Science of risk factors in fallers: impact of cognitive dysfunction

2001 ◽  
Vol 11 (4) ◽  
pp. 299-309 ◽  
Author(s):  
FE Shaw ◽  
RA Kenny
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Fall Risk ◽  
Cognitively Normal ◽  
The United Kingdom ◽  
Increased Risk ◽  
Risk Of Falls ◽  
The Uk ◽  
Cognitively Intact ◽  
Significant Health

Older people with cognitive impairment and dementia are at increased risk of falls and their adverse consequences when compared with cognitively intact older adults. Using prospectively gathered data, approximately three-quarters of older people with cognitive impairment and dementia can expect to fall each year, double the fall-risk of cognitively normal older people. In addition, compared with their cognitively normal counterparts, people with cognitive impairment and dementia have an increased annual incidence of fractures, and are less likely to make a good functional recovery after a fall. The prevalence of dementia in the United Kingdom is about 5% of the population aged over 65, and 15% of those aged over 80. Falls in patients with cognitive impairment and dementia represent a significant health problem in the UK.

39 A Model of Gait and Falls in Older Adults with Dementia

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv9-iv12
Author(s):  
Weihong Zhang ◽  
Lee-Fay Low ◽  
Michael Schwenk ◽  
Nicholas Mills ◽  
Josephine Diana Gwynn ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Fall Risk ◽  
Cognitive Domain ◽  
Increased Risk ◽  
Gait Dysfunction ◽  
Risk Of Falls ◽  
Fall Risks ◽  
Falls In Older Adults

Abstract Background Older people with cognitive impairment are at increased risk of falls; however, fall prevention strategies have limited success in reducing fall risks in this population (Fernando E, Fraser M, Hendriksen J et al. Physiotherapy Canada. 2017; 69: 161–170). We aim to present a model of factors contributing to gait and falls in older adults with dementia. Methods The model was developed based on an in-depth review of literature on fall risk factors particularly in people with dementia, and the relationship between cognition and gait, and their joint impact on risk of falls. Results Cognitive and motor functions are closely related as they share neuroanatomy (Rosso AL, Studenski SA, Chen WG et al. J Gerontol A Biol Sci Med Sci. 2013; 68: 1379–1386). This close relationship has been confirmed by imaging, observational and interventional studies. Executive function is the cognitive domain most commonly associated with gait dysfunction (Cohen JA, Verghese J, Zwerling JL. Maturitas. 2016; 93: 73-77). The sub-domains of executive function(Sachdev PS, Blacker D, Blazer DG et al. Neurology. 2014; 10: 634-642) - attention, sensory integration and motor planning affect risk of falls through gait dysfunction; whereas other non-gait associated sub-domains of executive function - cognitive flexibility, judgement and inhibitory control affect risk of falls through risk taking behaviour. Conclusion Gait, cognition and falls are closely related. The comoridity and interaction between gait abnormality and cognitive impairment may be the underlying mechanism behind the high prevalence of falls in older adults with dementia. Gait and cognitive assessment with particular focus on executive function, should be integrated in fall risk screening. Assessment results should inform interventions developed by a multidisciplinary team and may include strategies such as customised gait training and behavioural modulation. A comprehensive multidisciplinary approach could be more effective in reducing fall risks in older adults with dementia.

scholarly journals Quantitative Mobility Assessment for Fall Risk Prediction in Dementia: A Systematic Review

2018 ◽  
Vol 45 (5-6) ◽  
pp. 353-367 ◽  
Author(s):  
Elham Dolatabadi ◽  
Karen Van Ooteghem ◽  
Babak Taati ◽  
Andrea Iaboni
Keyword(s):  
Systematic Review ◽  
Fall Risk ◽  
Postural Stability ◽  
Timed Up And Go ◽  
Mobility Assessment ◽  
Increased Risk ◽  
Risk Of Falls ◽  
High Risk Populations ◽  
Cognitively Intact ◽  
The Relationship

Background: Impairments of gait and balance often progress through the course of dementia, and are associated with increased risk of falls. Summary: This systematic review provides a critical analysis of the evidence linking quantitative measures of gait and balance to fall risk in older adults with dementia. Various instrumented measures of gait and postural stability including gait speed and non-instrumented performance measures including Timed Up and Go were shown to be capable of distinguishing fallers from non-fallers. Key Messages: Existing reviews indicate that impairments of gait and balance are associated with increased risk of falls in cognitively intact older people. There are inconsistencies, however, regarding the characteristics most predictive of a fall. In order to advance fall prevention efforts, there is an important need to understand the relationship between gait, balance, and fall risk, particularly in high-risk populations such as individuals with dementia.

Physical impairments in cognitively impaired older people: implications for risk of falls

2012 ◽  
Vol 25 (1) ◽  
pp. 148-156 ◽  
Author(s):  
Morag E. Taylor ◽  
Kim Delbaere ◽  
Stephen R. Lord ◽  
A. Stefanie Mikolaizak ◽  
Jacqueline C. T. Close
Keyword(s):  
Older People ◽  
Physical Performance ◽  
Fall Risk ◽  
Community Dwelling ◽  
Risk Scores ◽  
Cognitively Impaired ◽  
Limited Information ◽  
Physical Impairments ◽  
Risk Of Falls ◽  
Cognitively Intact

