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Harrison-Dening K. Can falls as a behavioural marker indicate development of dementia down-line? Evid Based Nurs 2024; 27:77. [PMID: 37833032 DOI: 10.1136/ebnurs-2023-103712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
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Bouzid W, Tavassoli N, Berbon C, Qassemi S, Vaysset S, Poly M, Bounes V, Shourick J, Nourhashémi F. Exploring Population Characteristics and Recruitment Challenges in Older People Experiencing Falls at Home without Hospitalization or with an Emergency Department Visit: Insights from the RISING-DOM Experience. Clin Interv Aging 2023; 18:1995-2008. [PMID: 38058551 PMCID: PMC10697010 DOI: 10.2147/cia.s421053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background An increasing number of falls among community-living older adults are reported in emergency calls. Data on evidence of appropriate fall prevention interventions are limited and challenges in recruiting this population in randomized trials are acknowledged. Purpose The main aim of this study was to provide demographic data, circumstance and fall-related outcomes of the population in the RISING-DOM study [Impact d'une évaluation des facteurs de RISque de chute et d'une prise en charge personnalisée, sur la mortalité et l'institutionnalisation, après INtervention du SAMU chez la personne âGée à DOMicile], a multicenter, randomized interventional trial involving community-dwelling older adults who have experienced a fall at home and were not hospitalized. Additionally, the challenges of remote recruitment in this population were discussed. Patients and Methods Participants were identified through the Occitania Emergency Observatory database. Participant recruitment and data collection were performed through telephone interviews (October 2019-March 2022). Additionally, a sample survey of Emergency Medical Services calls was carried out. Results Out of the 1151 individuals screened, a total of 951 participants were included in the trial follow-up, resulting in an acceptance rate of 82.62%. The screening delay was extended due to the COVID-19 pandemic. Recruiting difficulties were mainly related to identifying potential participants, unavailable contact information and unreachability. Participants' mean age was 84.1 years, 65.8% were women, and 44.3% lived alone. Pain was the most frequent outcome (53%). In the previous year, 73.5% of participants reported experiencing a fall, with 66.7% of those falls requiring assistance from Emergency Medical Services (EMS). Nearly, 40% did not take proactive steps to prevent future falls and walking aids (79.8%) were the most common preventive action. Conclusion Indicators of a high-risk group of falls have been identified underscoring the need for appropriate fall interventions in the target population. Challenges of large sampling for randomized fall prevention trials were provided. Trial Registration Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.
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Affiliation(s)
- Wafa Bouzid
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
- Regional Health Agency of Occitanie, Toulouse, 31000, France
| | - Neda Tavassoli
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Caroline Berbon
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Soraya Qassemi
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Sandrine Vaysset
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Magali Poly
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Vincent Bounes
- Emergency Medicine Unit, University of Toulouse Hospital Center, Toulouse, France
| | - Jason Shourick
- Research Methodology Support Unit (USMR), Clinical Epidemiology and Public Health Department, University of Toulouse Hospital Center, Toulouse, France
- CERPOP, UMR 1295, INSERM – University of Toulouse III, Toulouse, France
| | - Fati Nourhashémi
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
- CERPOP, UMR 1295, INSERM – University of Toulouse III, Toulouse, France
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Talevski J, Gianoudis J, Bailey CA, Ebeling PR, Nowson CA, Hill KD, Sanders KM, Daly RM. Effects of an 18-month community-based, multifaceted, exercise program on patient-reported outcomes in older adults at risk of fracture: secondary analysis of a randomised controlled trial. Osteoporos Int 2023; 34:891-900. [PMID: 36862193 PMCID: PMC10104917 DOI: 10.1007/s00198-023-06693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Abstract
UNLABELLED This study identified that an 18-month community-based, multifaceted, exercise program consisting of resistance, weight-bearing impact, and balance/mobility training combined with osteoporosis education and behavioural support can improve health-related quality of life (HRQoL) and osteoporosis knowledge in older adults at risk of fracture, but only for those adherent to the exercise regime. PURPOSE To evaluate the effects of an 18-month community-based exercise, osteoporosis education and behaviour change program (Osteo-cise: Strong Bones for Life) on HRQoL, osteoporosis knowledge and osteoporosis health beliefs. METHODS This was a secondary analysis of an 18-month randomised controlled trial in which 162 older adults aged ≥ 60 years with osteopenia or increased falls/fracture risk were randomized to the Osteo-cise program (n = 81) or control group (n = 81). The program consisted of progressive resistance, weight-bearing impact and balance training (3 days/week); osteoporosis education to facilitate self-management of musculoskeletal health and behavioural support to enhance adherence to exercise. HRQoL, osteoporosis knowledge and osteoporosis health beliefs were assessed using the EuroQoL questionnaire (EQ-5D-3L), Osteoporosis Knowledge Assessment Tool and Osteoporosis Health Belief Scale, respectively. RESULTS Overall, 148 participants (91%) completed the trial. Mean exercise adherence was 55% and mean attendance for the three osteoporosis educational sessions ranged from 63-82%. After 12 and 18 months, there were no significant effects of the Osteo-cise program on HRQoL, osteoporosis knowledge or health beliefs relative to controls. Per protocol analyses (≥ 66% exercise adherence; n = 41) revealed a significant net benefit in EQ-5D-3L utility for the Osteo-cise group relative to controls after 12 months (P = 0.024) and 18 months (P = 0.029) and a significant net improvement in osteoporosis knowledge scores at 18 months (P = 0.014). CONCLUSION This study supports the importance of adherence to exercise regimes, as adherence to the Osteo-cise: Strong Bones for Life program was associated with improvements in HRQoL and osteoporosis knowledge in older adults at increased risk for falls and fractures. TRIAL REGISTRATION NUMBER ACTRN12609000100291.
