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Tai TW, Tsai YL, Shih CA, Li CC, Chang YF, Huang CF, Cheng TT, Hwang JS, Lu TH, Wu CH. Refracture risk and all-cause mortality after vertebral fragility fractures: Anti-osteoporotic medications matter. J Formos Med Assoc 2023; 122 Suppl 1:S65-S73. [PMID: 37120337 DOI: 10.1016/j.jfma.2023.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Osteoporotic vertebral fractures may predict the future occurrence of fractures and increase mortality. Treating underlying osteoporosis may prevent second fractures. However, whether anti-osteoporotic treatment can reduce the mortality rate is not clear. The aim of this population study was to identify the degree of decreased mortality following the use of anti-osteoporotic medication after vertebral fractures. METHODS We identified patients who had newly diagnosed osteoporosis and vertebral fractures from 2009 to 2019 using the Taiwan National Health Insurance Research Database (NHIRD). We used national death registration data to determine the overall mortality rate. RESULTS There were 59,926 patients with osteoporotic vertebral fractures included in this study. After excluding patients with short-term mortality, patients who had previously received anti-osteoporotic medications had a lower refracture rate as well as a lower mortality risk (hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.81-0.88). Patients receiving treatment for more than 3 years had a much lower mortality risk (HR: 0.53, 95% CI: 0.50-0.57). Patients who used oral bisphosphonates (alendronate and risedronate, HR: 0.95, 95% CI: 0.90-1.00), intravenous zoledronic acid (HR: 0.83, 95% CI: 0.74-0.93), and subcutaneous denosumab injections (HR: 0.71, 95% CI: 0.65-0.77) had lower mortality rates than patients without further treatment after vertebral fractures. CONCLUSION In addition to fracture prevention, anti-osteoporotic treatments for patients with vertebral fractures were associated with a reduction in mortality. A longer duration of treatment and the use of long-acting drugs was also associated with lower mortality.
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Lun Tsai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Li
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Feng Huang
- Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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2
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Burton E, Hill KD, Davey P, Ng YL, Williams SA. The Biomechanics of Healthy Older Adults Rising from the Floor Independently. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3507. [PMID: 36834201 PMCID: PMC9958992 DOI: 10.3390/ijerph20043507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
A third of older adults will fall each year and many will not be injured. Getting up from the floor in a timely manner is important, however it is unclear what technique older adults use to get themselves up off the ground unassisted, whether there are differences between men and women in getting up and what functional joint kinematics are used to rise from the floor. This study included a convenience sample of 20 older adults (65+ years) to answer these questions. Participants completed a series of movement tasks (i.e., rising from the floor using their own technique, a specified technique, walking 10 m and five repeated sit-to-stands), with temporospatial and joint kinematic data captured using an 18-camera 3D Vicon motion analysis system. Results found three techniques preferred by participants; the sit-up (n = 12), side-sit (n = 4) and the roll over (n = 4), with no differences found between sexes. The sit-up technique requires a higher degree of hip and knee flexion to complete compared to the side-sit and roll over. It may be beneficial for health professionals to work with older adults to identify their preferred technique for rising from the floor and encourage regular practice of this skill.
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Affiliation(s)
- Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- enAble Institute, Curtin University, Perth, WA 6102, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, VIC 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
| | - Paul Davey
- Curtin School of Nursing, Curtin University, Perth, WA 6102, Australia
| | - Yoke Leng Ng
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Sîan A. Williams
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Liggins Institute, University of Auckland, Auckland 1010, New Zealand
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3
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An Interpretable Machine Learning Approach to Predict Fall Risk Among Community-Dwelling Older Adults: a Three-Year Longitudinal Study. J Gen Intern Med 2022; 37:2727-2735. [PMID: 35112279 PMCID: PMC9411287 DOI: 10.1007/s11606-022-07394-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adverse health effects resulting from falls are a major public health concern. Although studies have identified risk factors for falls, none have examined long-term prediction of fall risk. Furthermore, recent evidence suggests that there are additional risk factors, such as psychosocial factors. OBJECTIVE In this 3-year longitudinal study, we evaluated a predictive model for risk of fall among community-dwelling older adults using machine learning methods. DESIGN A 3-year follow-up prospective longitudinal study (from 2010 to 2013). SETTING Twenty-four municipalities in nine of the 47 prefectures (provinces) of Japan. PARTICIPANTS Community-dwelling individuals aged ≥65 years who were functionally independent at baseline (n = 61,883). METHODS The baseline survey was conducted from August 2010 to January 2012, and the follow-up survey was conducted from October to December 2013. Both surveys were conducted involving self-reported questionnaires. The measured outcome at the follow-up survey was self-reported multiple falls during the previous year. The 142 variables included in the baseline survey were regarded as candidate predictors. The random-forest-based Boruta algorithm was used to select predictors, and the eXtreme Gradient Boosting algorithm with 10 repetitions of nested k-fold cross-validation was used for modeling and model evaluation. Furthermore, we used shapley additive explanations to gain insight into the behavior of the prediction model. KEY RESULTS Fourteen out of 142 candidate features were selected as predictors. Among these predictors, experience of falling as of the baseline survey was the most important feature, followed by self-rated health and age. Moreover, sense of coherence was newly identified as a risk factor for falls. CONCLUSIONS This study suggests that machine learning tools can be adapted to explore new associative factors, make accurate predictions, and provide actionable insights for fall prevention strategies.
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Kim TL, Byun SJ, Seong MY, Oh BM, Park SJ, Seo HG. Fracture risk and impact of osteoporosis in patients with Parkinson's disease: a nationwide database study. J Bone Miner Metab 2022; 40:602-612. [PMID: 35347431 DOI: 10.1007/s00774-022-01322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) showed an increased risk of fractures in previous studies and a high prevalence of osteoporosis is reportedly a potential contributor. We conducted a nationwide database study on the risk of fractures and the impact of osteoporosis on patients with PD compared to controls. MATERIALS AND METHODS Using a nationwide database in South Korea, we identified incident patients with PD in 2004-2006 and selected four age- and sex-matched controls. We checked the occurrence rates of overall and hip fractures and plotted Kaplan-Meier curves and a Cox proportional hazards model to determine risk. We also conducted stratified analyses according to the presence or absence of osteoporosis. RESULTS We identified 9126 patients with PD and 35,601 controls. Patients with PD had a greater probability of fractures throughout the study period in Kaplan-Meier curves, and an increased risk of overall (aHR 1.35, 95% CI 1.297-1.405) and hip (aHR 1.814, 95% CI 1.66-1.983) fractures in a Cox proportional hazards model. In the stratified analysis, the increased risk of overall fracture (aHR 1.333, 95% CI 1.273-1.396 and aHR 1.412, 95% CI 1.301-1.532, respectively) and hip fracture (aHR 1.773, 95% CI 1.604-1.96 and aHR 2.008, 95% CI 1.657-2.434, respectively) due to PD was similar between patients with and without osteoporosis. DISCUSSION Patients with PD, with or without osteoporosis, are more likely to experience fractures, especially hip fractures. There seems to be no interaction between PD and osteoporosis in regard to the occurrence of fractures, and therefore no effect modification by osteoporosis.
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Affiliation(s)
- Tae-Lim Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Songnam, Republic of Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi-do, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Songnam, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Šarabon N, Kozinc Ž, Marković G. Effects of age, sex and task on postural sway during quiet stance. Gait Posture 2022; 92:60-64. [PMID: 34826694 DOI: 10.1016/j.gaitpost.2021.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/16/2021] [Accepted: 11/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural sway during quiet standing has been shown as a useful task to assess risk of falling in older adults. While the risk of falling is consistently reported to be higher in older females than males, the sex-related differences in postural sway are not consistent across the studies. RESEARCH QUESTION What are the effects of age and sex on postural sway during quiet standing during different stance conditions? METHODS We examined the effects of age (40 young and 34 older adults), sex (37 males and 37 females), and their interaction on the postural sway during different stance conditions. We compared the center of pressure (CoP) velocity, amplitude and frequency during parallel (eyes open and eyes closed) and semi-tandem (eyes open) stances. RESULTS Our results suggest that postural sway is similar between sexes in young participants, while older males exhibit larger postural sway than older female participants (10/21 outcomes). Older female participants exhibited lower CoP amplitude (but larger total and anterior-posterior CoP velocity) compared to young female participants. We also found that the increase in the postural sway with increasing task difficulty is more pronounced in older vs. young adults. SIGNIFICANCE This study shows that ageing-related changes in postural sway are sex- and task-specific. Researchers and clinicians need to be aware of these effects when comparing groups or monitoring changes in time.
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Affiliation(s)
- Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Muzejski trg 2, SI-6000 Koper, Slovenia; InnoRenew CoE, Human Health Department, Livade 6, SI-6310 Izola, Slovenia; S2P, Science to Practice, Ltd., Laboratory for Motor Control and Motor Behavior, Tehnološki park 19, SI-1000 Ljubljana, Slovenia.
| | - Žiga Kozinc
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Goran Marković
- Faculty of Kinesiology, University of Zagreb, 10110 Zagreb, Croatia; Motus Melior Ltd., Hektorovićeva 2, 10000 Zagreb, Croatia
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6
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Racial and Ethnic Differences in Falls Among Older Adults: a Systematic Review and Meta-analysis. J Racial Ethn Health Disparities 2022; 9:2427-2440. [PMID: 34786654 PMCID: PMC9633486 DOI: 10.1007/s40615-021-01179-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022]
Abstract
The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.
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7
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Ashari A, Hamid TA, Hussain MR, Ibrahim R, Hill KD. Prevalence, Circumstances, and Risk Factors of Falls Among Community Dwelling Members of University of the Third Age. Front Public Health 2021; 9:610504. [PMID: 34900882 PMCID: PMC8652217 DOI: 10.3389/fpubh.2021.610504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Study aimed to identify the prevalence of falls and associated contributory factors among older Malaysians. Methods: A cross sectional study among community dwelling older adults aged 50 years and above. Self-administered questionnaires on history of falls in the previous 12 months, physical assessment and computerized and clinical measures of balance were assessed on a single occasion. Results: Forty nine (31.0%) participants fell, with 4.4% reported having multiple falls within the previous 12 months. Slips were the most prevalent cause of falls, accounting for 49% of falls. More than half (54.5%) of falls occurred in the afternoon while participants walked inside the home (32.7%), outside home (30.6%), and 36.7% were in community areas. More than half of respondents were identified as having turning instability. Step Test, turn sway, depression, physical activity level and edge contrast sensitivity were significantly worse for fallers (p < 0.05). Multiple logistic regression analysis showed that turning performance, visual acuity and back pain were significantly associated with falls risk, accounting for 72% of the variance of risk factors for falls among studied population. Conclusion: Falls are common among community dwelling older Malaysians. The findings provide information of falls and falls risk factors among community dwelling older adults in Malaysia. Future intervention studies should target locally identified falls risk factors. This study has highlighted the importance of instability during turning as an important fall risk factor.
