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Fay A, Synott E, McDaid E, Barrett E. A comparison of the immediate effects of the Andago over ground body weight support trainer versus over ground walking on selected gait parameters in a post-acute rehabilitation population. Physiother Theory Pract 2024; 40:767-777. [PMID: 36593733 DOI: 10.1080/09593985.2022.2162834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Andago is an electromechanical gait trainer providing dynamic body weight support while simultaneously enabling over ground walking. The aim of this study was to compare the effects of the Andago with over ground walking on selected gait parameters, during a single gait reeducation session in a post-acute rehabilitation population. METHODS Twenty-seven participants (mean age 78 yrs. (SD = 9.2), female 55.6% (n = 15)) undergoing rehabilitation for neurological (51.8%, n = 14), orthopedic (33.3%, n = 9), and medical conditions (14.8%, n = 4) completed the study. This was a single group, cross sectional, repeated measures study. Participants completed a 10-meter walk test (10MWT) and a 20-minute gait reeducation session under two conditions: i) harnessed in the Andago with body weight support or ii) using their normal walking pattern. Walking speed, steps taken, distance walked, rest breaks, Borg ratings of perceived exertion, and fear of falling were compared over both conditions. RESULTS Walking speed was significantly slower with the Andago (10MWT mean difference 0.12 (95% CI 0.03-0.20), eta squared 0.24, p = .008; 20-min gait mean difference 0.04 (95% CI 0.00-0.09), eta squared 0.15, p = .049). During the 20-minute gait reeducation session, step count, distance walked, and duration of walking was similar over both conditions, however participants recorded less rest breaks and fear of falling at minutes 10 and 20 in favor of the Andago. CONCLUSION Gait parameters measured during a single gait reeducation session in the Andago, in a mixed cohort of predominately older rehabilitation patients, appear comparable to conventional over ground training, other than walking speed which was reduced.
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Affiliation(s)
- Amy Fay
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, Ireland
| | - Eoin Synott
- Physiotherapy Department, Royal Hospital Donnybrook, Morehampton Road, Dublin, Ireland
| | - Edel McDaid
- Physiotherapy Department, Royal Hospital Donnybrook, Morehampton Road, Dublin, Ireland
| | - Emer Barrett
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, Ireland
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Santiago Martinez P, Lord SR, Close JCT, Taylor ME. Associations between psychotropic and anti-dementia medication use and falls in community-dwelling older adults with cognitive impairment. Arch Gerontol Geriatr 2023; 114:105105. [PMID: 37364485 DOI: 10.1016/j.archger.2023.105105] [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: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Evidence for effective fall prevention strategies is limited for people with cognitive impairment. Understanding what factors contribute to fall risk identifies potential intervention strategies. We aimed to determine if psychotropic and anti-dementia medication use are associated with falls in community-dwelling older people with mild-moderate cognitive impairment and dementia. DESIGN Secondary analysis of an RCT (i-FOCIS). PARTICIPANTS AND SETTING 309 community-dwelling people with mild to moderate cognitive impairment or dementia from Sydney, Australia. METHODS Demographic information, medical history, and medication use were collected at baseline and participants were followed up for 1-year for falls using monthly calendars and ancillary telephone falls. RESULTS Psychotropic medication use was associated with an increased rate of falls (IRR 1.41, 95%CI 1.03, 1.93) and slower gait speed, poor balance and reduced lower limb function when adjusting for age, sex, education and cognition, as well as RCT group allocation when examining prospective falls. Antidepressants use increased the rate of falls in a similarly adjusted model (IRR 1.54, 95%CI 1.10, 2.15), but when additionally adjusting for depressive symptoms, antidepressant use was no longer significantly associated with falls while depressive symptoms was. Anti-dementia medication use was not associated with rate of falls. CONCLUSIONS Psychotropic medication use increases fall risk, and anti-dementia medication does not reduce fall risk in older adults with cognitive impairment. Effective management of depressive symptoms, potentially with non-pharmacological approaches, is needed to prevent falls in this population. Research is also required to ascertain the risks/benefits of withdrawing psychotropic medications, particularly in relation to depressive symptoms.
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Affiliation(s)
| | - Stephen R Lord
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E Taylor
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.
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Ferreira CR, Mascarenhas-Melo F, Rodrigues AR, Lima MJR, Pinheiro JP, Chaves C, Teixeira-Lemos E, Bell V. Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study. Pharm Pract (Granada) 2022; 20:2717. [PMID: 36793917 PMCID: PMC9891778 DOI: 10.18549/pharmpract.2022.4.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022] Open
Abstract
Background Falls are a major public health issue, given their prevalence and social impact. Older adults living in long-term care facilities (LTCF) are at greater risk of injury resulting from a fall due to multiple factors, such as nutritional, functional/cognitive impairment, postural instability, polypharmacy, and the presence of potentially inappropriate medications (PIMs). Medication management in LTCF is complex and often sub-optimal and might be crucial for falls. Pharmacist intervention is important, since they have a unique knowledge of medication. However, studies mapping the impact of pharmaceutical activities in Portuguese LTC settings are scarce. Objective This study aims to assess the characteristics of older adult fallers living in LTFCs and examine the relationship between falling and several factors in this population. We also intend to explore the prevalence of PIMs and their relationship with the occurrence of falls. Methods The study was conducted in two long-term care facilities for elderly people, in the central region of Portugal. We included patients aged 65 and older with no reduced mobility or physical weakness and with the ability to understand spoken and written Portuguese. The following information was assessed: sociodemographic characteristics, comorbidities, polypharmacy, fear of falling, functional, nutritional and cognitive status. PIMs were evaluated according to the Beers criteria (2019). Results A total of 69 institutionalised older adults, 45 women and 24 men, with a mean age of 83.14 ± 8.87 years were included. The prevalence of falls was 21.74% Out of these, 46.67% (n=7) fell once, 13.33% (n=2) fell twice, and 40% (n=6) fell 3 or more times. Fallers were mainly women, had lower levels of education, were well nourished, had moderate to severe levels of dependence, and displayed moderate cognitive impairment. All adult fallers had a fear of falling. The main comorbidities of this population were related to the cardiovascular system. Polypharmacy was present in every patient, and at least one PIM was identified in 88.41% of the subjects. Fear of falling (FOF) and cognitive impairment (in subjects with 1 to 11 years of education) showed statistically significant associations with the occurrence of falls (p=0.005 and p=0.05, respectively). No significant differences were found between fallers and non-fallers for any other factors. Conclusions This present study is a preliminary contribution to characterise a group of older adult fallers living in Portuguese LTCFs and demonstrated that fear of falling and cognitive impairment are associated with the occurrence of falls in this population. The high prevalence of polypharmacy and PIMs emphasises the need for tailored interventions featuring the collaboration of a pharmacist to optimise medication management in this population.
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Affiliation(s)
- Carina Ramos Ferreira
- Pharmacist, Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
| | - Filipa Mascarenhas-Melo
- Pharmacist, PhD, Drug Development and Technology Laboratory, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal; REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
| | - Ana Rita Rodrigues
- Pharmacist, PhD student, Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
| | - Maria João Reis Lima
- Pharmacist, PhD, ESAV, CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, Portugal.
| | - João Páscoa Pinheiro
- MD, PhD, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Claúdia Chaves
- ND, MSN, PhD, Nursing Department, ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic Institute of Viseu, Portugal.
| | - Edite Teixeira-Lemos
- Pharmacist, MSc, PhD, CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, Portugal.
| | - Victoria Bell
- Pharmacist, MSc, PhD, Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
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Chantanachai T, Taylor ME, Lord SR, Menant J, Delbaere K, Sachdev PS, Kochan NA, Brodaty H, Sturnieks DL. Risk factors for falls in community-dwelling older people with mild cognitive impairment: a prospective one-year study. PeerJ 2022; 10:e13484. [PMID: 35663527 PMCID: PMC9161814 DOI: 10.7717/peerj.13484] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/03/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Mild cognitive impairment (MCI) is considered an intermediate stage between normal cognitive function and dementia. Fall risk is increased in this group, but there is limited literature exploring specific fall risk factors that may be addressed in fall prevention strategies. The aim of this study was to examine risk factors for falls in older people with MCI, focusing on cognitive, psychological and physical factors. Methods Participants (n = 266, 45% women) were community-dwelling older people aged 70-90 years who met the criteria for MCI. Cognitive, psychological, sensorimotor and physical assessments, physical activity levels, medication use, general health and disability were ascertained at baseline. Falls were monitored prospectively for 12 months. Results During follow-up, 106 (40%) participants reported one or more falls. Poorer visual contrast sensitivity, increased postural sway, lower levels of weekly walking activity, higher levels of depressive symptoms and psychotropic medication use were significantly associated with faller status (≥1 falls) in univariable analyses. Of these factors, poor visual contrast sensitivity, increased postural sway and psychotropic medication use were found to be significant independent predictors of falls in multivariable analysis while controlling for age and sex. No measures of cognitive function were associated with falls. Conclusions Poor visual contrast sensitivity, impaired balance and psychotropic medication use predicted falls in community-dwelling people with MCI. These risk factors may be amenable to intervention, so these factors could be carefully considered in fall prevention programs for this population.
