Anticoagulation and injurious falls in the elderly: a review

2015 ◽  
Vol 6 (4) ◽  
pp. 405-408
Author(s):  
Oludolapo Sotade
Keyword(s):  
The Elderly ◽  
Injurious Falls

Anemia in the Elderly and the Risk of Injurious Falls.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1333-1333
Author(s):  
Mei S. Duh ◽  
Samir H. Mody ◽  
Patrick Lefebvre ◽  
Richard C. Woodman ◽  
Sharon Buteau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Linear Trend ◽  
Head Injuries ◽  
The Elderly ◽  
Community Dwelling ◽  
Significant Linear Trend ◽  
Injurious Falls ◽  
Risk Of Falls ◽  
Increasing Risk ◽  
Risk Factors For Falls

Abstract Background: Anemia commonly occurs in the elderly (≥65), and has been associated with a number of adverse consequences. Thirty percent of the community-dwelling elderly fall annually and this risk increases to 50% by the age of 80. Serious injuries caused by a fall, such as fractures and head injuries, are sustained by about 10% of the elderly and often lead to functional disability, increased health care costs, and increased mortality. Identification of reversible risk factors is critical for the management of falls and related injuries. The purpose of the current study is to investigate whether anemia increases the risk of injurious falls (IF) in the elderly. Methods: Health claims data from over 30 health plans from 01/1999 through 04/2004 were used. Patients ≥65 years with ≥1 hemoglobin (Hb) measurement were selected. IF were defined as a fall claim followed by an injurious event claim within 30 days after the fall. Injurious events were defined as fractures of the hip, pelvis, femur, vertebrae, ribs, humerus, and lower limbs, Colle’s fracture, head injuries, or hematomas. An open-cohort design was employed to classify patients’ observation periods by: (1) by anemia status based on WHO criteria (< 12 g/dL for women; < 13 g/dL for men), and (2) by Hb level: <10, 10-<12, 12-<13, and ≥13 g/dL. The incidence rates (IF events / person-years of observation) were compared by anemia status and Hb levels, respectively. Subset analyses based on IF of the hip (including pelvis and femur) and the head were further conducted. The association of IF with anemia and Hb levels, respectively, was analyzed using both univariate and multivariate (adjusted for age, gender, health plan, comorbidities, concomitant medications) approaches. Results: Among the 47,530 study subjects, a statistically significant linear trend of increasing risk of falls (i.e., IF and non-IF events) with decreasing Hb was observed (p<.0001). The incidence of IF was 15.8, 14.0, 9.8, and 6.5 per 1,000 person-years for Hb levels of <10, 10-<12, 12-<13, and ≥13 g/dL, respectively (trend: p<.0001). Based on the univariate analysis, anemia increased the risk of IF by 1.66 times (95% CI: 1.41–1.95) compared to no anemia, and the effects of anemia on IF of the hip and head were more pronounced (rate ratio (RR)=2.25 [95% CI: 1.74–2.89] and 1.77 [95% CI: 1.22–2.55], respectively, (p<.01 for both)). Multivariate analysis revealed that Hb levels were significantly associated with the risk of IF (RR = 1.57, 1.48, 1.17 for Hb levels of <10, 10-<12, 12-<13 g/dL, respectively, compared to Hb≥ 13 g/dL), and the negative linear trend of the risk of IF by Hb levels remained statistically significant (p<.0001). In the subset of hip and head IF, the association with anemia was even stronger (Hip: RR=3.37, 1.83, 1.36 for Hb levels of <10, 10-<12, 12-<13 g/dL, respectively; Head: RR=1.65, 1.47, 1.18, respectively), with a statistically significant linear trend observed (Hip: p<.0001; Head: p=0.07). Anemia (esp. Hb < 10) had comparable risk to other well-known risk factors for falls such as Alzheimer’s disease, Parkinson’s disease, and osteoarthritis. Conclusion: Anemia was significantly and independently associated with an increasing risk for IF, especially IF to the hip and head, in elderly persons. Furthermore, the risk of IF increased as the anemia worsened. The impact of anemia correction on the risk of falls and IF needs to be evaluated.

