THE USE OF POSTUROGRAPHY IN INVESTIGATING THE RISK OF FALLING IN FRAIL OR PREFRAIL OLDER PEOPLE WITH DIABETES

2019 ◽  
pp. 1-7
Author(s):  
H. Domergue ◽  
L. Rodríguez-Mañas ◽  
O. Laosa Zafra ◽  
K. Hood ◽  
D. Gasq ◽  
...  
Keyword(s):  
Older People ◽  
Walking Speed ◽  
Analysis Data ◽  
Diabetic Patients ◽  
Clinical Test ◽  
Risk Of Falling ◽  
Timed Up And Go ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Risk Patients

Background: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.

scholarly journals Anticholinergic burden measures and older people’s falls risk: a systematic prognostic review

2021 ◽  
Vol 12 ◽  
pp. 204209862110166
Author(s):  
Carrie Stewart ◽  
Martin Taylor-Rowan ◽  
Roy L. Soiza ◽  
Terence J. Quinn ◽  
Yoon K. Loke ◽  
...  
Keyword(s):  
High Risk ◽  
Older People ◽  
Well Being ◽  
Risk Of Bias ◽  
Plain Language ◽  
Risk Of Falling ◽  
Increased Risk ◽  
Burden Scale ◽  
Risk Of Falls ◽  
Anticholinergic Burden

Introduction: Several adverse outcomes have been associated with anticholinergic burden (ACB), and these risks increase with age. Several approaches to measuring this burden are available but, to date, no comparison of their prognostic abilities has been conducted. This PROSPERO-registered systematic review (CRD42019115918) compared the evidence behind ACB measures in relation to their ability to predict risk of falling in older people. Methods: Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms and a validated search filter for prognostic studies. Inclusion criteria included: participants aged 65 years and older, use of one or more ACB measure(s) as a prognostic factor, cohort or case-control in design, and reporting falls as an outcome. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results: Eight studies reporting temporal associations between ACB and falls were included. All studies were rated high risk of bias in ⩾1 QUIPS tool categories, with five rated high risk ⩾3 categories. All studies (274,647 participants) showed some degree of association between anticholinergic score and increased risk of falls. Findings were most significant with moderate to high levels of ACB. Most studies (6/8) utilised the anticholinergic cognitive burden scale. No studies directly compared two or more ACB measures and there was variation in how falls were measured for analysis. Conclusion: The evidence supports an association between moderate to high ACB and risk of falling in older people, but no conclusion can be made regarding which ACB scale offers best prognostic value in older people. Plain language summary A review of published studies to explore which anticholinergic burden scale is best at predicting the risk of falls in older people Introduction: One third of older people will experience a fall. Falls have many consequences including fractures, a loss of independence and being unable to enjoy life. Many things can increase the chances of having a fall. This includes some medications. One type of medication, known as anticholinergic medication, may increase the risk of falls. These medications are used to treat common health issues including depression and bladder problems. Anticholinergic burden is the term used to describe the total effects from taking these medications. Some people may use more than one of these medications. This would increase their anticholinergic burden. It is possible that reducing the use of these medications could reduce the risk of falls. We need to carry out studies to see if this is possible. To do this, we need to be able to measure anticholinergic burden. There are several scales available, but we do not know which is best. Methods: We wanted to answer: ‘Which anticholinergic scale is best at predicting the risk of falling in older people?’. We reviewed studies that could answer this. We did this in a systematic way to capture all published studies. We restricted the search in several ways. We only included studies relevant to our question. Results: We found eight studies. We learned that people who are moderate to high users of these medications (often people who will use more than one of these medications) had a higher risk of falling. It was less clear if people who have a lower burden (often people who only use one of these medications) had an increased risk of falling. The low number of studies prevented us from determining if one scale was better than another. Conclusion: These findings suggest that we should reduce use of these medications. This could reduce the number falls and improve the well-being of older people.

scholarly journals Validation of the Timed Up and Go Test as a Predictor of Risk of Falls in Subjects with Rheumatoid Arthritis

2019 ◽  
pp. 3-9
Author(s):  
Luciana Barbalaco ◽  
Julia Abudarham ◽  
Fernando Argento ◽  
Eugenia Cazurro ◽  
Sofía Dilascio ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
High Risk ◽  
Predictive Value ◽  
Concurrent Validity ◽  
Walking Speed ◽  
Primary Objective ◽  
Risk Of Falling ◽  
Timed Up And Go ◽  
Risk Of Falls ◽  
Secondary Objective

Background: subjects with Rheumatoid Arthritis (RA) have a high risk of falling. The Timed Up and Go test (TUG) is used to predict the risk of falls but it has not been validated in subjects with RA. Purpose: the primary objective was to establish the predictive validity and the concurrent validity of TUG at the preferred walking speed or fastest speed possible as a predictor of falls in subjects with RA. The secondary objective was to establish if the TUG has a higher predictive value evaluated at the preferred walking speed or fastest speed possible.