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Affiliation(s)
- Thanwarat Chantanachai
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E. Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S. Sachdev
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia,Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Nicole A. Kochan
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Daina L. Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis. Ageing Res Rev 2021; 71:101452. [PMID: 34450352 DOI: 10.1016/j.arr.2021.101452] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 08/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community. RESULTS A comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample's results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high. CONCLUSIONS In older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.
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Kao PC, Pierro MA, Wu T, Gonzalez DM, Seeley R. Association between functional physical capacity and cognitive performance under destabilizing walking conditions in older adults. Exp Gerontol 2021; 155:111582. [PMID: 34637948 DOI: 10.1016/j.exger.2021.111582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive decline increases the risk of falls in older adults. Understanding the association between cognitive function, functional physical capacity, and falls may help identify targets for fall screening and intervention. This study examined (1) cognitive and functional physical capacity in community-dwelling older adults with and without a history of falls or the presence of brain-derived neurotrophic factor (BDNF) gene Val66Met polymorphism (Val/Met), and (2) the association between their cognitive and functional physical capacity, focusing on the cognitive performance during dual-task, challenging walking conditions. METHODS Twenty-nine healthy, community-dwelling older adults attended two testing sessions for (1) functional assessments of physical capacity and global cognitive status, and (2) performing four cognitive tasks (visual and auditory Stroop tasks, Clock task, and Paced Auditory Serial Addition Test) during standing and while walking on the treadmill with and without medio-lateral treadmill platform sways. RESULTS Participants with a fall history had reduced functional reach distance whereas individuals with Val/Met had reduced functional gait assessment (FGA) score compared to their controls. In addition, participants with a fall history or Val/Met showed reduced Clock task performance under dual-task conditions. Among all cognitive tasks, visual-Stroop performance, especially during the perturbed walking conditions, was significantly correlated with more physical capacity items. The performance of the other three cognitive tasks provided complementary information on those items not correlated with visual-Stroop performance. CONCLUSIONS Clock task performance can distinguish fallers from non-fallers as well as older adults with and without the BDNF gene polymorphism. Administering different types of cognitive tasks and under more challenging walking conditions can better reveal the association between cognitive and functional physical capacity in older adults. Fall screening and prevention intervention should integrate cognitive tasks into the functional physical capacity assessment and training regime, and progress to a more challenging condition such as introducing gait or balance perturbations during the assessment or training.
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Affiliation(s)
- Pei-Chun Kao
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States; New England Robotics Validation and Experimentation (NERVE) Center, University of Massachusetts Lowell, Lowell, MA, United States.
| | - Michaela A Pierro
- Biomedical Engineering and Biotechnology Program, University of Massachusetts Lowell, Lowell, MA, United States
| | - Tong Wu
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Daniela M Gonzalez
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, United States
| | - Rachel Seeley
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
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Thiamwong L, Ng BP, Kwan RYC, Suwanno J. Maladaptive Fall Risk Appraisal and Falling in Community-Dwelling Adults Aged 60 and Older: Implications for Screening. Clin Gerontol 2021; 44:552-561. [PMID: 34233599 PMCID: PMC10900196 DOI: 10.1080/07317115.2021.1950254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to examine the characteristics of maladaptive fall risk appraisal (FRA), discrepancies between physical and perceived-fall risk, and their associations with falls. METHODS Fall risk appraisal was determined using the full-tandem stand test as an objective measure and the Fall Efficacy Scale-International as a subjective measure, and 433 adults aged ≥60 years from Thailand were classified into four groups: irrational (low physical/high perceived risk), incongruent (high physical/low perceived risk), congruent (high physical/high perceived risk) and rational (low physical/low perceived risk) FRAs. RESULTS Only 20.8% of adults aged ≥60 years had rational FRA. The rest of the participants had either irrational (57.3%) or incongruent (2.3%), or congruent (19.6%) FRAs. Approximately 74% of those with congruent FRA reported experiencing a fall last year, followed by incongruent (60%), irrational (41.1%), and rational FRAs (27.8%, p < .001). After covariates adjustment, participants with congruent FRA were 3.06 times more likely of falling than those with rational FRA (p = .011). CONCLUSIONS Maladaptive FRA is highly prevalent among adults aged ≥60. Identifying maladaptive FRA is essential for ensuring that adults aged ≥60 receiving early treatment associated with falls. CLINICAL IMPLICATIONS Preventing a transition from rational to irrational, incongruent, and congruent fall risk appraisals is vital to prevent falls and mitigate this problematic health condition.
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Affiliation(s)
- Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, Florida, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, Florida, USA
| | - Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, Florida, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, Florida, USA
| | - Rick Yiu Cho Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Jom Suwanno
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
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Yoshikawa A, Smith ML, Ory MG. Differential risk of falls associated with pain medication among community-dwelling older adults by cognitive status. Age Ageing 2021; 50:1578-1585. [PMID: 33765121 DOI: 10.1093/ageing/afab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Persons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status. METHODS We analysed a nationally representative sample of community-dwelling Medicare beneficiaries (n = 7,491) who completed cognitive assessments used for dementia classification in the 2015 US National Health and Aging Trends Study. We performed survey-weighted logistic regression to investigate differential associations between pain medication use and a recent fall by cognitive status: no dementia, possible dementia and probable dementia, controlling for sociodemographic and health characteristics. RESULTS About 16.5% of the analytic sample was classified as possible dementia (8.3%) and probable dementia (8.2%). Pain medication use was associated with a recent fall among those with probable dementia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.14, 3.03], controlling for sociodemographic and health characteristics. Taking medication for pain 2 days a week or more (OR = 2.14, 95% CI: 1.20, 3.81) was associated with falls among those with probable dementia. Bothersome pain and worry about falling down were also associated with falls among participants with no dementia and possible dementia, respectively. CONCLUSION Differential risk factors for falls by cognitive status imply the need for tailored pain management and fall prevention strategies. The provision of fall prevention programmes stressing balance training and medication use is important regardless of cognitive status in community-dwelling older adults. Future research should explore other modifiable factors associated with the risk of falls among community-dwelling adults.
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Affiliation(s)
- Aya Yoshikawa
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Marcia G Ory
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
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Yuan JL, Zhao RX, Ma YJ, Li XD, Zhou XM, Wang XF, Jiang XY, Li SJ. Prevalence/potential risk factors for motoric cognitive risk and its relationship to falls in elderly Chinese people: a cross-sectional study. Eur J Neurol 2021; 28:2680-2687. [PMID: 33905575 DOI: 10.1111/ene.14884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR) is characterized by slow walking speed and subjective memory complaints (SMCs). This study investigated the prevalence and potential risk factors of MCR and its association with falls in Chinese community-dwelling older adults. METHODS The analysis was based on data from the Rugao Longevity and Aging Study (RuLAS). MCR was defined as the presence of both SMCs and slow walking speed in participants free of major neurocognitive disorders. SMCs were determined according to a positive answer to the question 'Do you feel you have more problems with memory than most?' in the 15-item Geriatric Depression Scale. Slow walking speed was defined as one standard deviation or more below the mean value for patients' age and sex. Data on falls were derived from a standardized questionnaire. RESULTS The prevalence of SMCs, slow walking speed and MCR in the RuLAS cohort (N = 1592) was 51.9%, 15.6% and 8.3%, respectively. After adjusting for other covariates, an occupation of farming (odds ratio [OR] 2.358, 95% confidence interval [CI] 1.007-5.521, p = 0.048), history of cerebrovascular disease (OR 2.215, 95% CI 1.032-4.752, p = 0.041) and hospitalization (OR 2.008, 95% CI 1.120-3.602, p = 0.019) were risk factors for MCR. Binary logistic regression analysis indicated that the risk of falls was increased by MCR (OR 1.547, 95% CI 1.009-2.371), SMC (OR 1.308, 95% CI 1.003-1.707) and slow walking speed (OR 1.442, 95% CI 1.030-2.017). CONCLUSIONS Early identification of potential risk factors of MCR can prevent the occurrence of adverse health events such as falls in the elderly.