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Affiliation(s)
- Jason Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - Jenny Gianoudis
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Christine A Bailey
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Kerrie M Sanders
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Kim GS, Shim MS, Won CW, Kim M, Lee S, Kim N, Park MK. Patterns and predictors of fall injury transitions among Korean older adult fallers: a 2-year longitudinal study. Sci Rep 2022; 12:22188. [PMID: 36564434 DOI: 10.1038/s41598-022-26665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This study was conducted to identify fall injury patterns, the transition from the baseline to follow-up, and the factors associated with the identified fall injury patterns using data obtained from the Korean Frailty and Aging Cohort Study. The participants were 566 community-dwelling older adults with fall experience. Three fall injury patterns were identified as the baseline and follow-up periods. The probability that the participant in the "fracture injury" pattern at Time 1 transitioned to the "fracture injury" pattern at Time 2 was 0.098. The factors associated with the "bruising and/or sprain injury" pattern were education level (relative risk ratio [RRR] = 0.55, p = 0.012), alcohol consumption (RRR = 0.50, p = 0.034), and balancing in tandem position (RRR = 2.77, p < 0.001). In the "fracture injury" pattern, male (RRR = 0.22, p = 0.038), frailty score (RRR = 0.58, p = 0.042), "bruising injury" (RRR = 0.23, p = 0.007), and "sprain injury" (RRR = 0.20, p = 0.007) at the baseline were significant factors. The findings indicate that previous fall experiences, higher alcohol consumption, lower frailty scores, and poor balance levels are associated with fall injury patterns. These patterns should be considered when developing prevention interventions.
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Luebbert S, Christensen W, Finkel C, Worsowicz G. Falls in Senior Adults: Demographics, Cost, Risk Stratification, and Evaluation. Mo Med 2022; 119:158-163. [PMID: 36036034 PMCID: PMC9339401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Falls occur at staggering rates across the country, with 25% of Americans over 65 reporting annual falls. The fall rate in Missourian older adults is 27.3%. Eighty-six percent of fall-related deaths happen over the age of 65. There are many intrinsic and extrinsic factors that contribute to falls, with some factors that can be targeted and optimized by physicians. There are nuances to the history and physical that can help physicians identify these risk factors.
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Affiliation(s)
- Stephen Luebbert
- Resident Physician at the University of Missouri - Columbia School of Medicine Department of Physical Medicine and Rehabilitation, Columbia, Missouri (UMC SOM DPMR COMO)
| | | | - Claire Finkel
- Associate Residency Program Director UMC SOM DPMR COMO
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Fung A, Fleps I, Cripton PA, Guy P, Ferguson SJ, Helgason B. Prophylactic augmentation implants in the proximal femur for hip fracture prevention: An in silico investigation of simulated sideways fall impacts. J Mech Behav Biomed Mater 2021; 126:104957. [PMID: 34861519 DOI: 10.1016/j.jmbbm.2021.104957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/26/2022]
Abstract
Femoral fractures from sideways falls in the elderly are associated with significant rates of morbidity and mortality. Approaches to prevent these catastrophic injuries include pharmacological treatments, which have limited efficacy. Prophylactic femoral augmentation systems are a promising alternative that are gaining prominence by addressing the most debilitating osteoporosis-related fracture. We have developed finite element models (FEMs) of a novel experimental sideways fall simulator for cadavers. By virtue of the range of specimens and injury outcomes, these FEMs are well-suited to the evaluation of such implants. The purpose of this study was to use the FEMs to evaluate the mechanical effectiveness of three different prophylactic femoral augmentation systems. Models of the Y-Strut® (Hyprevention®, Pessac, France), Gamma Nail® (Stryker, Kalamazoo, USA), and a simple lag screw femoral fracture implant systems were placed into FEMs of five cadaveric pelvis-femur constructs embedded in a soft tissue surrogate, which were then subject to simulated sideways falls at seven impact velocities. Femur-only FEMs were also evaluated. Peak impact forces and peak acetabular forces were examined, and failure was evaluated using a strain-based criterion. We found that the femoral augmentation systems increased the peak forces prior to fracture, but were unable to prevent fracture for severe impacts. The Gamma Nail® system consistently produced the largest strength increases relative to the unaugmented femur for all five specimens in both the pendulum-drop FEMs and the femur-only simulations. In some cases, the same implant appeared to cause fractures in the acetabulum. The femur-only FEMs showed larger force increases than the pendulum-drop simulations, which suggests that the results of the femur-only simulations may not represent sideways falls as accurately as the soft tissue-embedded pendulum-drop simulations. The results from this study demonstrate the ability to simulate a high energy phenomenon and the effect of implants in an in silico environment. The results also suggest that implants could increase the force applied to the proximal femur during impact. Fracture outcomes from the tested implants can be used to inform the design of future devices, which reaffirms the value of modelling with biofidelic considerations in the implant design process. To the authors' knowledge, this is the first paper to use more complex biofidelic FEMs to assess prophylactic femoral augmentation methods.
