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Assi S, Garcia Morales EE, Du EY, Martinez-Amezcua P, Reed NS. Association of Single and Dual Sensory Impairment with Falls among Medicare Beneficiaries. J Aging Health 2024; 36:390-399. [PMID: 37505080 DOI: 10.1177/08982643231190983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective: The purpose of this study was to determine if dual sensory impairment (DSI) is associated with falls and fear of falling among older adults. Methods: Using data from the 2019 Medicare Current Beneficiary Survey (MCBS), we studied the cross-sectional association of self-reported hearing/vision impairment with self-reported history/number of falls over the past year, fear of falling (scale 1-6), and a fall requiring medical help using weighted multivariable regressions adjusted for demographic and clinical covariates. Results: Among 11,089 Medicare beneficiaries (mean age = 74, 55% female, 9% Black), DSI is associated with increased prevalence (prevalence ratio = 1.45 [1.28-1.65]) and incidence (incidence ratio = 2.21 [1.79-2.75]) rate of falls, and greater odds of a higher fear of falling score (odds ratio = 1.38 [1.08-1.77]). Discussion: DSI is associated with falls among older adults. Consideration of DSI as a marker to initiate fall prevention programs and inclusion of sensory interventions in these programs may be valuable.
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Affiliation(s)
- Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric Y Du
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Pablo Martinez-Amezcua
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Doxey SA, Sorich MM, Abraham SC, Switzer JA, Cunningham BP, McKee MD, Myeroff CM. Iatrogenic open humeral shaft fractures following functional bracing. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05369-4. [PMID: 38743112 DOI: 10.1007/s00402-024-05369-4] [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: 02/22/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The treatment of closed humeral shaft fractures tends to be successful with functional bracing. Treatment failure due to iatrogenic conversion to an open fracture has not been described in the literature. We present a case series of patients that experienced open humeral shaft fractures after initially being treated with functional bracing for closed humeral shaft fractures and describe what factors are associated with this complication. MATERIALS AND METHODS This was a retrospective case series performed at three level 1 trauma centers across North America. All nonoperatively treated humeral shaft fractures were reviewed from 2001 to 2023. Patients were included if they sustained a humeral shaft fracture, > 18 years old, were initially treated non-operatively with functional bracing which subsequently converted to an open fracture. Eight patients met inclusion criteria. All included patients were eventually treated with irrigation, debridement, and open reduction and internal fixation. Outcomes assessed included mortality rate, time until the fracture converted from closed to open, need for further surgery, and bony union. Descriptive statistics were used in analysis. RESULTS The eight included patients on average were 65 ± 21.4 years old and had a body mass index (BMI) of 25.6 ± 5.2. Six patients were initially injured due to a fall. Time until the fractures became open on average was 5.2 ± 3.6 weeks. Three patients (37.5%) died within 1.8 ± 0.6 years after initial injury. The average Charlson Comorbidity Index (CCI) score was 4.5 ± 3.4. Three patients (37.5%) had dementia. Common characteristics among this cohort included a history of visual disturbances (50.0%), cerebrovascular accident (50.0%), smoking (50.0%), and alcohol abuse (50.0%). CONCLUSION Conversion from a closed to open humeral shaft fracture after functional bracing is a potentially devastating complication. Physicians should be especially cognizant of patients with a low BMI, history of falling or visual disturbance, dementia, age ≥ 65, decreased sensorimotor protection, and significant smoking or alcohol history when choosing to use functional bracing as the final treatment modality. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stephen A Doxey
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, MN, 55426, USA
| | - Megan M Sorich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah C Abraham
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | - Julie A Switzer
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, MN, 55426, USA
| | - Brian P Cunningham
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA.
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, MN, 55426, USA.
| | - Michael D McKee
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Orthopaedic Surgery, Banner University Medical Center, Phoenix, AZ, USA
| | - Chad M Myeroff
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
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Jin H, Zhou Y, Stagg BC, Ehrlich JR. Association between vision impairment and increased prevalence of falls in older US adults. J Am Geriatr Soc 2024; 72:1373-1383. [PMID: 38514075 PMCID: PMC11090722 DOI: 10.1111/jgs.18879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Vision impairment (VI) is associated with falls in older adults. However, past studies have relied on geographically constrained samples with limited generalizability or self-reports of visual difficulty. To date, there have not been nationally representative studies on the association of objective measures of visual function and falls outcomes. METHODS We used cross-sectional data from Round 11 of National Health and Aging Trends Study (NHATS), a nationally representative panel study of age-eligible Medicare beneficiaries (N = 2951). We performed Poisson regression to calculate the prevalence and prevalence ratio (PR) of >1 fall in the past year, any fall in the past month, fear of falling (FoF), and activity limitation due to FoF as a function of distance visual acuity, near visual acuity, and contrast sensitivity. Models were adjusted for demographic and health covariates and were weighted to make nationally representative parameter estimates. RESULTS The weighted proportion of participants with VI was 27.6% (95% CI, 25.4%-29.9%). Individuals with any VI had a higher prevalence of falls compared with those without VI (18.5% vs. 14.1%, PR = 1.25, 95% CI 1.02-1.53). Specifically, contrast sensitivity impairment was associated with a higher prevalence of recurrent falls (20.8% vs. 14.7%; PR = 1.30, 95% CI 1.01-1.67) and recent falls (17.1% vs. 9.9%; PR = 1.40, 95% CI 1.01-1.94). This relationship existed even independent of near and distance visual acuity. Distance and near visual acuity were not significantly associated with falls. Having any VI was also associated with a higher prevalence of FoF (38.4% vs. 30.5%, PR = 1.17, 95% CI 1.02-1.34). CONCLUSION The prevalence of falls is associated with poor contrast sensitivity but not with near or distance visual acuity. Findings suggest greater collaboration between geriatricians and eye care providers may be warranted to assess and address fall risk in older adults with VI.
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Affiliation(s)
- Huiyan Jin
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Hark LA, Wang Y, Gorroochurn P, Simon PR, Maruri SC, Henriquez DR, Diamond DF, Horowitz JD, Park L, Wang Q, Auran JD, Carrion J, Friedman DS, Liebmann JL, Cioffi GA, Harizman N. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): a nested cross-sectional assessment of falls risk within a cluster randomised trial. Br J Ophthalmol 2024:bjo-2022-323052. [PMID: 38609163 DOI: 10.1136/bjo-2022-323052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To investigate the feasibility of using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) Falls Risk Tool Kit during community-based eye health screenings to assess falls risk of participants enrolled in the Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT). METHODS Cross-sectional analysis of data from a 5-year prospective, cluster-randomised clinical trial conducted in affordable housing developments in New York City in adults age 40 years and older. Prescreening questions determined whether participants were at risk of falling. STEADI tests classified participants at low, moderate or high risk of falling. Multivariate logistic regression determined odds of falls risk of all enrolled participants. RESULTS 708 participants completed the eye health screening; 351 (49.6%) performed STEADI tests; mean age: 71.0 years (SD±11.3); 72.1% female; 53.6% Black, non-Hispanic, 37.6% Hispanic/Latino. Level of falls risk: 32 (9.1%) low, 188 (53.6%) moderate and 131 (37.3%) high. Individuals age >80 (OR 5.921, 95% CI (2.383 to 14.708), p=0.000), had blurry vision (OR 1.978, 95% CI (1.186 to 3.300), p=0.009), high blood pressure (OR 2.131, 95% CI (1.252 to 3.628), p=0.005), arthritis (OR 2.29876, 95% CI (1.362 to 3.875), p=0.002) or foot problems (OR 5.239, 95% CI (2.947 to 9.314), p=0.000) had significantly higher odds of falling, emergency department visits or hospitalisation due to falling. CONCLUSION This study detected a significant amount of falls risk in an underserved population. The STEADI Falls Risk screening questions were easy for eye care providers to ask, were highly predictive of falls risk and may be adequate for referral to occupational health and/or physical therapy.
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Affiliation(s)
- Lisa A Hark
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Yujia Wang
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Prakash Gorroochurn
- Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Phyllis R Simon
- Occupational Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Daniel F Diamond
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Jason D Horowitz
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Lisa Park
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Qing Wang
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - James D Auran
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | | | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jeffrey L Liebmann
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - George A Cioffi
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Noga Harizman
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
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Garmo V, Zhao X, Ng CD, Near A, Banerji T, Wada K, Oderda G, Brixner D, Biskupiak J, Ali FS, Khanani AM, Menezes A, Abbass IM. The Association of Retinal Disease with Vision Impairment and Functional Status in Medicare Patients. J Health Econ Outcomes Res 2024; 11:94-102. [PMID: 38560652 PMCID: PMC10981881 DOI: 10.36469/001c.93022] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
Background: The association of neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) with functional status in the general Medicare population are not well established. Objectives: This study examined patient-reported survey data linked with Medicare claims to describe the burden of these vision-threatening retinal diseases (VTRDs) among Medicare beneficiaries. Methods: Medicare Current Beneficiary Survey data linked with Medicare Fee-for-Service claims data from 2006 to 2018 were used in a nationally representative retrospective pooled cross-sectional population-based comparison study. Outcomes between community-dwelling beneficiaries with nAMD (n = 1228), DME (n = 101), or RVO (n = 251) were compared with community-dwelling beneficiaries without any VTRDs (n = 104 088), controlling for baseline demographic and clinical differences. Beneficiaries with a diagnosis of nAMD, DME, or RVO during the data year were included; those with other VTRDs were excluded. Outcomes included vision function and loss, overall functioning as assessed by difficulties with activities of daily living (ADLs) and instrumental ADLs (iADLs), anxiety/depression, falls, and fractures. Results: In patient cohorts with nAMD, DME, and RVO, approximately one-third (34.2%-38.3%) reported "a little trouble seeing" (vs 28.3% for controls), and 26%, 17%, and 9%, respectively, reported "a lot of trouble seeing/blindness" (vs 5% of controls). Difficulty walking and doing heavy housework were the most reported ADLs and iADLs, respectively. Compared with those without VTRDs, beneficiaries with nAMD had higher odds of diagnosed vision loss (odds ratio [OR], 5.39; 95% confidence interval, 4.06-7.16; P < .001) and difficulties with iADLs (odds ratio, 1.41; 95% confidence interval, 1.11-1.80; P = .005); no differences were observed for DME or RVO vs control. After adjusting for age, sex, race/ethnicity, poverty status, comorbidities, and other relevant covariates, nAMD, DME, and RVO were not significantly associated with anxiety/depression, falls, or fractures. Discussion: Patients with nAMD or DME were more likely to report severe visual impairment than those without VTRDs, although only those with nAMD were more likely to be diagnosed with vision loss. Conclusions: Patients with nAMD continue to experience more vision impairment and worse functional status compared with a similar population of Medicare beneficiaries despite availability of therapies like antivascular endothelial growth factor to treat retinal disease.
