years (range 75-93 years) participated. Both dual tasks decreased gait velocity and increased variability and trunk sway. Executive functions were associated with only stride length variability and mediolateral trunk sway during performance of animal naming as the dual task. Memory was not associated with the gait and balance variables. CONCLUSIONS In community-living elderly people, executive functions are associated with gait and balance impairment during a challenging dual-task condition that also depends on executive integrity. Next steps will be to explore the value of executive functions in defining fall-risk profiles and in fall-prevention interventions for frail patients.
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Affiliation(s)
- Marianne B van Iersel
- Radboud University Nijmegen Medical Centre, Department of Geriatrics, 6500 HB Nijmegen, the Netherlands.
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Alexander NB, Hausdorff JM. Guest editorial: linking thinking, walking, and falling. J Gerontol A Biol Sci Med Sci 2009; 63:1325-8. [PMID: 19126844 DOI: 10.1093/gerona/63.12.1325] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fonad E, Emami A, Wahlin TBR, Winblad B, Sandmark H. Falls in somatic and dementia wards at Community Care Units. Scand J Caring Sci 2008; 23:2-10. [PMID: 19055593 DOI: 10.1111/j.1471-6712.2007.00574.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Falls and fall injuries are common problems for patients at nursing homes in Sweden. Impaired cognitive function, a poor sense of orientation and a high intake of medicine, can lead to an increase in falls among older people. AIM The objective of this study was to investigate the associations between falls and: fall risks, fractures, the use of physical restraints and the use of certain medications in somatic and dementia wards, respectively. METHOD The study design is ecological, and aggregated data regarding falls, fall risk assessments, fractures, the use of physical restraints and medication were collected between 2000 and 2003. The Pearson correlation analysis and regression analyses were used to investigate associations between fall risks, medication, fractures, wheelchair-bound situations, bed rails and falls. RESULTS The total number of reported fall incidents was 2651; of these, 737 incidents were registered in dementia wards and 1914 in somatic wards. Dementia wards and somatic wards differed regarding falls and fractures, as it was only in dementia wards that falls were associated with fractures. There was also a significant correlation between falls and assessed risk of falling, the use of certain medication, and physical restraints such as wheelchairs and bed rails in dementia wards. Falls at somatic wards were associated with the use of sleeping pills with benzodiazepines. CONCLUSION For dementia wards there were associations between falls and fractures, physical restraints and the use of certain medications. Fractures were associated with the use of neuroleptics, sleeping pills and sleeping pills with benzodiazepines. At somatic wards, falls correlated with the use of sleeping pills with benzodiazepines, and with the use of wheelchairs and bed rails.
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Affiliation(s)
- Edit Fonad
- Stockholms Sjukhem Foundation, Stockholm, Sweden.
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Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing 2008; 37:442-8. [PMID: 18515291 DOI: 10.1093/ageing/afn101] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES to evaluate and compare the prognostic validity relative to falls of the Timed Up-and-Go test (TUG), a modified Get-Up-and-Go test (GUG-m), staff's judgement of global rating of fall risk (GLORF) and fall history among frail older people. DESIGN cohort study, 6-month prospective follow-up for falls. PARTICIPANTS 183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women. METHODS the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as 'high' or 'low'; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR(+) to rule in and LR(-) to rule out a high fall risk). RESULTS 53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR(+) between 0.9 and 2.6 and LR(-) between 0.1 and 1.0. The GLORF showed an LR(+) of 2.8 and an LR(-) of 0.6 and fall history showed an LR(+) of 2.4 and an LR(-) of 0.6. CONCLUSIONS in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.
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Affiliation(s)
- Ellinor Nordin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden.
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Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord 2008; 23:329-42; quiz 472. [PMID: 18058946 DOI: 10.1002/mds.21720] [Citation(s) in RCA: 1317] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher-level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk.
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Affiliation(s)
- Galit Yogev-Seligmann
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Abstract
Cognitive impairment has been recognized as a risk factor for falls and for increasing the severity of injury following a fall, but the mechanisms by which cognitive impairment influences gait and postural control have been unclear. A recent report that galantamine improves gait parameters in older adults may help to untangle this.
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Snijders AH, Verstappen CC, Munneke M, Bloem BR. Assessing the interplay between cognition and gait in the clinical setting. J Neural Transm (Vienna) 2007; 114:1315-21. [PMID: 17612789 DOI: 10.1007/s00702-007-0781-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
In this review, we outline how the influence of cognitive processes on gait or balance can be appreciated in a clinical setting. Careful history taking of the patient or direct carer provides information about multiple task problems in daily life and the presence of cognitive impairment, depression or fear of falling. Physical examination may reveal abnormalities such as an inappropriately high walking speed or an inability to handle secondary tasks while walking. Assessment of frontal executive function helps to understand the nature of these multiple task problems and to detect "risky" behaviour caused by frontal disinhibition. Examples of clinically useable techniques include pressure-sensitive insoles or an electronic walkway (to record strides) or accelerometers (to measure body motion while walking). Combining these assessments may lead to a better appreciation of the fascinating but complex interplay between cognition and gait.
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Affiliation(s)
- A H Snijders
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Snijders AH, van de Warrenburg BP, Giladi N, Bloem BR. Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurol 2007; 6:63-74. [PMID: 17166803 DOI: 10.1016/s1474-4422(06)70678-0] [Citation(s) in RCA: 230] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Gait disorders are common and often devastating companions of ageing, leading to reductions in quality of life and increased mortality. Here, we present a clinically oriented approach to neurological gait disorders in the elderly population. We also draw attention to several exciting scientific developments in this specialty. Our first focus is on the complex and typically multifactorial pathophysiology underlying geriatric gait disorders. An important new insight is the recognition of gait as a complex higher order form of motor behaviour, with prominent and varied effects of mental processes. Another relevant message is that gait disorders are not an unpreventable consequence of ageing, but implicate the presence of underlying diseases that warrant specific diagnostic tests. We next discuss the core clinical features of common geriatric gait disorders and review some bedside tests to assess gait and balance. We conclude by proposing a practical three-step approach to categorise gait disorders and we present a simplified classification system based on clinical signs and symptoms.
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Affiliation(s)
- Anke H Snijders
- Department of Neurology and Parkinson Center Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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