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Paillard T. Methods and Strategies for Reconditioning Motor Output and Postural Balance in Frail Older Subjects Prone to Falls. Front Physiol 2021; 12:700723. [PMID: 34712145 PMCID: PMC8546223 DOI: 10.3389/fphys.2021.700723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
In frail older subjects, the motor output of the antigravity muscles is fundamental in resisting falls. These muscles undergo accelerated involutions when they are inactive and the risk of falling increases during leisure and domestic physical activity. In order to reduce their risk of falling, frail older subjects limit their physical activities/exercises. The problem is that the less they exercise, the less they are able to exercise and the greater the risk in exercising. Hence, a vicious circle sets up and the antigravity muscles inevitably continue to deteriorate. This vicious circle must be broken by starting a reconditioning program based on developing the strength of antigravity muscles (especially lower-limb muscles). To begin with, for each increase in muscle strength, postural balance is improved. Once this increase reaches the threshold beyond which postural balance no longer improves, it seems appropriate to implement exercises aimed at concomitantly improving motor output and postural balance in order to counteract or even reverse the involution process of the postural balance system. Methods and strategies toward this end are proposed in this present communication. However, the transfer effects between strength increase and postural balance ability are not yet totally known and future research should evaluate the relationship between muscle strength and postural balance throughout rehabilitation programs (i.e., program follow-ups) in frail older subjects in order to advance knowledge of this relationship.
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Affiliation(s)
- Thierry Paillard
- Laboratoire Mouvement, Equilibre, Performance et Santé (UPRES EA 4445), Département STAPS, Université de Pau et des Pays de l'Adour/E2S, Pau, France
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Harris DM, Duckham RL, Daly RM, Abbott G, Johnson L, Rantalainen T, Teo WP. Development of a Parkinson's disease specific falls questionnaire. BMC Geriatr 2021; 21:614. [PMID: 34717574 PMCID: PMC8557480 DOI: 10.1186/s12877-021-02555-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Falls are a major health burden for older adults with Parkinson’s disease (PD), but there is currently no reliable questionnaire to capture the circumstances and consequences of falls in older adults with PD. This study aimed to develop a PD-specific falls questionnaire and to evaluate its test-retest reliability in older adults with PD. Methods A novel PD-specific falls questionnaire (PDF-Q) was developed in two modes (online and paper-based version) and used to assess falls and near-falls events over the past 12-months. Questions were agreed upon by an expert group, with the domains based on previous falls-related questionnaires. The questions included the number and circumstances (activities, location and direction) of falls and near-falls, and consequences (injuries and medical treatment) of falls. The PDF-Q was distributed to 46 older adults with PD (online n = 30, paper n = 16), who completed the questionnaire twice, 4 weeks apart. Kappa (κ) statistics were used to establish test-retest reliability of the questionnaire items. Results Pooled results from both questionnaires for all participants were used to assess the overall test-retest reliability of the questionnaire. Questions assessing the number of falls (κ = 0.41) and the number of near-falls (κ = 0.51) in the previous 12-months demonstrated weak agreement, while questions on the location of falls (κ = 0.89) and near-falls (κ = 1.0) demonstrated strong to almost perfect agreement. Questions on the number of indoor (κ = 0.86) and outdoor (κ = 0.75) falls demonstrated moderate to strong agreement, though questions related to the number of indoor (κ = 0.47) and outdoor (κ = 0.56) near-falls demonstrated weak agreement. Moderate to strong agreement scores were observed for the most recent fall and near-fall in terms of the direction (indoor fall κ = 0.80; outdoor fall κ = 0.81; near-fall κ = 0.54), activity (indoor fall κ = 0.70; outdoor fall κ = 0.82; near-fall κ = 0.65) and cause (indoor fall κ = 0.75; outdoor fall κ = 0.62; near-fall κ = 0.56). Conclusions The new PDF-Q developed in this study was found to be reliable for capturing the circumstances and consequences of recent falls and near-falls in older adults with PD. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02555-6.
