scholarly journals 84 Identifying Potential Recurrent Fallers in the Community using Frailty Indicators

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Freddy M H Lam ◽  
Jason C S Leung ◽  
Timothy C Y Kwok
Keyword(s):  
Older Women ◽  
Characteristic Curve ◽  
Community Dwelling ◽  
Classification And Regression Tree ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Clinical Value ◽  
Cart Analysis ◽  
Recurrent Falls ◽  
History Of

Abstract Introduction Frailty indicators were proposed to be significant predictors of falls. However, their comparative and additional value to other simple fall predictors has not been evaluated. This study aims to compare the clinical value of three frailty indicators to fall history in predicting recurrent falls in older adults. Methods Four thousand community-dwelling elderly (2000 female) aged 65 years or above were recruited in Hong Kong. The three candidate frailty indicators were the FRAIL scale, the Cardiovascular Health Study Criteria (CHS), and the Study for Osteoporosis and Fracture Criteria (SOF). The comparative predictor was fall history. The area under the receiver operating characteristic curve (AUC) was used to assess their ability to predict recurrent falls in the second year after baseline. Classification and Regression Tree (CART) analysis was used to evaluate the clinical potential of significant predictors on identifying older recurrent fallers in a simulated clinical pathway. Results Fall history is better than all frailty indicators in predicting recurrent falls in men and women (Fall History: AUC: men=0.681; women=0.645; Frailty indicators: AUC≤0.641). Upon adjusting for fall history, FRAIL and SOF remained as significant predictors for women but no frailty indicator remained significant for men. FRAIL could separate older women into two groups with different proportion of recurrent fallers in those with history of recurrent falls (16.0% vs 30.8%), single fall history (9.5% vs 37.5%), and no fall history (3.8% vs 7.5%). SOF provides limited value in people with a single fall history (history of recurrent falls: 16.5% vs 20.6%; single fall history: 10.2% vs 10.9%; no fall history: 3.9% vs 8.6%). Conclusion Adding FRAIL or SOF on top of fall history improves the prediction of recurrent falls in older women but not men. FRAIL could be a useful tool for identifying community-dwelling older women at high risk of recurrent falls.

scholarly journals Incidence and multidimensional predictors of occasional and recurrent falls among Malaysian community‐dwelling older persons

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Theng Choon Ooi ◽  
Devinder Kaur Ajit Singh ◽  
Suzana Shahar ◽  
Nor Fadilah Rajab ◽  
Divya Vanoh ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Older Persons ◽  
Test Score ◽  
Community Dwelling ◽  
Chair Stand ◽  
Stand Test ◽  
Chair Stand Test ◽  
Recurrent Falls ◽  
History Of

Abstract Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.

scholarly journals Intersection of Sex and Frailty in Humoral Immune Responses to Influenza Vaccine in Community-Dwelling Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 271-272
Author(s):  
Janna Shapiro ◽  
Helen Kuo ◽  
Rosemary Morgan ◽  
Huifen Li ◽  
Sabra Klein ◽  
...  
Keyword(s):  
Older Adults ◽  
Immune Responses ◽  
Influenza A ◽  
Community Dwelling ◽  
Influenza Vaccines ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
High Dose ◽  
Humoral Immune ◽  
Humoral Immune Responses

Abstract Older adults bear the highest burden of severe disease and complications associated with seasonal influenza, with annual vaccination serving as the best option for protection. Variability in vaccine efficacy exists, yet the host factors that affect immune responses to inactivated influenza vaccines (IIV) are incompletely understood. We hypothesized that sex and frailty interact to affect vaccine-induced humoral responses among older adults. To test this hypothesis, community-dwelling adults above 75 years of age were recruited yearly, assessed for frailty (as defined by the Cardiovascular Health Study criteria), and vaccinated with the high-dose trivalent IIV. Humoral immune responses were evaluated via hemagglutination inhibition titers. The study began during the 2014-2015 influenza season, with yearly cohorts ranging from 76-163 individuals. A total of 617 vaccinations were delivered from 2014-2019. In preliminary analyses, the outcome of interest was seroconversion, defined as ≥ 4-fold rise in titers. Crude odds ratios suggest that females are more likely to seroconvert to influenza A strains (H1N1: OR = 1.39, (0.98-1.96) ; H3N2: 1.17 (0.85 – 1.62)), while males are more likely to seroconvert to the B strain (OR = 0.85 (0.60 – 1.22)). Furthermore, this sex difference was modified by frailty – for example, the odds of seroconversion to H1N1 were 65% higher for females than males among those who were nonfrail, and only 30% higher among females who were frail. Together, these results suggest that sex and frailty interact to impact immune responses to influenza vaccines. These findings may be leveraged to better protect vulnerable populations.

scholarly journals Association between Physical Frailty Subdomains and Oral Frailty in Community-Dwelling Older Adults