154 The Feasibility of Assessing Sarcopenia Among Older People with Arm Fracture Using Different Criteria

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
K Ibrahim ◽  
M A Mullee ◽  
G Lily Yao ◽  
S Zhu ◽  
M Baxter ◽  
...  
Keyword(s):  
Older People ◽  
Grip Strength ◽  
Sensitivity And Specificity ◽  
Gait Speed ◽  
Speed Test ◽  
Increased Risk ◽  
European Working ◽  
Hand Dynamometer ◽  
Risk Of Falls ◽  
And Gender

Abstract Introduction Osteoporosis and sarcopenia often co-exist (osteo-sarcopenia) and both are associated with increased risk of falls and fractures. Early identification and treatment of sarcopenia among older people with fragility arm fractures could prevent further fractures. This study evaluated the feasibility of assessing sarcopenia in a fracture clinic. Methods People aged 65+ years with arm fracture attending fracture clinics in one acute trust were recruited. Sarcopenia was assessed using gait speed, grip strength with unfractured arm (hand dynamometer using appropriate cut off adjusted for age and gender), skeletal muscle mass index SMI (Bioimpedance BIA), SARC-F questionnaire, the European Working Group on Sarcopenia in Older People (EWGSOP) I and II criteria. The sensitivity and specificity of each measure was calculated against the EWGSOP II criteria as the standard reference. Results 100 patients (Mean age 75 years±7.2; 80 female) were recruited. Sarcopenia was identified among 4% (EWGSOP I), 5% (SMI), 13% (EWGSOP II), 16% (gait speed test), 18% (SARC-F) and 39% (grip strength) and was more prevalent among men. SARC-F had the best sensitivity and specificity (100% and 96% respectively) when compared to the EWGSOP II criteria. Sensitivity and specificity for the remaining measures were respectively (100%, 71%) for grip strength, (75%, 94%) for gait speed, (25%, 97%) with SMI and (25%, 99%) for EWGSOP I. Time needed to complete the assessments was 1–2 minutes for gait speed, grip strength and SARC-F; five minutes for BIA test, and nine minutes when EWGSOP I and II criteria were applied. Data were complete for grip strength and SARC-F. Missing data was reported among 2% for gait speed, 8% for BIA test, 8% for EWGSOP II and 10% for EWGSOP I. Conclusion It was feasible to assess sarcopenia in fracture clinics and SARC-F was a quick, simple and sensitive tool suitable for routine use.

scholarly journals Coping with adequate and inadequate self-assessment of older people’s risk of falling: a mixed-methods study in Germany.

2019 ◽  
Author(s):  
Nicole Strutz ◽  
Hanna Brodowski ◽  
Sandra Mümken ◽  
Ursula Müller-Werdan ◽  
Jörn Kiselev
Keyword(s):  
Older People ◽  
Coping Strategies ◽  
Fall Risk ◽  
Qualitative Content Analysis ◽  
Self Awareness ◽  
Risk Of Falling ◽  
Self Assessment ◽  
Functional Changes ◽  
Positive Coping ◽  
Increased Risk