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Affiliation(s)
- Vincent Garmo
- Genentech, Inc., South San Francisco, California, USA
| | | | - Carmen D Ng
- Genentech, Inc., South San Francisco, California, USA
| | | | | | | | - Gary Oderda
- University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Archad M Khanani
- Sierra Eye Associates, Reno, Nevada
- School of Medicine University of Nevada, Reno
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Akuffo KO, Osei Duah Junior I, Acquah EA, Abadua Mensah E, Andoh AKA, Kumah DB, Boateng BS, Boateng JA, Osei-Poku K, Eisenbarth W. Low Vision Practice and Service Provision Among Optometrists in Ghana: A Nationwide Survey. Ophthalmic Epidemiol 2024:1-8. [PMID: 38451021 DOI: 10.1080/09286586.2024.2317816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To characterize practice patterns of low vision services among Optometrists in Ghana. METHODS The nationwide cross-sectional survey identified entities through the Ghana Optometrists Association (GOA) registry and utilized a semi-structured questionnaire to consolidate survey information that comprises practitioners' demographics, available services, diagnostic equipment, barriers to service provision and utilization, and interventions. RESULTS 300 Optometrists were identified, with 213 surveyed (71% response rate). About fifty percent (52.6%) were in private practice, and more than two-thirds (77%) did not provide low vision services. Most (≥70%) reported lack of assistive devices, and basic eye care examination kits as the main barriers to low vision service provision. Similarly, practitioners reported unawareness of the presence of low vision centres (76.1%), and high cost of low vision aids (75.1%) as the prime perceived barriers for patients to utilize low vision services. Continuous professional development and public education (89-90%) were suggested as interventions to improve the uptake of low vision services. After statistical adjustment, private facility type (Adjusted odds ratio [AOR] = 0.35, p = 0.010) and lack of basic eye examination kits (AOR = 0.32, p = 0.002) were significantly associated with reduced odds of low vision service provision. Conversely, ≥15 years of work experience (AOR = 6.37, p = 0.011) was significantly associated with increased odds of low vision service provision. CONCLUSIONS Overall, the results indicate inadequate low vision coverage and service delivery. Government policies must be directed towards equipping practitioners with equipment and subsidize patient cost of treatment to optimize low vision care.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaiah Osei Duah Junior
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Biological Sciences, Purdue University, West-Lafayette, Indiana, USA
| | - Eldrick Adu Acquah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elna Abadua Mensah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Kwadjo Amoah Andoh
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ben Kumah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Josephine Ampomah Boateng
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Osei-Poku
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Werner Eisenbarth
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Applied Science and Mechatronics, HM Hochschule München University of Applied Sciences, Munich, Germany
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Killeen OJ, Niziol LM, Elam AR, Bicket AK, John D, Wood SD, Musch DC, Zhang J, Johnson L, Kershaw M, Woodward MA, Newman-Casey PA. Visual Impairment from Uncorrected Refractive Error among Participants in a Novel Program to Improve Eye Care Access among Low-Income Adults in Michigan. Ophthalmology 2024; 131:349-359. [PMID: 37758028 PMCID: PMC10922592 DOI: 10.1016/j.ophtha.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To assess the rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program. DESIGN Cross-sectional study. PARTICIPANTS Adults ≥ 18 years without acute ocular symptoms. METHODS MI-SIGHT program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical store. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA], ≤ 20/50; best-corrected visual acuity [BCVA], ≥ 20/40), URE without VI (PVA, ≥ 20/40; ≥ 2-line improvement to BCVA), and no or adequately corrected RE (PVA, ≥ 20/40; < 2-line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared among groups using analysis of variance, Kruskal-Wallis, chi-square, and Fisher exact testing. MAIN OUTCOME MEASURES PVA, BCVA, and presence of VI (defined as PVA ≤ 20/50). RESULTS Of 1171 participants enrolled in the MI-SIGHT program during the first year, average age was 55.1 years (SD = 14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 participants (10.3%); 96 had VI from URE (8.2%), 168 participants (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI resulting from URE reported having a college degree, and a larger percentage reported income < $10 000 compared with participants with no or adequately corrected RE (3.2% vs. 14.2% [P = 0.02]; 45.5% vs. 21.6% [P < 0.0001], respectively). Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (9-item National Eye Institute Visual Function Questionnaire composite score, 67.3 ± 19.6 vs. 77.0 ± 14.4 vs. 82.2 ± 13.3, respectively; P < 0.0001). In total, 71.2% (n = 830) ordered glasses for an average cost of $36.80 ± $32.60; 97.7% were satisfied with their glasses. CONCLUSIONS URE was the main cause of VI at 2 clinics serving low-income communities and was associated with reduced vision-related quality of life. An online optical store with lower prices made eyeglasses accessible to low-income patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Amanda K Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Denise John
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Dougherty Wood
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Jason Zhang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | | | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
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Xu AL, Hamedani AG. Cataract surgery utilization in Parkinson's disease: the english longitudinal survey on ageing. Graefes Arch Clin Exp Ophthalmol 2024; 262:865-870. [PMID: 37947822 DOI: 10.1007/s00417-023-06314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Older adults with Alzheimer's disease are less likely to be offered cataract surgery than the general population, but these disparities have not been examined in the context of other neurodegenerative disorders such as Parkinson's disease (PD). METHODS Using data from the English Longitudinal Study on Ageing (ELSA), an ongoing, longitudinal population-based survey of older adults in England, we examined the relationship between PD and cataract surgery among adults 50 and older. We used logistic regression to measure the association between PD and history of cataract surgery at baseline. In longitudinal analyses of subjects with no history of cataract surgery at time of enrollment, we used semiparametric, discrete-time proportional hazards models to model the incidence of cataract surgery as a function of PD and other time-dependent covariates. Models were adjusted for demographic variables, self-reported comorbidities, and measures of daily activity limitation. RESULTS We included data from 19,241 eligible ELSA respondents, of whom 231 (1.2%) reported a diagnosis of PD. PD was positively associated with a history of self-reported cataract surgery at baseline (OR 3.66, 95% CI: 2.55-5.26), but this did not remain significant after adjusting for confounders (OR 1.22, 95% CI: 0.75-1.98). Among subjects with no history of cataract surgery at baseline, PD was also not associated with incident cataract surgery (adjusted HR 1.32, 95% CI: 0.86-2.02). CONCLUSION Unlike Alzheimer's disease, people with PD were no less likely to receive cataract surgery compared to those without PD.
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Affiliation(s)
- Angela L Xu
- Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr., Blockley 829, Philadelphia, PA, 19104, USA
| | - Ali G Hamedani
- Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr., Blockley 829, Philadelphia, PA, 19104, USA.
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Stalin A, Narayan A, Labreche T, Khan S, Stanberry A, Christian LWT, Leat SJ. Status of Vision and Eye Care Among Patients in Rehabilitation Hospital Units: A Cross-Sectional Study. J Am Med Dir Assoc 2024; 25:361-367.e1. [PMID: 38052415 DOI: 10.1016/j.jamda.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES The prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit. DESIGN Cross-sectional study. SETTING & PARTICIPANTS Inpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019. METHODS Participants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed. RESULTS The majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were "not happy with their vision." This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital. CONCLUSIONS AND IMPLICATIONS Reduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery.
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Affiliation(s)
- Amritha Stalin
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada.
| | | | - Tammy Labreche
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Shamrozé Khan
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Andre Stanberry
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Lisa W T Christian
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Leat
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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10
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Sutin AR, Luchetti M, Stephan Y, Canada B, Terracciano A. Purpose in Life and Risk of Falls: A Meta-Analysis of Cross-Sectional and Prospective Associations. Gerontol Geriatr Med 2024; 10:23337214241236039. [PMID: 38455641 PMCID: PMC10919135 DOI: 10.1177/23337214241236039] [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: 11/01/2023] [Revised: 12/15/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
Background and Aim: Purpose in life is an aspect of well-being that is associated with better health outcomes in older adulthood. We examine the association between purpose in life and likelihood of a recent fall and risk of an incident fall over time. Methods: Purpose in life and falls were reported concurrently and falls were reported again up to 16 years later in four established longitudinal studies of older adults (total N = 25,418). Results: A random-effects meta-analysis of the four samples indicated that purpose was associated with a 14% lower likelihood of having fallen recently at baseline (meta-analytic OR = 0.88, 95% CI [0.84-0.92]). Among participants who reported no falls at baseline (N = 15,632), purpose was associated with a nearly 10% lower risk of an incident fall over the up to 16-year follow-up (meta-analytic HR = 0.92, 95% CI [0.90-0.94]). These associations were independent of age, sex, race, ethnicity, and education, were not moderated by these factors, and persisted controlling for physical activity and disease burden. Conclusion and Recommendations: Purpose in life is a meaningful aspect of well-being that may be useful to identify individuals at risk for falling, particularly among individuals without traditional risk factors, and be a target of intervention to reduce fall risk.
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Affiliation(s)
| | - Martina Luchetti
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Yannick Stephan
- Euromov, University of Montpellier, Montpellier, Occitanie, France
| | - Brice Canada
- University of Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
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11
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Almidani L, Varadaraj V, Mihailovic A, Ramulu PY. Using Objective Vision Measures to Explore the Association of Vision Impairment With Cognition Among Older Adults in the United States. Am J Ophthalmol 2023; 255:18-29. [PMID: 37286156 DOI: 10.1016/j.ajo.2023.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the association between vision impairment (VI) and cognitive function using objective measures. DESIGN Cross-sectional analysis with a nationally representative sample. METHODS The association between VI and dementia was investigated in a US population-based, nationally representative sample of Medicare beneficiaries, the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries aged ≥65 years, using objective vision measures. Exposures included distance VI (>20/40), near VI (>20/40), contrast sensitivity impairment (CSI) (<1.55), any objective VI (distance and near visual acuity, or contrast), and self-reported VI. The main outcome measure was dementia status defined based on survey reports, interviews, and cognitive tests. RESULTS A total of 3026 adults were included in this study; the majority were female (55%) and White (82%). The weighted prevalence rates were 10% for distance VI, 22% for near VI, 22% for CSI, 34% for any objective VI, and 7% for self-reported VI. Across all measures of VI, dementia was more than twice as prevalent in adults with VI compared to their peers without (P < .001 for all). In adjusted models, all measures of VI were associated with higher odds of dementia (distance VI: OR 1.74, 95% CI 1.24-2.44; near VI: OR 1.68, 95% CI 1.29-2.18; CSI: OR 1.95, 95% CI 1.45-2.62; any objective VI: OR 1.83, 95% CI 1.43-2.35; self-reported VI: OR 1.86, 95% CI 1.20-2.89). CONCLUSIONS In a nationally representative sample of older US adults, VI was associated with increased odds of dementia. These results suggest that maintaining good vision and eye health may help preserve cognitive function in older age, although more research is needed to investigate the potential benefits of interventions that focus on vision and eye health on cognitive outcomes.
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Affiliation(s)
- Louay Almidani
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA
| | - Varshini Varadaraj
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA
| | - Aleksandra Mihailovic
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA
| | - Pradeep Y Ramulu
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA..
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12
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Terheyden JH, Gerhards J, Ost RAD, Wintergerst MWM, Holz FG, Finger RP. Patient-reported vision impairment in low luminance predicts multiple falls. BMC Geriatr 2023; 23:583. [PMID: 37735629 PMCID: PMC10515075 DOI: 10.1186/s12877-023-04317-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Visual impairment is an independent risk factor for falling. Whether this extends to patient-reported visual difficulties has not been assessed to date. We have evaluated whether patient-reported visual difficulties in low-contrast and low luminance situations are a risk factor for falls and concerns about falling. METHODS Baseline assessments in outpatients with varying degrees of visual impairment aged ≥ 60 years included the Vision Impairment in Low Luminance (VILL) questionnaire and socio-demographic data; prospective follow-up assessments included falls over 12 months, the Falls Efficacy Scale (FES-I) and the VILL. The VILL was scored using Rasch models, and the FES-I was categorized following published guidelines. Associations were investigated using logistic regression analysis, controlling for age, visual acuity and known risk factors of falling. RESULTS We included 112 participants (74 women, mean age 70 ± 7 years). Twenty-seven participants recalled any falls and eleven recalled multiple falls at follow-up. Higher VILL reading subscale and mobility subscale scores at baseline were significantly associated with reporting less multiple falls at follow-up (OR 0.559 [0.333-0.936], p = 0.027 and OR 0.595 [0.377-0.940], p = 0.026). VILL scores were significantly associated with concerns about falling (high versus low: p ≤ 0.004, reading, mobility and emotional subscales; high versus moderate: p = 0.004, emotional subscale). CONCLUSIONS Patient-reported visual difficulties under low illumination and in low-contrast conditions are predictive of multiple falls in the future, have an additional predictive value over established risk scores, and are associated with concerns to fall. Current fall risk assessments may benefit from the inclusion of such assessments, e.g. the VILL questionnaire.