2021 ◽  
Vol 18 (6) ◽  
pp. 2931
Author(s):  
Ryo Komatsu ◽  
Koutatsu Nagai ◽  
Yoko Hasegawa ◽  
Kazuki Okuda ◽  
Yuto Okinaka ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Physical Frailty ◽  
Cross Sectional ◽  
Important Indicator ◽  
Community Dwelling Older Adults ◽  
Oral Frailty

This cross-sectional study aimed to demonstrate the association between physical frailty subdomains and oral frailty. This study involved community-dwelling older adults (aged ≥65 years). Physical frailty was assessed with the Japanese version of the Cardiovascular Health Study criteria. Oral frailty was defined as limitations in at least three of six domains. Logistic regression analysis was used to analyze the association between physical frailty risk and oral frailty. In addition, we examined the association between physical frailty subdomains (gait speed, grip strength, exhaustion, low physical activity, and weight loss) and oral frailty. A total of 380 participants were recruited for this study. Overall, 18% and 14% of the participants were at risk of physical frailty and had oral frailty, respectively. Physical frailty risk (odds ratio (OR) = 2.40, 95% confidence interval (CI): 1.22–4.75, p = 0.012) was associated with oral frailty in multivariate analysis. In secondary analysis, among physical frailty subdomains, gait speed (OR = 0.85, 95% CI: 0.73–0.97, p = 0.019) was associated with oral frailty. The present findings suggest that physical frailty is closely related to oral frailty. Among physical frailty subdomains, decreased gait speed in particular is an important indicator related to the development of oral frailty.

scholarly journals Left atrial diameter and vascular brain injury on MRI

Neurology ◽  
2018 ◽  
Vol 91 (13) ◽  
pp. e1237-e1244 ◽  
Author(s):  
Shadi Yaghi ◽  
Traci M. Bartz ◽  
Richard Kronmal ◽  
Hooman Kamel ◽  
John Gottdiener ◽  
...  
Keyword(s):  
Brain Injury ◽  
Left Atrial ◽  
Cardiovascular Health ◽  
Brain Mri ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Linear Regression Models ◽  
Left Atrial Diameter ◽  
Brain Infarcts

ObjectiveTo determine the association left atrial diameter (LAD) and vascular brain injury on brain MRI.MethodsWe analyzed data from the Cardiovascular Health Study (CHS), a prospective cohort of community-dwelling adults ≥65 years old. LAD was measured from 2-dimensional transthoracic echocardiograms. Among CHS participants who underwent brain MRI, we examined associations of LAD with brain infarcts and leukoaraiosis. Primary outcomes (number for analysis) were prevalent infarcts (2,327) and degree of leukoaraiosis on initial MRI (2,315). Secondary outcomes were prevalent nonlacunar infarcts (2,327), incident infarcts (939), incident nonlacunar infarcts (1,185), and degree of leukoaraiosis on follow-up MRI adjusted for initial MRI (1,158). Relative risk (RR) and linear regression models were adjusted for demographics, vascular risk factors, and potential confounders.ResultsMean age of the 2,335 participants with initial brain MRI was 72.0 ± 4.8 years; 38.7% were men; and 29.0% participants had prevalent infarcts. In multivariable, fully adjusted models, LAD was associated with prevalent infarcts (RR 1.20, 95% confidence interval [CI] 1.08–1.34) and prevalent nonlacunar infarcts (RR 1.28, 95% CI 1.06–1.54) but not with leukoaraiosis (−0.08, 95% CI −0.17 to 0.07), incident infarcts (RR 1.00, 95% CI 0.78–1.29), nonlacunar infarcts (RR 0.98, 95% CI 0.67–1.42), or worsening leukoaraiosis (−0.04, 95% CI −0.10 to 0.02).ConclusionLAD is independently associated with prevalent brain infarcts, particularly nonlacunar infarcts, but not leukoaraiosis. Larger studies are needed to determine associations with incident infarct risk and whether this risk in patients with left atrial enlargement can be reduced with anticoagulant agents.

HOW DO COMMUNITY PHYSICAL AND OCCUPATIONAL THERAPISTS CLASSIFY FRAILTY? A PILOT STUDY

2014 ◽  
pp. 1-4
Author(s):  
K.P. ROLAND ◽  
O. THEOU ◽  
J.M. JAKOBI ◽  
L. SWAN ◽  
G.R. JONES
Keyword(s):  
Cardiovascular Health ◽  
Healthcare Professionals ◽  
Frailty Index ◽  
Occupational Therapists ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Geriatric Syndrome ◽  
Dimensional Approach

Background: Frailty is a complex geriatric syndrome that is often difficult to diagnose, especially by healthcare professionals working in the community. Objectives, Measurements: This study examined how physical and occupational therapists classified community-dwelling clients using categories of ‘nonfrail’, ‘prefrail’ or ‘frail’ as compared to measurements of established frailty criteria from the Cardiovascular Health Study frailty index (CHSfi). Results: Results indicate that community therapists underestimate frailty in comparison to the CHSfi. Therapists’ classification of frailty suggested their perceptions of frailty may not only relate to client’s functional capacity, but the context in which the client receives care. Conclusion: A multi-dimensional approach is required to capture all aspects of frailty across the healthcare continuum that accounts for how the client thrives within their personal environment.