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Affiliation(s)
- Jing-Lin Yuan
- Department of Neurology, Beijing Daxing District People's Hospital, Beijing, China
| | - Rui-Xue Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ya-Jun Ma
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dong Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Mei Zhou
- Department of Neurology, Beijing Daxing District People's Hospital, Beijing, China
| | - Xiao-Feng Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai, China
| | - Xiao-Yan Jiang
- Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, China
| | - Shu-Juan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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van Schooten KS, Taylor ME, Close JCT, Davis JC, Paul SS, Canning CG, Latt MD, Hoang P, Kochan NA, Sachdev PS, Brodaty H, Dean CM, Hulzinga F, Lord SR, Delbaere K. Sensorimotor, Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study. Arch Phys Med Rehabil 2020; 102:874-880. [PMID: 33253696 DOI: 10.1016/j.apmr.2020.10.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations. DESIGN We pooled data from 5 studies for this observational analysis of prospective falls. SETTING Community or low-level care facility. PARTICIPANTS Older people (N=1090; 74.0±9.4y; 579 female); 500 neurologically intact (NI) older people and 3 groups with neurologic disorders (cognitive impairment, n=174; multiple sclerosis (MS), n=111; Parkinson disease, n=305). INTERVENTIONS None. MAIN OUTCOME MEASURES Sensorimotor function was assessed with the Physiological Profile Assessment, cognitive function with tests of executive function, affect with questionnaires of depression, and concern about falling with falls efficacy questionnaires. These variables were associated with fall incidence rates, obtained prospectively over 6-12 months. RESULTS Poorer sensorimotor function was associated with falls (incidence rate ratio [95% CI], 1.46 [1.28-1.66]). Impaired executive function was the strongest predictor of falls overall (2.91 [2.27-3.73]), followed by depressive symptoms (2.07 [1.56-2.75]) and concern about falling (2.02 [1.61-2.55]). Associations were similar among groups, except for a weaker relationship with executive impairment in NI persons and a stronger relationship with concern about falling in persons with MS. Multivariable analyses showed that executive impairment, poorer sensorimotor performance, depressive symptoms, and concern about falling were independently associated with falls. CONCLUSIONS Deficits in cognition (executive function) and affect (depressive symptoms) and concern about falling are as important as sensorimotor function for fall prediction. These domains should be included in fall risk assessments for older people and clinical groups.
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Affiliation(s)
- Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, Australia
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Serena S Paul
- Faculty of Health Sciences, University of Sydney, Sydney Lidcombe, Sydney, New South Wales, Australia
| | - Colleen G Canning
- Faculty of Health Sciences, University of Sydney, Sydney Lidcombe, Sydney, New South Wales, Australia
| | - Mark D Latt
- Geriatric Medicine Department, University of Sydney, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| | - Phu Hoang
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Catherine M Dean
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, Sydney, New South Wales, Australia
| | - Femke Hulzinga
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Department of Rehabilitation Sciences, Biomedical Sciences Group, KU Leuven University, Leuven, Belgium
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
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11
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Moon Y, Han SH, Kim YS, Shin J, Uhm KE, Jeon HJ, Choi J, Lee J. Hospital adverse outcomes of the elderly in a tertiary referral hospital: A prospective cohort study of 9,586 admissions. Arch Gerontol Geriatr 2020; 92:104253. [PMID: 33032184 DOI: 10.1016/j.archger.2020.104253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the hospital adverse outcomes (HAO) of admitted older adult patients in a large prospective cohort and investigate the demographic, economic, and health-related characteristics at risk of HAO in all older adult patients admitted in the general ward of a tertiary referral hospital. MATERIALS AND METHODS We recruited admission episodes of older adult patients aged over 65 years who were admitted at the general ward of Konkuk University Medical Center, which is a tertiary referral hospital, from September 2016 to October 2017. Out of 9,586 admission episodes, 8,263 were included. Modified from the Geriatric Screening for Care-10, six common geriatric health issues, namely, dysphagia, polypharmacy, fecal incontinence, functional mobility, depression, and dementia, were evaluated. Fall, hospital-acquired pressure ulcer (HPU), and mortality were checked daily by experienced nurses during the patients' hospital stay. A logistic regression model was used, and P < 0.05 was the threshold of significance. RESULTS The incidence rates of fall and HPU were 1.3 % and 4.0 %, respectively. The hospital mortality was 6.1 %. Older adult patients with dysphagia or dementia upon admission were significantly associated with an increased likelihood of falls. Furthermore, age, ER admission, low income, fecal incontinence, or functional immobility increased the HPU incidence. Meanwhile, age, male, ER admission, fecal incontinence, or functional immobility significantly increased the hospital mortality. CONCLUSION All demographic, economic, and health-related characteristics, except for polypharmacy and depression, affect the incidence of HAO. Intervention to vulnerable older adult patients with HAO risk could improve the treatment outcome.
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Affiliation(s)
- Yeonsil Moon
- Department of Neurology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea; Center for Geriatric Neuroscience Research, Institute of Biomedical Science, Konkuk University, Seoul, Republic of Korea
| | - Yoon-Sook Kim
- Department of Quality Improvement, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea.
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea.
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12
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Lipardo DS, Tsang WW. Effects of combined physical and cognitive training on fall prevention and risk reduction in older persons with mild cognitive impairment: a randomized controlled study. Clin Rehabil 2020; 34:773-782. [PMID: 32380917 DOI: 10.1177/0269215520918352] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effects of combined physical and cognitive training on fall rate and risks of falling in older adults with mild cognitive impairment. DESIGN The design of this study was an assessor-blinded, randomized controlled trial. SETTING The setting for this study is the community from Manila, Philippines. SUBJECTS In total, 92 community-dwelling older persons with mild cognitive impairment (aged 60-83) were randomly allocated to three intervention groups and one waitlist control group. INTERVENTIONS The physical training, cognitive training, and combined physical and cognitive training intervention programs were delivered for 60 to 90 minutes, one to three times per week for 12 weeks with six-month follow-up. MAIN MEASURES Participants were assessed at baseline, 12 weeks after baseline, and 36 weeks after baseline for fall incidence, overall fall risk, dynamic balance, walking speed, and lower limb strength. RESULTS No significant difference was observed across time and groups on fall incidence rate at 12 weeks (P = 0.152) and at 36 weeks (P = 0.954). The groups did not statistically differ in other measures except for a significant improvement in dynamic balance based on Timed Up and Go Test in the combined physical and cognitive training group (9.0 seconds with P = 0.001) and in the cognitive training alone group (8.6 seconds with P = 0.012) compared to waitlist group (11.1 seconds) at 36 weeks. CONCLUSION There was no significant difference among groups on fall rate and risks of falling post-intervention. Dynamic balance was improved with combined physical and cognitive training and cognitive training alone. Further research with a larger sample size is needed to establish whether or not the interventions are effective.
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Affiliation(s)
- Donald S Lipardo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Department of Physical Therapy, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - William Wn Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Department of Physiotherapy, School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong, China
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13
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White matter hyperintensities are associated with falls in older people with dementia. Brain Imaging Behav 2020; 13:1265-1272. [PMID: 30145714 DOI: 10.1007/s11682-018-9943-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
White Matter Hyperintensities (WMHs) are associated with impaired gait, balance and cognition and increased fall risk in cognitively healthy older people. However, few studies have examined such relationships in older people with dementia. Understanding the role of WMHs in falls may assist in developing effective fall prevention strategies. We investigated the relationship between baseline WMHs, cognitive and sensorimotor function and prospective falls in older people with dementia. Twenty-eight community-dwelling older people with mild-moderate dementia (MMSE 11-23; ACE-R < 83) underwent magnetic resonance imaging and assessment of sensorimotor and cognitive (global and processing speed) function at baseline. WMHs, were quantified using a fully automated segmentation toolbox, UBO Detector ( https://cheba.unsw.edu.au/group/neuroimaging-pipeline ). Falls were ascertained prospectively for 12-months using monthly calendars with the assistance of carers. The median age of the participants was 83 years (IQR 77-86); 36% were female; 21 (75%) fell during follow-up. Using Generalized Linear Models, larger volumes of total WMHs were found to be significantly associated with poorer global cognitive and sensorimotor function. Using modified Poisson regression, total, periventricular and deep WMHs were each associated with future falls while controlling for age, sex, intracranial volume and vascular risk. Each standard deviation increase in total and periventricular WMH volume resulted in a 33% (RR 1.33 95%CI 1.07-1.66) and 30% (RR 1.30 95%CI 1.06-1.60) increased risk of falling, respectively. When the deep WMH volume z-scores were dichotomized at the median, individuals with greater deep WMH volumes had an 81% (RR 1.81 95% CI 1.02-3.21) increased risk of falling. WMHs were associated with poorer sensorimotor and cognitive function in people with dementia and total, periventricular and deep WMHs were associated with falls. Further research is needed to confirm these preliminary findings and explore the impact of vascular risk reduction strategies on WMHs, functional performance and falls.