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Affiliation(s)
- Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
| | - Johanna Gerhards
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Reglind A D Ost
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Maximilian W M Wintergerst
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, NRW, Venusberg-Campus 1, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
- Department of Ophthalmology, University Hospital Mannheim & Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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13
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Eden K, Doliszny K, Shukla R, Foster J, Bona M. Improving access to vision rehabilitation care: implementation of the South East Ontario Vision Rehabilitation Service. Can J Ophthalmol 2023:S0008-4182(23)00272-7. [PMID: 37743046 DOI: 10.1016/j.jcjo.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/12/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To investigate the effect of the South East Ontario Vision Rehabilitation Service (SOVRS), a centrally administered, regionally delivered vision rehabilitation service, on access to vision rehabilitation care. DESIGN Pre-implementation (n = 1196) and post-implementation (n = 414) observational study. PARTICIPANTS Patients referred for low-vision assessment at the hospital-based Kingston Health Sciences Centre Vision Rehabilitation Clinic and community-based Southeastern Vision Loss Rehabilitation Ontario clinics from 2014 to 2019. METHODS Markers for access to care (e.g., patient rurality, diversity of referral source, distance and time travelled, and wait times) were compared before and after SOVRS implementation. RESULTS After SOVRS implementation, there was a significant increase (p < 0.001) in the number of rural patients seen in the community. After SOVRS implementation, the hospital-based Vision Rehabilitation Clinic site experienced a significant increase in referrals from outside of Kingston (p < 0.001) and non-eye-care clinicians (p < 0.001), a significant reduction in patient time and distance travelled (p < 0.001), a 6% decrease in median wait time for low-vision assessments, and a significant reduction in wait time between referral and first available appointment (p = 0.011). CONCLUSION SOVRS, a novel service-delivery model for vision rehabilitation care, improved the delivery of and access to vision rehabilitation care in southeast Ontario through the integration of regional resources and services.
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Affiliation(s)
- Karen Eden
- South East Ontario Vision Rehabilitation Service, Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON
| | - Kathie Doliszny
- Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, ON
| | - Rohit Shukla
- Department of Civil Engineering, Queen's University, Kingston, ON
| | - Julia Foster
- South East Ontario Vision Rehabilitation Service, Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, ON
| | - Mark Bona
- South East Ontario Vision Rehabilitation Service, Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, ON.
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14
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Ardaneh M, Fararouei M, Hassanzadeh J. Gender difference in the perceived cause of fall leading to fracture and its potentially contributing factors among older adults. J Inj Violence Res 2023; 15:157-164. [PMID: 37543839 PMCID: PMC10915882 DOI: 10.5249/jivr.v15i2.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/19/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND the present study aimed to investigate gender difference in the perceived cause (intrinsic or extrinsic) of falls leading to fracture (FLF) and its association with selected social, health, and environmental factors. METHODS All patients aged 60 years or older who were admitted to two referral hospitals due to FLF from August 1, 2018, to the end of May 2019, were included in the study. An interview-administered questionnaire was used to collect the required data from 300 participants (136 men and 164 women). RESULTS When compared to men, women were less physical active, were less smoker, had lower education, had more vision problems, used more sedatives, and were more satisfied with their life (P less than 0.05 for all). No statistical difference was observed between men and women about the perceived cause of Fall. CONCLUSIONS Although women and men were the same in the perceived cause of fall, they had considerably riskier lifestyles and lower health status. These factors include education, vision condition, physical activity, occupation, and taking sleeping pills. On the other hand, men were more smoker and alcohol user.
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Affiliation(s)
- Mahdieh Ardaneh
- Epidemiology Department, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Fararouei
- HIV/AIDs Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Jafar Hassanzadeh
- Research Center for Health Sciences, Institute of Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Zou M, Lu R, Jiang Y, Liu P, Tian B, Liang Y, Wang X, Jiang L. Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study. BMJ Open 2023; 13:e065544. [PMID: 37263694 DOI: 10.1136/bmjopen-2022-065544] [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] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES This study aimed to explore the potential risk factors associated with toileting-related falls in community-dwelling older adults who presented to the emergency department and were subsequently hospitalised. DESIGN This was a cross-sectional study. SETTING AND PARTICIPANTS This study was conducted in two teaching hospitals in Shanghai, China between October 2019 and December 2021 among community-dwelling adults aged ≥60 years. METHODS In-person interviews, physical assessment and medical record review were performed to collect data on the characteristics and risk factors of falls. Associations of toileting-related falls with demographic characteristics and geriatric syndromes were examined using logistic regression models. MAIN OUTCOME MEASURES Potential risk factors for toileting-related falls. RESULTS This study included 419 older patients with a mean age of 73.8±9.7 years. Among 60 (14.3%) patients with toileting-related falls (mean age: 78.8±9.2 years), 63.3% of toileting-related falls, mainly occurred between 00:00 and 05:59 hours, compared with 17.3% of non-toileting-related falls, which primarily occurred during the daytime. The rate of recurrent falls (35%) was significantly higher in the toileting-related falls group than in the non-toileting-related falls group (21.2%) (p=0.02). Logistic regression showed that visual impairment (OR 2.7, 95% CI 1.1 to 7.1), cognitive impairment (OR 3.3, 95% CI 1.3 to 8.4), gait instability (OR 3.1, 95% CI 1.1 to 8.8) and urinary incontinence (OR 3.4, 95% CI 1.2 to 9.9) were strongly associated with toileting-related falls. Twenty-three (38.3%) patients in the toileting-related falls group had moderate and severe injuries, compared with 71.7% in the non-toileting-related falls group (p<0.05). CONCLUSIONS This study revealed that patients who reported toileting-related falls were more likely to have cognitive impairment, urinary incontinence, gait instability, visual impairment than patients who fell during other activities. Social and healthcare professionals should prioritise the management of toileting activities in older patients and provide targeted interventions to those in the high-risk group.
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Affiliation(s)
- Min Zou
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Emergency Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Lu
- Emergency Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijun Jiang
- Department of Pharmaceutics, Shanghai Pharmaceutical School, Shanghai, China
| | - Ping Liu
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bingjie Tian
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Liang
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - XiaoLing Wang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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16
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Osuka Y, Okubo Y, Nofuji Y, Maruo K, Fujiwara Y, Oka H, Shinkai S, Lord SR, Sasai H. Occupational Fall Risk Assessment Tool for older workers. Occup Med (Lond) 2023; 73:161-166. [PMID: 36893360 DOI: 10.1093/occmed/kqad035] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND No easy-to-use fall risk assessment tools have been devised to assess occupational fall risk in older workers. AIMS To develop an Occupational Fall Risk Assessment Tool (OFRAT) and report its predictive validity and reliability in older workers. METHODS The baseline fall risk assessment was completed by 1113 participants aged ≥60 years who worked ≥4 days/month in Saitama, Japan. Participants were followed up for falls during occupational activities for 1 year, and 30 participants were assessed twice for test-retest reliability. The following assessment measures were summed to form the OFRAT risk score: older age, male sex, history of falls, physical work participation, diabetes, use of medications increasing fall risk, reduced vision, poor hearing, executive dysfunction and slow stepping. The scores were then classified into four grades (0-2 points: very low, 3 points: low, 4 points: moderate and ≥5 points: high). RESULTS During follow-up, 112 participants fell 214 times during work. The negative binomial regression model showed that participants with higher grades had a higher incidence rate ratio [95% confidence interval] for falls than those with very low grades (low: 1.64 [1.08-2.47], moderate: 4.23 [2.82-6.34] and high: 6.12 [3.83-9.76]). The intraclass correlation coefficient for risk score was 0.86 [0.72-0.93], and the weighted kappa coefficient for grade assessment was 0.74 [0.52-0.95]. CONCLUSIONS The OFRAT is a valid and reliable tool for estimating the occupational fall risk in older workers. It may assist occupational physicians implement strategies to prevent falls in this group.
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Affiliation(s)
- Y Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Y Okubo
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Sydney 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, Australia
| | - Y Nofuji
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
| | - K Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Y Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
| | - H Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - S Shinkai
- Graduate School of Nutrition and Health Science, Kagawa Nutrition University, Saitama 350-0214, Japan
| | - S R Lord
- Falls, Balance and Injury Research Center, Neuroscience Research Australia, Sydney 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, Australia
| | - H Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan
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17
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Strutz N, Brodowski H, Mümken SA, Müller-Werdan U, Kiselev J. Fall Risk and Coping of Older Adults After Hospitalization: A Mixed Methods Study. Gerontol Geriatr Med 2023; 9:23337214231152700. [PMID: 36755745 PMCID: PMC9900158 DOI: 10.1177/23337214231152700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 02/04/2023] Open
Abstract
Coping is defined as cognitive and behavioral effort to manage specific external and/or internal demands, such as managing one's own fall risk. Little is known about the relationship between the risk of falling in older adults and their coping strategies. The purpose of this study is to examine the fall risk after hospitalization, the adequacy of self-perceived fall risk and coping strategies of older adults. In this mixed-methods study, the adequacy of perceived fall risk was determined using the de Morton Mobility Index and the ABC Scale in 98 geriatric patients recruited in a geriatric hospital. Semi-structured interviews were conducted with a subsample of 16 participants 6 months after discharge to identify coping strategies. The six interviewees who adequately assessed their fall risk reported active/positive coping. In contrast, participants who assessed their fall risk inadequately (10 out of 16) reported passive/negative coping. Older adults who inadequately assessed their fall risk need special accompaniment in geriatric wards to develop active/positive coping strategies.
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Affiliation(s)
- Nicole Strutz
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany,Nicole Strutz, Geriatrics Research Group,
Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität
Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health,
Reinickendorfer Str. 61, Berlin 13347, Germany.
| | - Hanna Brodowski
- Institution of Health Sciences,
Department od Physiotherapy, Pain and Exercise Research Luebeck University of
Luebeck, Luebeck, Germany
| | - Sandra Angelika Mümken
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany
| | - Ursula Müller-Werdan
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany
| | - Joern Kiselev
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany
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18
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Killeen OJ, De Lott LB, Zhou Y, Hu M, Rein D, Reed N, Swenor BK, Ehrlich JR. Population Prevalence of Vision Impairment in US Adults 71 Years and Older: The National Health and Aging Trends Study. JAMA Ophthalmol 2023; 141:197-204. [PMID: 36633858 PMCID: PMC9857701 DOI: 10.1001/jamaophthalmol.2022.5840] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023]
Abstract
Importance Existing estimates of the prevalence of vision impairment (VI) in the United States are based on self-reported survey data or measures of visual function that are at least 14 years old. Older adults are at high risk for VI and blindness. There is a need for up-to-date, objectively measured, national epidemiological estimates. Objective To present updated national epidemiological estimates of VI and blindness in older US adults based on objective visual function testing. Design, Setting, and Participants This survey study presents a secondary data analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study of Medicare beneficiaries 65 years and older. NHATS includes community-dwelling older adults or their proxies who complete in-person interviews; annual follow-up interviews are conducted regardless of residential status. Round 11 NHATS data were collected from June to November 2021, and data were analyzed in August 2022. Interventions In 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity with habitual correction. Main Outcomes and Measures National prevalence of impairment in presenting distance visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), presenting near visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), and contrast sensitivity (>1 SD below the sample mean). Prevalence estimates stratified by age and socioeconomic and demographic data were calculated. Results In the 2021 round 11 NHATS sample, there were 3817 respondents. After excluding respondents who did not complete the sample person interview (n = 429) and those with missing vision data (n = 362), there were 3026 participants. Of these, 29.5% (95% CI, 27.3%-31.8%) were 71 to 74 years old, and 55.2% (95% CI, 52.8%-57.6%) were female respondents. The prevalence of VI in US adults 71 years and older was 27.8% (95% CI, 25.5%-30.1%). Distance and near visual acuity and contrast sensitivity impairments were prevalent in 10.3% (95% CI, 8.9%-11.7%), 22.3% (95% CI, 20.3%-24.3%), and 10.0% (95% CI, 8.5%-11.4%), respectively. Older age, less education, and lower income were associated with all types of VI. A higher prevalence of near visual acuity and contrast sensitivity impairments was associated with non-White race and Hispanic ethnicity. Conclusions and Relevance More than 1 in 4 US adults 71 years and older had VI in 2021, higher than prior estimates. Differences in the prevalence of VI by socioeconomic and demographic factors were observed. These data could inform public health planning.