Abstract Background: Older people are exposed to an increased risk of falling due to a multitude of physiological and functional changes and fear of falling. The risk of falling is assessed and managed differently. It should be found out whether the coping strategies of older people differ with regard to their activities in daily life depending on the adequacy of their self-assessed fall risk. Methods: Adequacy of the perceived fall risk was evaluated with the de Morton Mobility Index and the Activities-specific Balance Confidence Scale among 100 older people. Additionally, semi-structured interviews were conducted in 16 participants with an identified fall risk. Coding techniques, based on structuring qualitative content analysis and the half-split method were applied. Results: Six out of 16 interviewees assessed their fall risk adequately. Interviews with the seniors resulted in topics such as coping strategies and awareness and several sub-topics in each category. Participants who adequately assessed their own fall risk reported an “active/positive” coping behavior and awareness of themselves. In contrast, those who assessed their own risk of falling inadequately covered all identified categories with no identifiable pattern. Conclusion: An adequate self-assessment of fall risks is accompanied by positive coping strategies to maintain an active lifestyle. In contrast, a lack of an adequate self-awareness seems to lead to arbitrary coping strategies. Assisting older people in their self-awareness regarding their own fall risk should be emphasized in order to adopt positive coping strategies. Future studies are necessary to better understand the underlying mechanisms that lead to an adequate or inadequate self-assessment in older people fall risk.

scholarly journals Balance Strategy Exercise versus Lower Limb-ROM Exercise for Reducing the Risk of Falls among Older People

2021 ◽  
Vol 11 (1) ◽  
pp. 114-123
Author(s):  
Zakia Azkia ◽  
Rahmi Setiyani ◽  
Lita Heni Kusumawardani
Keyword(s):  
Nursing Homes ◽  
Older People ◽  
Range Of Motion ◽  
Lower Limb ◽  
Institutional Care ◽  
Control Group ◽  
Timed Up And Go ◽  
Term Care ◽  
Risk Of Falls ◽  
Balance Strategy

Background: Falls are a significant health problem and the most common cause of injuries in older people. Different types of exercise have been recommended to prevent falls, including balance exercise and range of motion. However, there is a lack of evidence to compare the effect of the two exercises.Purpose: This study aimed to compare the effect of Balance Strategy Exercise (BSE) and Lower Limb-Range of Motion (ROM) exercise on reducing the risk of falls among older people living in long-term care facilities. Methods: This was a quasi-experimental study using a pre-post design without a control group. A total of 30 older adults from two nursing homes who met the inclusion and exclusion criteria participated in the study. A cluster randomization technique was used to assign the older people into either BSE or Lower-Limb ROM groups evenly. Treatment was given for 30 minutes per session, three sessions per week for three weeks. The risk of falls was measured using the Timed Up and Go (TUG) test. The paired t-test, Wilcoxon and Mann-Whitney U-test were used to analyze the data. Results: Results showed significant differences in the TUG scores before and after the intervention within both the BSE (p=0.001) and the Lower Limb-ROM group (p=0.001). However, the Lower Limb-ROM group demonstrated a significantly higher reduction in TUG score than the BSE group after the intervention (p=0.008).Conclusion: Lower Limb-ROM exercise is better to reduce the risk of falls among older people living in institutional care than BSE. This exercise can be applied as part of a fall prevention program in nursing homes.

Changes in the Dynamic Stability of Walking in Active Healthy Older Adults Independent of Changes in Walking Speed

2008 ◽  
Author(s):  
Hyun Gu Kang ◽  
Jonathan B. Dingwell
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Dynamic Stability ◽  
Walking Speed ◽  
Age Groups ◽  
Leg Strength ◽  
Age Related ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Walking Speeds

Older adults commonly walk slower, which many believe helps improve their walking stability. However, they remain at increased risk of falls. We investigated how differences in age and walking speed independently affect dynamic stability during walking, and how age-related changes in leg strength and ROM affected this relationship. Eighteen active healthy older and 17 younger adults walked on a treadmill for 5 minutes each at each of 5 speeds (80–120% of preferred). Local divergence exponents and maximum Floquet multipliers (FM) were calculated to quantify each subject’s responses to small inherent perturbations during walking. These older adults exhibited the same preferred walking speeds as the younger subjects (p = 0.860). However, these older adults still exhibited greater local divergence exponents (p<0.0001) and higher maximum FM (p<0.007) than young adults at all walking speeds. These older adults remained more unstable (p<0.04) even after adjusting for declines in both strength and ROM. In both age groups, local divergence exponents decreased at slower speeds and increased at faster speeds (p<0.0001). Maximum FM showed similar changes with speed (p<0.02). The older adults in this study were healthy enough to walk at normal speeds. However, these adults were still more unstable than the young adults, independent of walking speed. This greater instability was not explained by loss of leg strength and ROM. Slower speeds led to decreased instability in both groups.

scholarly journals How should the ticagrelor be used? The point after the TWILIGHT and THEMIS-PCI studies