35 The Impact of Postural Hyperkyphosis on Postural Stability and Cognition

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv9-iv12
Author(s):  
Krista Burns
Keyword(s):  
Vestibular System ◽  
Postural Stability ◽  
Muscle Activation ◽  
Treatment Protocol ◽  
The Elderly ◽  
Lower State ◽  
Muscle Activation Patterns ◽  
Injurious Falls ◽  
Postural Correction ◽  
The Impact

Abstract Background Postural Hyperkyphosis results from flexor dominant posture habits. Flexor dominance occurs due to dysfunction of the pontomedullary reticular formation (PMRF) of the brainstem and the vestibular system. The role of the PMRF is to inhibit anterior flexion above T6 spinal level, and the vestibular system stimulates upright postural extension and balance. When patients present with flexor dominance they have a Postural Hyperkyphosis postural distortion pattern and abnormal muscle activation patterns. To correct flexor dominance, practitioners should perform brain-based exercises, not just structural exercises. Brain based stimulation of the vestibular system and the brainstem stimulates upright extension of the Posture System and inhibition of anterior flexion to reduce Postural Hyperkyphosis. Postural Hyperkyphosis contributes to multiple health discrepancies. According to Cohen, Vasavada, and Wiest et al. (2016) in the Frontiers of Neuroscience, Postural Hyperkyphosis is associated with a lower state of cognition. According to Kado, Huang, and Nguyen et al. (2007) in the Journals of Gerontology hyperkyphosis is associated with poor balance and injurious falls in the elderly. Brainstem and vestibular activation reduces flexion and improves extension for better postural correction outcomes. Results Brain Based exercises reduce Postural Hyperkyphosis and improve postural stability and cognition of elderly patients. Brain Based exercises are safe for the elderly to perform and can be easily implemented into physical rehabilitation treatment plans for better postural correction results. Conclusion Correcting Postural Hyperkyphosis to improve Postural Stability and cognition requires a Brain Based treatment protocol.

POSSIBLE ROLE OF NUTRITION IN PREVENTION OF SARCOPENIA AND FALLS

2019 ◽  
Vol 25 (11) ◽  
pp. 1184-1190
Author(s):  
Darius Alexander Schneider ◽  
Dace Liliana Trence
Keyword(s):  
Muscle Protein ◽  
Muscle Protein Synthesis ◽  
The Elderly ◽  
Extensive Literature ◽  
Nutritional Interventions ◽  
Hydroxyvitamin D ◽  
Injurious Falls ◽  
Increased Risk ◽  
Risk Of Falls ◽  
25 Hydroxyvitamin D

Objective: In this review, we analyze the foundation of sarcopenia as a potentially modifiable risk factor for falls, and we try to formulate practical strategies for nutritional interventions aimed at reducing the risk for sarcopenia and falls in our elderly patients. Methods: An extensive literature search was performed using the PubMed and the Google Scholar databases. Results: Falls are a common and costly source of injury and death in elderly adults. A large proportion of injurious falls are due to a trip or slip, suggesting that muscular factors are major determinants of both fall risk and the risk for fall-related injury. Conclusion: An increasing body of evidence links sarcopenia, the loss of muscle strength and mass that occurs with advancing age, with an increased risk for falls. Nutritional factors, as well as exercise, can help with both prevention and treatment of sarcopenia and may reduce the risk of falls in the elderly. Abbreviations: 25-OHD = 25-hydroxyvitamin D; EAA = essential amino acid; IGF-1 = insulin-like growth factor 1; IU = international units; MPS = muscle protein synthesis; PUFA = polyunsaturated fatty acid

scholarly journals Population ageing and injurious falls among one million elderly people who used emergency medical services from 2010 to 2017 in Beijing, China: a longitudinal observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028292 ◽  
Author(s):  
Siyu Zhao ◽  
Yu Cao ◽  
Yanni Lei ◽  
Fangchao Liu ◽  
Shiyu Shao ◽  
...  
Keyword(s):  
Observational Study ◽  
Emergency Medical Services ◽  
Elderly People ◽  
Elderly Population ◽  
The Elderly ◽  
Ageing Population ◽  
Longitudinal Observational Study ◽  
Emergency Medical ◽  
Injurious Falls ◽  
Beijing China