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14
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Feasibility and Accuracy of Different Methods for Collecting Data on Falls Among Older People With Dementia. Alzheimer Dis Assoc Disord 2019; 34:362-365. [PMID: 31789633 PMCID: PMC7116406 DOI: 10.1097/wad.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. This study compared different methods for collecting data on falls among people with dementia to identify which is most feasible and accurate. Eighty-three dyads, comprised of a community-dwelling person with dementia and their informal carer, participated in the TAi ChI for people with demenTia (TACIT) trial. Falls were collected prospectively over 6 months using monthly calendars, weekly and monthly telephone interviews, and 3-monthly telephone interviews with the carer. Unique falls identified across the reporting methods were combined, and this total was compared against each reporting method in isolation and combinations. A higher frequency of falls indicated greater accuracy. Falls data collection was most feasible with weekly telephone interviews (84%), and most accurate with the combination of weekly telephone interviews with monthly calendars (96%). For the greatest completeness and accuracy of falls data with community-dwelling people with dementia, researchers should use both weekly telephone interviews and monthly calendars.
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15
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Thiamwong L. A hybrid concept analysis of fall risk appraisal: Integration of older adults' perspectives with an integrative literature review. Nurs Forum 2019; 55:190-196. [PMID: 31773750 DOI: 10.1111/nuf.12415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to define the concept of fall risk appraisal (FRA) and its measures by integrating the older adults' perspectives with an integrative literature review. BACKGROUND Appraised fall risk is based mainly on either subjective or objective measures, which may result in inaccurate predictions of fall risk. DESIGN This study was developed based on three phases of the hybrid concept analysis including a theoretical phase, a fieldwork phase, and an analytic phase. Eleven articles were selected to review in the theoretical phase. Qualitative data from in-depth interviews and focus groups in the fieldwork phase were used to compare and integrate into the analytic phase. RESULTS FRA is a two-dimensional assessment of fall risk in older adults. Two independent dimensions were defined as (a) physiological fall risk dimension reflecting physical or body function, which may decline with age, and (b) perceived fall risk dimension reflecting the older adults' perception of their likelihood to fall. FRA consists of two categories including adaptive fall risk appraisal and maladaptive fall risk appraisal. CONCLUSION A practical definition of FRA and its measures could be extremely valuable for supporting the need for fall risk assessments and would be integral to nursing practice.
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Affiliation(s)
- Ladda Thiamwong
- Nursing Systems Department, College of Nursing, University of Central Florida, Orlando, Florida.,Disability, Aging and Technology Cluster, University of Central Florida, Orlando, Florida
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16
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Beauchet O, Sekhon H, Schott AM, Rolland Y, Muir-Hunter S, Markle-Reid M, Gagne H, Allali G. Motoric Cognitive Risk Syndrome and Risk for Falls, Their Recurrence, and Postfall Fractures: Results From a Prospective Observational Population-Based Cohort Study. J Am Med Dir Assoc 2019; 20:1268-1273. [DOI: 10.1016/j.jamda.2019.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 01/24/2023]
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17
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Ghanavati T, Smitt MS, Lord SR, Sachdev P, Wen W, Kochan NA, Brodaty H, Delbaere K. Deep white matter hyperintensities, microstructural integrity and dual task walking in older people. Brain Imaging Behav 2019; 12:1488-1496. [PMID: 29297156 DOI: 10.1007/s11682-017-9787-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To examine neural, physiological and cognitive influences on gait speed under single and dual-task conditions. Sixty-two community-dwelling older people (aged 80.0 ± 4.2 years) participated in our study. Gait speed was assessed with a timed 20-meter walk under single and dual-task (reciting alternate letters of the alphabet) conditions. Participants also underwent tests to estimate physiological fall risk based on five measures of sensorimotor function, cognitive function across five domains, brain white matter (WM) hyperintensities and WM microstructural integrity by measuring fractional anisotropy (FA). Univariate linear regression analyses showed that global physiological and cognitive measures were associated with single (β = 0.594 and β=-0.297, respectively) and dual-task gait speed (β = 0.306 and β=-0.362, respectively). Deep WMHs were associated with dual-task gait speed only (β = 0.257). Multivariate mediational analyses showed that global and executive cognition reduced the strength of the association between deep WMHs and dual-task gait speed by 27% (β = 0.188) and 44% (β = 0.145) respectively. There was a significant linear association between single-task gait speed and mean FA values of the genu (β=-0.295) and splenium (β=-0.326) of the corpus callosum, and between dual-task gait speed and mean FA values of Superior Cerebellar Peduncle (β=-0.284), splenium of the Corpus Callosum (β=-0.286) and Cingulum (β=-0.351). Greater deep WMH volumes are associated with slower walking speed under dual-task conditions, and this relationship is mediated in part by global cognition and executive abilities specifically. Furthermore, both cerebellum and cingulum are related to dual-task walking due to their role in motor skill performance and attention, respectively.
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Affiliation(s)
- Tabassom Ghanavati
- Department of Physiotherapy Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Myriam Sillevis Smitt
- Neuroscience Research Australia, University of New South Wales, NeuRA, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, NeuRA, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA) School of Psychiatry UNSW Medicine, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing (CHeBA) School of Psychiatry UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA) School of Psychiatry UNSW Medicine, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA) School of Psychiatry UNSW Medicine, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, University of New South Wales, NeuRA, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia.
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18
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Manuel AL, Foxe D, Bradshaw N, Cordato NJ, Hodges JR, Burrell JR, Piguet O. Sustained attention failures on a 3-min reaction time task is a sensitive marker of dementia. J Neurol 2019; 266:1323-1331. [PMID: 30834482 DOI: 10.1007/s00415-019-09261-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/11/2019] [Accepted: 02/26/2019] [Indexed: 12/14/2022]
Abstract
The objective of the study is to determine the utility of a simple reaction time task as a marker of general cognitive decline across the frontotemporal lobar degeneration (FTLD) spectrum and in Alzheimer's disease (AD). One hundred and twelve patients presenting with AD or FTLD affecting behaviour (behavioural-variant frontotemporal dementia), language (progressive non fluent aphasia, logopenic progressive aphasia, semantic dementia) or motor function (corticobasal syndrome, progressive supranuclear palsy, frontotemporal dementia-motor neuron disease) and 25 age-matched healthy controls completed the Psychomotor Vigilance Task (PVT), a 3-min reaction time (RT) task. The proportion of lapses (RT > 500 ms) was significantly increased in dementia patients compared to healthy controls, except for semantic dementia, and correlated with all cognitive functions except language. Discrimination of individuals (dementia patients versus healthy controls) based on the proportion of lapses yielded the highest classification performance (Area Under the Curve, AUC, 0.90) compared to standard neuropsychological tests. Only the complete and lengthy neuropsychological battery had a higher predictive value (AUC 0.96). The basic ability to sustain attention is fundamental to perform any cognitive task. Lapses, interpreted as momentary shifts in goal-directed processing, can therefore, be used as a marker of general cognitive decline indicative of possible dementia.
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Affiliation(s)
- Aurélie L Manuel
- School of Psychology, The University of Sydney, Sydney, Australia. .,Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia. .,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.
| | - David Foxe
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - Nathan Bradshaw
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Nicholas J Cordato
- Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia.,The Department of Aged Care, St George Hospital, Kogarah, Australia.,Calvary Health Care Sydney, Kogarah, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - John R Hodges
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia.,Clinical Medical School, The University of Sydney, Sydney, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia.,Clinical Medical School, The University of Sydney, Sydney, Australia.,Concord General Hospital, Sydney, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, 100 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
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19
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Murphy SL, Tapper EB, Blackwood J, Richardson JK. Why Do Individuals with Cirrhosis Fall? A Mechanistic Model for Fall Assessment, Treatment, and Research. Dig Dis Sci 2019; 64:316-323. [PMID: 30327964 DOI: 10.1007/s10620-018-5333-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/09/2018] [Indexed: 12/12/2022]
Abstract
Falls are prevalent for people with cirrhosis and commonly lead to loss of independence, reduced quality of life, and mortality. Despite a critical need for fall prevention in this population, cirrhosis-specific fall-related mechanisms are not well understood. We posit that most falls in this patient population are due to a coalescence of discrete subclinical impairments that are not typically detected at the point of care. The combined effect of these subtle age- and disease-related neurocognitive and muscular impairments leads to the inability to respond successfully to a postural perturbation within the available 300 to 400 ms. This article provides a conceptual model of physiological resilience to avoid a fall that focuses on attributes that underlie the ability to withstand a postural perturbation and their clinical evaluation. Evidence supporting this model in cirrhosis and other high fall risk conditions will be synthesized and suggestions for fall assessment and treatment will be discussed.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 344, Ann Arbor, MI, 48106, USA. .,Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA.