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L72-L76
Author(s):  
Laura Gatto ◽  
Francesco Prati
Keyword(s):  
Clinical Trials ◽  
Heart Attack ◽  
Randomized Clinical Trials ◽  
Stable Coronary Artery Disease ◽  
Diabetic Patients ◽  
Increased Risk ◽  
The Face ◽  
Risk Patients ◽  
History Of ◽  
Artery Disease

Abstract The ticagrelor represents a cornerstone of antiplatelet therapy and its use has been supported, over the years, by several clinical trials that have enrolled thousands of patients; while the PLATO study initially demonstrated its effectiveness in the immediate treatment of acute coronary syndromes, the PEGASUS study documented the benefit of prolonging this treatment beyond 12 months from the heart attack. Over the past few months, two new randomized clinical trials have been published that have seen the use of ticagrelor in different clinical settings. The TWILIGHT study showed that in high-risk patients who completed 3 months of double antiplatelet drugs after coronary angioplasty, ticagrelor monotherapy is associated with a 44% reduction in the risk of clinically relevant bleeding in the absence of an increase in the ischaemic risk. The THEMIS study instead concluded that in the population of diabetics with stable coronary artery disease, but without a history of heart attack or stroke, a strategy that involves the addition of ticagrelor to the acetylsalicylic acid is not advisable as in the face of a benefit in the prevention of events ischaemic an increased risk of bleeding has been observed. Only in the subgroup of diabetic patients with a history of previous angioplasty would a more powerful antithrombotic therapy seem to be advantageous.

scholarly journals Instrumented Analysis of the Sit-to-Stand Movement for Geriatric Screening: A Systematic Review

2020 ◽  
Vol 7 (4) ◽  
pp. 139
Author(s):  
Brajesh Shukla ◽  
Jennifer Bassement ◽  
Vivek Vijay ◽  
Sandeep Yadav ◽  
David Hewson
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Older People ◽  
Search Strategy ◽  
Risk Of Falling ◽  
Sit To Stand ◽  
Risk Of Falls ◽  
Geriatric Screening ◽  
Meta Analyses ◽  
Future Work

The Sit-to-Stand (STS) is a widely used test of physical function to screen older people at risk of falls and frailty and is also one of the most important components of standard screening for sarcopenia. There have been many recent studies in which instrumented versions of the STS (iSTS) have been developed to provide additional parameters that could improve the accuracy of the STS test. This systematic review aimed to identify whether an iSTS is a viable alternative to a standard STS to identify older people at risk of falling, frailty, and sarcopenia. A total of 856 articles were found using the search strategy developed, with 12 articles retained in the review after screening based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six studies evaluated the iSTS in fallers, five studies in frailty and only one study in both fallers and frailty. The results showed that power and velocity parameters extracted from an iSTS have the potential to improve the accuracy of screening when compared to a standard STS. Future work should focus on standardizing the segmentation of the STS into phases to enable comparison between studies and to develop devices integrated into the chair used for the test to improve usability.

scholarly journals Effects of training with nintendo wii on balance and mobility in institutionalized elderly

2020 ◽  
pp. 1-6
Author(s):  
Lara Alves Moreira ◽  
Lívia Marcondes Faber ◽  
Marcos Eduardo Scheicher
Keyword(s):  
The Elderly ◽  
Functional Mobility ◽  
Static Balance ◽  
Nintendo Wii ◽  
Timed Up And Go ◽  
Term Care ◽  
Institutionalized Elderly ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Pre Treatment

Background: One of the consequences of the institutionalization of the elderly is the increased risk of falls. Games of video games have shown ability to improve balance in the elderly population, but there is no data on their use in institutionalized elderly. Objective: To evaluate the effects of training with Nintendo Wii on static balance and functional mobility in elderly living in Long-Term Care Facilities for Elderly. Methods: Participated in the research 10 institutionalized elderly, who underwent training with Nintendo Wii for eight weeks, twice a week. Functional mobility was assessed by the Timed Up and Go (TUG) test and the static balance by a force platform. Results: Significant improvement in TUG was observed (17.65 ± 4.38s pre-treatment and 15.30 ± 3.70s p= 0.03). There was no significant improvement in the static equilibrium variables, but there was a tendency for improvement. Conclusion: The results demonstrated that the intervention with Nintendo Wii significantly improved the functional mobility, but with no improvement in the static balance in the institutionalized elderly.

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