ObjectivesTo access the epidemiological characteristics of elderly people using emergency medical services (EMS) in Beijing, as a consequence of injurious falls, and the association between an ageing population and injurious falls.DesignA longitudinal observational study based on Beijing EMS data.SettingAll citizens aged 60 years or above who used EMS from 2010 to 2017 in Beijing, China.ParticipantsDuring 2010 to 2017, 2516 128 people used EMS in Beijing. Of these, 1528 938 people aged under 60 years were excluded and the remaining 987 190 people were included in our study.MethodsData were from the emergency dispatch database of Beijing’s Emergency Medical Centre. We described the proportion of elderly people using EMS in Beijing due to injurious falls with regard to region, time, sex, age and proportion of the elderly population.ResultsAmong the 987 190 participants who used EMS, 82 694 (8.38%) had had a fall. The proportion of falls rose from 7.12% in 2010 to 9.45% in 2017, and was higher in urban (8.62%) than in suburban (7.80%) regions. Elderly people were more likely to use EMS due to injurious falls during September to November (8.99%) than during December to February (7.68%) (adjusted OR (aOR)=1.19), and during 08:00 to 09:59 (10.02%) than during 00:00 to 01:59 (4.11%) (aOR=2.52). Elderly people in districts with high (8.92%, aOR=1.15) and medium (8.23%, aOR=1.09) proportions of an elderly population were more likely to use EMS due to injurious falls than those in districts with a low proportion of elderly population (7.81%).ConclusionsIn Beijing, the proportion of elderly people using EMS due to injurious falls increased with age, and was positively correlated with the proportion of the elderly population. Taking care of elderly people and preventing injurious falls should be one of the key issues to be handled in a society with an ageing population.

Impact of Anemia on the Medical Cost of Injurious Falls in the Elderly.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2238-2238
Author(s):  
Patrick Lefebvre ◽  
Samir H. Mody ◽  
Mei S. Duh ◽  
Richard C. Woodman ◽  
Sharon Buteau ◽  
...  
Keyword(s):  
Incremental Cost ◽  
Functional Disability ◽  
Nursing Home Residents ◽  
The Elderly ◽  
Medical Costs ◽  
Community Dwelling ◽  
Lower Limbs ◽  
Cost Ratio ◽  
Injurious Falls ◽  
Injurious Fall

Abstract Background: Anemia is common in the elderly (≥65) and increases with age, reaching 26% in community dwelling (CD) men 85 yrs and older. Falls, especially those leading to serious injuries such as a fracture or head injury, affect about 10% of the CD elderly. The prevalence of anemia and the occurrence of falls is even higher in nursing home residents. Falls in the elderly are a significant cause of functional disability and significantly increase health care burden. This analysis was performed to determine if the presence of anemia significantly increases medical costs related to injurious falls (IF) in the CD elderly. Methods: A retrospective economic analysis of medical claims from over 30 health plans from 01/1999 through 04/2004 was conducted. Patients ≥65 years with ≥1 hemoglobin (Hb) reading were selected. An open-cohort design was employed to classify patients’ observation period into anemic and non-anemic periods. Anemia was defined as Hb<12 g/dL for women and Hb<13 g/dL for men based on the WHO criteria. IF were defined as a fall claim followed by an injurious event claim (fractures of the hip, pelvis, femur, vertebrae, ribs, humerus, and lower limbs, Colle’s fracture, head injuries, or hematomas) within 30 days after the fall. Anemia status was determined at the date of the IF and average monthly direct medical costs (outpatient, inpatient, and pharmacy costs in US dollars) were calculated for six months before and after the IF. A difference-in-difference approach was used to calculate the incremental costs and cost ratios of IF associated with anemia status. Results: 620 subjects with at least one IF were identified. Mean age for these patients was 76.3 ± 2.9 years; 70.2% were women. At the date of IF, 3%, 21%, 25%, and 51% of patients had Hb level of <10, 10–<12, 12–<13, and ≥ 13 g/dL, respectively. Table 1 shows the total medical costs in the pre-injurious and post-injurious fall periods by anemia status. Results indicate the difference in medical costs between patients with and without anemia increased significantly in the post-injurious fall period, compared to the pre-injurious fall period (incremental cost for anemia: $1,855; costs ratio: 3.7, p=0.030), with 90% due to increased costs for inpatient services ($1,675/patient/month) The economic impact of anemia in the subset of injurious falls of the hip was more pronounced (incremental cost: $2,811; costs ratio: 12.0, p=0.049). Conclusion: Anemia in the elderly is an important cost multiplier in the post-injurious fall period. Anemia contributes to an average increase of $1,855 and $2,811 per patient per month for all injurious falls and hip-specific injurious falls, respectively. It remains to be determined if anemia correction in the elderly will impact the medical costs associated with injurious falls. Table 1. Monthly Direct Healthcare Utilization Costs Pre-Injurious Fall Period Post-Injurious Fall period Inc. Cost {([C]−[D]) −([A]−[B])} Cost Ratio {([C]−[D]) /([A]−[B])} Anemia ([A]) Non-Anemia ([B]) Anemia ([C]) Non-Anemia [D] All IF $2,151 $1,467 $8,640 $6,101 $1,855 3.7 (p=0.030) Hip IF $1,753 $1,499 $12,446 $9,380 $2,811 12.0 (p=0.049)