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Affiliation(s)
- Dale M Harris
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia. .,First Year College, Victoria University, Melbourne, Australia.
| | - Rachel L Duckham
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Department of Medicine-Western Health, University of Melbourne, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Liam Johnson
- Physiotherapy Department, Epworth HealthCare, Melbourne, Australia.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Timo Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Wei-Peng Teo
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Scott D, Johansson J, Gandham A, Ebeling PR, Nordstrom P, Nordstrom A. Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults. J Sport Health Sci 2021; 10:577-584. [PMID: 34088651 PMCID: PMC8500807 DOI: 10.1016/j.jshs.2020.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/06/2019] [Accepted: 12/16/2019] [Indexed: 06/12/2023]
Abstract
PURPOSE This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior, light physical activity (LPA), and moderate-to-vigorous PA (MVPA) with sarcopenia and incident falls over 12 months. METHODS A total of 3334 Swedish 70-year-olds were assessed for sarcopenia, as defined by the revised definition of the European Working Group on Sarcopenia in Older People. Assessments were based on low scores for appendicular lean mass (dual-energy X-ray absorptiometry), hand grip strength, and the Timed Up and Go test. For 7 days after baseline, total time and total number of bouts (≥10 min of continuous activity at a given intensity) of activity performed at sedentary, LPA, and MVPA intensities were assessed by accelerometer. Incident falls were self-reported 6 months and 12 months after baseline. RESULTS Only 1.8% of participants had probable or confirmed sarcopenia. After multivariable adjustment for other levels of activity, only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass, low hand grip strength, and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria (all p < 0.05), and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia (odds ratio = 0.80, 95% confidence interval: 0.71-0.91 h/week). Similar associations were identified for total number of bouts, with no evidence of threshold effects for longer duration of bouts of MVPA. A total of 14% of participants reported ≥1 fall, but neither total time nor bouts of activity was associated with incident falls (all p > 0.05). CONCLUSION Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components, regardless of the length of bouts or amounts of sedentary behavior.
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Affiliation(s)
- David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School-Western Campus, the University of Melbourne, St Albans, VIC 3021, Australia.
| | - Jonas Johansson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå SE-901 87, Sweden; Department of Community Medicine, UiT the Arctic University of Norway, Tromsø 9010, Norway
| | - Anoohya Gandham
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
| | - Peter Nordstrom
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå SE-901 87, Sweden
| | - Anna Nordstrom
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå SE-901 87, Sweden; School of Sport Sciences, UiT the Arctic University of Norway, Tromsø 9010, Norway
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Gebre AK, Sim M, Rodríguez AJ, Hodgson JM, Blekkenhorst LC, Szulc P, Bondonno N, Zhu K, Bondonno C, Kiel DP, Schousboe JT, Prince RL, Lewis JR. Abdominal aortic calcification is associated with a higher risk of injurious fall-related hospitalizations in older Australian women. Atherosclerosis 2021; 328:153-9. [PMID: 34120736 DOI: 10.1016/j.atherosclerosis.2021.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/02/2021] [Accepted: 05/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUNDS AND AIMS Abdominal aortic calcification (AAC) is associated with weaker grip strength, an established risk factor for fall-related hospitalizations. However, its association with long-term fall-related hospitalisations remains unknown. This study investigated the association between AAC and long-term fall-related hospitalizations in community-dwelling older women. METHODS Fall-related hospitalizations were obtained from linked data over 14.5-years in a prospective cohort of 1053 older women (mean age 75.0 ± 2.6 years). At baseline (1998/99), AAC was assessed from lateral spine images obtained using dual-energy X-ray absorptiometry, and scored using a semi-quantitative method (AAC24, range 0-24). The presence of any AAC was defined by AAC24 ≥ 1. RESULTS Over 14.5-years, 413 (39.2%) women experienced a fall-related hospitalization. In the multivariable-adjusted model, each unit increase in baseline AAC24 was associated with a 3% increase in relative hazards for a fall-related hospitalization (HR 1.03 95%CI, 1.01 to 1.07). Compared to women with no AAC, women with any AAC had a 40% (HR 1.40 95%CI, 1.11 to 1.76) and 39% (HR 1.39 95%CI, 1.10 to 1.76) greater risk for fall-related hospitalizations in the minimal and multivariable-adjusted models, respectively. This relationship was not attenuated by including measures of muscle function such as grip strength and timed-up-and-go. CONCLUSIONS The presence of AAC is associated with long-term fall-related hospitalizations risk, independent of muscle function, in community-dwelling older women. Concurrent assessment of AAC may be a simple and cost-effective way to identify older women at higher risk of falling as part of routine osteoporosis screening.