ABSTRACTBackground:Cognitively impaired older people fall twice as often as their cognitively intact counterparts. There is, however, limited information on factors that increase the risk of falls in this population. This study aimed to determine whether a group of cognitively impaired older people (CIG) perform worse than a matched group of cognitively intact older people (NCIG) on a profile of physical performance and mobility tests.Methods:One hundred and thirty-eight cognitively impaired and 276 age and gender matched cognitively intact community-dwelling older adults (>60 years) took part in the study. Participants completed a detailed physical performance battery from which composite fall risk scores were derived. Falls were measured prospectively for 12 months with monthly falls diaries, telephone calls, and by regularly contacting participants’ “person responsible.”Results:The CIG performed worse than the NCIG in tests of reaction time, muscle strength (grip and quadriceps), balance (sway on floor, sway on foam, controlled leaning balance and near tandem standing ability), and mobility (sit to stand, timed up and go (TUG) and steps required to turn 180 degrees). The CIG had significantly higher composite fall risk scores than the NCIG and fell significantly more during follow-up (Multiple falls (2+): CIG 43%; NCIG 21%).Conclusions:Fall risk in the CIG was significantly increased due to multiple physical impairments. Physical profiles provide a means of quantifying the extent of impairment in older people with cognitive impairment and potential direction for targeting interventions for reducing fall risk.

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.

The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

2014 ◽  
Vol 24 (3) ◽  
pp. 219-227 ◽  
Author(s):  
Francisco J Tarazona-Santabalbina ◽  
Juan R Doménech-Pascual ◽  
Ángel Belenguer-Varea A ◽  
Eduardo Rovira Daudi
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Older Patients ◽  
Future Research ◽  
Research Perspectives ◽  
Increased Risk ◽  
Risk Of Falls

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

scholarly journals Depressive symptoms in relation to clinical symptom onset of mild cognitive impairment

2018 ◽  
Vol 31 (04) ◽  
pp. 561-569 ◽  
Author(s):  
Carol K. Chan ◽  
Anja Soldan ◽  
Corinne Pettigrew ◽  
Mei-Cheng Wang ◽  
Jiangxia Wang ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Mild Cognitive Impairment ◽  
Clinical Symptom ◽  
Symptom Onset ◽  
Symptom Severity ◽  
Hamilton Depression Scale ◽  
Cognitively Normal ◽  
Increased Risk ◽  
Time To Onset

ABSTRACTObjective:There is increasing evidence of an association between depressive symptoms and mild cognitive impairment (MCI) in cross-sectional studies, but the longitudinal association between depressive symptoms and risk of MCI onset is less clear. The authors investigated whether baseline symptom severity of depression was predictive of time to onset of symptoms of MCI.Method:These analyses included 300 participants from the BIOCARD study, a cohort of individuals who were cognitively normal at baseline (mean age = 57.4 years) and followed for up to 20 years (mean follow-up = 2.5 years). Depression symptom severity was measured using the Hamilton Depression Scale (HAM-D). The authors assessed the association between dichotomous and continuous HAM-D and time to onset of MCI within 7 years versus after 7 years from baseline (reflecting the mean time from baseline to onset of clinical symptoms in the cohort) using Cox regression models adjusted for gender, age, and education.Results:At baseline, subjects had a mean HAM-D score of 2.2 (SD = 2.8). Higher baseline HAM-D scores were associated with an increased risk of progression from normal cognition to clinical symptom onset ≤ 7 years from baseline (p= 0.043), but not with progression > 7 years from baseline (p= 0.194). These findings remained significant after adjustment for baseline cognition.Conclusions:These results suggest that low levels of depressive symptoms may be predictive of clinical symptom onset within approximately 7 years among cognitively normal individuals and may be useful in identifying persons at risk for MCI due to Alzheimer’s disease.

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 Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome

2021 ◽  
Vol 67 (4) ◽  
pp. 409-415
Author(s):  
Köksal Sarıhan ◽  
Hülya Uzkeser ◽  
Akın Erdal
Keyword(s):  
Social Isolation ◽  
Fall Risk ◽  
Nottingham Health Profile ◽  
Risk Index ◽  
Control Group ◽  
Healthy Individuals ◽  
Increased Risk ◽  
Study Results ◽  
Significant Difference ◽  
Risk Of Falls

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

scholarly journals Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project

2020 ◽  
Author(s):  
Gerard C. Millen ◽  
Roland Arnold ◽  
Jean-Baptiste Cazier ◽  
Helen Curley ◽  
Richard G. Feltbower ◽  
...  
Keyword(s):  
Severe Infection ◽  
Paediatric Population ◽  
Population Based ◽  
Children With Cancer ◽  
The United Kingdom ◽  
Increased Risk ◽  
Polymerase Chain ◽  
The Uk ◽  
Active Care ◽  
Care Support

Abstract Background Children with cancer are frequently immunocompromised. While children are generally thought to be at less risk of severe SARS-CoV-2 infection than adults, comprehensive population-based evidence for the risk in children with cancer is unavailable. We aimed to produce evidence of the incidence and outcomes from SARS-CoV-2 in children with cancer attending all hospitals treating this population across the UK. Methods Retrospective and prospective observational study of all children in the UK under 16 diagnosed with cancer through data collection from all hospitals providing cancer care to this population. Eligible patients tested positive for SARS-CoV-2 on reverse transcription polymerase chain reaction (RT-PCR). The primary end-point was death, discharge or end of active care for COVID-19 for those remaining in hospital. Results Between 12 March 2020 and 31 July 2020, 54 cases were identified: 15 (28%) were asymptomatic, 34 (63%) had mild infections and 5 (10%) moderate, severe or critical infections. No patients died and only three patients required intensive care support due to COVID-19. Estimated incidence of hospital identified SARS-CoV-2 infection in children with cancer under 16 was 3%. Conclusions Children with cancer with SARS-CoV-2 infection do not appear at increased risk of severe infection compared to the general paediatric population. This is reassuring and supports the continued delivery of standard treatment.

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