Cell surface changes during aging of human bladder epithelium examined by lectin probes and SEM

1990 ◽  
Vol 48 (3) ◽  
pp. 966-967
Author(s):  
J. Jacob ◽  
M.F.M. Ismail
Keyword(s):  
The Elderly ◽  
Ultrastructural Changes ◽  
Pokeweed Mitogen ◽  
Asymmetric Structure ◽  
Luminal Surface ◽  
Bladder Epithelium ◽  
Aldehyde Groups ◽  
Cell Surface Changes ◽  
Phosphate Buffered Saline ◽  
Surface Changes

Ultrastructural changes have been shown to occur in the urinary bladder epithelium (urothelium) during the life span of humans. With increasing age, the luminal surface becomes more flexible and develops simple microvilli-like processes. Furthermore, the specialised asymmetric structure of the luminal plasma membrane is relatively more prominent in the young than in the elderly. The nature of the changes at the luminal surface is now explored by lectin-mediated adsorption visualised by scanning electron microscopy (SEM).Samples of young adult (21-31 y old) and elderly (58-82 y old) urothelia were fixed in buffered 2% glutaraldehyde for 10 m and washed with phosphate buffered saline (PBS) containing Ca++ and Mg++ at room temperature. They were incubated overnight at 4°C in 0.1 M ammonium chloride in PBS to block any remaining aldehyde groups. The samples were then allowed to stand in PBS at 37°C for 2 h before incubation at 37°C for 30 m with lectins. The lectins used were concanavalin A (Con A), wheat germ agglutinin (WGA), phytohaemagglutinin (PHA) and pokeweed mitogen (PWM) at a concentration of 500 mg/ml in PBS at pH 7.A.

The effect of dental geriatric curricula on attitudes toward the elderly

1988 ◽  
Vol 52 (9) ◽  
pp. 516-518 ◽  
Author(s):  
J Mann ◽  
TJ Bomberg ◽  
JM Holtzman ◽  
DB Berkey
Keyword(s):  
The Elderly

Pharmacology Issues Related to Dementia Syndrome of Depression in Elderly Residents of Long-Term Care Settings

2015 ◽  
Vol 25 (2) ◽  
pp. 61-69
Author(s):  
Angel L. Ball ◽  
Adina S. Gray
Keyword(s):  
Depressive Symptoms ◽  
The Elderly ◽  
Environmental Communication ◽  
Pharmacological Intervention ◽  
Team Approach ◽  
Discussion Paper ◽  
Term Care ◽  
Anticholinergic Medications ◽  
Inappropriate Treatment ◽  
Dementia Syndrome

Pharmacological intervention for depressive symptoms in institutionalized elderly is higher than the population average. Among the patients on such medications are those with a puzzling mix of symptoms, diagnosed as “dementia syndrome of depression,” formerly termed “pseudodementia”. Cognitive-communicative changes, potentially due to medications, complicate the diagnosis even further. This discussion paper reviews the history of the terminology of “pseudodementia,” and examines the pharmacology given as treatment for depressive symptoms in the elderly population that can affect cognition and communication. Clinicians can reduce the risk of misdiagnosis or inappropriate treatment by having an awareness of potential side effects, including decreased attention, memory, and reasoning capacities, particularly due to some anticholinergic medications. A team approach to care should include a cohesive effort directed at caution against over-medication, informed management of polypharmacology, enhancement of environmental/communication supports and quality of life, and recognizing the typical nature of some depressive signs in elderly institutionalized individuals.

Acquired haemophilia in the elderly is a severe disease: report of five new cases

Haemophilia ◽  
2001 ◽  
Vol 7 (4) ◽  
pp. 428-432 ◽  
Author(s):  
S. Godreuil ◽  
R. Navarro ◽  
P. Quittet ◽  
L. Landreau ◽  
J-F. Schved ◽  
...  
Keyword(s):  
Severe Disease ◽  
The Elderly ◽  
Acquired Haemophilia
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