Predicting falls within 3 months of emergency department discharge among community-dwelling older adults using self-report and functional assessments

Author(s):  
Pritika Dasgupta ◽  
Adam Frisch ◽  
James Huber ◽  
Ervin Sejdic ◽  
Brian Suffoletto
2019 ◽  
Vol 31 (12) ◽  
pp. 1699-1707 ◽  
Author(s):  
Toshinori Nishizawa ◽  
Ayako Morita ◽  
Takeo Fujiwara ◽  
Katsunori Kondo

ABSTRACTBackground:Subjective memory complaints (SMC) have been suggested as an early marker of mild cognitive impairment and dementia. However, there is a paucity of evidence on the effects of early life conditions on the development of SMC in old age. This study is aimed at investigating the association between childhood socioeconomic status (SES) and SMC in community-dwelling older adults.Methods:We used the data of the Japan Gerontological Evaluation Study, a population-based cohort study of people aged 65 years or older enrolled from 28 municipalities across Japan. Childhood SES and SMC in everyday life were assessed from the self-report questionnaire administered in 2010 (n = 16,184). Poisson regression was performed to determine their association, adjusted for potential confounders and life-course mediators and examined cohort effects.Results:We identified SMC in 47.4% of the participants. After adjusting for sex, age, and number of siblings, low and middle childhood SES were associated with 29% (prevalence ratio [PR]: 1.29, 95% confidence interval [CI]: 1.22, 1.36) and 10% higher prevalence of SMC (PR: 1.10, 95%CI: 1.04, 1.17), respectively, compared with high childhood SES (p for trend <.001). The interaction terms between childhood SES and age groups were not statistically significant.Conclusion:Childhood SES is significantly associated with SMC among community-dwelling older adults. Efforts to minimize childhood poverty may diminish or delay the onset of SMC and dementia in later life.


2016 ◽  
Vol 65 (2) ◽  
pp. 364-372 ◽  
Author(s):  
Mary Man-Lai Chu ◽  
Kenneth Nai-Kuen Fong ◽  
Albert Chau-Hung Lit ◽  
Timothy Hudson Rainer ◽  
Stella Wai-Chee Cheng ◽  
...  

2012 ◽  
Vol 92 (2) ◽  
pp. 318-328 ◽  
Author(s):  
Alaina M. Newell ◽  
Jessie M. VanSwearingen ◽  
Elizabeth Hile ◽  
Jennifer S. Brach

BackgroundPerceived ability or confidence plays an important role in determining function and behavior. The modified Gait Efficacy Scale (mGES) is a 10-item self-report measure used to assess walking confidence under challenging everyday circumstances.ObjectiveThe purpose of this study was to determine the reliability, internal consistency, and validity of the mGES as a measure of gait in older adults.DesignThis was a cross-sectional study.MethodsParticipants were 102 community-dwelling older adults (mean [±SD] age=78.6±6.1 years) who were independent in ambulation with or without an assistive device. Participants were assessed using the mGES and measures of confidence and fear, measures of function and disability, and performance-based measures of mobility. In a subsample (n=26), the mGES was administered twice within a 1-month period to establish test-retest reliability through the intraclass correlation coefficient (ICC [2,1]). The standard error of measure (SEM) was determined from the ICC and standard deviation. The Cronbach α value was calculated to determine internal consistency. To establish the validity of the mGES, the Spearman rank order correlation coefficient was used to examine the association with measures of confidence, fear, gait, and physical function and disability.ResultsThe mGES demonstrated test-retest reliability within the 1-month period (ICC=.93, 95% confidence interval=.85, .97). The SEM of the mGES was 5.23. The mGES was internally consistent across the 10 items (Cronbach α=.94). The mGES was related to measures of confidence and fear (r=.54–.88), function and disability (Late-Life Function and Disability Instrument, r=.32–.88), and performance-based mobility (r=.38–.64).LimitationsThis study examined only community-dwelling older adults. The results, therefore, should not be generalized to other patient populations.ConclusionThe mGES is a reliable and valid measure of confidence in walking among community-dwelling older adults.


2010 ◽  
Vol 90 (5) ◽  
pp. 748-760 ◽  
Author(s):  
Ankur Desai ◽  
Valerie Goodman ◽  
Naaz Kapadia ◽  
Barbara L. Shay ◽  
Tony Szturm