| | - Elliot B Tapper
- Department of Internal Medicine, Division of Gasteroenterology, University of Michigan, Ann Arbor, MI, USA. .,Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA.
| | - Jennifer Blackwood
- Department of Physical Therapy, University of Michigan - Flint Campus, Flint, MI, USA
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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20
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Araújo RS, Nascimento ÉRD, Barros RDS, Ritter SRF, Abreu AMS, Garcia PA. Can clinical and physical-functional factors predict falls in cognitively impaired older adults? REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to investigate the frequency of falls and clinical and physical-functional factors associated with falls, and the accuracy of such factors to identify the risk of falling in cognitively impaired older adults. Method: a cross-sectional study with cognitively impaired older adults was carried out using the Mini-Mental State Examination. The dependent variable was a history of falls in the previous six months. The independent variables were self-reported mental confusion, hearing and visual impairment, physical fatigue, muscle weakness, dizziness, body imbalance, insecurity when walking, diagnosed depression, hospitalizations, continuous use medications (form from study used), muscle mass (calf circumference) and handgrip strength (dynamometry), functional capacity (Pfeffer) and mobility (SAM-Br). Descriptive statistics were applied. The groups were compared using the Mann Whitney U test, the risk factors were identified by univariate and multivariate logistic regression, and the area under the ROC curve (AUC) was calculated for the associated factors. Results: 216 cognitively impaired older adults were included in the analysis, 41.7% of whom were fallers. Multivariate regression analyzes indicated that complaints of visual impairment (OR=2.8; p=0.015) and body imbalance (OR=2.7; p=0.004), and greater medication use (OR=1.1; p=0.038) were associated with a history of falls. The AUC found poor accuracy for quantity of medications as a screening tool for fallers (AUC=0.6 [0.5; 0.7]; p=0.028). Conclusion: cognitively impaired older adults had a high frequency of falls. Complaints of visual impairment, body imbalance and polypharmacy were predictors of falls. The early assessment of these factors can contribute to the identification of cognitively-impaired older adults at risk of falling in clinical practice and research.
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21
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Taylor ME, Butler AA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JC. Inaccurate judgement of reach is associated with slow reaction time, poor balance, impaired executive function and predicts prospective falls in older people with cognitive impairment. Exp Gerontol 2018; 114:50-56. [DOI: 10.1016/j.exger.2018.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/26/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022]
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22
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Chen R, Chien WC, Kao CC, Chung CH, Liu D, Chiu HL, Chou KR. Analysis of the risk and risk factors for injury in people with and without dementia: a 14-year, retrospective, matched cohort study. Alzheimers Res Ther 2018; 10:111. [PMID: 30376887 PMCID: PMC6208020 DOI: 10.1186/s13195-018-0437-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. In this study, we investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan. METHODS We collected relevant data between 2000 and 2013 from the National Health Insurance Research Database (NHIRD). Overall, 455,630 cases, consisting of 91,126 people with dementia and 364,504 people without dementia, were included in this study and we performed subgroup analysis. A multivariate Cox proportional hazards regression analysis was used to determine the risk of injuries. RESULTS The 14-year follow-up data showed that people with dementia had a higher risk of injury-related hospitalization than did people without dementia (19.92% vs 18.86%, hazard ratio (HR) = 1.070, p < 0.001). Regarding the cause of injury, people with dementia were more likely to be hospitalized due to suffocation (HR = 2.301, p < 0.001), accidental drug poisoning (HR = 1.485, p < 0.001), or falls (HR = 1.076, p < 0.001), and were less likely to be hospitalized due to suicide or self-inflicted injury (HR = 0.670, p < 0.001) or a traffic accident (HR = 0.510, p < 0.001) than were people without dementia. Subgroup analysis showed that people with dementia with any of the three subtypes of dementia were at a higher risk of homicide or abuse than were people without dementia (vascular dementia, HR = 2.079, p < 0.001; Alzheimer's disease, HR = 1.156, p < 0.001; other dementia, HR = 1.421, p < 0.001). The risk factors for overall injury included dementia diagnosis, female gender, age 65-74 years, and seeking medical attention for an injury within the past year. CONCLUSION People with dementia are at a higher risk of injury-related hospitalization than people without dementia. The results of this study provide a reference for preventing suffocation, drug poisoning, and falls in people with dementia. In addition, government agencies should pay attention to and intervene in cases of abuse suffered by people with dementia.
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Affiliation(s)
- Ruey Chen
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490 Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
| | - Ching-Chiu Kao
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Doresses Liu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Huei-Ling Chiu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Kuei-Ru Chou
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, No.252, Wuxing St, Xinyi District, Taipei, 110 Taiwan
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Taylor BJ, Stevenson M, McDowell M. Communicating risk in dementia care: Survey of health and social care professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e291-e303. [PMID: 29226458 DOI: 10.1111/hsc.12519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision-making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June-September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants' responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10-fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.
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Affiliation(s)
- Brian J Taylor
- Institute for Social Sciences, Ulster University, Northern Ireland, UK
| | - Mabel Stevenson
- School of Sociology & Applied Social Studies, Ulster University, Northern Ireland, UK
| | - Michelle McDowell
- Harding Centre for Risk Literacy, Max Planck Institute, Berlin, Germany
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24
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Harwood RH, van der Wardt V, Goldberg SE, Kearney F, Logan P, Hood-Moore V, Booth V, Hancox JE, Masud T, Hoare Z, Brand A, Edwards RT, Jones C, das Nair R, Pollock K, Godfrey M, Gladman JRF, Vedhara K, Smith H, Orrell M. A development study and randomised feasibility trial of a tailored intervention to improve activity and reduce falls in older adults with mild cognitive impairment and mild dementia. Pilot Feasibility Stud 2018; 4:49. [PMID: 29468084 PMCID: PMC5816352 DOI: 10.1186/s40814-018-0239-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
Background People with dementia progressively lose abilities and are prone to falling. Exercise- and activity-based interventions hold the prospect of increasing abilities, reducing falls, and slowing decline in cognition. Current falls prevention approaches are poorly suited to people with dementia, however, and are of uncertain effectiveness. We used multiple sources, and a co-production approach, to develop a new intervention, which we will evaluate in a feasibility randomised controlled trial (RCT), with embedded adherence, process and economic analyses. Methods We will recruit people with mild cognitive impairment or mild dementia from memory assessment clinics, and a family member or carer. We will randomise participants between a therapy programme with high intensity supervision over 12 months, a therapy programme with moderate intensity supervision over 3 months, and brief falls assessment and advice as a control intervention. The therapy programmes will be delivered at home by mental health specialist therapists and therapy assistants. We will measure activities of daily living, falls and a battery of intermediate and distal health status outcomes, including activity, balance, cognition, mood and quality of life. The main aim is to test recruitment and retention, intervention delivery, data collection and other trial processes in advance of a planned definitive RCT. We will also study motivation and adherence, and conduct a process evaluation to help understand why results occurred using mixed methods, including a qualitative interview study and scales measuring psychological, motivation and communication variables. We will undertake an economic study, including modelling of future impact and cost to end-of-life, and a social return on investment analysis. Discussion In this study, we aim to better understand the practicalities of both intervention and research delivery, and to generate substantial new knowledge on motivation, adherence and the approach to economic analysis. This will enable us to refine a novel intervention to promote activity and safety after a diagnosis of dementia, which will be evaluated in a definitive randomised controlled trial. Trial registration ClinicalTrials.gov: NCT02874300; ISRCTN 10550694.