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Affiliation(s)
- Asmidawati Ashari
- Department of Human Development and Family Studies, Faculty of Human Ecology, University Putra Malaysia, Serdang, Malaysia.,Laboratory of Social Gerontology, Malaysian Research Institute on Ageing MyAgeing™, University Putra Malaysia, Serdang, Malaysia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Tengku Aizan Hamid
- Laboratory of Social Gerontology, Malaysian Research Institute on Ageing MyAgeing™, University Putra Malaysia, Serdang, Malaysia
| | - Mohd Rizal Hussain
- Laboratory of Social Gerontology, Malaysian Research Institute on Ageing MyAgeing™, University Putra Malaysia, Serdang, Malaysia
| | - Rahimah Ibrahim
- Department of Human Development and Family Studies, Faculty of Human Ecology, University Putra Malaysia, Serdang, Malaysia.,Laboratory of Social Gerontology, Malaysian Research Institute on Ageing MyAgeing™, University Putra Malaysia, Serdang, Malaysia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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Battisti S, Napoli N, Pedone C, Lombardi M, Leanza G, Tramontana F, Faraj M, Agnoletti V, Verna M, Viola L, Giampalma E, Strollo R. Vertebral fractures and mortality risk in hospitalised patients during the COVID-19 pandemic emergency. Endocrine 2021; 74:461-469. [PMID: 34529239 PMCID: PMC8444515 DOI: 10.1007/s12020-021-02872-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Bone fragility has been linked to COVID-19 severity. The objective of this study was to evaluate whether a diagnosis of vertebral fracture (VF) increased mortality risk in COVID-19 patients and whether this effect was greater than in those without COVID-19. METHODS We assessed VFs by computed tomography (CT) in a cohort of 501 patients consecutively admitted to the emergency department (ED) for clinical suspicion of SARS-CoV-2 infection during the first wave of pandemic emergency. Of those, 239 had a confirmed diagnosis of COVID-19. RESULTS VF prevalence was similar between COVID-19 and non-COVID-19 groups (22.2 vs. 19%; p = 0.458). Death rates were similar between COVID-19 and non-COVID-19 groups at both 30 (15.8 vs. 12.2%; p = 0.234) and 120 days (21.8 vs. 17.6%; p = 0.236). The mortality risk was higher in COVID-19 patients either with one or multiple fractures compared to those without VFs, at 30 and 120 days, but statistical significance was reached only in those with multiple VFs (30-day HR 3.03, 95% CI 1.36-6.75; 120-day HR 2.91, 95% CI 1.43-5.91). In the non-COVID-19 group, the 30-day mortality risk was significantly higher in patients either with one (HR 7.46, 95% CI 3.12-17.8) or multiple fractures (HR 6.2, 95% CI 2.75-13.98) compared to those without VFs. A similar effect was observed at 120 days. After adjustment for age, sex and bone density, mortality risk remained associated with VFs in the non-COVID-19 group only. CONCLUSIONS VFs were not independently associated with short-term mortality in patients with COVID-19, but they strongly increased mortality risk in those without COVID-19.
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Affiliation(s)
- Sofia Battisti
- Radiology Department, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
- Radiology Unit, Scientific Institute of Romagna for the Study and Treatment of Tumors (IRST) IRCCS, Meldola, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum-Università di Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Medicine, Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA
| | - Claudio Pedone
- Department of Medicine, Unit of Geriatrics, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Giulia Leanza
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Flavia Tramontana
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Malak Faraj
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Martina Verna
- Radiology Department, ASST Mantova "Carlo Poma" Hospital, Mantova, Italy
| | - Lorenzo Viola
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | | | - Rocky Strollo
- Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Rome, Italy.
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Kitayuguchi J, Abe T, Okuyama K, Gomi T, Okada S, Shiwaku K, Mutoh Y. Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study. J Rural Med 2021; 16:214-221. [PMID: 34707730 PMCID: PMC8527625 DOI: 10.2185/jrm.2021-028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: Falls in older adults are a major public health issue, and it is
unclear whether the neighborhood environment is associated with falls among this group.
This cross-sectional study investigated whether hilly neighborhood environmental factors
were associated with fall status (falls or fear of falling) in rural Japanese older
adults. Materials and Methods: Data obtained from 965 participants aged 65 years and
older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status
was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of
falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental
factors, the mean elevation and land slope were assessed using a geographic information
system. The logistic regression model examined the odds ratios (OR) and 95% confidence
intervals (CIs) of fall status in quartiles for elevation and land slope, respectively,
and was adjusted for confounders. Results: Falls and fear of falling were observed in 16.8% and 43.2% of
participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI
1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74,
95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling
was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR
1.51, 95% CI 1.01–2.25 for Q4 vs. Q1). Conclusion: Our study found that elevation and land slope as hilly
neighborhood environment factors were positively associated with falls or fear of falling
among older adults living in rural Japan. Prospective observational studies that
investigate the effects of region-specific environmental factors on falls among older
adults should be conducted.
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Affiliation(s)
- Jun Kitayuguchi
- Physical Education and Medicine Research Center UNNAN, Japan
| | - Takafumi Abe
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Japan
| | - Kenta Okuyama
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Japan.,Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
| | | | - Shinpei Okada
- Physical Education and Medicine Research Foundation, Japan
| | | | - Yoshiteru Mutoh
- The Research Institute of Health Rehabilitation of Tokyo, Japan
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10
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Nakanishi T, Ikeda T, Nakamura T, Yamanouchi Y, Chikamoto A, Usuku K. Development of an algorithm for assessing fall risk in a Japanese inpatient population. Sci Rep 2021; 11:17993. [PMID: 34504235 PMCID: PMC8429765 DOI: 10.1038/s41598-021-97483-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Falling is a representative incident in hospitalization and can cause serious complications. In this study, we constructed an algorithm that nurses can use to easily recognize essential fall risk factors and appropriately perform an assessment. A total of 56,911 inpatients (non-fall, 56,673; fall; 238) hospitalized between October 2017 and September 2018 were used for the training dataset. Correlation coefficients, multivariable logistic regression analysis, and decision tree analysis were performed using 36 fall risk factors identified from inpatients. An algorithm was generated combining nine essential fall risk factors (delirium, fall history, use of a walking aid, stagger, impaired judgment/comprehension, muscle weakness of the lower limbs, night urination, use of sleeping drug, and presence of infusion route/tube). Moreover, fall risk level was conveniently classified into four groups (extra-high, high, moderate, and low) according to the priority of fall risk. Finally, we confirmed the reliability of the algorithm using a validation dataset that comprised 57,929 inpatients (non-fall, 57,695; fall, 234) hospitalized between October 2018 and September 2019. Using the newly created algorithm, clinical staff including nurses may be able to appropriately evaluate fall risk level and provide preventive interventions for individual inpatients.
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Affiliation(s)
- Tomoko Nakanishi
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan. .,Department of Nursing, Kumamoto University Hospital, Kumamoto, Japan.
| | - Tokunori Ikeda
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan. .,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto, 860-0082, Japan.
| | - Taishi Nakamura
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan.,Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshinori Yamanouchi
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan
| | - Akira Chikamoto
- Department of Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
| | - Koichiro Usuku
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan.,Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
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11
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Fear of Falling, Recurrence of Falls, and Quality of Life in Patients with a Low Energy Fracture-Part II of an Observational Study. ACTA ACUST UNITED AC 2021; 57:medicina57060584. [PMID: 34200303 PMCID: PMC8226509 DOI: 10.3390/medicina57060584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022]
Abstract
Background and objective: Falls in elderly cause injury, mortality, and loss of independence, making Fear of Falling (FoF) a common health problem. FoF relates to activity restriction and increased fall risk. A voluntary intervention including fall risk assessment and prevention strategies was implemented to reduce falls in elderly patients with low energy fractures (LEF). The primary purpose of this study was to evaluate FoF and the number of subsequent falls in trauma patients one year after a LEF. The secondary aim was to examine how FoF affects patients' lives in terms of Quality of Life (QoL), mobility, and activity levels. Finally, participation in the voluntary fall prevention program (FPP) was evaluated. Materials and Methods: Observational cohort study in one Swiss trauma center. LEF patients, treated between 2012 and 2015, were analyzed one year after injury. Primary outcomes were Falls-Efficacy Score-International (FES-I) and number of subsequent falls. Secondary outcomes were EuroQoL-5-Dimensions-3-Levels (EQ5D-3L), mobility, activity levels, and participation in the FPP. Subgroup analysis was performed for different age categories. Results: 411 patients were included for analysis. Mean age was 72 ± 9.3, mean FES-I was 21.1 ± 7.7. Forty percent experienced FoF. A significant negative correlation between FoF and QoL (R = 0.64; p < 0.001) was found. High FoF correlated with lower activity levels (R= -0.288; p < 0.001). Six percent visited the FPP. Conclusions: At follow-up, 40% suffered from FoF which seems to negatively affect patients' QoL. Nevertheless, participation in the FPP was low. Simply informing patients about their susceptibility to falls and recommending participation in FPPs seems insufficient to motivate and recruit patients into FPPs. We suggest implementing repeated fall risk- and FoF screenings as standard procedures in the follow-up of LEF, especially in patients aged over 75 years.