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Drake SA, Conway SH, Yang Y, Cheatham LS, Wolf DA, Adams SD, Wade CE, Holcomb JB. When falls become fatal-Clinical care sequence. PLoS One 2021; 16:e0244862. [PMID: 33406164 PMCID: PMC7787527 DOI: 10.1371/journal.pone.0244862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study encompassed fall-related deaths, including those who died prior to medical care, that were admitted to multiple healthcare institutions, regardless of whether they died at home, in long-term care, or in hospice. The common element was that all deaths resulted directly or indirectly from injuries sustained during a fall, regardless of the temporal relationship. This comprehensive approach provides an unusual illustration of the clinical sequence of fall-related deaths. Understanding this pathway lays the groundwork for identification of gaps in healthcare needs. DESIGN This is a retrospective study of 2014 fall-related deaths recorded by one medical examiner's office (n = 511) within a larger dataset of all trauma related deaths (n = 1848). Decedent demographic characteristics and fall-related variables associated with the deaths were coded and described. RESULTS Of those falling, 483 (94.5%) were from heights less than 10 feet and 394 (77.1%) were aged 65+. The largest proportion of deaths (n = 267, 52.3%) occurred post-discharge from an acute care setting. Of those who had a documented prior fall, 216 (42.3%) had a history of one fall while 31 (6.1%) had ≥2 falls prior to their fatal incident. For the 267 post-acute care deaths, 440 healthcare admissions were involved in their care. Of 267 deaths occurring post-acute care, 129 (48.3%) were readmitted within 30 days. Preventability, defined as opportunities for improvement in care that may have influenced the outcome, was assessed. Of the 1848 trauma deaths, 511 (27.7%) were due to falls of which 361 (70.6%) were determined to be preventable or potentially preventable. CONCLUSION Our data show that readmissions and repeated falls are frequent events in the clinical sequence of fall fatalities. Efforts to prevent fall-related readmissions should be a top priority for improving fall outcomes and increasing the quality of life among those at risk of falling.
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Affiliation(s)
- Stacy A. Drake
- Texas A&M University, College of Nursing, College Station, Texas, United States of America
| | - Sadie H. Conway
- The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Yijiong Yang
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, Texas, United States of America
| | - Latarsha S. Cheatham
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, Texas, United States of America
| | - Dwayne A. Wolf
- Harris County Institute of Forensic Sciences, Houston, Texas, United States of America
| | - Sasha D. Adams
- Center for Translational Injury Research, Houston, Texas, United States of America
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Charles E. Wade
- Center for Translational Injury Research, Houston, Texas, United States of America
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - John B. Holcomb
- Department of Surgery, University of Alabama, Birmingham, Alabama, United States of America
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12
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Scott D, Johansson J, Ebeling PR, Nordstrom P, Nordstrom A. Adiposity Without Obesity: Associations with Osteoporosis, Sarcopenia, and Falls in the Healthy Ageing Initiative Cohort Study. Obesity (Silver Spring) 2020; 28:2232-2241. [PMID: 33012137 DOI: 10.1002/oby.22984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Obesity is commonly defined by BMI rather than adiposity, which may have differential effects on musculoskeletal health. Musculoskeletal outcomes were compared in older adults with normal adiposity and normal BMI (NA-NBMI), those with high adiposity but normal BMI (HA-NBMI), and those with high adiposity and high BMI (HA-HBMI). METHODS In 3,411 70-year-olds, obesity was defined as BMI ≥ 30 kg/m2 and adiposity as body fat percentage ≥ 25% (men) or ≥ 35% (women) from dual-energy x-ray absorptiometry. Bone parameters were measured by dual-energy x-ray absorptiometry and peripheral quantitative computed tomography. Sarcopenia was defined as low handgrip strength with or without low appendicular lean mass. Falls were self-reported 6 and 12 months later. RESULTS Prevalence of NA-NBMI, HA-NBMI, and HA-HBMI was 14.2%, 68.1%, and 17.7%, respectively. Compared with HA-HBMI, HA-NBMI had increased likelihood for sarcopenia (adjusted odds ratio: 3.99; 95% CI: 1.41-11.32) and osteoporosis (2.91; 95% CI: 2.35-3.61) but similar likelihood of falls (P > 0.05). HA-NBMI had lower values for bone geometry parameters, as well as grip strength, than both NA-NBMI and HA-HBMI (all P < 0.05). CONCLUSIONS High adiposity without high BMI is more common than BMI-defined obesity in older Swedish adults but does not provide similar protection from osteoporosis and sarcopenia.