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Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor
| | - David Rein
- National Opinion Research Center, University of Chicago, Chicago, Illinois
| | - Nicholas Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
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19
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Soysal P, Koc Okudur S, Uslu F, Smith L. Functional loss and worsening geriatric assessment parameters are more common in dementia with Lewy bodies than Alzheimer's disease. Psychogeriatrics 2023; 23:77-85. [PMID: 36349708 DOI: 10.1111/psyg.12905] [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: 05/30/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The main aim of this study was to compare older patients with Alzheimer's disease (AD) to those with dementia with Lewy bodies (DLB) according to their dependency in daily living activities and comprehensive geriatric assessment parameters. METHOD A total of 227 AD and 123 DLB patients underwent a geriatric assessment that included comorbidities, number of drugs used, falls, urinary incontinence, hand grip strength, Mini-Nutritional Assessment (MNA), Tinetti Performance Oriented Mobility Assessment Scale, Insomnia Severity Index (ISI), and Epworth Sleepiness Scale. Basic and instrumental activities of daily living were assessed by the Barthel Index and the Lawton scale, respectively. RESULTS The mean age of the participants was 83.4 years, and 73% were female. There were no statistically significant differences between AD and DLB patients in age, gender, cognitive function, or comorbidities except for coronary artery disease (P < 0.05). The number of falls, drugs used, and ISI and Epworth scores were higher in patients with DLB than patients with AD (P < 0.05). DLB patients had lower MNA, Tinetti scale, and hand grip strength scores than AD patients. The ratio of patients highly dependent in basic daily activities as a whole was significantly greater in DLB than in AD (P < 0.05), but there was no significant difference in the overall levels of dependency in instrumental activities. CONCLUSION DLB patients are more dependent on their caregivers than AD patients. Nutritional deterioration, sleep disorders, falls, balance and gait problems, decreased muscle strength, and multiple drug use are more common in those with DLB compared to those with AD. The management of older patients with DLB may be more difficult than older patients with AD.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkiye
| | - Saadet Koc Okudur
- Department of Geriatric Medicine, Manisa State Hospital, Manisa, Turkey
| | - Ferda Uslu
- Department of Neurology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkiye
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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20
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Rauchman SH, Zubair A, Jacob B, Rauchman D, Pinkhasov A, Placantonakis DG, Reiss AB. Traumatic brain injury: Mechanisms, manifestations, and visual sequelae. Front Neurosci 2023; 17:1090672. [PMID: 36908792 PMCID: PMC9995859 DOI: 10.3389/fnins.2023.1090672] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Traumatic brain injury (TBI) results when external physical forces impact the head with sufficient intensity to cause damage to the brain. TBI can be mild, moderate, or severe and may have long-term consequences including visual difficulties, cognitive deficits, headache, pain, sleep disturbances, and post-traumatic epilepsy. Disruption of the normal functioning of the brain leads to a cascade of effects with molecular and anatomical changes, persistent neuronal hyperexcitation, neuroinflammation, and neuronal loss. Destructive processes that occur at the cellular and molecular level lead to inflammation, oxidative stress, calcium dysregulation, and apoptosis. Vascular damage, ischemia and loss of blood brain barrier integrity contribute to destruction of brain tissue. This review focuses on the cellular damage incited during TBI and the frequently life-altering lasting effects of this destruction on vision, cognition, balance, and sleep. The wide range of visual complaints associated with TBI are addressed and repair processes where there is potential for intervention and neuronal preservation are highlighted.
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Affiliation(s)
| | - Aarij Zubair
- NYU Long Island School of Medicine, Mineola, NY, United States
| | - Benna Jacob
- NYU Long Island School of Medicine, Mineola, NY, United States
| | - Danielle Rauchman
- Department of Neuroscience, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Aaron Pinkhasov
- NYU Long Island School of Medicine, Mineola, NY, United States
| | | | - Allison B Reiss
- NYU Long Island School of Medicine, Mineola, NY, United States
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21
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Monaco W, Qureshi R, Arif A, Aggarwal S, Meng H. Risk Factors for Vision Loss among Nursing Home Residents: A Cross-Sectional Analysis. J Am Med Dir Assoc 2023; 24:105-112.e1. [PMID: 36442539 DOI: 10.1016/j.jamda.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/22/2022] [Accepted: 10/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Approximately 2% of older adults currently live in nursing homes. It is important that the risks for vision loss be characterized to ensure appropriate vision care is provided for nursing home patients. Our objective was to evaluate the association of age-related eye diseases (AREDs) and multimorbidities with vision loss. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS This is a cross-sectional analysis of comprehensive eye examination records for 7753 residents of 74 North Carolina nursing homes who were ≥65 years of age at time of the initial patient visit. METHODS Complete data on vision and associated factors were included from the standardized Centers for Medicare and Medicaid Services eye examination. We defined vision impairment and blindness respectively as best-corrected visual acuity between 20/40 and 20/200, and 20/200 or worse. Clinical diagnoses of AREDs were defined by the attending clinician. Data were extracted from electronic health records, and all analyses were conducted in SAS v 9.4. We used descriptive statistics to summarize the resident characteristics and AREDs and logistic regression analysis to examine independent risk factors for vision impairment. RESULTS A total of 7753 initial eye examination records with complete data were included in the analysis. Overall, 34% of the residents had normal vision, 43% had vision impairment, and 23% were blind. Among participants with various AREDs, the prevalence of vision impaired/blind ranged from 63% to 76%, while blindness ranged from 23% to 53%. We found correction of refractive error alone served to reduce vision impairment or blindness. CONCLUSIONS AND IMPLICATIONS Comprehensive eye examinations showed vision impairment and blindness affected 66% of nursing home residents, overall. This study substantiates the positive impact of comprehensive eye examinations to promote visual, systemic, and cognitive health and well-being and the need that eye care service be used to inform policy and practice to improve patient functioning and independence.
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Affiliation(s)
- William Monaco
- School of Aging Studies, University of South Florida, Tampa, FL, USA.
| | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Areeb Arif
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Sulbh Aggarwal
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Hongdao Meng
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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22
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Yorgason JB, Tanner CT, Richardson S, Hill MMYS, Stagg B, Wettstein M, Ehrlich JR. The Longitudinal Association of Late-Life Visual and Hearing Difficulty and Cognitive Function: The Role of Social Isolation. J Aging Health 2022; 34:765-774. [PMID: 35100881 PMCID: PMC9801657 DOI: 10.1177/08982643211063338] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Sensory impairments are prevalent among older adults and have been associated with cognitive challenges in later life, yet mechanisms are less well understood. We examined the mediating role of social isolation in the longitudinal relationship between self-reported sensory difficulty and impaired cognitive functioning among older adults. METHODS Data were taken from the NHATS Study, an annual survey of Medicare beneficiaries' age ≥ 65. Participants (N = 6,338) provided data at Rounds 5, 6, and 7 (2015, 2016, 2017). Structural equation models were estimated to test longitudinal direct and indirect associations. RESULTS All sensory difficulties were negatively associated with all cognitive functioning measures cross-sectionally through social isolation. Longitudinally, vision difficulty and dual sensory difficulty were indirectly associated with cognitive functioning across time. Hearing difficulty had no longitudinal indirect associations with cognitive functioning through social isolation. DISCUSSION Social isolation is an important pathway through which late-life vision difficulty is associated with decreased cognitive function.
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Affiliation(s)
| | | | | | | | - Brian Stagg
- Department of Ophthalmology and Visual Sciences, 114380University of Utah, Salt Lake City, UT, USA
| | - Markus Wettstein
- Network Aging Research, 7891Heidelberg University, Heidelberg, Germany
| | - Joshua R Ehrlich
- Department of Ophthalmology, Institute for Social Research, 1259University of Michigan, Ann Arbor, MI, USA
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23
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Fisher K, Sanders C, Stanmore E. Impact of Charles Bonnet Syndrome on visually impaired older adults’ ability to engage in physical activity: A scoping review. British Journal of Visual Impairment 2022. [DOI: 10.1177/02646196221112800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Charles Bonnet syndrome (CBS) is a condition associated with sight loss, characterised by vivid, spontaneous visual hallucinations. Currently, it is unclear whether CBS presents challenges to participation in physical activities, in addition to barriers attributed to sight loss alone. The purpose of this scoping review was to establish the extent of the literature, and gaps in the knowledge base, concerning the impact of CBS on older adults’ engagement in physical activities. Review conduct was informed by Arksey and O’Malley and Levac et al.’s scoping review methodologies. Six academic databases were searched during May 2021, yielding 2709 results: eight articles met eligibility criteria. Two additional sources were located via a reference check of included papers and stakeholder consultation. Quantitative cross-sectional studies ( n = 3) indicate that CBS may interfere with the ability to move around, while qualitative sources (case report/series n = 6; autobiography n = 1) show that sudden presentation of hallucinations in a person’s pathway, or threatening content, may jeopardise safety while walking. Moving to avoid a hallucination could present a fall risk if attention is diverted from environmental hazards. One case report stated that CBS did not affect personal care activities. Due to a limited evidence base, further empirical research is needed to achieve a comprehensive understanding about how CBS affects older adults’ participation in physical activities.
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Affiliation(s)
| | - Caroline Sanders
- University of Manchester, UK; Manchester Academic Health Science Centre (MAHSC), UK
| | - Emma Stanmore
- University of Manchester, UK; Manchester Academic Health Science Centre (MAHSC), UK; Manchester University NHS Foundation Trust, UK
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24
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Blanco‐Blanco J, Albornos‐Muñoz L, Costa‐Menen MÀ, García‐Martínez E, Rubinat‐Arnaldo E, Martínez‐Soldevila J, Moreno‐Casbas MT, Bays‐Moneo AB, Gea‐Sánchez M. Prevalence of falls in noninstitutionalized people aged 65−80 and associations with sex and functional tests: A multicenter observational study. Res Nurs Health 2022; 45:433-445. [PMID: 35735212 PMCID: PMC9543892 DOI: 10.1002/nur.22249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022]
Abstract
Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65−80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk‐specific fall prevention programs to prevent disabilities in older people.