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12
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Choo PL, Tou NX, Jun Pang BW, Lau LK, Jabbar KA, Seah WT, Chen KK, Ng TP, Wee SL. Timed Up and Go (TUG) Reference Values and Predictive Cutoffs for Fall Risk and Disability in Singaporean Community-Dwelling Adults: Yishun Cross-Sectional Study and Singapore Longitudinal Aging Study. J Am Med Dir Assoc 2021; 22:1640-1645. [PMID: 33819451 DOI: 10.1016/j.jamda.2021.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The "timed up and go" (TUG) test is a simple and widely used test of overall functional mobility. There is a paucity of TUG normative data among Asian individuals who differ in habitual gait speed and fall risk from Western population. The objectives of this study were to determine TUG reference values and optimum cutoffs predicting prevalent and incident disability for community-dwelling adults. DESIGN One cross-sectional (Study 1-Yishun Study) and one longitudinal (Study 2-Singapore Longitudinal Aging Study) study in Singapore. SETTING AND PARTICIPANTS Study 1 comprised 538 nondisabled, community-dwelling adults aged between 21 and 90 years. Study 2 comprised 1356 community-dwelling older adults aged ≥55 years followed for 3 years. METHODS Study 1 collected TUG reference values and assessed physiological fall risk (PFR) using the Physiological Profile Assessment (PPA). Study 2 assessed association of TUG with disability with the Barthel Index and the Lawton scale at baseline and follow-up. RESULTS From Study 1, mean TUG time for individuals aged 60 to 74 years was 9.80 seconds, shorter than values reported for Westerners of 12.30 seconds. It was significantly associated with high PFR [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.03-1.27], 74.0% agreement, Cohen's kappa = 0.314 (95% CI 0.238-0.390); area under the curve = 0.85 (95% CI 0.80-0.90). A TUG cutoff of 10.2 seconds discriminated high PFR from low PFR with 84.4% sensitivity and 72.6% specificity. In Study 2, the threshold for observing significantly increased risk of disability was ≥9.45 seconds for prevalent disability (OR 2.98, 95% CI 1.41-6.78), functional decline (OR 2.68, 95% CI 1.33-5.80), and incidental disability (OR 2.25, 95% CI 1.08-4.97). CONCLUSIONS AND IMPLICATIONS TUG reference values and cutoff predicting disability for community-dwelling older adults in Singapore are consistent with Asian data and lower than for Western individuals. TUG could be used to guide development and evaluation of risk screening of adverse health outcomes across the life span in Singapore.
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Affiliation(s)
- Pei Ling Choo
- Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | | | | | - Lay Khoon Lau
- Geriatric Education and Research Institute, Singapore
| | | | - Wei Ting Seah
- Geriatric Education and Research Institute, Singapore
| | | | - Tze Pin Ng
- Geriatric Education and Research Institute, Singapore; Department of Psychological Medicine, National University of Singapore, Singapore
| | - Shiou-Liang Wee
- Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore; Geriatric Education and Research Institute, Singapore.
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13
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Sato A, Goh AC. Concurrent and discriminant validity of Nintendo Wii Fit exergame for the assessment of postural sway. J Phys Ther Sci 2021; 33:100-105. [PMID: 33642682 PMCID: PMC7897537 DOI: 10.1589/jpts.33.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the concurrent validity of Wii Fit center-of-pressure parameters with Clinical Test of Sensory Integration for Balance and to evaluate the discriminant validity of the Wii Fit center-of-pressure parameters for adults and the elderly for the assessment of postural sway. [Participants and Methods] This study used an observational cross-sectional correlational design. All 70 participants were required to complete a questionnaire for eligibility screening, followed by a center-of-pressure assessment using three Wii Fit balance activities (snowboard slalom, ski slalom, and balance bubble) and Clinical Test of Sensory Integration for Balance using a force platform. [Results] For center-of-pressure assessment, our results showed there was concurrent validity of Wii Fit ski slalom and balance bubble with Clinical Test of Sensory Integration for Balance conditions 6 and 4, respectively. Our results also demonstrated that the three Wii Fit balance activities selected in this study could be used to discriminate between adults and the elderly. [Conclusion] Our results suggest that Wii Fit is a viable and affordable alternative method for center-of-pressure assessment.
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Affiliation(s)
- Atsushi Sato
- Faculty of Health Sciences, Iryo Sosei University: 5-5-1 Chuodai Iino, Iwaki-shi, Fukushima 970-8551, Japan
| | - Ah-Cheng Goh
- Faculty of Health Sciences, Iryo Sosei University: 5-5-1 Chuodai Iino, Iwaki-shi, Fukushima 970-8551, Japan
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14
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The Prevalence and Associated Factors of the Fear of Falling in Elderly Patients at the Primary Care Clinic of Songklanagarind Hospital. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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15
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HEO JAEHOON, JEON HEEJUN, JEON HYEONGMIN, CHO YEONGJUN, EOM GWANGMOON. AGE–GENDER DIFFERENCE IN THE PERCEPTION AND MUSCLE RESPONSE THRESHOLDS OF SUPPORT SURFACE ROTATION. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Proprioception while standing is important for the balance control, but the proprioception has not been investigated in the unconstrained standing conditions. The purpose of this study was to investigate the effects of age and gender on the thresholds of perception and muscle response in response to the support surface rotation. The experiment was designed so that the thresholds depend mainly on the proprioception, i.e., quasistatic condition (0.2∘/s rotation of the platform) with eyes closed. Fifty-two healthy subjects (half young and half elderly) participated in this study. A platform was developed which can be rotated in four directions. Perception threshold angle was registered from subjects’ pressing a button. Muscle response threshold angle was determined as the earlier onset of EMG in lower limb muscles. Two standing conditions (feet together and natural stance) were tested. Repeated-measures ANOVA showed that both thresholds increased with age. Post hoc tests revealed (1) that the perception threshold was greater for women than men in the elderly and (2) both thresholds of the elderly were greater for the feet-together stance than natural stance. Inferior perception sensitivity of platform rotation in elderly women may be associated with inferior performance in cortical postural control and greater fall ratio compared to elderly men, which suggests the need of proprioception trainings.
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Affiliation(s)
- JAE-HOON HEO
- School of Biomedical Engineering, Konkuk University, Chungju, 380-701, Republic of Korea
| | - HEE-JUN JEON
- School of Biomedical Engineering, Konkuk University, Chungju, 380-701, Republic of Korea
| | - HYEONG-MIN JEON
- School of Biomedical Engineering, Konkuk University, Chungju, 380-701, Republic of Korea
| | - YEONG-JUN CHO
- School of Biomedical Engineering, Konkuk University, Chungju, 380-701, Republic of Korea
| | - GWANG MOON EOM
- School of Biomedical Engineering, Konkuk University, Chungju, 380-701, Republic of Korea
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16
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Pauelsen M, Jafari H, Strandkvist V, Nyberg L, Gustafsson T, Vikman I, Röijezon U. Frequency domain shows: Fall-related concerns and sensorimotor decline explain inability to adjust postural control strategy in older adults. PLoS One 2020; 15:e0242608. [PMID: 33216812 PMCID: PMC7678972 DOI: 10.1371/journal.pone.0242608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022] Open
Abstract
Human postural control is a complex system and changes as we age. Frequency based analyses have been argued to be useful to identify altered postural control strategies in balance tasks. The aim of this study was to explore the frequency domain of the quiet stance centre of pressure of older adults with various degrees of fall-related concerns and sensorimotor functioning. We included 45 community dwelling older adults and used a force plate to register 30 seconds of quiet stance with eyes open and closed respectively. We also measured sensory and motor functions, as well as fall-related concerns and morale. We analysed the centre of pressure power spectrum density and extracted the frequency of 4 of its features for each participant. Orthogonal projection of latent structures-discriminant analysis revealed two groups for each quiet stance trial. Group 1 of each trial showed less sensory and motor decline, low/no fall-related concerns and higher frequencies. Group 2 showed more decline, higher fall-related concerns and lower frequencies. During the closed eyes trial, group 1 and group 2 shifted their features to higher frequencies, but only group 1 did so in any significant way. Higher fall-related concerns, sensory and motor decline, and explorative balancing strategies are highly correlated. The control system of individuals experiencing this seems to be highly dependent on vision. Higher fall-related concerns, and sensory and motor decline are also correlated with the inability to adjust to faster, more reactive balancing strategies, when vision is not available.
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Affiliation(s)
- Mascha Pauelsen
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
- * E-mail:
| | - Hedyeh Jafari
- Department of Computer Science, Electrical and Space Engineering Luleå University of Technology, Luleå, Sweden
| | - Viktor Strandkvist
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Lars Nyberg
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Thomas Gustafsson
- Department of Computer Science, Electrical and Space Engineering Luleå University of Technology, Luleå, Sweden
| | - Irene Vikman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Ulrik Röijezon
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
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17
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Yokoi K, Miyai N, Utsumi M, Hattori S, Kurasawa S, Hayakawa H, Uematsu Y, Arita M. Relationship between Fall History and Self-Perceived Motor Fitness in Community-Dwelling People: A Cross-Sectional Study. J Clin Med 2020; 9:jcm9113649. [PMID: 33202806 PMCID: PMC7697988 DOI: 10.3390/jcm9113649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
History of falling is an important fall risk factor. If a relationship between fall history and self-perceived motor fitness could be established, then treating it as a correctable risk of re-fall due to falls may be possible. We conducted a cross-sectional study of the relationship between fall history and self-perceived motor fitness in daily life among 670 community-dwelling people (mean age 62.0 ± 9.6 years, 277 men and 393 women) who had participated in health examinations. They completed a self-administered questionnaire that asked about their history of single or multiple falls and included a 14-item motor fitness scale. The responses were analyzed using multivariate logistic regression analysis. The results showed that in both younger and older (<65 years) subjects, a history of single or multiple falls was associated with a negative response to "being able to put on socks, pants or a skirt while standing without support". For subjects ≥65 years, an association was also observed with "shortness of breath when climbing stairs". Self-perceived motor fitness related to fall history can easily be noticed by an individual and may help them become aware of fall-related factors earlier in everyday life.