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Affiliation(s)
- Rowan H Harwood
- 1Health Care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH UK.,2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Veronika van der Wardt
- 2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Sarah E Goldberg
- 3School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Fiona Kearney
- 1Health Care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Pip Logan
- 2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Vicky Hood-Moore
- 3School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Vicky Booth
- 2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Jennie E Hancox
- 2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Tahir Masud
- 1Health Care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH UK.,2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Zoe Hoare
- 4NWORTH Clinical Trials Unit, Bangor University, Bangor, LL57 2PZ UK
| | - Andrew Brand
- 4NWORTH Clinical Trials Unit, Bangor University, Bangor, LL57 2PZ UK
| | - Rhiannon Tudor Edwards
- 5Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ UK
| | - Carys Jones
- 5Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ UK
| | - Roshan das Nair
- 6Institute of Mental Health, University of Nottingham, Nottingham, NG8 1BB UK
| | - Kristian Pollock
- 3School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Maureen Godfrey
- 2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - John R F Gladman
- 2Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH UK
| | - Kavita Vedhara
- 7Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD UK
| | - Helen Smith
- 8Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, NG6 9RD UK
| | - Martin Orrell
- 6Institute of Mental Health, University of Nottingham, Nottingham, NG8 1BB UK
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25
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Öhman H, Savikko N, Strandberg T, Kautiainen H, Raivio M, Laakkonen ML, Tilvis R, Pitkälä KH. Effects of Exercise on Functional Performance and Fall Rate in Subjects with Mild or Advanced Alzheimer's Disease: Secondary Analyses of a Randomized Controlled Study. Dement Geriatr Cogn Disord 2017; 41:233-41. [PMID: 27160164 DOI: 10.1159/000445712] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exercise improves functional performance in subjects with dementia. However, whether the benefits of exercise are evident in all stages of dementia remains uncertain. This study examines how people in different stages of Alzheimer's disease (AD) benefit from exercise intervention in their physical functioning and risk of falling. METHODS The present study is a subanalysis of a randomized controlled trial examining the effects of exercise intervention (twice a week for 12 months) in AD patients (n = 194). We studied the effects separately in participants with mild dementia and in participants with advanced dementia. RESULTS In subjects with mild dementia, the deterioration in physical functioning was slower in the intervention group than in the controls. Changes in Functional Independence Measure at 12 months were -2.7 (95% CI -0.5 to -4.9) in the intervention group and -10.1 (95% CI -7.0 to -13.3) in the control group (p < 0.001). The exercise intervention proved effective in preventing falls among patients with advanced AD, with an incidence rate ratio of 0.47 (95% CI 0.37-0.60; p < 0.001). CONCLUSIONS Regular exercise may slow the rate of functional deterioration in mild AD and reduce falls in patients suffering from advanced AD.
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Affiliation(s)
- Hannareeta Öhman
- Department of General Practice and Unit of Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Finland
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26
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Taylor ME, Lasschuit DA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Kvelde T, Close JCT. Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study. Arch Gerontol Geriatr 2017; 73:148-153. [PMID: 28818760 DOI: 10.1016/j.archger.2017.07.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia. METHODS One hundred and seventy-seven older people with dementia (Mini-Mental State Examination 11-23; Addenbrooke's Cognitive Examination-Revised <83) residing in the community or low level care facility completed baseline neuropsychological, physical and functional assessments. Of these, 134 participants agreed to reassessment of the above measures one year later. RESULTS Overall, many neuropsychological, physical and functional performance measures declined significantly over the one year study period. Baseline gait speed was significantly associated with decline in verbal fluency (B(109)=2.893, p=0.046), specifically phonemic/letter fluency (B(109)=2.812, p=0.004) while controlling for age, education, dementia drug use and baseline cognitive performance. There was also a trend for an association between baseline gait speed and decline in clock drawing performance (B(107)=0.601, p=0.071). CONCLUSIONS Older people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; Cognitive Decline Partnership Centre, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia.
| | - Danielle A Lasschuit
- Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia; Department of Geriatric Medicine, Prince of Wales Hospital, South East Sydney Local Health District, Sydney, NSW, Australia.
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia.
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia.
| | - Susan E Kurrle
- Cognitive Decline Partnership Centre, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - A Stefanie Mikolaizak
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.
| | - Tasha Kvelde
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia.
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27
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Cartagena LJ, Kang A, Munnangi S, Jordan A, Nweze IC, Sasthakonar V, Boutin A, George Angus LD. Risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. Aging Clin Exp Res 2017; 29:427-433. [PMID: 27142683 DOI: 10.1007/s40520-016-0579-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Falls are a significant cause of mortality in the elderly patients. Despite this, the literature on in-hospital mortality related to elderly falls remains sparse. Our study aims to determine the risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. METHODS All elderly case records with fall-related injuries between 2003 and 2013 were retrospectively analyzed for demographic characteristics, injury severities, comorbidity factors and clinical outcomes. Logistic regression analysis was used to examine the risk factors associated with in-hospital mortality. RESULTS In total, 1026 elderly patients with fall-related injuries were included in the study. The average age of patients was 80.94 ± 8.16 years. Seventy seven percent of the patients had at least one comorbid condition. Majority of the falls occurred at home. More than half of the patients fell from ground level. Overall, the in-hospital mortality rate was 16 %. Head injury constituted the most common injury sustained in patients who died (77 %). In addition to age, ISS, GCS, ICU admission and anemia were significantly (P < 0.05) associated with in-hospital deaths in elderly fall patients. CONCLUSION Ground-level falls in the elderly can be devastating and carry a significant mortality rate. Elderly patients with anemia were two times more likely to die in the hospital after sustaining a fall in our study population. Increased focus on anemia which is often underappreciated in elderly fall patients can be beneficial in improving outcomes and reducing in-hospital mortality.
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Affiliation(s)
- L J Cartagena
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
| | - A Kang
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
| | - S Munnangi
- Department of Emergency Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA.
| | - A Jordan
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
| | - I C Nweze
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
| | - V Sasthakonar
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
| | - A Boutin
- Department of Emergency Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
| | - L D George Angus
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
- Department of Surgery, Kings County Hospital Center, Brooklyn, NY, USA
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28
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Lipardo DS, Aseron AMC, Kwan MM, Tsang WW. Effect of Exercise and Cognitive Training on Falls and Fall-Related Factors in Older Adults With Mild Cognitive Impairment: A Systematic Review. Arch Phys Med Rehabil 2017; 98:2079-2096. [PMID: 28554873 DOI: 10.1016/j.apmr.2017.04.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/09/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of exercise and cognitive training on falls reduction and on factors known to be associated with falls among community-dwelling older adults with mild cognitive impairment (MCI). DATA SOURCES Seven databases (PubMed, CINAHL, Cochrane Library, Web of Science, ProQuest, ProQuest Dissertations and Theses, Digital Dissertation Consortium) and reference lists of pertinent articles were searched. STUDY SELECTION Randomized controlled trials (RCTs) on the effect of exercise, cognitive training, or a combination of both on falls and factors associated with falls such as balance, lower limb muscle strength, gait, and cognitive function among community-dwelling older adults with MCI were included. DATA EXTRACTION Data were extracted using the modified Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) tool. Study quality was assessed using the JBI-MAStARI appraisal instrument. DATA SYNTHESIS Seventeen RCTs (1679 participants; mean age ± SD, 74.4±2.4y) were included. Exercise improved gait speed and global cognitive function in MCI; both are known factors associated with falls. Cognitive training alone had no significant effect on cognitive function, while combined exercise and cognitive training improved balance in MCI. Neither fall rate nor the number of fallers was reported in any of the studies included. CONCLUSIONS This review suggests that exercise, and combined exercise and cognitive training improve specific factors associated with falls such as gait speed, cognitive function, and balance in MCI. Further research on the direct effect of exercise and cognitive training on the fall rate and incidence in older adults with MCI with larger sample sizes is highly recommended.
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Affiliation(s)
- Donald S Lipardo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - Anne Marie C Aseron
- College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - Marcella M Kwan
- Rural Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - William W Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Fernando E, Fraser M, Hendriksen J, Kim CH, Muir-Hunter SW. Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Physiother Can 2017; 69:161-170. [PMID: 28539696 DOI: 10.3138/ptc.2016-14] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: People with dementia fall more often than cognitively healthy older adults, but their risk factors are not well understood. A review is needed to determine a fall risk profile for this population. The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia. Methods: Articles published between January 1988 and October 2014 in EMBASE, PubMed, PsycINFO, and CINAHL were searched. Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment, prospective cohort design, detailed fall definition, falls as the primary outcome, and multi-variable regression analysis. Two authors independently reviewed and extracted data on study characteristics, quality assessment, and outcomes. Adjusted risk estimates were extracted from the articles. Results: A total of 17 studies met the inclusion criteria. Risk factors were categorized into demographic, balance, gait, vision, functional status, medications, psychosocial, severity of dementia, and other. Risk factors varied with living setting and were not consistent across all studies within a setting. Conclusion: Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors, some shared with older adults in general and others unique to the disease. Risk factors vary between community- and institution-dwelling samples of adults with dementia or cognitive impairment.