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Affiliation(s)
- David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Victoria, Australia
| | - Jonas Johansson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Peter Nordstrom
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Anna Nordstrom
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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13
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Fleps I, Guy P, Ferguson SJ, Cripton PA, Helgason B. Explicit Finite Element Models Accurately Predict Subject-Specific and Velocity-Dependent Kinetics of Sideways Fall Impact. J Bone Miner Res 2019; 34:1837-1850. [PMID: 31163090 DOI: 10.1002/jbmr.3804] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
The majority of hip fractures in the elderly are the result of a fall from standing or from a lower height. Current injury models focus mostly on femur strength while neglecting subject-specific loading. This article presents an injury modeling strategy for hip fractures related to sideways falls that takes subject-specific impact loading into account. Finite element models (FEMs) of the human body were used to predict the experienced load and the femoral strength in a single model. We validated these models for their predicted peak force, effective pelvic stiffness, and fracture status against matching ex vivo sideways fall impacts (n = 11) with a trochanter velocity of 3.1 m/s. Furthermore, they were compared to sideways impacts of volunteers with lower impact velocities that were previously conducted by other groups. Good agreement was found between the ex vivo experiments and the FEMs with respect to peak force (root mean square error [RMSE] = 10.7%, R2 = 0.85) and effective pelvic stiffness (R2 = 0.92, RMSE = 12.9%). The FEMs were predictive of the fracture status for 10 out of 11 specimens. Compared to the volunteer experiments from low height, the FEMs overestimated the peak force by 25% for low BMI subjects and 8% for high BMI subjects. The effective pelvic stiffness values that were derived from the FEMs were comparable to those derived from impacts with volunteers. The force attenuation from the impact surface to the femur ranged between 27% and 54% and was highly dependent on soft tissue thickness (R2 = 0.86). The energy balance in the FEMS showed that at the time of peak force 79% to 93% of the total energy is either kinetic or was transformed to soft tissue deformation. The presented FEMs allow for direct discrimination between fracture and nonfracture outcome for sideways falls and bridge the gap between impact testing with volunteers and impact conditions representative of real life falls. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Ingmar Fleps
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Pierre Guy
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | | | - Peter A Cripton
- Orthopaedics and Injury Biomechanics Group, Department of Mechanical Engineering and Orthopaedics and School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
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14
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Abstract
Maintaining mobility is an important aspect of health and well-being in older men. This literature review describes several modifiable and nonmodifiable risk factors impacting bone, muscle, and joint health. Exercise and nutritional interventions may help to prevent the progressive deterioration in bones, muscles, and joints impacting mobility in later life. Limitations in mobility are increasingly recognized as a major public health problem due to an aging population and growing number of older individuals affected by disabling comorbidities. Despite increasing numbers and debilitating consequences, there are no guidelines providing recommendations on strategies to maintain mobility for healthy aging among older men. This narrative review aims to fill this literature gap. PubMed, Scopus, and Google Scholar databases were searched using predefined search terms. Primary studies, exploratory analyses, cross-sectional surveys, meta-analyses, evidence-based clinical reviews, and guidelines from nationally recognized societies focusing on mobility in older men and key elements including bone, muscle and joint health, and balance were selected. Several modifiable and nonmodifiable risk factors have been reported in the literature that impact bone, muscle, and joint health and predispose older men to falls and fractures. The most common conditions impacting bones, muscles, and joints are osteoporosis, sarcopenia, and osteoarthritis, respectively. In addition to being key contributors to disability in the elderly, these conditions are all associated with a higher mortality risk. Although more studies are required, current evidence supports the use of various nonpharmacological (mainly exercise and nutrition) and/or pharmacological treatment modalities to help prevent and/or reverse these conditions. Incorporating lifestyle interventions involving exercise and nutrition at a younger age can help prevent the age-related, progressive deterioration in bones, muscles, and joints that can reduce mobility in later life. Established barriers to physical activities (e.g., poor health, social isolation) in men are important to consider for optimizing outcomes.