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Affiliation(s)
- Katsushi Yokoi
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka 583-8555, Japan
- Correspondence: ; Tel.: +81-729-50-2111
| | - Nobuyuki Miyai
- School of Health and Nursing Science, Wakayama Medical University, Wakayama 641-0011, Japan; (N.M.); (S.H.); (H.H.); (Y.U.)
| | - Miyoko Utsumi
- Wakayama Faculty Nursing, Tokyo Healthcare University, Wakayama 640-8269, Japan;
| | - Sonomi Hattori
- School of Health and Nursing Science, Wakayama Medical University, Wakayama 641-0011, Japan; (N.M.); (S.H.); (H.H.); (Y.U.)
| | - Shigeki Kurasawa
- Faculty of Health Sciences, Kansai University of Welfare Sciences, Kashiwara 582-0026, Japan;
| | - Hiroko Hayakawa
- School of Health and Nursing Science, Wakayama Medical University, Wakayama 641-0011, Japan; (N.M.); (S.H.); (H.H.); (Y.U.)
| | - Yuji Uematsu
- School of Health and Nursing Science, Wakayama Medical University, Wakayama 641-0011, Japan; (N.M.); (S.H.); (H.H.); (Y.U.)
| | - Mikio Arita
- Sumiya Rehabilitation Hospital, Wakayama 640-8344, Japan;
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18
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KWON MOONSEOK, KWON YURI, CHOI YOONHYEOK, EOM GWANGMOON, KO JUNGHYUK, KIM JIWON. GAIT CHARACTERISTICS OF ELDERLY WOMEN IN OVERGROUND, ASCENT AND DESCENT WALKWAY CONDITIONS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gait assessment is important for identification of potential faller among the elderly populations. Slope walking is associated with fall risk factor and elderly women have higher fall rate compared with elderly men. Therefore, this study investigated gait characteristics of elderly women in overground and slope walkway conditions. Thirty healthy elderly women (15 younger-elderly women and 15 older-elderly women) walked along the linear walkway including three walking conditions (overground, ascent and descent conditions). Temporal gait variables and normalized peak vertical GRF (ground reaction force) variables were derived from commercial motion analysis software. Repeated-measures analysis of variance (ANOVA) was evaluated to compare mean differences of the three conditions and mean difference between younger and older elderly women. All gait characteristics were significantly different from the slope walking conditions ([Formula: see text]). Elderly women walked with longer loading response and mid stance phase during descent walking. Also, ascent walking induced a longer terminal stance phase. Interactions of age and walkway conditions were also significant in vertical GRF, where older-elderly women were greater than younger-elderly women in ascent walkway condition ([Formula: see text]) and in descent walkway condition ([Formula: see text]). These findings suggest that specific-walkway condition should be considered for fall prevention and clinical interventions in elderly women.
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Affiliation(s)
- MOON-SEOK KWON
- Sports Convergence Institute, Konkuk University, Chungju, Republic of Korea
| | - YU-RI KWON
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - YOON-HYEOK CHOI
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - GWANG-MOON EOM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - JUNGHYUK KO
- Division of Mechanical Engineering, College of Engineering Korea Maritime and Ocean University, Busan, Korea
| | - JI-WON KIM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
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19
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Dos Santos RB, Lago GN, Jencius MC, Barbosa BA, Lima CA, Paschoal SM, Hill KD, Leme LEG, Perracini MR. Older adults' views on barriers and facilitators to participate in a multifactorial falls prevention program: Results from Prevquedas Brasil. Arch Gerontol Geriatr 2020; 92:104287. [PMID: 33147535 DOI: 10.1016/j.archger.2020.104287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence. METHODS Cross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0-5 sessions) and moderate/high (6-12 sessions) adherence regarding barriers and facilitators. RESULTS Physical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program. CONCLUSION Although barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.
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Affiliation(s)
- Renato Barbosa Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Giulia Neves Lago
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Mariane Chikasawa Jencius
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Bianca Alexandre Barbosa
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Camila Astolphi Lima
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Sergio Marcio Paschoal
- Orthopedic and Traumatology Institute, Faculty of Medicine, Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Keith David Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Luiz Eugenio Garcez Leme
- Orthopedic and Traumatology Institute, Faculty of Medicine, Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil.
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20
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Kimachi K, Kimachi M, Takegami M, Ono R, Yamazaki S, Goto Y, Onishi Y, Sekiguchi M, Otani K, Konno SI, Kikuchi SI, Fukuhara S, Yamamoto Y. Level of Low Back Pain-Related Disability Is Associated with Risk of Subsequent Falls in an Older Population: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS). PAIN MEDICINE 2020; 20:2377-2384. [PMID: 30856262 DOI: 10.1093/pm/pny313] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To examine the longitudinal association between baseline disability due to low back pain (LBP) and future risk of falls, particularly significant falls requiring treatment, in a community-dwelling older population. METHODS This was a prospective population-based cohort study using data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS; 2008-2010). A total of 2,738 residents aged ≥60 years were enrolled. LBP was assessed using the Roland-Morris Disability Questionnaire (RMDQ), and the level of LBP-related disability was divided into three categories (none, low, and medium to high). Incidence of falls over the following year was determined using a self-reported questionnaire after the one-year follow-up period. The risk ratio (RR) for LBP-related disability associated with any fall and any fall requiring treatment was estimated using log binomial regression models. RESULTS Data were analyzed for 1,358 subjects. The prevalence of LBP at baseline was 16.4%, whereas 122 (8.9%) participants reported a low level of LBP-related disability and 101 (7.4%) reported medium to high levels of LBP-related disability. Incidence of any fall and falls requiring treatment was reported by 22.1% and 4.6% of participants, respectively. Subjects with medium to high levels of disability were more likely to experience subsequent falls (adjusted RR = 1.53, 95% confidence interval [CI] = 1.21-1.95) and falls requiring treatment (adjusted RR = 2.55, 95% CI = 1.41-4.60) than those with no LBP-related disability. CONCLUSIONS Level of LBP-related disability was associated with an increased risk of serious falls in a general population of community-living older adults. These findings can alert health care providers involved in fall prevention efforts to the important issue of activity-related disability due to LBP.
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Affiliation(s)
- Kimihiko Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Miho Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Rei Ono
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Shin Yamazaki
- Department of Environmental Epidemiology, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yoshihito Goto
- Department of Community Medicine Supporting System, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | | | | | | | | | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Center for Innovation in Clinical Research, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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21
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Rahman S, Islam SMS, Ali M, Khan A, Kim SY, Maddison R. The prevalence and correlates of fear of falling among older people in Bangladesh. Psychogeriatrics 2020; 20:771-773. [PMID: 32162444 DOI: 10.1111/psyg.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sazedur Rahman
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Mohammad Ali
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Active Healthy Kids Bangladesh (AHKBD), Dhaka, Bangladesh
| | - Sun-Young Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Ikutomo H, Nagai K, Tagomori K, Miura N, Nakagawa N, Masuhara K. Incidence and Risk Factors for Falls in Women With End-Stage Hip Osteoarthritis. J Geriatr Phys Ther 2020; 42:161-166. [PMID: 29351126 DOI: 10.1519/jpt.0000000000000156] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Fall-induced injuries and resulting deaths are a serious health problem among older adults. The most common risk factors for falls in older adults are muscle weakness, gait deficiencies, and balance deficits. Patients with end-stage hip osteoarthritis (OA) also have many hip dysfunctions, and these all have the potential to increase the risk of falls. However, the incidence and risk factors for falls in patients with end-stage hip OA remain unclear. The aim of this study was to determine the incidence of falls in women with end-stage hip OA and to identify risk factors for falls in this patient population. METHODS This study was a cross-sectional analysis. One hundred fifty-three women with end-stage hip OA (mean age = 64.0 years) and 112 age-matched healthy women (mean age = 64.1 years) were analyzed using available data. All participants were examined for the number and circumstances of falls in the past year. The circumstances of falls included the location, time, direction, cause, and injury. We examined the outcome of hip function, ambulatory ability, physical activity, and limping severity in women with end-stage hip OA. Multivariate logistic regression analysis was used to identify factors influencing falls in women with hip OA. RESULTS The incidence of at least 1 fall in the past year was significantly higher in women with end-stage hip OA (30.1%) than in healthy women (12.5%) (P < .001). Falls in women with end-stage hip OA were most often caused by tripping and falling forward during the daytime. The majority of falls (65.2%) resulted in injuries and 13.0% resulted in fractures. The occurrence of a fall significantly correlated with limping (odds ratio = 3.26, 95% confidence interval = 1.49-7.14, P = .003) and knee extensor muscle strength (odds ratio = 0.22, 95% confidence interval = 0.05-0.85, P = .029). CONCLUSIONS Women with end-stage hip OA have an increased risk of falls and fall-induced injuries. The prevention of falls in this vulnerable population should be a priority among health care practitioners. In particular, women who are limping and have reduced lower knee extensor strength should take care to avoid falls.
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Affiliation(s)
| | - Koutatsu Nagai
- Department of Rehabilitation, Graduate School of Health Science, Hyogo University of Health Sciences, Hyogo, Japan
| | | | - Namika Miura
- Department of Rehabilitation, Masuhara Clinic, Osaka, Japan
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23
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Fear of Falling among Older Patients Admitted to Hospital after Falls in Vietnam: Prevalence, Associated Factors and Correlation with Impaired Health-Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072493. [PMID: 32268486 PMCID: PMC7178070 DOI: 10.3390/ijerph17072493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022]
Abstract
Fear of falling (FOF) diminishes older people’s independence in daily activities, as well as causes serious health and economic consequences. This study examined the prevalence of FOF in older patients hospitalized due to fall-injuries, its effect on health-related quality of life (HRQOL), and its associated factors. We conducted a cross-sectional study in seven hospitals in Thai Binh, Vietnam. FOF was assessed using a single close-ended question. HRQOL was evaluated by the EQ-5D-5L instrument. Multilevel logistic regression and Tobit regression models were utilized. The prevalence of FOF in 405 older patients admitted to hospitals after fall injuries was 88.2%, with a mean EQ-5D index and EQ-VAS of 0.34 (SD = 0.38) and 61.6 (SD = 15.2), respectively. Factors associated with FOF included living alone (OR = 0.13, 95%CI = 0.04; 0.50.,), history of eye diseases (OR = 4.12; 95%CI = 1.91; 8.89), and experiencing psychological distress (OR= 3.56, 95% CI = 1.05; 12.00). After adjusting for confounders, the EQ-5D index in the FOF group reduced by 0.15 points (Coef. = −0.15; 95%CI= −0.24; −0.05) compared to that of non-FOF group. Our study shows that FOF had an independent negative relationship with HRQOL of patients. Improving knowledge about fall prevention in patients and caregivers could reduce the burden of falls in older people.