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Affiliation(s)
- Eresha Fernando
- School of Physical Therapy, University of Western Ontario, London, Ont
| | - Michelle Fraser
- School of Physical Therapy, University of Western Ontario, London, Ont
| | - Jane Hendriksen
- School of Physical Therapy, University of Western Ontario, London, Ont
| | - Corey H Kim
- School of Physical Therapy, University of Western Ontario, London, Ont
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30
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Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JCT. Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment. Am J Geriatr Psychiatry 2017; 25:397-406. [PMID: 28063853 DOI: 10.1016/j.jagp.2016.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the relationship between cognitive performance and falls in older people with mild to moderate cognitive impairment (CI) by investigating the mediational effects of medical, medication, neuropsychological, and physiological factors. DESIGN Secondary analysis, prospective cohort study. SETTING Community and low-level care. PARTICIPANTS 177 older people (aged 82 ± 7 years) with mild to moderate CI (MMSE 11-23; ACE-R < 83). MEASUREMENTS Global cognition and six neuropsychological domains (memory, language, visuospatial, processing speed, executive function [EF], and affect) were assessed. Participants also underwent sensorimotor and balance assessments. Falls were recorded prospectively for 12 months. RESULTS The EF domain was most strongly associated with multiple falls (relative risk [RR]: 1.50, 95% CI: 1.18-1.91). Global cognition was not associated with falls (RR: 1.09, 95% CI: 0.92-1.30). Additional analyses showed that participants with poorer EF (median cutpoint) were more likely to be taking centrally acting medications and were less physically active. They also had significantly worse vision, reaction time, knee extension strength, balance (postural sway, controlled leaning balance), and higher physiological fall risk scores. Participants with poorer EF were 1.5 times (RR: 1.50, 95% CI: 1.03-2.18) more likely to have multiple falls. Mediational analyses demonstrated that reaction time and postural sway reduced the relative risk of EF on multiple falls by 31% (RR: 1.19, 95% CI: 0.81-1.74). CONCLUSIONS Within this sample of older people with mild to moderate CI, poorer EF increased the risk of multiple falls. This relationship was mediated by reaction time and postural sway,suggesting cognitively impaired older people with poorer EF may benefit from fall prevention programs targeting these mediating factors.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; Cognitive Decline Partnership Centre, Sydney Medical School, University of Sydney, Australia; Department of Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Stephen R Lord
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; School of Public Health and Community Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; School of Public Health and Community Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Susan E Kurrle
- Cognitive Decline Partnership Centre, Sydney Medical School, University of Sydney, Australia
| | - A Stefanie Mikolaizak
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Australia; Department of Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Goble DJ, Hearn MC, Baweja HS. Combination of BTrackS and Geri-Fit as a targeted approach for assessing and reducing the postural sway of older adults with high fall risk. Clin Interv Aging 2017; 12:351-357. [PMID: 28228655 PMCID: PMC5312691 DOI: 10.2147/cia.s131047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Atypically high postural sway measured by a force plate is a known risk factor for falls in older adults. Further, it has been shown that small, but significant, reductions in postural sway are possible with various balance exercise interventions. In the present study, a new low-cost force-plate technology called the Balance Tracking System (BTrackS) was utilized to assess postural sway of older adults before and after 90 days of a well-established exercise program called Geri-Fit. Results showed an overall reduction in postural sway across all participants from pre- to post-intervention. However, the magnitude of effects was significantly influenced by the amount of postural sway demonstrated by individuals prior to Geri-Fit training. Specifically, more participants with atypically high postural sway pre-intervention experienced an overall postural sway reduction. These reductions experienced were typically greater than the minimum detectable change statistic for the BTrackS Balance Test. Taken together, these findings suggest that BTrackS is an effective means of identifying older adults with elevated postural sway, who are likely to benefit from Geri-Fit training to mitigate fall risk.
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Affiliation(s)
- Daniel J Goble
- School of Exercise and Nutritional Sciences, College of Health and Human Services, San Diego State University, San Diego, CA, USA
| | - Mason C Hearn
- School of Exercise and Nutritional Sciences, College of Health and Human Services, San Diego State University, San Diego, CA, USA
| | - Harsimran S Baweja
- School of Exercise and Nutritional Sciences, College of Health and Human Services, San Diego State University, San Diego, CA, USA
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A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia. Int Psychogeriatr 2017; 29:81-91. [PMID: 27692024 DOI: 10.1017/s1041610216001629] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia. METHODS Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial. RESULTS Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions. CONCLUSIONS This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.
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Anderson JG, Lopez RP, Rose KM, Specht JK. Nonpharmacological Strategies for Patients With Early-Stage Dementia or Mild Cognitive Impairment: A 10-Year Update. Res Gerontol Nurs 2017; 10:5-11. [DOI: 10.3928/19404921-20161209-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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34
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Lach HW, Harrison BE, Phongphanngam S. Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review. Res Gerontol Nurs 2016; 10:139-148. [PMID: 27665756 DOI: 10.3928/19404921-20160908-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/12/2016] [Indexed: 11/20/2022]
Abstract
Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.].
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35
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Lord SR, Delbaere K, Gandevia SC. Use of a physiological profile to document motor impairment in ageing and in clinical groups. J Physiol 2016; 594:4513-23. [PMID: 26403457 PMCID: PMC4983617 DOI: 10.1113/jp271108] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/24/2015] [Indexed: 11/08/2022] Open
Abstract
Ageing decreases exercise performance and is frequently accompanied by reductions in cognitive performance. Deterioration in the physiological capacity to stand, locomote and exercise can manifest itself as falling over and represents a significant deterioration in sensorimotor control. In the elderly, falling leads to serious morbidity and mortality with major societal costs. Measurement of a suite of physiological capacities that are required for successful motor performance (including vision, muscle strength, proprioception and balance) has been used to produce a physiological profile assessment (PPA) which has been tracked over the age spectrum and in different diseases (e.g. multiple sclerosis, Parkinson's disease). As well as measures of specific physiological capacities, the PPA generates an overall 'score' which quantitatively measures an individual's cumulative risk of falling. The present review collates data from the PPA (and the physiological capacities it measures) as well as its use in strategies to reduce falls in the elderly and those with different diseases. We emphasise that (i) motor impairment arises via reductions in a wide range of sensorimotor abilities; (ii) the PPA approach not only gives a snapshot of the physiological capacity of an individual, but it also gives insight into the deficits among groups of individuals with particular diseases; and (iii) deficits in seemingly restricted and disparate physiological domains (e.g. vision, strength, cognition) are funnelled into impairments in tasks requiring upright balance. Motor impairments become more prevalent with ageing but careful physiological measurement and appropriate interventions offer a way to maximise health across the lifespan.
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Affiliation(s)
- S. R. Lord
- Neuroscience Research AustraliaUniversity of New South WalesBarker StreetRandwick, SydneyNew South Wales2031Australia
| | - K. Delbaere
- Neuroscience Research AustraliaUniversity of New South WalesBarker StreetRandwick, SydneyNew South Wales2031Australia
| | - S. C. Gandevia
- Neuroscience Research AustraliaUniversity of New South WalesBarker StreetRandwick, SydneyNew South Wales2031Australia
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Renfro M, Maring J, Bainbridge D, Blair M. Fall Risk Among Older Adult High-Risk Populations: a Review of Current Screening and Assessment Tools. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0181-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Borges APO, Carneiro JAO, Zaia JE, Carneiro AAO, Takayanagui OM. Evaluation of postural balance in mild cognitive impairment through a three-dimensional electromagnetic system. Braz J Otorhinolaryngol 2016; 82:433-41. [PMID: 26787112 PMCID: PMC9449082 DOI: 10.1016/j.bjorl.2015.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/05/2015] [Accepted: 08/17/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction Elderly people with cognitive impairment are at greater risk for falls; thus, an understanding of the earliest stages of cognitive decline is necessary. Objective To compare postural balance between elderly people with and without mild cognitive impairment using a three-dimensional system. Methods Thirty elderly people with mild cognitive impairment and thirty healthy elderly subjects were selected. Static posturography was performed using three-dimensional electromagnetic equipment and the following parameters were evaluated: maximum displacement, mean speed and total trajectory. Open- and closed-eye stabilometric variable comparisons between groups and within each group were carried out, and a relationship between the Mini Mental State Examination and the total trajectory of all elderly subjects was determined. Results The analysis among open- and closed-eye conditions showed a significant difference in maximum anteroposterior displacement in the control group and a significant difference in all stabilometric variables in the mild cognitive impairment group. A significant difference between the groups in all variables in the closed-eye condition was observed. There was a strong correlation between cognitive performance and total trajectory. Conclusion Evaluations showed decrease in balance in elderly people with mild cognitive impairment. Presence of anteroposterior displacement can be an early sign of postural control impairment, and the evaluation with visual restriction can be useful in detecting small postural instabilities.