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Affiliation(s)
- P R Ebeling
- School of Clinical Sciences at Monash Health, Monash Medical Centre, Monash University, Level 5 / Block E, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| | - F Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - D Scott
- Australian Institute for Musculoskeletal Science, The University of Melbourne, Melbourne, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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15
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Fleps I, Fung A, Guy P, Ferguson SJ, Helgason B, Cripton PA. Subject-specific ex vivo simulations for hip fracture risk assessment in sideways falls. Bone 2019; 125:36-45. [PMID: 31071479 DOI: 10.1016/j.bone.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/17/2019] [Accepted: 05/04/2019] [Indexed: 12/18/2022]
Abstract
The risk of hip fracture of a patient due to a fall can be described from a mechanical perspective as the capacity of the femur to withstand the force that it experiences in the event of a fall. So far, impact forces acting on the lateral aspect of the pelvic region and femur strength have been investigated separately. This study used inertia-driven cadaveric impact experiments that mimic falls to the side from standing in order to evaluate the subject-specific force applied to the hip during impact and the fracture outcome in the same experimental model. Eleven fresh-frozen pelvis-femur constructs (6 female, 5 male, age = 77 years (SD = 13 years), BMI = 22.8 kg/m2 (SD = 7.8 kg/m2), total hip aBMD = 0.734 g/cm2 (SD = 0.149 g/cm2)), were embedded into soft tissue surrogate material that matched subject-specific mass and body shape. The specimens were attached to metallic lower-limb constructions with subject-specific masses and subjected to an inverted pendulum motion. Impact forces were recorded with a 6-axis force plate at 10,000 Hz and three dimensional deflections in the pelvic region were tracked with two high-speed cameras at 5000 Hz. Of the 11 specimens, 5 femur fractures and 3 pelvis fractures were observed. Three specimens did not fracture. aBMD alone did not reliably separate femur fractures from non-fractures. However, a mechanical risk ratio, which was calculated as the impact force divided by aBMD, classified specimens reliably into femur fractures and non-fractures. Single degree of freedom models, based on specimen kinetics, were able to predict subject-specific peak impact forces (RMSE = 2.55% for non-fractures). This study provides direct evidence relating subject-specific impact forces and subject-specific strength estimates and improves the assessment of the mechanical risk of hip fracture for a specific femur/pelvis combination in a sideways fall.
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Affiliation(s)
- Ingmar Fleps
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland; Orthopaedics and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and School of Biomedical Engineering, University of British Columbia, Vancouver, Canada.
| | - Anita Fung
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland; Orthopaedics and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Pierre Guy
- Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | | | | | - Peter A Cripton
- Orthopaedics and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
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16
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Scott D, Johansson J, McMillan LB, Ebeling PR, Nordstrom P, Nordstrom A. Associations of Sarcopenia and Its Components with Bone Structure and Incident Falls in Swedish Older Adults. Calcif Tissue Int 2019; 105:26-36. [PMID: 30899995 DOI: 10.1007/s00223-019-00540-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
The aim of this study was to compare bone structure parameters and likelihood of falls across European Working Group on Sarcopenia in Older People (EWGSOP2) sarcopenia categories. 3334 Swedish 70-year olds had appendicular lean mass (normalized to height; ALMHt), lumbar spine and total hip areal BMD (aBMD) estimated by dual-energy X-ray absorptiometry. Volumetric BMD (vBMD) and structure at the distal and proximal tibia and radius were estimated by peripheral quantitative computed tomography. Hand grip strength and timed up-and-go were assessed, and sarcopenia was defined according to EWGSOP2 criteria. Incident falls were self-reported 6 and 12 months after baseline. Only 0.8% and 1.0% of participants had probable and confirmed sarcopenia, respectively. Almost one-third of participants with confirmed sarcopenia reported incident falls, compared with 20% for probable sarcopenia and 14% without sarcopenia (P = 0.025). Participants with confirmed sarcopenia had poorer bone parameters (all P < 0.05) except endosteal circumference at the proximal radius and tibia, while those with probable sarcopenia had lower cortical area at the proximal radius (B = - 5.9; 95% CI - 11.7, - 0.1 mm2) and periosteal and endosteal circumferences at the proximal tibia (- 3.3; - 6.4, - 0.3 and - 3.8; - 7.5, - 0.1 mm2, respectively), compared with those without sarcopenia. Compared with probable sarcopenia, confirmed sarcopenic participants had significantly lower lumbar spine and total hip aBMD, distal radius and tibia total vBMD, and proximal radius and tibia cortical vBMD, area and thickness (all P < 0.05). Swedish 70-year olds with confirmed sarcopenia demonstrate poorer BMD and bone architecture than those with probable and no sarcopenia, and have increased likelihood of incident falls.
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Affiliation(s)
- David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, VIC, Australia.