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24
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Kawabata K, Matsumoto T, Kasai T, Chang SH, Hirose J, Tanaka S. Association between fall history and performance-based physical function and postural sway in patients with rheumatoid arthritis. Mod Rheumatol 2020; 31:373-379. [PMID: 32063092 DOI: 10.1080/14397595.2020.1731134] [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] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) are at increased risk of falling; therefore, fall prevision and prevention are critical. The present study aimed to evaluate the ability of physical performance assessments to discriminate between RA patients with and without a history of falling. METHODS Fifty patients with RA were divided into two groups according to the presence or absence of a history of falls within the previous 1 year. Physical performance was assessed using the short physical performance battery (SPPB), which consists of the timed standing balance, gait speed, and chair stand tests. Standing balance was also assessed as postural sway using a force platform in several positions including standing with both feet together, semitandem, and tandem. Backgrounds, SPPB, and postural sway were compared between the two groups. RESULTS Fourteen patients (28%) reported one or more falls within the previous year. There were no significant intergroup differences in baseline characteristics or SPPB score. The group with a history of falls had significantly longer measured time for the 5-repetition chair stand test and significantly longer postural sway in the semitandem position. The discriminate analysis revealed that 5-repetition chair stand test or its combination with postural sway in the semitandem position significantly discriminated between fallers and non-fallers. CONCLUSION Numerical evaluation of the chair stand test and postural sway in the semitandem position seems more appropriate than SPPB for assessing the fall risk of patients with RA.
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Affiliation(s)
- Kensuke Kawabata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taro Kasai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Song Ho Chang
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Hirose
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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25
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Hagiya H, Koyama T, Zamami Y, Tatebe Y, Funahashi T, Shinomiya K, Kitamura Y, Hinotsu S, Sendo T, Rakugi H, Kano MR. Fall-related mortality trends in older Japanese adults aged ≥65 years: a nationwide observational study. BMJ Open 2019; 9:e033462. [PMID: 31831549 PMCID: PMC6924807 DOI: 10.1136/bmjopen-2019-033462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Fall-related mortality among older adults is a major public health issue, especially for ageing societies. This study aimed to investigate current trends in fall-related mortality in Japan using nationwide population-based data covering 1997-2016. DESIGN We analysed fall-related deaths among older persons aged ≥65 years using the data provided by the Japanese Ministry of Health, Labour and Welfare. RESULTS The crude and age-standardised mortality rates were calculated per 100 000 persons by stratifying by age (65-74, 75-84 and ≥85 years) and sex. To identify trend changes, a joinpoint regression model was applied by estimating change points and annual percentage change (APC). The total number of fall-related deaths in Japan increased from 5872 in 1997 to 8030 in 2016, of which 78.8% involved persons aged ≥65 years. The younger population (65-74 years) showed continuous and faster-decreasing trends for both men and women. Average APC among men aged ≥75 years did not decrease. Among middle-aged and older women (75-84 and ≥85 years) decreasing trends were observed. Furthermore, the age-adjusted mortality rate of men was approximately twice that of women, and it showed a faster decrease for women. CONCLUSIONS Although Japanese healthcare has shown improvement in preventing fall-related deaths over the last two decades, the crude mortality for those aged over 85 years remains high, indicating difficulty in reducing fall-related deaths in the super-aged population. Further investigations to uncover causal factors for falls in older populations are required.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Internal Medicine, Osaka University Hospital, Suita, Japan
| | - Toshihiro Koyama
- Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoshito Zamami
- Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School, Tokushima, Japan
| | - Yasuhisa Tatebe
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Tomoko Funahashi
- Department of Pharmaceutical Biomedicine, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Kazuaki Shinomiya
- Department of Pharmaceutical Care and Clinical Pharmacy, Faculty of Pharmaceutical Sciences Tokushima Bunri University, Tokushima, Japan
| | | | - Shiro Hinotsu
- Department of Biostatistics, Sapporo Medical University, Sapporo, Japan
| | - Toshiaki Sendo
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Hiromi Rakugi
- Department of General Internal Medicine, Osaka University Hospital, Suita, Japan
| | - Mitsunobu R Kano
- Department of Pharmaceutical Biomedicine, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
- Department of Geriatric Medicine, University of Tokyo, Tokyo, Japan
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26
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KO JUNGHYUK, KWON YURI, CHOI YOONHYEOK, EOM GWANGMOON, KIM JIWON. GENDER DIFFERENCE OF KNEE JOINT TORQUE DURING MAXIMAL VOLUNTARY CONTRACTION IN THE ELDERLY. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419400360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reduced muscle strength is an important fall risk factor. The fall occurs more in elderly women than in elderly men. The aim of this study is to investigate muscle strength and the ability to generate rapid torque for knee joint in elderly men and women. Twenty healthy elderly participants (10 men and 10 women) performed maximal voluntary knee extension and flexion during concentric, isometric and eccentric conditions. The peak torque and rate of torque development (RTD) was normalized by each subject’s body mass. Independent [Formula: see text]-tests were employed in the comparison of elderly women with elderly men. Elderly women exhibited weaker isometric flexion and eccentric extension strength compared to elderly men ([Formula: see text]). Although there was no significant gender difference in isometric extension peak torque, RTD of elderly women was slower than it of elderly men ([Formula: see text]). In contrast, no significant gender differences were observed in concentric contraction condition ([Formula: see text]). These results indicate that the deteriorated RTD as well as muscle strength per body mass may be associated with a higher frequency of falls in elderly women than in elderly men. This study suggests that training of specific-contraction type should be considered for fall prevention in elderly women.
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Affiliation(s)
- JUNGHYUK KO
- Division of Mechanical Engineering, College of Engineering, Korea Maritime and Ocean University, Busan, Korea
| | - YU-RI KWON
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - YOON-HYEOK CHOI
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - GWANG-MOON EOM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - JI-WON KIM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
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27
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Kamide N, Shiba Y, Sakamoto M, Sato H, Kawamura A. Fall-related efficacy is a useful and independent index to detect fall risk in Japanese community-dwelling older people: a 1-year longitudinal study. BMC Geriatr 2019; 19:293. [PMID: 31664911 PMCID: PMC6820944 DOI: 10.1186/s12877-019-1318-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/15/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Fall-related efficacy has been found to be associated with both falls and fall risk factors such as physical performance. The aim of the present study was to clarify whether fall-related efficacy is, independent of physical performance and other potential risk factors, associated with future falls in community-dwelling older people. METHODS The study participants were 237 Japanese older people aged 65 years and over who were living independently in their community. Fall-related efficacy and physical performance were assessed at baseline using the short version of the Falls Efficacy Scale-International (short FES-I) and 5-m walking time, the Timed Up and Go Test, the 5 Times Sit to Stand Test, and grip strength. Physical performance was then again assessed at 1-year follow-up. The number of falls was obtained every 6 months for 1 year after the baseline survey. Instrumental activities of daily living (IADL), depression, fall history, current medications, medical history, and pain were also investigated as potential confounding factors that have possible associations with falls. The associations between the short FES-I, physical performance, and number of falls were analyzed using Poisson regression analysis adjusted for physical performance and potential confounding factors. RESULTS The mean age of the participants (75.9% women) was 71.1 ± 4.6 years, and 92.8% could perform IADL independently. The total numbers of falls and fallers during the 1-year follow-up period were 70 and 42, respectively. On Poisson regression analysis adjusted for walking time and potential confounding factors, independent of physical performance, the short FES-I was found to be significantly associated with number of falls (relative risk = 1.09, p < 0.05). On the other hand, physical performance was not significantly associated with the number of falls. CONCLUSIONS The findings of the present study suggest that the short FES-I, independent of physical performance and other potential risk factors, is a useful index to detect fall risk in community-dwelling older people, and that fall-related efficacy is an important factor in terms of fall prevention.
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Affiliation(s)
- Naoto Kamide
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan. .,Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.
| | - Yoshitaka Shiba
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Miki Sakamoto
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Haruhiko Sato
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Akie Kawamura
- School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
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28
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Ghaffari-Rafi A, Horak RD, Miles DT, Eum KS, Jahanmir J. Case Report on Fear of Falling Syndrome: A Debilitating but Curable Gait Disorder. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1587-1591. [PMID: 31659147 PMCID: PMC6839539 DOI: 10.12659/ajcr.918879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 70 Final Diagnosis: Fear of falling syndrome Symptoms: Inability to get up from a chair and ambulate independently Medication: — Clinical Procedure: Lumbar puncture Specialty: Neurology
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Affiliation(s)
- Arash Ghaffari-Rafi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Richard D Horak
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA
| | - Daniel T Miles
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA
| | - Ki Suk Eum
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA
| | - Jay Jahanmir
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA
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29
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Chen TY, Chan A, Andersen-Ranberg K, Herr M, Fors S, Jeune B, Herrmann FR, Robine JM, Gondo Y, Saito Y. Prevalence and Correlates of Falls Among Centenarians: Results from the Five-Country Oldest Old Project (5-COOP). J Gerontol A Biol Sci Med Sci 2019; 75:974-979. [DOI: 10.1093/gerona/glz116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Many studies have been conducted to investigate risk factors of falls in older people, but little is known about falls among centenarians. We analyzed the cross-sectional data from the Five-Country Oldest Old Project (5-COOP) to investigate the prevalence and correlates of falls among centenarians.
Methods
Data collection was carried out in 2011–2014 in Japan, France, Switzerland, Sweden, and Denmark. The sample consisted of 1,165 centenarians who were at least 100 years old in 2011. The outcome variable was falls in the past 6 months. Demographics, chronic conditions, pain, visual impairment, global cognitive function, dizziness and syncope, number of medications, functional limitation (ie, dressing, bathing, toileting, transferring, incontinence, and feeding), mobility difficulty, poor strength, and assistive device usage were included in the analysis.
Results
The prevalence of falls within the last 6 months was 33.7%, ranging from 21.6% (Japan) to 40.9% (France). Being male, experiencing dizziness, syncope, incontinence, and using assistive devices indoors were associated with an increased risk of falls among centenarians. Significant cross-country differences in the relationships between some risk factors (ie, gender, difficulty with bathing, toileting, transferring, and feeding, and using assistive devices for walking indoors and outdoors) and falls were observed. Subsample analysis using data from each country also showed that factors related to falls were different.