BackgroundPoor balance control, mobility restrictions, and fall injuries are serious problems for many older adults.ObjectiveThe purpose of this study was to evaluate a new dynamic standing balance assessment test for identifying individuals at risk for falling in a group of community-dwelling older adults.DesignThis was a cross-sectional observational study of 72 community-dwelling older adults who were receiving rehabilitation in a geriatric day hospital.MethodA Dynamic Balance Assessment (DBA) test protocol was developed based on the concept of the Sensory Organization Test and the Clinical Test of Sensory Interaction and Balance. The DBA consists of 6 tasks performed on a normal floor surface and repeated on a sponge surface. A flexible pressure mat was used to record the foot's center of pressure (COP) on both surfaces, and loss of balance was recorded. Balance performance also was evaluated using the Berg Balance Scale, the Timed “Up & Go” Test, gait speed, and the Six-Minute Walk Test. Participants were classified as “fallers” or “nonfallers” based on a self-report.ResultsNo significant differences were noted between the faller group (n=47) and the nonfaller group (n=25) for demographic variables or medications. The DBA composite scores, which were derived from analysis of COP excursions of the 6 tasks performed on the sponge surface, were able to distinguish between fallers and nonfallers. Of the clinical tests, only the Timed “Up & Go” Test was able to differentiate between the faller and nonfaller groups.LimitationsA prospective study is needed to confirm the current findings and to expand testing to a larger and more diverse sample.ConclusionsThe findings indicate that analysis of the extent and amount of COP displacements during selected tasks and under different surface conditions is an appropriate method to assess dynamic standing balance controls and can discriminate between fallers and nonfallers among community-dwelling elderly people.


Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1193
Author(s):  
Chia-Hui Lin ◽  
Chieh-Yu Liu ◽  
Jiin-Ru Rong

Screening the frailty level of older adults is essential to avoid morbidity, prevent falls and disability, and maintain quality of life. The Tilburg Frailty Indicator (TFI) is a self-report instrument developed to assess frailty for community-dwelling older adults. The aim of this study was to explore the psychometric properties of the Taiwanese version of TFI (TFI-T). The sample consisted of 210 elderly participants living in the community. The scale was implemented to conduct a confirmatory factor analysis (CFA) test for validity. The models were evaluated through sensitivity, specificity, area under the curve, and receiving operating characteristic (ROC) curve. CFA was performed to evaluate construct validity, and the TFI-T has a goodness of fit with the three-factor structure of the TFI. Totally, the 15 items of TFI-T have acceptable internal consistency (Cronbach’s alpha = 0.78), and test–retest reliability (r = 0.88, p < 0.001). The criterion-related validity was examined, the TFI-T correlation with the Kihon Checklist (KCL) score (r = 0.74; p < 0.001). The cutoff of 5.5 based on the Youden index was considered optimal. The area under the ROC curve analysis indicated that the TFI-T has good accuracy in frailty screening. The TFI-T exhibits good reliability and validity and can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in Taiwan among older adults.


Author(s):  
Aarthi Madhavan ◽  
Nicole Shuman ◽  
Claire Snyder ◽  
Nicole Etter

Purpose Patient-reported outcomes (PROs) are an important feature in clinical evaluation of swallowing. The Eating Assessment Tool (EAT-10) and the Sydney Swallow Questionnaire (SSQ) are two validated dysphagia PROs commonly used in healthy older adult populations as screening tools for swallowing problems. The purpose of this study is to compare the consistency of the EAT-10 and SSQ scores for self-reported swallowing difficulties in a group of community-dwelling older adults (CDOA) completing both questionnaires. Method A total of 316 individuals over the age of 60 years completed the EAT-10, SSQ, and provided demographic data, including a self-report of any medical diagnoses. Participants were excluded if they had any diagnoses known to cause dysphagia. Questionnaire responses were analyzed for frequencies of responses across all participants. Results Seventy-five participants were identified as having dysphagia by the EAT-10 (23.7%), while 30 participants were identified by the SSQ (9.49%). When comparing the results of the two assessments, the scales agreed on 289 out of 316 participants (91%). There was a disagreement on the results in 27 of the 316 participants, with 26 of these self-reporting dysphagia symptoms on the EAT-10 but not on the SSQ. Conclusions Two commonly used dysphagia PROs resulted in different prevalence rates of self-reported dysphagia in a group of CDOA. CDOAs may need questionnaires specifically validated for them with special consideration for specific age-related risk factors, to ensure accurate early identification.


2005 ◽  
Vol 85 (7) ◽  
pp. 648-655 ◽  
Author(s):  
Anne Shumway-Cook ◽  
Marcia A Ciol ◽  
William Gruber ◽  
Cynthia Robinson

Abstract Background and Purpose. Hip fracture is a major medical problem among older adults, leading to impaired balance and gait and loss of functional independence. The purpose of this study was to determine the incidence of and risk factors for falls 6 months following hospital discharge for a fall-related hip fracture in older adults. Subjects. Ninety of 100 community-dwelling older adults (≥65 years of age) hospitalized for a fall-related hip fracture provided data for this study. Methods. An observational cohort study used interviews and medical records to obtain information on demographics, prefracture health, falls, and functional status. Self-report of falls and performance-based measures of balance and mobility were completed 6 months after discharge. Results. A total of 53.3% of patients (48/90) reported 1 or more falls in the 6 months after hospitalization. Older adults who fell following discharge had greater declines in independence in activities of daily living and lower performance on balance and mobility measures. Prefracture fall history and use of a gait device predicted postdischarge falls. Discussion and Conclusion. Falls following hip fracture can be predicted by premorbid functional status.


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