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Affiliation(s)
- Joan Blanco‐Blanco
- Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Group for the Study of Society Health Education and Culture, GESEC University of Lleida Lleida Spain
- Health Care Research Group GRECS, Biomedical Research Institute of Lleida IRB‐Lleida Lleida Spain
| | - Laura Albornos‐Muñoz
- Unidad de Investigación en Cuidados y Servicios de Salud (Investén‐isciii), REDISSEC, Instituto de Salud Carlos III Madrid Spain
| | - Maria Àngels Costa‐Menen
- Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Health Care Research Group GRECS, Biomedical Research Institute of Lleida IRB‐Lleida Lleida Spain
- CAP Onze de Setembre, ICS Lleida Spain
| | - Ester García‐Martínez
- Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Group for the Study of Society Health Education and Culture, GESEC University of Lleida Lleida Spain
- Health Care Research Group GRECS, Biomedical Research Institute of Lleida IRB‐Lleida Lleida Spain
| | - Esther Rubinat‐Arnaldo
- Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Group for the Study of Society Health Education and Culture, GESEC University of Lleida Lleida Spain
- Health Care Research Group GRECS, Biomedical Research Institute of Lleida IRB‐Lleida Lleida Spain
| | - Jordi Martínez‐Soldevila
- Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Group for the Study of Society Health Education and Culture, GESEC University of Lleida Lleida Spain
- Health Care Research Group GRECS, Biomedical Research Institute of Lleida IRB‐Lleida Lleida Spain
| | - María Teresa Moreno‐Casbas
- Unidad de Investigación en Cuidados y Servicios de Salud (Investén‐isciii), CIBERFES, Instituto de Salud Carlos III Madrid Spain
| | | | - Montserrat Gea‐Sánchez
- Department of Nursing and Physiotherapy University of Lleida Lleida Spain
- Group for the Study of Society Health Education and Culture, GESEC University of Lleida Lleida Spain
- Health Care Research Group GRECS, Biomedical Research Institute of Lleida IRB‐Lleida Lleida Spain
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25
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Saberi N, Darvishpoor Kakhki A, Ilkhani M, Khan HTA. Falls in older ambulatory care patients with cancer in Iran: Implications for clinical practice. J Eval Clin Pract 2022; 28:624-630. [PMID: 34854180 DOI: 10.1111/jep.13639] [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: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
RATIONALE/AIM Falls can have severe consequences particularly for older patients with cancer undergoing ambulatory care. The aim of the study is to identify the predictors of falls in older patients receiving cancer ambulatory care and evaluate the accuracy of the final multivariable model in detecting older patients with falls. METHOD A retrospective study was conducted on 300 older patients aged 60 years and above that were referred for ambulatory care in three oncology clinics based at hospitals in Tehran, Iran. Participants completed a questionnaire comprising demographic, history of falls, and cancer-related factors. Logistic regression was used to determine risk factors associated with falls. RESULTS A total of 35.3% of the older patients with cancer had experienced a fall in the 6 months following the start of their ambulatory care. The most important predictors of falls include the fourth stage of cancer (odds ratio [OR]: 6.47, 95% confidence interval [CI]: 3.20-13.08, p < 0.001), fear of falling (OR: 5.64, 95% CI: 2.58-12.33, p < 0.001), use of hearing (OR: 2.38, 95% CI: 1.07-5.29, p = 0.033) and visual aids (OR: 2.36, 95% CI: 1.12-5.01, p = 0.025), and the number of visits to the doctor (OR: 1.10, 95% CI: 1.01-1.21, p = 0.035). CONCLUSIONS The results indicate that a reduction in falls is possible by introducing strategies to improve care for older patients in the advanced stage of cancer, eliminating the causes of fear of falling, examining and improving vision and hearing, and identifying and addressing the underlying causes of visits to the doctor.
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Affiliation(s)
- Najmeh Saberi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical and Surgical Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Ilkhani
- Department of Medical and Surgical Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hafiz T A Khan
- Public Health Group, College of Nursing, Midwifery and Healthcare, University of West London, London, UK
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26
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Coleman AL, McLeod SD. Screening for Impaired Visual Acuity in Older Adults. JAMA 2022; 327:2090-2091. [PMID: 35608845 DOI: 10.1001/jama.2022.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anne L Coleman
- Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Stephen D McLeod
- Department of Ophthalmology, School of Medicine, University of California, San Francisco
- Francis I. Proctor Foundation, University of California, San Francisco
- American Academy of Ophthalmology, San Francisco, California
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27
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Sohail A, Du J, Nawaz Abbasi B, Taiwo AK. Prevalence, causes, and impact of self-reported vision impairment among older people in China: Findings from the China health and retirement longitudinal study. British Journal of Visual Impairment 2022. [DOI: 10.1177/02646196221099160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article investigated the prevalence, causes, and impact of self-reported vision impairment among older people in China. A total of 12,910 participants aged ⩾50 years were included in this study from China Health and Retirement Longitudinal Study (CHARLS) over the periods of 2011, 2013, and 2015. All data were reported by participants via a self-reported questionnaire. Distance vision was assessed by asking if they could see the face of a person on the other side of the street. Near vision was assessed by asking if they could read ordinary newspaper. Depressive symptoms were evaluated by 10-item Center for Epidemiological Studies Depression Scale. The analysis method included the χ2 – square distribution test and multiple regression analysis. This article first found that prevalence of self-reported vision impairment was much higher in rural than in urban areas; in urban areas, females had a greater chance of being affected than males, and for both sexes, it increases with increasing age. Second, some factors found are significantly associated with increased vision impairment rates, include increasing age, female gender, rural residents, elementary-level education, unmarried individuals, and non-agricultural occupations. Third, the leading cause of vision impairment was a refractive error and the most common causes of vision impairment include cataracts and glaucoma. Fourth, vision impairment was significantly associated with falls and depressive symptoms and has a negative effect on the quality of life of older Chinese. The article concluded that older people with self-reported vision impairment were relatively low and it is majorly caused by refractive error. Older people with distance vision impairment and near vision impairment were more likely to report falls and depressive symptoms in the future. In line with these findings, a couple of policy recommendations for further research were made.
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Affiliation(s)
- Ali Sohail
- Xian Jiaotong University, China; Shaanxi Normal University, China
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28
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Canever JB, Danielewicz AL, Leopoldino AAO, Corseuil MW, de Avelar NCP. Gender differentiated score on the Falls Efficacy Scale International (FES-I Brazil) to assess self-efficacy in falls in community-dwelling older adults. Aging Clin Exp Res 2022; 34:1341-7. [PMID: 35050494 DOI: 10.1007/s40520-021-02058-9] [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: 10/08/2021] [Accepted: 12/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Since fear of falling is associated with a history of falls and is more prevalent in women, it is important to define cut-off points differentiated between genders on the Falls Efficacy Scale International Brazil (FES-I Brazil) to implement early prevention and/or rehabilitation strategies. AIMS To determine cut-off points on the FES-I Brazil differentiated between genders which discriminate falls and verify their association with the history of falls. METHODS This was a cross-sectional study including 306 community-dwelling older adults. Fear of falling score from the FES-I Brazil was the independent variable and the outcome was the history of falls in the last 12 months. The cut-off points differentiated between genders were established according to sensitivity and specificity values evaluated by the Receiver Operating Characteristic Curves (ROC). The multivariable logistic regression was used to verify the association between fear of falling and history of falls. RESULTS The cut-off points on the FES-I Brazil to discriminate falls were > 25 points [AUC: 0.67 (95% CI 0.59-0.73)] for women, and > 19 points [AUC: 0.66 (95% CI 0.57-0.74) for men, suggesting that women present a greater fear of falling than men, due to the higher cut-off point found for women. Women and men with fear of falling, respectively, had 2.14 (95% CI 1.11-4.13) and 2.62 (95% CI 1.10-6.85) higher odds of suffering falls compared to those without this condition. CONCLUSIONS The FES-I can be used to discriminate falls in the elderly and shows that women have a higher cut-off point than men on the scale.
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29
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Bachmann BC, Bachofner M, Mickan S, Stojcic D, Carnier KA, Giamboni A, Neugebauer Z, Lienhard KR, Bachmann LM. Frequency of Eye Diseases in Residents of Nursing Homes - 1-Year Results of a Novel Telemedicine Service in Switzerland. Klin Monbl Augenheilkd 2022; 239:610-614. [PMID: 35472817 DOI: 10.1055/a-1778-4782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE For the elderly in nursery homes, a visit to the ophthalmologist is a burden, which might lead to undertreatment. We have recently started offering a novel ophthalmological service combining onsite examination and telemedical interpretation for patients with limited access to ophthalmological care. This study summarises the frequency of findings of treatable eye diseases after the first year of operation in participants who dropped out from regular ophthalmological control. METHODS Participants' clinical characteristics, frequency of service utilisation, and findings were extracted from the system and analysed. RESULTS Of 1946 residents approached, 540 (27.7%; 1080 eyes) signed up for the service. A complete examination was possible in 412 persons (813 eyes) and partially possible in the remaining 128. The mean age of the examined participants mean age was 83.9 years (SD 9.7), and they were predominantly female (69.8%). The majority had a diagnosis of dementia (54.5%) and 20.2% had diabetes mellitus requiring treatment. The median care level (ranging from 0 - 12) was 7 (interquartile range 6 - 9), corresponding to a care need of 121 - 140 min/d. The mean best-corrected decimal visual acuity was 0.55 (SD 0.24). For 164 eyes (15.2%), the current spectacle correction was insufficient. An untreated cataract was present in 145 eyes (13.4%), 89 eyes (8.2%) were receiving glaucoma treatment, and 7 eyes had a decompensated glaucoma. Dry age-related macular degeneration (AMD) appeared in 276 eyes (25.6%), 12 eyes (1.1%) had wet AMD, and 24 eyes (11.0%) among patients with diabetes showed signs of diabetic retinopathy. Other pathologies were uncommon. CONCLUSION Residents of nursery homes, who are unable to attend regular ophthalmological control, show various treatable ophthalmological conditions, including cataracts, glaucoma, and retinal pathologies. Screening with a novel telemedicine service allows for the identification of treatable conditions and careful planning and referral of patients to appropriate clinics having the necessary infrastructure for this particular population.
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Affiliation(s)
| | | | - Sandra Mickan
- Mobile Messungen, Augenmobil AG, Zürich, Zürich, Switzerland
| | - Danica Stojcic
- Mobile Messungen, Augenmobil AG, Zürich, Zürich, Switzerland
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30
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Osuka Y, Okubo Y, Nofuji Y, Sasai H, Seino S, Maruo K, Fujiwara Y, Oka H, Shinkai S, Lord SR, Kim H. Modifiable intrinsic factors related to occupational falls in older workers. Geriatr Gerontol Int 2022; 22:338-343. [PMID: 35266260 DOI: 10.1111/ggi.14370] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/21/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
AIM Identification of modifiable intrinsic factors for occupational falls is required for initiating effective fall prevention strategies for older workers. This study aimed to identify modifiable intrinsic factors related to falls during occupational activities among older workers. METHODS This retrospective study involved 1164 older workers (aged ≥60 years, workdays ≥4/month) sampled from 18 public employment agencies for seniors in Saitama, Japan. Participants were assessed regarding the following 10 modifiable intrinsic factors: multimorbidity, polypharmacy, fall-risk-increasing medication use, self-rated vision and hearing, functional strength, bilateral stepping, standing balance, executive function and visuospatial ability. The number of falls during occupational activities in the past year was also recorded. RESULTS In total, 111 falls occurred in 73 of the 1164 participants during occupational activities in the past year. A negative binomial regression model showed that use of fall-risk-increasing medications (incidence rate ratio [IRR]: 2.23, 95% confidence interval [CI]: 1.08, 4.60, P = 0.031), reduced functional strength (IRR: 1.81, 95% CI: 1.02, 3.21, P = 0.042), poor standing balance (IRR: 1.83, 95% CI: 1.09, 3.09, P = 0.023) and poor visuospatial ability (IRR: 1.56, 95% CI: 1.03, 2.36, P = 0.034) were independently associated with occupational falls. CONCLUSIONS Our findings suggest that the assessment of medication use, functional strength, standing balance and visuospatial ability in regular health checks in the workplace may be useful for screening older workers at risk of occupational falls. Geriatr Gerontol Int 2022; 22: 338-343.