Conclusions
The prevalence of falls among centenarians is high and fall-related factors may be different than those for their younger counterparts. Given that centenarians is an emerging population, more studies investigating risk factors are needed to better understand falls among centenarians.
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Affiliation(s)
- Tuo-Yu Chen
- Ageing Research Institute for Society and Education, Nanyang Technological University, Singapore
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Karen Andersen-Ranberg
- Danish Aging Research Center, Institute of Public Health, University of Southern Denmark, Odense
- Department of Geriatrics, Odense University Hospital, Denmark
| | - Marie Herr
- INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, Villejuif, France
- Département Hospitalier d’Epidémiologie et de Santé Publique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Sainte Périne, AP-HP, France
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet & Stockholm University, Sweden
| | - Bernard Jeune
- Danish Aging Research Center, Institute of Public Health, University of Southern Denmark, Odense
| | - François R Herrmann
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Switzerland
| | - Jean-Marie Robine
- Ecole Pratique des Hautes Etudes (EPHE), Paris, France
- Université de Montpellier, INSERM, U1198, France
| | - Yasuyuki Gondo
- Graduate School of Human Sciences, Osaka University, Japan
| | - Yasuhiko Saito
- College of Economics and Population Research Institute, Nihon University, Tokyo, Japan
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30
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Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls? Clin Interv Aging 2019; 14:701-719. [PMID: 31190764 PMCID: PMC6514257 DOI: 10.2147/cia.s197857] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/17/2019] [Indexed: 11/03/2022] Open
Abstract
Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.
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Affiliation(s)
- Daniel Schoene
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Heller
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Yan N Aung
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
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31
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Zheng Y, Wang X, Zhang ZK, Guo B, Dang L, He B, Zhang C, Zhou J, Shi W, Zhao Y, Zhan H, Xu Y, Liang C, Liu J, Guan D, Wang L, Wu X, Li J, Zhuo Z, Lin Z, Qiu H, Zhong L, Bian Z, Shi Y, Zhang BT, Zhang G, Lu A. Bushen Yijing Fang Reduces Fall Risk in Late Postmenopausal Women with Osteopenia: A Randomized Double-blind and Placebo-controlled Trial. Sci Rep 2019; 9:2089. [PMID: 30765762 PMCID: PMC6375933 DOI: 10.1038/s41598-018-38335-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/20/2018] [Indexed: 01/06/2023] Open
Abstract
Falls in late postmenopausal women with osteopenia usually cause fractures with severe consequences. This 36-month randomized, double-blind and placebo-controlled trial with a 10-year observational follow-up study aimed to investigate the long-term effect of herbal formula Bushen Yijing Fang (BSYJF) on fall risk in the late postmenopausal women with osteopenia. 140 late postmenopausal women (Femoral neck T-score, −2.5~−2 SD) were recruited and randomized to orally receive calcium carbonate 300 mg daily with either BSYJF or placebo for 36 months. The effect was further investigated for another 10-year follow-up. During the 36-month administration, there were 12 falls in BSYJF group and 28 falls in placebo group, respectively, indicating 64% lower risk of falls (RR 0.36 [95% CI, 0.18 to 0.71]; P = 0.004) in BSYJF group. During the 10-year follow-up, 36% lower fall risk (RR 0.64 [95% CI, 0.46 to 0.89]; P = 0.009) was observed in BSYJF group. No significant difference was found in safety profile between two groups. Thirty-six-month administration of BSYJF reduced fall risk with an increase in bone mass, and its latent effect on fall risk was continually observed in the 10-year follow-up in late postmenopausal women with osteopenia. This clinical trial was registered at Chinese clinical trial registry (ChiCTR-IOR-16008942).
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Affiliation(s)
- Yuxin Zheng
- Department of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuezong Wang
- Department of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zong-Kang Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Baosheng Guo
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China.,School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Dang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Bing He
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China.,Institute of Integrated Bioinformedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Chi Zhang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Jiwei Zhou
- Department of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wanzhong Shi
- Preparation Center of Traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongfang Zhao
- Institute of Orthopaedics and Traumatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Hongsheng Zhan
- Institute of Orthopaedics and Traumatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yu Xu
- Institute of Orthopaedics and Traumatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Chao Liang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Jin Liu
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Daogang Guan
- Institute of Integrated Bioinformedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Luyao Wang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Xiaohao Wu
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Jie Li
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhenjian Zhuo
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhixiu Lin
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hong Qiu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lidan Zhong
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Zhaoxiang Bian
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Yinyu Shi
- Department of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bao-Ting Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Ge Zhang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China.
| | - Aiping Lu
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China. .,Institute of Integrated Bioinformedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China. .,School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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KWON YURI, CHOI YOONHYEOK, EOM GWANGMOON, KO JUNGHYUK, KIM JIWON. COMPARISON OF MAXIMAL HIP JOINT TORQUE DURING CONCENTRIC, ISOMETRIC AND ECCENTRIC CONTRACTIONS BETWEEN ELDERLY MEN AND WOMEN. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519418400365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A higher fall rate has been reported in elderly women than in elderly men. Muscle strength is one of the key fall risk factors. The aim of this study was to investigate gender differences associated with maximal voluntary hip flexion and extension torque in concentric, isometric and eccentric contractions among the elderly subjects. A total of 20 healthy elderly subjects (10 men and 10 women) participated in this study. A dynamometer was used to measure hip joint torque during various modes of isokinetic contraction in frontal plane. The peak torque was normalized according to each subject’s body mass. Independent [Formula: see text]-tests were conducted to compare elderly women with elderly men. Elderly women exhibited weaker normalized peak torque during flexion and extension compared with elderly men in isometric contraction mode ([Formula: see text]). Eccentric strength of elderly women was significantly lower than in elderly men primarily in hip extension ([Formula: see text]). In contrast, no significant differences were observed in concentric contraction mode between the two genders ([Formula: see text]). These results suggest that the decreased muscle strength per body mass, especially in isometric and eccentric contraction, may be associated with a higher frequency of falls in elderly women than in elderly men. This study suggests the need for effective muscle strength training and intervention for fall prevention in elderly women.
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Affiliation(s)
- YU-RI KWON
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - YOON-HYEOK CHOI
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - GWANG-MOON EOM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
| | - JUNGHYUK KO
- Division of Mechanical Engineering, College of Engineering, Korea Maritime and Ocean University, Busan, Korea
| | - JI-WON KIM
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
- School of Biomedical Engineering, Konkuk University, Chungju, Republic of Korea
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Sotoudeh GR, Mohammadi R, Mosallanezhad Z, Viitasara E, Soares JJF. The prevalence, circumstances and consequences of unintentional falls among elderly Iranians: A population study. Arch Gerontol Geriatr 2018; 79:123-130. [PMID: 30205318 DOI: 10.1016/j.archger.2018.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/15/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Falling threatens the health, independence and quality of life of older adults. Information about characteristics and predisposing factors of falls is essential to develop and implement effective preventing measure. The aim of this study was to examine the prevalence, circumstances and consequences of falls among community-dwelling older adults in Tehran, Iran, and scrutinize factors (e.g. demographics) associated with falls. METHODS A cross-sectional study was conducted in Tehran. A total of 653 individuals aged 65 years and over were selected by a stratified random sampling as representing older adults in Tehran. All required data were collected through face-to-face interviews using questionnaires. RESULTS The prevalence of falls was 39.7% and higher in women than in men. For both sexes, most of the falls occurred in the afternoon (n = 135, 52.1%) and at home (n = 209, 80.7%). One-fourth of the falls (23.2%) occurred in a forward direction, mostly among women (60%). For both sexes, one-third of the causes of falls were loss of balance, mostly among women and the oldest persons. Two-hundred and twelve of the fallers reported injuries. The logistic regression showed that female gender, low education and constant worries about living expenses were significantly associated with falls. CONCLUSIONS This study may have provided new insights into the characteristics/ circumstances/ consequences of injurious falls and their relation with age, gender and injury severity in Iran. It may be useful for health policy makers and health providers when designing falls intervention and prevention programs at the community level.
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Affiliation(s)
- Gholam Reza Sotoudeh
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Mohammadi
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Unit for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Eija Viitasara
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Joaquim J F Soares
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Tomita Y, Arima K, Tsujimoto R, Kawashiri SY, Nishimura T, Mizukami S, Okabe T, Tanaka N, Honda Y, Izutsu K, Yamamoto N, Ohmachi I, Kanagae M, Abe Y, Aoyagi K. Prevalence of fear of falling and associated factors among Japanese community-dwelling older adults. Medicine (Baltimore) 2018; 97:e9721. [PMID: 29369207 PMCID: PMC5794391 DOI: 10.1097/md.0000000000009721] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the prevalence of fear of falling and associated factors among Japanese community-dwelling older adults.Cross-sectional study between 2011 and 2013.Community in which residents voluntarily attended a health examination.We recruited 844 older adults (male, n = 350; female, n = 494) aged 60 to 92 years from among those who presented at the health examination.We assessed fear of falling, falls in the previous year, pain, comorbidity, and cataracts. Five times chair stand time was applied as an indicator of physical performance.The prevalence of fear of falling was 26.9% and 43.3% among the men and women, respectively. Men and women who feared falling were older (P < .01), had longer 5 times chair stand time (P < .01), and more falls in the previous year (P < .05), pain (P < .01), and comorbidity (P < .05). Multivariate logistic regression analysis identified advanced age (odds ratios [OR], 1.57; 95% confidence interval [CI], 1.03-2.39), falls in the previous year (OR, 2.44; 95%CI, 1.29-4.64), and pain (OR, 1.82; 95%CI, 1.03-3.22) in men, and advanced age (OR, 1.59; 95%CI, 1.13-2.24), longer 5 times chair stand times (OR, 1.28; 95%CI, 1.04-1.59), falls in the previous year (OR, 2.59; 95%CI, 1.54-4.34), and pain (OR, 1.65; 95%CI, 1.06-2.55) in women as being independently associated with fear of falling.The prevalence of fear of falling was similar to previous reports. Advanced age, falls in previous year, and pain were associated with fear of falling in men. A longer 5 times chair stand time was also associated with fear of falling among older adult women. Maintenance of physical function and pain management might be important for older adults with fear of falling.