| | - Jonas Johansson
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Lachlan B McMillan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Peter Nordstrom
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Anna Nordstrom
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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17
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Sim M, Prince RL, Scott D, Daly RM, Duque G, Inderjeeth CA, Zhu K, Woodman RJ, Hodgson JM, Lewis JR. Utility of four sarcopenia criteria for the prediction of falls-related hospitalization in older Australian women. Osteoporos Int 2019; 30:167-176. [PMID: 30456572 DOI: 10.1007/s00198-018-4755-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/22/2018] [Indexed: 01/07/2023]
Abstract
UNLABELLED Numerous sarcopenia definitions are not associated with increased falls-related hospitalization risk over 5 years to 9.5 years in older community-dwelling Australian women. Measures of muscle strength and physical function, but not appendicular lean mass (measured by dual-energy X-ray absorptiometry) may help discriminate the risk of falls-related hospitalization. INTRODUCTION The aim of this prospective, population-based cohort study of 903 Caucasian-Australian women (mean age 79.9 ± 2.6 years) was to compare the clinical utility of four sarcopenia definitions for the prediction of falls-related hospitalization over 9.5 years. METHODS The four definitions were the United States Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP), and modified FNIH (AUS-POPF) and EWGSOP (AUS-POPE) definitions using Australian population-specific cut points (< 2 SD below the mean of young healthy Australian women). Components of sarcopenia including muscle strength, physical function, and appendicular lean mass (ALM) were quantified using hand grip strength, timed-up-and-go (TUG), and dual-energy X-ray absorptiometry (DXA), respectively. Incident 9.5-year falls-related hospitalization were captured by linked data. RESULTS Baseline prevalence of sarcopenia according to FNIH (9.4%), EWGSOP (24.1%), AUS-POPF (12.0%), and AUS-POPE (10.7%) differed substantially. Sarcopenia did not increase the relative hazard ratio (HR) for falls-related hospitalization before or after adjustment for age (aHR): FNIH aHR 1.00 95%CI (0.69-1.47), EWGSOP aHR 1.20 95%CI (0.93-1.54), AUS-POPF aHR 0.96 95%CI (0.68-1.35), and AUS-POPE aHR 1.33 95%CI (0.94-1.88). When examining individual components of sarcopenia, only muscle strength and physical function but not ALM (adjusted for height2 or BMI) were associated with falls-related hospitalization. CONCLUSION Current definitions of sarcopenia were not associated with falls-related hospitalization risk in this cohort of community-dwelling older Australian women. Finally, measures of muscle strength and physical function, but not ALM (measured by DXA) may help discriminate the risk of falls-related hospitalization.
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Affiliation(s)
- M Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
- Medical School, The University Western Australia, Perth, Western Australia, Australia.
| | - R L Prince
- Medical School, The University Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - D Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, Victoria, Australia
| | - R M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - G Duque
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - C A Inderjeeth
- Medical School, The University Western Australia, Perth, Western Australia, Australia
- North Metropolitan Health Service, Nedlands, Western Australia, Australia
| | - K Zhu
- Medical School, The University Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - R J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - J M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, The University Western Australia, Perth, Western Australia, Australia
| | - J R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, The University Western Australia, Perth, Western Australia, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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18
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Teister CJ, Chocano-Bedoya PO, Orav EJ, Dawson-Hughes B, Meyer U, Meyer OW, Freystaetter G, Gagesch M, Rizzoli R, Egli A, Theiler R, Kanis JA, Bischoff-Ferrari HA. Which Method of Fall Ascertainment Captures the Most Falls in Prefrail and Frail Seniors? Am J Epidemiol 2018; 187:2243-2251. [PMID: 29912266 DOI: 10.1093/aje/kwy113] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/23/2018] [Indexed: 01/14/2023] Open
Abstract
There is no consensus on the most reliable method of ascertaining falls among the elderly. Therefore, we investigated which method captured the most falls among prefrail and frail seniors from 2 randomized controlled trials conducted in Zurich, Switzerland: an 18-month trial (2009-2010) including 200 community-dwelling prefrail seniors with a prior fall and a 12-month trial (2005-2008) including 173 frail seniors with acute hip fracture. Both trials included the same methods of fall ascertainment: monthly active asking, daily self-report diary entries, and a call-in hotline. We compared numbers of falls reported and estimated overall and positive percent agreement between methods. Prefrail seniors reported 499 falls (fall rate = 2.5/year) and frail seniors reported 205 falls (fall rate = 1.4/year). Most falls (81% of falls in prefrail seniors and 78% in frail seniors) were reported via active asking. Among prefrail seniors, diaries captured an additional 19% of falls, while the hotline added none. Among frail seniors, the hotline added 16% of falls, while diaries added 6%. The positive percent agreement between active asking and diary entries was 100% among prefrail seniors and 88% among frail seniors. While monthly active asking captures most falls in both groups, this method alone missed 19% of falls in prefrail seniors and 22% in frail seniors. Thus, a combination of active asking and diaries for prefrail seniors and a combination of active asking and a hotline for frail seniors is warranted.
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Affiliation(s)
- Corina J Teister
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patricia O Chocano-Bedoya
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Endel J Orav
- Division of General Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts
| | - Ursina Meyer
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Otto W Meyer
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Gregor Freystaetter
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Gagesch
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Rene Rizzoli
- Bone Disease Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Andreas Egli
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Robert Theiler
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - John A Kanis
- Institute of Health and Ageing, Catholic University of Australia, Melbourne, Victoria, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Heike A Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Ageing Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Acute Geriatric Care, City Hospital Waid, Zurich, Switzerland
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19
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Nagaraj G, Hullick C, Arendts G, Burkett E, Hill KD, Carpenter CR. Avoiding anchoring bias by moving beyond 'mechanical falls' in geriatric emergency medicine. Emerg Med Australas 2018; 30:843-850. [PMID: 30091183 DOI: 10.1111/1742-6723.13129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Guruprasad Nagaraj
- Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Carolyn Hullick
- Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Glenn Arendts
- Department of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Ellen Burkett
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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