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Affiliation(s)
- Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Japan
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yu Nofuji
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Japan
| | - Satoshi Seino
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Shoji Shinkai
- Graduate School of Nutrition and Health Science, Kagawa Nutrition University, Sakado-shi, Japan
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Japan
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Lundeen EA, Saydah S, Ehrlich JR, Saaddine J. Self-Reported Vision Impairment and Psychological Distress in U.S. Adults. Ophthalmic Epidemiol 2022; 29:171-181. [PMID: 33896341 PMCID: PMC10949979 DOI: 10.1080/09286586.2021.1918177] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Examine the relationship between vision impairment and psychological distress in adults ≥18 years. METHODS Using the 2016-2017 cross-sectional, U.S. National Health Interview Survey, we analyzed self-reported data (n = 57,644) on: Kessler psychological distress scores; general vision impairment (GVI), defined as difficulty seeing even when wearing glasses or contacts; and visual function impairment (VFI), measured using six visual function questions. Multinomial logistic regression was used to estimate adjusted odds ratios (aOR) for mild/moderate and serious psychological distress, by GVI and VFI status, and identify predictors of psychological distress among those with GVI or VFI. RESULTS Among adults, 10.6% (95% CI: 10.2, 11.0) had GVI; 11.6% (CI: 11.1, 12.0) had VFI. One in four adults with GVI had psychological distress (14.9% [CI: 13.8, 16.0] reported mild/moderate and 11.2% [CI: 10.2, 12.3] reported serious). Individuals with GVI, versus those without, had higher odds of mild/moderate (aOR = 2.24; CI: 2.00, 2.52) and serious (aOR = 3.41; CI: 2.96, 3.93) psychological distress; VFI had similar findings. Among adults with GVI, odds of serious psychological distress were higher for those aged 18-39 (aOR = 4.46; CI: 2.89, 6.90) or 40-64 (aOR = 6.09; CI: 4.33, 8.57) versus ≥65 years; smokers (aOR = 2.45; CI: 1.88, 3.18) versus non-smokers; physically inactive (aOR = 1.61; CI: 1.22, 2.11) versus active; and with arthritis (aOR = 2.18; CI: 1.66, 2.87) or chronic obstructive pulmonary disease (aOR = 1.65; CI: 1.15, 2.37) versus without. CONCLUSION Adults with self-reported vision impairment had higher odds of psychological distress. These findings may inform screening interventions to address psychological distress, particularly among younger working-age adults vision impairment.
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Affiliation(s)
- Elizabeth A Lundeen
- Division of Diabetes Translation (DDT, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sharon Saydah
- Division of Diabetes Translation (DDT, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA
| | - Jinan Saaddine
- Division of Diabetes Translation (DDT, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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32
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Trujillo Tanner C, Yorgason JB, Richardson S, Redelfs AH, Serrao Hill MMY, White A, Stagg B, Ehrlich JR, Markides KS. Sensory Disabilities and Social Isolation Among Hispanic Older Adults: Toward Culturally Sensitive Measurement of Social Isolation. J Gerontol B Psychol Sci Soc Sci 2022; 77:2091-2100. [PMID: 35022736 PMCID: PMC9683500 DOI: 10.1093/geronb/gbac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Sensory disabilities, including vision disability and hearing disability, increase risk for social isolation, which is associated with multiple negative health outcomes. Existing literature suggests that the cultural value of familism may provide a buffer against social isolation. We examined the longitudinal trajectory of social isolation among Hispanic older adults with self-reported vision disability (SRVD) and self-reported hearing disability and tested a modified measure of social isolation incorporating familism. METHODS We compared 8-year trajectories of social isolation among Hispanics (n = 445) and non-Hispanic Whites (n = 4,861) from the National Health and Aging Trends Study. We used structural equation modeling to explore the longitudinal relationships between sensory disability and social isolation while comparing 2 measures of social isolation. RESULTS Social isolation increased longitudinally for both groups, with SRVD significantly associated with higher initial levels. Social isolation started and remained higher across time among Hispanics. Using an adjusted measure of social isolation (added familial support), neither initial levels nor trajectories of social isolation differed between Hispanic and non-Hispanic White participants. DISCUSSION Initially, Hispanics appeared more socially isolated, reporting less social support from outside the home. Yet, we found that they were more likely to report family social connections. Traditional measures of social isolation focusing on social support outside of the home (neglecting support by family) may lack content validity among Hispanic groups. Culturally sensitive measures of social isolation will be increasingly consequential for future research and health policy to meet the needs of a diverse older population.
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Affiliation(s)
- Corinna Trujillo Tanner
- Address correspondence to: Corinna Trujillo Tanner, PhD, RN, MSN, College of Nursing, Brigham Young University, 432 KMBL, Provo, UT 84602, USA. E-mail:
| | | | | | - Alisha H Redelfs
- School of Public Health, Brigham Young University, Provo, Utah, USA
| | | | - Avalon White
- School of Family Life, Brigham Young University, Provo, Utah, USA
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Kyriakos S Markides
- Department of Preventive Medicine and Population Health, University of Texas, Galveston, Texas, USA
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Lin CC, Meardon S, O'Brien K. The Predictive Validity and Clinical Application of Stopping Elderly Accidents, Deaths & Injuries (STEADI) for Fall Risk Screening. Adv Geriatr Med Res 2022; 4:e220008. [PMID: 36315107 DOI: 10.20900/agmr20220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fall prevention is critical for older adults. Stopping Elderly Accidents, Deaths, and Injuries (STEADI) is a fall prevention initiative, promoted by the Center for Disease Control (CDC). The purpose of this review aims to discuss the predictive validity, improve the predictive validity of STEADI, and apply STEADI in clinical settings.
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Abstract
Background Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature. Methods A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis. Results The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline. Conclusions Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors.
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Affiliation(s)
- Scott MacKay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary
| | - Patricia Ebert
- Department of Psychology, University of Calgary, Calgary.,Hotchkiss Brain Institute, University of Calgary, Calgary.,Specialized Geriatric Services, Calgary Regional Health Authority, Calgary
| | - Cathy Harbidge
- Specialized Geriatric Services, Calgary Regional Health Authority, Calgary
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
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Abstract
PURPOSE The full utility of general health Patient-Reported Outcomes Measurement Information System® (PROMIS) surveys in the eye care setting has not been previously demonstrated. This report demonstrates the feasibility of implementing PROMIS in an eye care clinic. PATIENTS AND METHODS Over 2 months, general health and functioning PROMIS surveys were offered to all patients in an optometric clinic in Rochester, NY. Demographic and clinical variables were recorded along with percent completion and time to completion of the survey. RESULTS Across 651 patients, 258 chose to attempt PROMIS. Patients with low visual acuity were less likely to attempt the survey (p=0.049), and younger patients were more likely to complete the survey (p=0.025); no other patient characteristics were found to differ between those who did and did not participate in, nor complete, PROMIS. A total of 193 patients completed the survey (74.8%) in a mean time of 6.36 minutes (range = [1.43, 51.92] minutes; standard deviation = 5.62 minutes). Time to completion did not vary significantly across any groups. CONCLUSION Our relatively high completion rate among those who attempted PROMIS indicates that PROMIS surveys are feasible to implement in an optometry clinic. While most patients completed the survey in little time, the large range of time to completion may indicate that some patients had difficulty completing the survey. Furthermore, the significant difference in visual acuity between those who participated in the survey and those who did not highlights the need to address the way PROMIS is delivered in order to foster greater inclusion.
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Affiliation(s)
- Randall S Porter
- Pediatric Ophthalmology and Ocular Genetics Service, University of Rochester Flaum Eye Institute, Rochester, NY, USA
| | - Kathleen Holt
- University of Rochester Clinical & Translational Science Institute, Rochester, NY, USA
| | - Rajeev S Ramchandran
- Retina and Vitreous Service, University of Rochester Flaum Eye Institute, Rochester, NY, USA
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Lundälv J, Thodelius C. Risk of Injury Events in Patients With Visual Impairments: A Swedish Survey Study Among Hospital Social Workers. Journal of Visual Impairment & Blindness 2021. [DOI: 10.1177/0145482x211046666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: People with visual impairments (those who are blind or have low vision) are exposed to risks in everyday life, especially injury risks. This study aimed to examine experiences and practical knowledge among hospital social workers in Sweden concerning meetings with patients with visual impairments who have been affected by injury events in residential environments. Methods: Swedish hospital social workers specializing in patients with visual impairments ( n=30) answered a questionnaire comprising 14 questions. Both fixed and open-ended questions were included, allowing an analysis of both comparable numeric data and subjectively perceived experiences and opinions. Results: A majority of the respondents had met patients who had been injured in the residential setting; the most common injury mechanism reported was tripping or falling on the stairs, or accidentally stumbling into furniture. The hospital social workers acknowledged that they could work more preventively in their professional role by encouraging patients to use orientation and mobility devices such as long canes, increasing collaboration with other professions, and conducting home visits to enable trustful dialogues with both patients and relatives. Discussion: According to these specialized hospital social workers, the provision of education and information to patients with visual impairments could potentially prevent future injury. However, in order to achieve this, there is a need to first enable a trustful dialogue between social workers and patients. Implications for practitioners: This study provides a better understanding of the importance of trustful dialogue between hospital social workers and patients with visual impairments, from the point of view injury prevention. It also offers a summary of the knowledge of hospital social workers about risks and injury events in residential settings for patients with visual impairments.
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Affiliation(s)
- Jörgen Lundälv
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Charlotta Thodelius
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
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De Lott LB, Kolli A, Zhou Y, Hu M, Ehrlich JR. Development and Validation of a Novel Indicator of Visual Disability in the National Health and Aging Trends Study. Innov Aging 2021; 5:igab018. [PMID: 34423139 PMCID: PMC8374875 DOI: 10.1093/geroni/igab018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives The National Health and Aging Trends Study (NHATS) is an ongoing, nationally representative panel study of older adults that collects data on health and disability, including measures on self-reported visual disability (SRVD). Prior studies assessing the association of SRVD with other measures of healthy aging have classified participants as having or not having SRVD, which does not capture the full spectrum of SRVD reported by participants. Therefore, we sought to develop and validate an ordinal indicator of SRVD to facilitate research on the impact of late-life SRVD on health and disability in NHATS. Research Design and Methods We used 2015 NHATS data with community-dwelling participants who answered survey questions about visual functioning and vision aid use. Based on responses, participants were categorized into one of 6 groups: blind, near and distance SRVD without vision aid use, near and distance SRVD with vision aid use, near or distance SRVD without vision aid use, near or distance SRVD with vision aid use, or no SRVD. Multivariable Poisson regression models assessed convergent validity of the ordinal SRVD scale with functional activity and well-being scores, while adjusting for demographic factors and medical comorbidities. Results Of the 7061 eligible individuals, 8.3% (n = 742) reported SRVD. Using our novel ordinal indicator of SRVD in NHATS, higher levels of SRVD were significantly associated with lower functional activity scores (p < .001 for all) and subjective well-being (p < .001), except for participants reporting blindness. Significant differences between SRVD groups were found, which could not be captured using a binary SRVD variable. Discussion and Implications A novel 6-level SRVD scale in NHATS demonstrated convergent validity with functional activity and well-being scales. This scale provides a new tool with improved measurement precision to study the impact of late-life SRVD on health and disability in a nationally representative study of older adults.