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Affiliation(s)
- Yoshihito Tomita
- Department of Public Health
- Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya
| | | | | | | | | | - Satoshi Mizukami
- Department of Public Health
- Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya
| | - Takuhiro Okabe
- Department of Public Health
- Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya
| | | | | | | | - Naoko Yamamoto
- Department of Health Science, Faculty of Medicine Kagoshima University, Kagoshima
| | - Izumi Ohmachi
- Department of Health Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mitsuo Kanagae
- Department of Public Health
- Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya
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JEON HYEONGMIN, KIM JIWON, KWON YURI, HEO JAEHOON, CHOI EUIBUM, EOM GWANGMOON. UPPER BODY ACCELERATIONS DURING LOCOMOTION IN DIFFERENT AGE GROUPS AND GENDERS. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417400267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aim: The purpose of this study is to measure the acceleration of upper body (pelvis, shoulder and head) during walking and to investigate whether the acceleration patterns differ among age groups and genders. Methods: Twenty-nine old subjects and thirty young subjects participated in this study. Tri-axial accelerations were measured on the back of upper body (head, shoulder and pelvis). Subjects performed two trials of walking on a treadmill in their own comfortable speeds. Three-way ANOVA (repeated measures) was carried out for the root mean square of each directional acceleration with age, gender and sensor position as independent factors. Results: Age effect was significant on the RMS accelerations of the transverse plane. In the anteroposterior direction, the pelvis acceleration was greater in the younger group, while the head acceleration was greater in the older group ([Formula: see text]). In the mediolateral direction, the pelvis acceleration was comparable between age groups but the shoulder and head accelerations were greater in the older group ([Formula: see text]). The overall accelerations were greater in men than in women ([Formula: see text]). The phase-delay and attenuation of shoulder acceleration relative to the pelvis acceleration was smaller for the elderly in AP and ML directions ([Formula: see text]). Normalization of RMS accelerations by height, weight and leg length did not affect the age differences but negated the gender differences. Discussion: Greater head acceleration in older subjects were related to less attenuation of acceleration in the upper body, which may affect the sensory systems in the head and deteriorate balance control during locomotion.
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Affiliation(s)
- HYEONG-MIN JEON
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - JI-WON KIM
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - YURI KWON
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - JAE-HOON HEO
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - EUI-BUM CHOI
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - GWANG-MOON EOM
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
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KIM JIWON, KWON YURI, EOM GWANGMOON. AGE-RELATED DIFFERENCE IN DYNAMIC POSTURAL BALANCE AGAINST TILTING PERTURBATION IN MEN AND WOMEN. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417400383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to investigate how age and gender affect the dynamic postural balance during tilting perturbation. Fifty healthy subjects (15 young men, 13 young women, 11 elderly men and 11 elderly women) performed balance test on a movable force plate that tilted toe-up and toe-down. As outcome measures, maximum excursion and fluctuation were calculated from center of pressure (COP) data in the sagittal plane (anteroposterior). Two-way analysis of variance (ANOVA) and post-hoc comparisons were performed for the outcome measures with the independent factors of age and gender. The elderly had a greater COP maximum excursion as compared to the young during both perturbations ([Formula: see text]). COP fluctuation showed significant interaction of age and gender only in toe-up perturbation ([Formula: see text]). Especially, age-related difference existed only in women ([Formula: see text]). These results suggest that elderly women have dynamic balance strategy with great and fluctuated sway in response to toe-up perturbation. The age-related changes in dynamic balance among women may be related to the greater fall rate of elderly women.
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Affiliation(s)
- JI-WON KIM
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Korea
| | - YU-RI KWON
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Korea
| | - GWANG-MOON EOM
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Korea
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Crenshaw JR, Bernhardt KA, Achenbach SJ, Atkinson EJ, Khosla S, Kaufman KR, Amin S. The circumstances, orientations, and impact locations of falls in community-dwelling older women. Arch Gerontol Geriatr 2017; 73:240-247. [PMID: 28863352 PMCID: PMC5858880 DOI: 10.1016/j.archger.2017.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women. METHODS For this longitudinal, observational study, 125 community-dwelling women age≥65years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires. RESULTS More than half (59%) of participants fell, with 30% of participants falling more than once (fall rate=1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41% of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR=12.6; 95% CI: 4.7-33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR=2.6; 95% CI: 1.2-5.9). CONCLUSION Falls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.
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Affiliation(s)
- Jeremy R Crenshaw
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | | | - Sara J Achenbach
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shreyasee Amin
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
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Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. CURRENT ORTHOPAEDIC PRACTICE 2017; 28:580-585. [PMID: 29177024 PMCID: PMC5671779 DOI: 10.1097/bco.0000000000000563] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fragility fractures in the elderly is an ongoing concern for orthopaedic surgeons. A 50-year-old woman has a 40% chance of having a vertebral compression fracture in her lifetime. The incidence of vertebral fractures, reported to be more than 10 times higher than that of femoral fractures, is estimated as 1–1.5 million per year in Japan. Vertebral fractures often occur without a fall, whereas the majority of nonvertebral fractures are the consequence of falls; the site of the nonvertebral fracture appears to be dictated by the type of fall. Distal radial fractures commonly occur as a consequence of hand protection during the fall. In older patients, falling load tends to directly affect shoulder and hip joints and lead to proximal humeral and femoral fractures. The incidence of vertebral fractures is increased in women over 50 yr of age, following the same trend as osteoporosis prevalence. Conversely, the mean age for proximal femoral fractures is around 80 yr, and more than 75% of femoral fractures occur in individuals over the age of 75. The prognostic risk of aging is 11-fold greater than that of reduced bone mineral density, and age is another risk factor for femoral fractures. Prophylactic therapy for osteoporosis and femoral fractures was shown to more effective in women in their 70s than in those over the age of 80. Although several approaches, including exercise therapy, vitamin D administration, and environmental adjustment at home, have been reported to be effective in fall prevention, effective fracture prevention approaches in frail elderly individuals have not yet been well established.
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Thiamwong L, Suwanno J. Fear of Falling and Related Factors in a Community-based Study of People 60 Years and Older in Thailand. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons R, Mason S, Nicholl J, Peconi J, Phillips C, Phillips J, Porter A, Siriwardena AN, Smith G, Toghill A, Wani M, Watkins A, Whitfield R, Wilson L, Russell IT. Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate. Health Technol Assess 2017; 21:1-218. [PMID: 28397649 PMCID: PMC5402213 DOI: 10.3310/hta21130] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. OBJECTIVES To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use. DESIGN Cluster randomised controlled trial. PARTICIPANTS Participating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas. INTERVENTIONS Intervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal. OUTCOMES The primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation. RESULTS Across sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied with assessments carried out by paramedics. Paramedics reported that the intervention had increased their confidence to leave patients at home, but barriers to referral included patients' social situations and autonomy. CONCLUSIONS Findings indicate that this new pathway may be introduced by ambulance services at modest cost, without risk of harm and with some reductions in further emergency calls. However, we did not find evidence of improved health outcomes or reductions in overall NHS emergency workload. Further research is necessary to understand issues in implementation, the costs and benefits of e-trials and the performance of the modified Falls Efficacy Scale. TRIAL REGISTRATION Current Controlled Trials ISRCTN60481756 and PROSPERO CRD42013006418. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen A Snooks
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Rebecca Anthony
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachael Fothergill
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Sarah Gaze
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Mary Halter
- Faculty of Health and Social Care Sciences, St George's University Hospital, London, UK
| | - Ioan Humphreys
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Marina Koniotou
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Phillipa Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Ronan Lyons
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Julie Peconi
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Judith Phillips
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | - Alison Porter
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | | | | | | | - Mushtaq Wani
- Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, UK
| | - Alan Watkins
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Richard Whitfield
- Pre-hospital Emergency Research Unit (PERU), Welsh Ambulance Services NHS Trust, Cardiff, UK
| | - Lynsey Wilson
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Ian T Russell
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
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KWON YURI, HEO JAEHOON, JEON HYEONGMIN, MIN SEDONG, JUN JAEHOON, TACK GYERAE, PARK BYUNGKYU, KIM JIWON, EOM GWANGMOON. AGE–GENDER DIFFERENCE IN THE BIOMECHANICAL FEATURES OF SIT-TO-STAND MOVEMENT. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416400273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate the effects of age and gender on the biomechanical features of sit-to-stand (STS) movement. Twenty young subjects and 20 elderly subjects participated in this study. Nine events during STS movement were defined where joint angles and joint moments were extracted for further analyses. Two-way repeated measures ANOVA was performed for joint angles and joint moments with age and gender as independent factors. Major gender differences were shown in joint angles. Women used a sliding forward strategy more than men (more flexion of ankle and knee joint) during mid-phases of STS movement ([Formula: see text]) and men used an exaggerated trunk flexion strategy more than women (more hip flexion) in later phases of STS movement ([Formula: see text]). Age differences were shown in joint moments. Elderly subjects showed smaller knee extension moment (normalized by body weight) but greater ankle plantar flexion moment than young subjects in mid-to-late phases of STS movement ([Formula: see text]). More anterior positioning of center of mass (COM) in the elderly might be the reason for the strategy difference. That is, the shorter distance of COM from the knee joint would require less knee extension moment, and likewise, the more forward displacement of COM with respect to the ankle joint would need more plantar flexion moment. More anterior positioning of COM in the elderly, compared to the young was reflected on center of pressure (COP), and the forward displacement of COP was correlated well with the higher body mass index (BMI) and shorter thigh length ([Formula: see text]).