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Affiliation(s)
- Ana Paula Oliveira Borges
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil; Universidade de Franca (UNIFRAN), Franca, SP, Brazil.
| | - José Ailton Oliveira Carneiro
- Clinical Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil; Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, BA, Brazil
| | - José Eduardo Zaia
- Biological Sciences, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), São Paulo, SP, Brazil; Master's and Doctorate Program in Health Promotion, Universidade de Franca (UNIFRAN), Franca, SP, Brazil
| | - Antonio Adilton Oliveira Carneiro
- Universidade de São Paulo (USP), São Paulo, SP, Brazil; Department of Physics and Mathematics, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (FFCLRP-USP), Ribeirão Preto, SP, Brazil
| | - Osvaldo Massaiti Takayanagui
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil; Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Uemura K, Hasegawa T, Tougou H, Shuhei T, Uchiyama Y. Analysis of Choice Stepping with Visual Interference Can Detect Prolonged Postural Preparation in Older Adults with Mild Cognitive Impairment at High Risk of Falling. Dement Geriatr Cogn Disord 2016; 40:13-21. [PMID: 25895943 DOI: 10.1159/000375408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We aimed to clarify postural control deficits in older adults with mild cognitive impairment (MCI) at high risk of falling by addressing the inhibitory process. METHODS This study involved 376 community-dwelling older adults with MCI. Participants were instructed to execute forward stepping on the side indicated by the central arrow while ignoring the 2 flanking arrows on each side (→→→→→, congruent, or →→←→→, incongruent). Initial weight transfer direction errors [anticipatory postural adjustment (APA) errors], step execution times, and divided phases (reaction, APA, and swing phases) were measured from vertical force data. Participants were categorized as fallers (n = 37) and non-fallers (n = 339) based on fall experiences in the last 12 months. RESULTS There were no differences in the step execution times, swing phases, step error rates, and APA error rates between groups, but fallers had a significantly longer APA phase relative to non-fallers in trials of the incongruent condition with APA errors (p = 0.005). Fallers also had a longer reaction phase in trials with the correct APA, regardless of the condition (p = 0.01). CONCLUSION Analyses of choice stepping with visual interference can detect prolonged postural preparation as a specific falling-associated deficit in older adults with MCI.
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Affiliation(s)
- Kazuki Uemura
- Institute for Innovation for Future Society, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Rowe J. “I’ve Fallen and I Can’t Get Up,” a Basic Primer for Caregivers to Understand Falls in Persons With Dementia, Alzheimer’s Disease, and Cognitive Impairment. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822314559833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article seeks to demystify the complexity of what constitutes dementia, Alzheimer’s disease, and cognitive impairment as it relates to identifying the basic contexts of these diseases in relationship with falls and fall prevention. It further will identify the new changes in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) that replaces the term dementia and provides the new diagnostic framework for major and mild neurocognitive functioning. This article additionally provides some practical strategies for caregivers to equip themselves to understand some of the difficulties and challenges that they face when dealing with loved ones or patients who become afflicted by these diseases.
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Affiliation(s)
- Jimmy Rowe
- State University of New York at Buffalo, USA
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Chan WC, Fai Yeung JW, Man Wong CS, Wa Lam LC, Chung KF, Hay Luk JK, Wah Lee JS, Kin Law AC. Efficacy of Physical Exercise in Preventing Falls in Older Adults With Cognitive Impairment: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2015; 16:149-54. [DOI: 10.1016/j.jamda.2014.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
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Can a tailored exercise and home hazard reduction program reduce the rate of falls in community dwelling older people with cognitive impairment: protocol paper for the i-FOCIS randomised controlled trial. BMC Geriatr 2014; 14:89. [PMID: 25128411 PMCID: PMC4138412 DOI: 10.1186/1471-2318-14-89] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of falls in community dwelling older people with cognitive impairment (CI) is twice that of a cognitively intact population, with almost two thirds of people with CI falling annually. Studies indicate that exercise involving balance and/or a home hazard reduction program are effective in preventing falls in cognitively intact older people. However the potential benefit of these interventions in reducing falls in people with CI has not been established.This randomised controlled trial will determine whether a tailored exercise and home hazard reduction program can reduce the rate of falls in community dwelling older people with CI. We will determine whether the intervention has beneficial effects on a range of physical and psychological outcome measures as well as quality of life of participants and their carers. A health economic analysis examining the cost and potential benefits of the program will also be undertaken. METHODS AND DESIGN Three hundred and sixty people aged 65 years or older living in the community with CI will be recruited to participate in the trial. Each will have an identifiable carer with a minimum of 3.5 hours of face to face contact each week.Participants will undergo an assessment at baseline with retests at 6 and 12 months. Participants allocated to the intervention group will participate in an exercise and home hazard reduction program tailored to their cognitive and physical abilities.The primary outcome measure will be the rate of falls which will be measured using monthly falls calendars. Secondary outcome measures will include the risk of falling, quality of life, measures of physical and cognitive function, fear of falling and planned and unplanned use of health services. Carers will be followed up to determine carer burden, coping strategies and quality of life. DISCUSSION The study will determine the impact of this tailored intervention in reducing the rate of falls in community dwelling older people with CI as well as the cost-effectiveness and adherence to the program. The results will have direct implications for the design and implementation of interventions for this high-risk group of older people. TRIAL REGISTRATION The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry - ACTRN12614000603617.
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Abstract
Over the years, a number of strategies have been investigated to prevent falls in older people in a number of settings. Over 200 randomised controlled trials now exist, and the challenge for the discerning clinician is to read and interpret the existing literature so as to be able to implement effective strategies, targeting the right individual with the right intervention. This chapter reviews the current literature and attempts to simplify what has become an enormously complex area. Interventions are reviewed in three main settings - community, hospital and care facilities and based on the type of approach - single, multiple or multifactorial interventions. It also considers the reality in which we practise and provides some 'best bets' to consider at this point in time.
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Affiliation(s)
- Jacqueline C T Close
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
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Murnaghan CD, Squair JW, Chua R, Inglis JT, Carpenter MG. Cortical contributions to control of posture during unrestricted and restricted stance. J Neurophysiol 2014; 111:1920-6. [DOI: 10.1152/jn.00853.2012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There is very little consensus regarding the mechanisms underlying postural control. Whereas some theories suggest that posture is controlled at lower levels (i.e., brain stem and spinal cord), other theories have proposed that upright stance is controlled using higher centers, including the motor cortex. In the current investigation, we used corticomuscular coherence (CMC) to investigate the relationship between cortical and shank muscle activity during conditions of unrestricted and restricted postural sway. Participants were instructed to stand as still as possible in an apparatus that allowed the center of mass to move freely (“Unlocked”) or to be stabilized (“Locked”) without subject awareness. EEG (Cz) and electromyography (soleus and lateral/medial gastrocnemii) were collected and used to estimate CMC over the Unlocked and Locked periods. Confirming our previous results, increases in center of pressure (COP) displacements were observed in 9 of 12 participants in the Locked compared with Unlocked condition. Across these 9 participants, CMC was low or absent in both the Unlocked and Locked conditions. The results from the current study suggest that this increase is not associated with an increase in the relationship between cortical and shank muscle activities. Rather, it may be that increases in COP displacement with locking are mediated by subcortical structures as a means of increasing sway to provide the central nervous system with a critical level of sensory information.
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Affiliation(s)
- Chantelle D. Murnaghan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan W. Squair
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Romeo Chua
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - J. Timothy Inglis
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark G. Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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Delbaere K, Close JCT, Taylor M, Wesson J, Lord SR. Validation of the Iconographical Falls Efficacy Scale in Cognitively Impaired Older People. J Gerontol A Biol Sci Med Sci 2013; 68:1098-102. [DOI: 10.1093/gerona/glt007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Taylor ME, Delbaere K, Close JCT, Lord SR. Managing falls in older patients with cognitive impairment. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ahe.12.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With an aging population, both dementia and fall-related injury pose an international health challenge. Individuals with dementia fall twice as often as cognitively intact people and are more likely to have injurious falls. Higher morbidity and rates of mortality and institutionalization after falls have also been reported in this group. There is limited but emerging literature that is attempting to define and explain why fall risk is increased in this population. This will allow for targeted fall prevention programs. Currently, there are no published randomized controlled trials that have prevented falls in community-dwelling cognitively impaired older people, and conflicting evidence is reported in hospital and residential care trials. Recent exercise interventions have demonstrated significant benefits, such as improved gait speed, strength and balance in people with cognitive impairment/dementia, providing encouraging evidence for further research and clinical interventions.
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Affiliation(s)
- Morag E Taylor
- Falls & Balance Research Group, Neuroscience Research Australia, Barker Street, Randwick, University of New South Wales 2031, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls & Balance Research Group, Neuroscience Research Australia, Barker Street, Randwick, University of New South Wales 2031, Sydney, Australia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Jacqueline CT Close
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- Falls & Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Falls & Balance Research Group, Neuroscience Research Australia, Barker Street, Randwick, University of New South Wales 2031, Sydney, Australia
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