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Affiliation(s)
- Lindsey B De Lott
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Ajay Kolli
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Yunshu Zhou
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA.,Institute for Social Research, University of Michigan, Ann Arbor, USA
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Seong HJ, Kim J, Youk TM, Kim H, Chung EJ. Changes in Incidences of Chronic and Traumatic Diseases before and after Registration as Visually Disabled. J Korean Ophthalmol Soc 2021. [DOI: 10.3341/jkos.2021.62.8.1084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose: To analyze changes in the incidences of chronic and traumatic diseases before and after registration as visually disabled.Methods: The incidence and risk of chronic and traumatic diseases were compared between patients registered as visually disabled from 2005 to 2013 and a control group, selected through 1:1 propensity score matching for age, sex, premium quantile, and residential area distribution. Data from the National Health Insurance Service were used and the observation period was set from 2 years before to 5 years after the time of registration as visually disabled. The incidences (%) of chronic and traumatic diseases at the point of interest were determined as the mean values according to year of registration, and the risk was measured by conditional logistic regression analysis.Results: 131,434 visually disabled patients and the same number of non-visually impaired controls were included. The incidences of chronic disease and fall-related injury were higher in the visually disabled group before registration, but gradually decreased and became similar to the control group after registration. In addition, the risk of developing chronic diseases was higher in the visually disabled group until 2 years after registration, while the risk of fall-related injury remained consistently higher in the visually disabled group during the observation period. The incidence and risk of hip fracture in the visually disabled group increased gradually from approximately 1 year before registration and remained consistently higher than in the control group.Conclusions: People with visual disability have higher incidences of chronic diseases than do non-visually impaired people and are at greater risk of traumatic injuries, such as hip fractures or falls. There is a need to establish community infrastructure and expand welfare services for the prevention and early treatment of comorbidities, both for patients with registered visual disabilities and for patients who have not yet registered.
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Varadaraj V, Swiatek KS, Chung SE, Ehrlich JR, Assi L, Wolff JL, Swenor BK. Caring for Older Adults With Self-Reported Vision Impairment: Findings from the National Study of Caregiving. Am J Ophthalmol 2021; 227:211-221. [PMID: 33831341 PMCID: PMC8817230 DOI: 10.1016/j.ajo.2021.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to examine caregiving relationships for older adults with vision impairment (VI). DESIGN Cross-sectional study with a nationally representative sample. METHODS Setting: the National Health and Aging Trends Study linked to the National Study of Caregiving, Year 2011. STUDY POPULATION 1,776 family or unpaid caregivers to community-dwelling Medicare beneficiaries age ≥65 years old. OUTCOME MEASUREMENT in the preceding month, 1) the number of hours of care provided; 2) the valued activities affected by caregiving; and 3) the odds of experiencing substantial emotional, financial, and physical difficulty related to providing care. EXPOSURE VI was defined as a report of blindness or difficulty with distance or near vision. RESULTS Among 1,776 caregivers, 428 caregivers spent an average ± standard error (SE) of 111 ± 9.1 hours per month assisting older adults with VI, whereas 1,348 spent an average of 72 ± 3.3 hours assisting older adults without VI. In fully adjusted negative binomial regression analyses, caregivers of older adults with VI spent 36% more hours (incident rate ratio [IRR]: 1.36; 95% confidence interval [CI]: 1.15-1.60) providing care and reported having 61% more valued activities affected (IRR: 1.61; 95% CI: 1.23-2.10) than caregivers of older adults without VI. In fully adjusted logistic regression analyses, caregivers of older adults with VI had greater odds of emotional (odds ratio [OR]: 1.46; 95% CI: 1.04-2.03) but not financial (OR: 1.33; 95% CI: 0.87-2.03) or physical (OR: 1.13; 95% CI: 0.74-1.74) difficulty related to providing care than caregivers of older adults without VI. CONCLUSIONS These results suggest that caring for older adults with VI places different demands on time and emotional wellbeing than caring for older adults without VI, but no differences in financial or physical difficulties.
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Affiliation(s)
- Varshini Varadaraj
- Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA,The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, USA
| | | | - Shang-En Chung
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Joshua R. Ehrlich
- Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lama Assi
- Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Jennifer L. Wolff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Lipitz Center for Integrated Health Care, and the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnielin K. Swenor
- Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA,The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, USA,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bhorade AM, Perlmutter MS, Sabapathypillai SL, Goel M, Wilson B, Gordon MO. Rate of Falls, Fear of Falling, and Avoidance of Activities At-Risk for Falls in Older Adults With Glaucoma. Am J Ophthalmol 2021; 227:275-283. [PMID: 33626364 DOI: 10.1016/j.ajo.2021.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/15/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the relationship between glaucoma severity and rate of falls, fear of falling, and avoidance of activities at-risk for falls. DESIGN Cross-sectional study. METHODS Patients with glaucoma (n = 138) 55 to 90 years of age with mild (n = 61), moderate (n = 54), or advanced (n = 23) glaucoma in the better eye based on the Glaucoma Staging System and age-matched control subjects (n = 50) were recruited from the Eye Clinics at Washington University, St. Louis, MO. Participants completed questionnaires regarding falls, the fear of falling, and the avoidance of activities at-risk for falls. RESULTS Of the glaucoma participants, 36% reported ≥1 fall in the previous 12 months compared with 20% of control subjects (adjusted odds ratio [OR] 2.7 [95% confidence interval {CI} 1.18-6.17]; P = .018). Compared with control subjects, the mild glaucoma group trended toward a higher fall risk (adjusted OR 2.43 [95% CI 0.97-6.08]; P = .059) and the advanced group had the highest fall risk (adjusted OR 7.97 [95% CI 2.44-26.07]; P = .001). A greater risk of a high fear of falling and high avoidance of at-risk activities occurred at the moderate stage of glaucoma compared with control subjects (adjusted OR 4.66 [95% CI 1.24-17.49]; P = .023 and adjusted OR 4.49 [95% CI 1.34-15.05]; P = .015, respectively). CONCLUSIONS Patient education, interventions, and appropriate referrals to minimize falls should be considered in older adults with early glaucoma and continue with advancing disease. Minimizing a patient's fall risk may decrease their fear of falling and avoidance of at-risk activities. Reducing falls, the fear of falling, and the avoidance of at-risk activities may lower morbidity and mortality and improve emotional and social well-being of patients with glaucoma. Am J Ophthalmol 2021;221:•••-•••. © 2021 Elsevier Inc. All rights reserved.
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Farrell MT, Jia Y, Berkman LF, Wagner RG. Do You See What Eye See? Measurement, Correlates, and Functional Associations of Objective and Self-Reported Vision Impairment in Aging South Africans. J Aging Health 2021; 33:803-816. [PMID: 34029165 DOI: 10.1177/08982643211012839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Our study investigates measurement, correlates, and functional associations of vision impairment (VI) in an aging population in rural South Africa. Methods: 1582 participants aged 40-69 reported on near (NVI) and distance vision impairment (DVI) and completed objective vision tests. Logistic and linear regression were used to evaluate sociodemographic, health, and psychosocial correlates of VI and assess relationships between VI and cognitive and physical function. Results: VI prevalence was considerably higher according to objective testing (56%) versus self-reports (18%). Older adults were especially likely to underreport impairment. Objective VI was associated with age, education, cardiometabolic disease, and female sex. Conversely, self-reported VI was associated with psychosocial factors. Objective NVI and both types of DVI were associated with worse visual cognition and slower gait speed, respectively. Discussion: Self-reported and objective VI measures should not be used interchangeably in this context. Our findings highlight extensive burden of untreated VI in this region.
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Affiliation(s)
- Meagan T Farrell
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Yusheng Jia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lisa F Berkman
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ryan G Wagner
- University of the Witwatersrand, Johannesburg, South Africa
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Ogliari G, Ryg J, Qureshi N, Andersen-Ranberg K, Scheel-Hincke LL, Masud T. Subjective vision and hearing impairment and falls among community-dwelling adults: a prospective study in the Survey of Health, Ageing and Retirement in Europe (SHARE). Eur Geriatr Med 2021; 12:1031-1043. [PMID: 34003480 DOI: 10.1007/s41999-021-00505-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the association between vision and hearing impairment and falls in community-dwelling adults aged ≥ 50 years. METHODS This is a prospective study on 50,986 participants assessed in Waves 6 and 7 of the Survey of Health, Ageing and Retirement in Europe. At baseline, we recorded socio-demographic data, clinical factors and self-reported vision and hearing impairment. We classified participants as having good vision and hearing, impaired vision, impaired hearing or impaired vision and hearing. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The cross-sectional and longitudinal associations between vision and hearing impairment categories and falls were analysed by binary logistic regression models; odds ratios (OR) and 95% confidence intervals (CI) were calculated. All analyses were adjusted for socio-demographic and clinical factors. RESULTS Mean age was 67.1 years (range 50-102). At baseline, participants with impaired vision, impaired hearing, and impaired vision and hearing had an increased falls risk (OR (95% CI)) of 1.34 (1.22-1.49), 1.34 (1.20-1.50) and 1.67 (1.50-1.87), respectively, compared to those with good vision and hearing (all p < 0.001). At follow-up, participants with impaired vision, without or with impaired hearing, had an increased falls risk of 1.19 (1.08-1.31) and 1.33 (1.20-1.49), respectively, compared to those with good vision and hearing (both p < 0.001); hearing impairment was longitudinally associated with falls in middle-aged women. CONCLUSION Vision impairment was cross-sectionally and longitudinally associated with an increased falls risk. This risk was highest in adults with dual sensory impairment.
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Affiliation(s)
- Giulia Ogliari
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, Nottinghamshire, UK.
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Nadeem Qureshi
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winslowvej 9B, 5000, Odense, Denmark
| | - Lasse Lybecker Scheel-Hincke
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winslowvej 9B, 5000, Odense, Denmark
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, Nottinghamshire, UK.,Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
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Iftikhar M, Mir T, Seidel N, Rice K, Trang M, Bhowmik R, Chun J, Goldberg MF, Woreta FA. Epidemiology and outcomes of hyphema: a single tertiary centre experience of 180 cases. Acta Ophthalmol 2021; 99:e394-e401. [PMID: 33124159 DOI: 10.1111/aos.14603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/21/2020] [Accepted: 08/01/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To characterize the epidemiology and outcomes of hyphema. METHODS Retrospective case series. Medical records from patients with traumatic and spontaneous hyphema seen at the Wilmer Eye Institute, Johns Hopkins, from 2011 through 2017 were evaluated. Aetiology, demographics, clinical characteristics, complications, management and outcomes were ascertained. Multivariable logistic regression was used to identify factors associated with elevated intraocular pressure (IOP), rebleeding and poor outcome (final visual acuity ≤ 20/40) in traumatic hyphema. A safe frequency of follow-up was retrospectively determined. RESULTS Traumatic hyphema (n = 152) was more common in males (78%) and adults (55%), with sports/recreational activities being the most frequent cause (40%). Elevated IOP was the most common complication (39%). Rebleeding occurred in seven patients (5%) and was more likely with a higher IOP on presentation (OR:1.1; p = 0.004). Thirty-seven patients (24%) had a poor outcome, mostly due to traumatic sequelae such as cataract (32%) or posterior segment involvement (30%). A poor outcome was more likely with worse presenting visual acuity (OR: 9.1; p = 0.001), rebleeding (OR: 37.5; p = 0.035) and age > 60 years (OR: 16.0; p = 0.041). Spontaneous hyphema (n = 28) did not have a gender predominance and was more common in adults > 60 years (71%). The most common cause was iris neovascularization (61%). Complications and visual outcomes were worse compared with traumatic hyphema. CONCLUSIONS Traumatic hyphema continues to be common in young males engaging in sports, necessitating increased awareness for preventive eyewear. Older age and rebleeding can lead to poor outcomes. Elevated IOP at presentation predisposes to rebleeding and warrants frequent follow-up. Otherwise, routine follow-up at days 1, 3, 5, 7 and 14 is sufficient for uncomplicated cases.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Tahreem Mir
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Natalie Seidel
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Katya Rice
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Michelle Trang
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ryan Bhowmik
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Justin Chun
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Morton F. Goldberg
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
| | - Fasika A. Woreta
- Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD USA
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Hark LA, Tan CS, Kresch YS, De Moraes CG, Horowitz JD, Park L, Auran JD, Gorroochurn P, Stempel S, Maruri SC, Besagar S, Saaddine JB, Lambert BC, Pizzi LT, Sapru S, Price S, Williams OA, Cioffi GA, Liebmann JM. Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results. Curr Eye Res 2021; 46:1597-1604. [PMID: 33726583 DOI: 10.1080/02713683.2021.1905000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care.Materials and Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in Upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers.Results:Participants (n = 42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n = 33) failed vision screening. Of those who failed, 84.8% (n = 28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses.Conclusion: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Camille S Tan
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Yocheved S Kresch
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - C Gustavo De Moraes
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - James D Auran
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Stella Stempel
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Sonya Besagar
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Bianca C Lambert
- Department of General Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, New Brunswick, New Jersey, USA
| | - Saloni Sapru
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Simani Price
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Olajide A Williams
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
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45
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Seo Y, Kim K, Kim JS. Trends of Nursing Research on Accidental Falls: A Topic Modeling Analysis. Int J Environ Res Public Health 2021; 18:3963. [PMID: 33918730 PMCID: PMC8068873 DOI: 10.3390/ijerph18083963] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
This descriptive study analyzed 1849 international and 212 Korean studies to explore the main topics of nursing research on accidental falls. We extracted only nouns from each abstract, and four topics were identified through topic modeling, which were divided into aspects of fall prevention and its consequences. "Fall prevention program and scale" is popular among studies on the validity of fall risk assessment tools and the development of exercise and education programs. "Nursing strategy for fall prevention" is common in studies on nurse education programs and practice guidelines to improve the quality of patient safety care. "Hospitalization by fall injury" is used in studies about delayed discharge, increased costs, and deaths of subjects with fall risk factors hospitalized at medical institutions due to fall-related injuries. "Long-term care facility falls" is popular in studies about interventions to prevent fall injuries that occur in conjunction with dementia in long-term care facilities. It is necessary to establish a system and policy for fall prevention in Korean medical institutions. This study confirms the trends in domestic and international fall-related research, suggesting the need for studies to address insufficient fall-related policies and systems and translational research to be applied in clinical trials.