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Affiliation(s)
- YURI KWON
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - JAE-HOON HEO
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - HYEONG-MIN JEON
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - SE DONG MIN
- Department of Medical IT Engineering, Soon Chun Hyang University, Asan 336-745, Korea
| | - JAE-HOON JUN
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - GYE-RAE TACK
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - BYUNG KYU PARK
- Department of Physical Medicine & Rehabilitation, Korea University, Seoul, Korea
| | - JI-WON KIM
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
| | - GWANG-MOON EOM
- School of Biomedical Engineering, Konkuk University, Chungju 380-701, Korea
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Kitayuguchi J, Kamada M, Inoue S, Kamioka H, Abe T, Okada S, Mutoh Y. Association of low back and knee pain with falls in Japanese community-dwelling older adults: A 3-year prospective cohort study. Geriatr Gerontol Int 2016; 17:875-884. [DOI: 10.1111/ggi.12799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/16/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jun Kitayuguchi
- Physical Education and Medicine Research Center UNNAN; Shimane Japan
- Department of Environmental Symbiotic Studies; Tokyo University of Agriculture; Tokyo Japan
| | - Masamitsu Kamada
- Division of Preventive Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
- Department of Health Promotion and Exercise; National Institute of Health and Nutrition; Tokyo Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health; Tokyo Medical University; Tokyo Japan
| | - Hiroharu Kamioka
- Faculty of Regional Environment Science; Tokyo University of Agriculture; Tokyo Japan
| | - Takafumi Abe
- Physical Education and Medicine Research Center UNNAN; Shimane Japan
- Department of Orthopaedic Surgery; Shimane University School of Medicine; Shimane Japan
| | - Shimpei Okada
- Physical Education and Medicine Research Foundation; Nagano Japan
| | - Yoshiteru Mutoh
- The Research Institute of Nippon Sport Science University; Tokyo Japan
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Levy F, Leboucher P, Rautureau G, Komano O, Millet B, Jouvent R. Fear of falling: efficacy of virtual reality associated with serious games in elderly people. Neuropsychiatr Dis Treat 2016; 12:877-81. [PMID: 27143889 PMCID: PMC4841394 DOI: 10.2147/ndt.s97809] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Fear of falling is defined as an ongoing concern about falling that is not explained by physical examination. Focusing on the psychological dimension of this pathology (phobic reaction to walking), we looked at how virtual reality associated with serious games can be used to treat this pathology. METHODS Participants with fear of falling were randomly assigned to either a treatment group or a waiting list. The therapy consisted of 12 weekly sessions of virtual reality exposure therapy associated with serious games. RESULTS Sixteen participants were included. The mean age of the treatment group was 72 years and that of the control group was 69 years. Participants' scores on the fear of falling measure improved after treatment with virtual reality associated with serious games, leading to a significant difference between the two groups. CONCLUSION Virtual reality exposure therapy associated with serious games can be used in the treatment of fear of falling. The two techniques are complementary (top-down and bottom-up processes). To our knowledge, this is the first time that a combination of the two has been assessed. There was a specific effect of this therapy on the phobic reaction. Further studies are needed to confirm its efficacy and identify its underlying mechanism.
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Affiliation(s)
- Fanny Levy
- Department of Adults Psychiatry, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Pierre Leboucher
- PRISME-Virtual Reality, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Gilles Rautureau
- PRISME-Virtual Reality, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Odile Komano
- PRISME-Virtual Reality, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Bruno Millet
- Department of Adults Psychiatry, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Roland Jouvent
- Department of Adults Psychiatry, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
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Zimba Kalula S, Ferreira M, Swingler G, Badri M, Aihie Sayer A. Prevalence of Falls in an Urban Community-Dwelling Older Population of Cape Town, South Africa. J Nutr Health Aging 2015; 19:1024-31. [PMID: 26624215 DOI: 10.1007/s12603-015-0664-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Falls are a major cause of disability and mortality in older adults. Studies on falls in this population have mainly been conducted in high income countries, and scant attention has been given to the problem in low and middle income countries, including South Africa. The aim of the study was to establish a rate for falls in older adults in South Africa. DESIGN A cross-sectional survey with a 12-month follow-up survey. SETTING Three purposively selected suburbs of Cape Town: Plumstead, Wynberg Central and Gugulethu. PARTICIPANTS Eight hundred and thirty seven randomly sampled ambulant community-dwelling subjects aged ≥ 65 years grouped according to ethnicity in three sub-samples: black Africans, coloureds (people of mixed ancestry) and whites. MEASUREMENTS Data were collected on socio-demographic and health characteristics, and history of falls using a structured questionnaire and a protocol for physical assessments and measurements. RESULTS Of the total baseline (n=837) and follow-up (n=632) survey participants, 76.5% and 77.2 % were females with a mean (S.D) age of 74 years (6.4) and 75 years (6.2), respectively. Rates of 26.4% and 21.9% for falls and of 11% and 6.3% for recurrent falls, respectively, were calculated at baseline and follow-up. Fall rates differed by ethnic sub-sample at baseline: whites 42 %, coloureds 34.4% and black Africans 6.4 % (p=0.0005). Rates of 236, 406 and 354 falls per 1000 person years were calculated for men, women and both genders, respectively. Recurrent falls were more common in women than in men. CONCLUSION Falls are a significant problem in older adults in South Africa. Effective management of falls and falls prevention strategies for older people in South Africa, need to be developed and implemented.
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Affiliation(s)
- S Zimba Kalula
- S. Zimba Kalula, University of Cape Town, Institute of Ageing in Africa, L51, Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, Western Cape 7925, South Africa,
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Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, Abe Y, Goto H, Horiguchi I, Aoyagi K. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine (Baltimore) 2015; 94:e1449. [PMID: 26334906 PMCID: PMC4616514 DOI: 10.1097/md.0000000000001449] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women.The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured.The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P = 0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts.Maintaining physical functioning and managing pain may be important for elderly women with fear of falling.
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Affiliation(s)
- Yoshihito Tomita
- From the Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (YT, KA, MK, TO, TN, YA, KA); Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan (YT, MK, TO, SM); Goto Health Care Office, Nagasaki, Japan (HG); and Center for Public Relations Strategy, Nagasaki University, Nagasaki, Japan (IH)
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Abstract
Anxiety disorders are highly prevalent among the elderly and are associated with increased disability, poor quality of life, and cognitive impairment. Despite this high prevalence and associated morbidities, anxiety disorders in late life are underreported and understudied. In this article, we discuss the epidemiology, disease presentation, and current treatment of anxiety disorders in older adults. We also discuss limitations in the current understanding of such disorders in this population, as well as future research directions that may reveal the mechanisms and rationale for treatment regimens for anxiety disorders in late life. We present material on the application of the Research Domain Criteria (RDoC) model to geriatric anxiety. Finally, we describe optimal management strategies of anxiety disorders.
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Ikutomo H, Nagai K, Nakagawa N, Masuhara K. Falls in patients after total hip arthroplasty in Japan. J Orthop Sci 2015; 20:663-8. [PMID: 25797333 DOI: 10.1007/s00776-015-0715-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/07/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND There have been few reports on falls in patients who have undergone total hip arthroplasty (THA). In the present study, we aimed to investigate the incidence and circumstances of falls in post-THA patients and to identify the factors associated with falling. MATERIALS AND METHODS After excluding comorbidities, osteoarthritis without THA, and patients who had undergone THA within the previous 1 year, 214 patients [11 males, 203 females; mean (SD) age, 66.0 (8.7) years] living independently for at least 1 year after THA were analyzed as available data. Using a self-administered questionnaire, we investigated the number and circumstances of falls in the preceding year, as well as functional outcome and ambulatory ability via the Oxford Hip Score. Multivariate logistic regression analysis was used to identify factors influencing falls in post-THA patients. RESULTS The incidence of at least one fall in the past year was 36 %. Falls were most often caused by tripping and falling forward during the daytime. In the present study, 37.7 % of falls resulted in injuries and 5.2 % resulted in fractures. Experience of fall was significantly related to medication [odds ratio (OR) 4.09, 95 % confidence interval (CI) 1.90-8.80, P < 0.001] and postoperative duration (OR 0.89, 95 % CI 0.81-0.98, P < 0.05). CONCLUSIONS Thus, patients have an increased risk for falls and fall-induced injuries after THA. Falls in post-THA patients are associated with medication and shorter postoperative duration. Therefore, it is essential to prevent falls in patients who have undergone THA, particularly during the early postoperative period and among patients administered medications.
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Affiliation(s)
- Hisashi Ikutomo
- Department of Rehabilitation, Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka, 530-0042, Japan,
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Yuki K, Asaoka R, Tsubota K. Investigating the Influence of Visual Function and Systemic Risk Factors on Falls and Injurious Falls in Glaucoma Using the Structural Equation Modeling. PLoS One 2015; 10:e0129316. [PMID: 26053502 PMCID: PMC4459810 DOI: 10.1371/journal.pone.0129316] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the relationship between visual function and the risks of falling and injurious falls in subjects with primary open angle glaucoma (POAG) Methods Questionnaires were conducted in 365 POAG patients to assess history of falls and falls with injury and general patient health. Structural equation modeling (SEM) was used to investigate the relationship between visual function, as measured by a patient’s binocular integrated visual field and visual acuity (VA), general health and the risks of falling and injurious falls. Results Among the 365 subjects, 55 subjects experienced falls in the past year. A significant difference was observed in worse-eye VA between the faller and non-faller groups (p = 0.03). SEM of fallers obtained a Root Mean Square Error of Approximation (RMSEA) of 0.035 and a Comparative Fit Index (CFI) of 0.99. The 95% confidence intervals (CI) of regression coefficients from this model suggested better VA and worse VA were significant risk factors for falling. Among the 55 fallers, 22 subjects experienced an associated injury. There was a significant difference in gender between the non-injurious and injurious faller groups (p = 0.002). SEM of injurious fallers obtained a RMSEA of 0.074 and a CFI of 0.97. In this SEM model, the 95% CI of regression coefficients suggested gender and average total deviation values in the lower peripheral visual field were significant risk factors for an injurious fall. Conclusions This study suggests that worse-eye and better-eye VAs are associated with falls. Furthermore, patients with inferior visual field loss and females were found to be at greater risk of injurious falls.
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Affiliation(s)
- Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
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Kalula SZ, Ferreira M, Swingler GH, Badri M. Ethnic differences in rates and causes of falls in an urban community-dwelling older population in South Africa. J Am Geriatr Soc 2015; 63:403-4. [PMID: 25688622 DOI: 10.1111/jgs.13277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Sebastiana Z Kalula
- Division of Geriatric Medicine, Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, Cape Town, South Africa
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Schmid AA, Acuff M, Doster K, Gwaltney-Duiser A, Whitaker A, Damush T, Williams L, Hendrie H. Poststroke Fear of Falling in the Hospital Setting. Top Stroke Rehabil 2015; 16:357-66. [DOI: 10.1310/tsr1605-357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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