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Affiliation(s)
| | | | - Ji-Su Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-Ro Dongjak-Gu, Seoul 06974, Korea; (Y.S.); (K.K.)
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Ardaneh M, Fararouei M, Hassanzadeh J. Factors Contributing to Falls Leading to Fracture among Older Adults. Population Ageing 2021. [DOI: 10.1007/s12062-021-09326-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ge L, Yu Q, Wang C, Huang H, Li X, Zhang S, Zhang S. How cognitive loads modulate the postural control of older women with low back pain? BMC Geriatr 2021; 21:82. [PMID: 33509117 PMCID: PMC7841999 DOI: 10.1186/s12877-021-02025-z] [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: 08/18/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The capacity of postural control is a key factor related to falling in older people, particularly in older women with low back pain (LBP). Cognitive involvement in postural control increases with age. However, most scholars have not considered different difficulty levels of cognitive loads when exploring the effects of cognition on postural control in older patients with LBP. The present study is to investigate how different levels of cognitive loads modulate postural control in older women with LBP. METHODS This was a cross-sectional study. Twenty older women with LBP were recruited into the LBP group, and 20 healthy older women without the history of LBP were recruited into the healthy control group. Balance parameters were computed to quantify postural control. All participants underwent the balance test, which required the participant to maintain stability during standing on a force platform with or without a concurrent cognitive task. The balance test included three levels of difficulties of posture tasks (eyes-open vs. eyes-closed vs. one-leg stance) and three cognitive tasks (without cognitive task vs. auditory arithmetic task vs. serial-7 s arithmetic task). RESULTS A repeated-measure analysis of variance (3 postural tasks × 3 congnitive tasks× 2 groups) testing the effects of the different congnitive task levels on the performance in different postural conditions. Older women with LBP had worse postural control (as reflected by larger center of pressure (COP) parameters) than control group regardless of postural or cognitive difficulties. Compared with the single task, the COP parameters of participants with LBP were larger during dual tasks, even though the difficulty level of the cognitive task was low. Larger COP parameters were shown only if the difficulty level of the cognitive task was high in control group. Correlations between sway area/sway length and the number of falls were significant in dual tasks. CONCLUSION Our findings shed light on how cognitive loads modulate postural control for older women with LBP. Compared with control group, cognitive loads showed more disturbing effects on postural control in older women with LBP, which was associated with falling.
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Affiliation(s)
- Le Ge
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, Guangdong Province, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, Guangdong Province, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, Guangdong Province, China.
| | - Huanjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, Guangdong Province, China
| | - Xin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, Guangdong Province, China
| | - Shanshan Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, Guangdong Province, China
| | - Siyun Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, 510080, Guangdong Province, China
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Soysal P, Tan SG, Smith L. A comparison of the prevalence of Fear of Falling between older patients with Lewy body dementia, Alzheimer's disease, and without dementia. Exp Gerontol 2021; 146:111248. [PMID: 33486068 DOI: 10.1016/j.exger.2021.111248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/09/2021] [Accepted: 01/18/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The development of cognitive impairment and Fear of Falling (FoF) are strongly linked, but prevalence of FoF is not known in patients with different types of dementia. This study aims to evaluate and compare the prevalence and severity of FoF in patients' with dementia with Lewy bodies (DLB), Alzheimer disease (AD), and non-dementia. METHODS 46 participants with DLB, 86 participants with AD and participants without dementia (controls), underwent Comprehensive Geriatric Assessment (CGA). The Falls Efficacy Scale-International (FES-I) was used to determine and classify FoF. An overall score on the FES-I of 16-19, 20-27 and ≥28, was accepted as low, moderate, and high concern about FoF, respectively. RESULTS Prevalence of high FoF was 86.9% in DLB, 36.0% in AD and 37.4% in controls. All CGA parameters were worse in the DLB and AD group than non-dementia group (p < 0.001). The prevalence of high FoF/FES-scores was significantly higher in the DLB group than in the AD and non-dementia group (p < 0.001), but was similar in AD and non-dementia groups (p > 0.05). The significant relationship between DLB and FoF was maintained when adjusted for age, CGA parameters, and orthostatic hypotension (OR: 2.55, CI: 1.03-6.25, p = 0.041 comparison to AD; OR: 4.79, CI: 2.10-10.92, p < 0.001 comparison to non-dementia). CONCLUSION Eight out of ten elderly patients with DLB have high FoF, which is much higher than those with AD and without dementia. Therefore, clinicians should be aware of FoF and its related consequences in the management of DLB in older adults.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
| | - Semen Gokce Tan
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, UK
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49
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Patel N, Stagg BC, Swenor BK, Zhou Y, Talwar N, Ehrlich JR. Association of Co-occurring Dementia and Self-reported Visual Impairment With Activity Limitations in Older Adults. JAMA Ophthalmol 2021; 138:756-763. [PMID: 32407444 DOI: 10.1001/jamaophthalmol.2020.1562] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance The number of older adults with visual impairment (VI) and dementia is projected to increase in the US because of the aging of the population. Dementia and VI commonly co-occur and are each independently associated with disability. To care for an aging population, it may be important to characterize the association of coexisting dementia and self-reported VI on daily functioning. Objective To evaluate the association of co-occurring dementia and self-reported VI on daily functioning. Design, Setting, and Participants This cross-sectional analysis of a nationally representative cohort study used data from the National Health and Aging Trends Study (NHATS), an annual study of US adults 65 years and older. Participants in the 2015 survey with complete data on outcomes, associated factors, and covariates were included in this study. Data analysis took place from January 2019 to November 2019. Main Outcomes and Measures Multivariable Poisson regression was used to model the independent associations and interaction of dementia and self-reported VI status on 3 functional activity scales (self-care, mobility, and household activities). Marginal predicted proportions were calculated. Analyses were adjusted for sociodemographic and medical factors and accounted for the complex survey design. Results A total of 7124 participants were included. The weighted proportion of female respondents was 55.3% (95% CI, 54.0%-56.6%), and 56.1% (95% CI, 54.1%-58.1%) were between 65 and 74 years old. Self-reported VI was present in 8.6% (95% CI, 7.8%-9.3%) of participants, while 8.3% (95% CI, 7.8%-8.9%) had possible dementia and 6.3% (95% CI, 5.7%-6.9%) had probable dementia. Self-reported VI was associated with an expected decrease in mobility score of 14.7% (functional scale scores: no VI, 10.82 vs VI, 9.23), self-care score of 9.5% (no VI, 14.54 vs VI, 13.16), and household activity score of 15.2% (no VI, 18.23 vs VI, 15.45), while probable dementia was associated with expected decreases of 27.8% (no dementia, 10.82 vs probable dementia, 7.81), 22.9% (no dementia, 14.54 vs probable dementia, 11.20), and 34.7% (no dementia, 18.23 vs probable dementia, 11.90), respectively. Among those with probable dementia and self-reported VI, there was an expected decrease in mobility score of 50.1% (functional ability scores: no VI and no dementia, 10.82 vs VI and probable dementia, 5.40), self-care score of 42.4% (no VI and no dementia, 14.54 vs VI and probable dementia, 8.38), and household activity score of 52.4% (no VI and no dementia, 18.23 vs VI and probable dementia, 8.68), suggesting that respondents with co-occurring dementia and self-reported VI had lower functional activity scores than would be associated with the independent contributions of these conditions. Conclusions and Relevance Older adults with both dementia and self-reported VI may be at high risk for disability, and their co-occurrence may potentiate this risk. These findings suggest that the growing population of older adults with both visual impairment and dementia may benefit from interventions to maximize vision and cognition and promote functioning and independence.
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Affiliation(s)
- Nish Patel
- University of Michigan Medical School, Ann Arbor.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Brian C Stagg
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City
| | - Bonnelin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
| | - Nidhi Talwar
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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50
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Tsai CY, Tung TH, Li YT, Chen WC. The relationship between home ownership and fall-related outcomes: The National Health and Aging Trends Study. PLOS Glob Public Health 2021; 1:e0000019. [PMID: 36962064 PMCID: PMC10021867 DOI: 10.1371/journal.pgph.0000019] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
Although many studies have tried to explore the association between fall incidents and fear of falling (FOF)/worry about fall-limited activities and various risk factors, few studies have recognized the relationship between house ownership and fall-related outcomes. The aim of this study was to assess whether house ownership will affect an older adult's experience of falling or lead to fear of falling. The National Health and Aging Trends Study (NHATS) collected data that would provide an understanding of basic trends in people aged 65 years and older living in the United States of America. This study conducted round one of the NHATS and did logistic regression to examine the relationship between house ownership and fall-related outcomes among 7,090 persons aged 65 or older. Twenty five percent of the sampled population who lacked house ownership. All fall-related outcomes (fall last month, fall last year, fear of falling, and worry about fall-limited activities) were statistically significant in the bivariate analysis. Multiple logistic regression analysis showed that house ownership (OR = 0.75, 95%CI: 0.65-0.86) was significantly associated with fear of falling after adjusting for other covariates. The findings underscore the association between the lack of house ownership and fall-related outcomes.
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Affiliation(s)
- Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- MS Program in Transdisciplinary Long Term Care and Bachelor's Program in Business Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Tao-Hsin Tung
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Yang-Tzu Li
- Department of long term care, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Wei-Cheng Chen
- Taiwan Stipendiary Co., Ltd., Kaohsiung, Taiwan
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
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