CONCURRENCE OF FRAILTY AND PARKINSON’S DISEASE

2012 ◽  
pp. 1-5
Author(s):  
K.P. ROLAND ◽  
K.M.D. CORNETT ◽  
O. THEOU ◽  
J.M. JAKOBI ◽  
G.R. JONES
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cardiovascular Health ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Physical Frailty ◽  
Levodopa Dose ◽  
Frailty Phenotype ◽  
Age Related

Background: Females with Parkinson’s disease (PD) are at greater risk of frailty than males. Little is known about how age and disease-related characteristics influence frailty in females with PD because frailty studies often exclude persons with underlying neurological pathologies. Objective: To determine age and diseaserelated characteristics that best explain physical frailty in community-dwelling females with and without PD. Design & Measurement: Correlation coefficients described relationships between PD-related characteristics and physical frailty phenotype criteria (Cardiovascular Health Study). Regression analysis identified associations between disease-related characteristics and frailty in non-PD and PD females. Setting: Community-dwelling. Participants: Females with mild to moderate PD (n = 17, mean age = 66 ± 8.5 years) and non-PD (n = 18, mean age = 72 ± 13.2 years) participated. Results: Daily carbidopa-levodopa dose best explained frailty in PD females (β = 0.5), whereas in non-PD females, age (β = 0.7) and comorbidity (β = 0.5) were most associated with frailty. Conclusions: Dopaminergic medication explained frailty in PD and not measures of disease progression (i.e. severity, duration). In females without PD age-related accumulation of comorbidities resulted in greater risk of frailty. This indicates dopaminergic management of PD symptoms may better reflect frailty in females with PD than disease severity or duration. These data suggest the influence of underlying frailty should be considered when managing neurological conditions. Understanding how frailty concurrently exists with PD and how these conditions progress within the aging female will facilitate future care management.

Association Between Erythrocyte Levels of n-3 Polyunsaturated Fatty Acids and Risk of Frailty in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study

2020 ◽  
Author(s):  
Doyeon Kim ◽  
Chang Won Won ◽  
Yongsoon Park
Keyword(s):  
Fatty Acids ◽  
Cohort Study ◽  
Polyunsaturated Fatty Acids ◽  
Cardiovascular Health ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Cross Sectional ◽  
Frailty Criterion ◽  
Long Chain

Abstract Background Inflammation is a major risk factor for frailty, but n-3 polyunsaturated fatty acids (PUFA) has been suggested as an anti-inflammatory agent. The present study aimed to investigate the hypothesis that the higher erythrocyte levels of long-chain n-3 PUFA were associated with lower odds of frailty and frailty criterion. Methods Cross-sectional analysis from the Korean Frailty and Aging Cohort Study, a total of 1,435 people aged 70–84 years were included. Sex- and age-stratified community residents, drawn in urban and rural regions nationwide, were eligible for participation in the study. All participants were categorized as frail and nonfrail according to the Cardiovascular Health Study index. Results The likelihood of frailty was inversely associated with the erythrocyte levels of eicosapentaenoic acid (EPA; odds ratio [OR] per unit 0.33; 95% confidence interval [CI] 0.14–0.77; p for trend = .002) and docosahexaenoic acid (DHA; OR per unit 0.42; 95% CI 0.20–0.87; p for trend = .018). Among each frailty criterion, the likelihood of slow walking speed was associated with erythrocyte levels of EPA and DHA, and the likelihood of exhaustion was inversely associated with the erythrocyte levels of DHA. Conclusions The present study showed that the frailty and frailty criterion were significantly associated with lower erythrocyte levels of long-chain n-3 PUFA, suggesting that lower n-3 PUFA could be a marker for the risk of frailty.

scholarly journals Association of Frailty With Recovery From Disability Among Community-Dwelling Older Adults: Results From Two Large U.S. Cohorts

2018 ◽  
Vol 74 (4) ◽  
pp. 575-581 ◽  
Author(s):  
Chenkai Wu ◽  
Dae H Kim ◽  
Qian-Li Xue ◽  
David S H Lee ◽  
Ravi Varadhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Daily Living ◽  
Cardiovascular Health ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Factors Affecting ◽  
Frailty Assessment ◽  
Community Dwelling Older Adults ◽  
Retirement Study

Abstract Background Disability in activities of daily living (ADLs) is a dynamic process and transitions among different disability states are common. However, little is known about factors affecting recovery from disability. We examined the association between frailty and recovery from disability among nondisabled community-dwelling elders. Methods We studied 1,023 adults from the Cardiovascular Health Study (CHS) and 685 adults from the Health and Retirement Study (HRS), who were ≥65 years and had incident disability, defined as having difficulty in ≥1 ADL (dressing, eating, toileting, bathing, transferring, walking across a room). Disability recovery was defined as having no difficulty in any ADLs. Frailty was assessed by slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as “nonfrail” (0 criteria), “prefrail” (1–2 criteria), or “frail” (3–5 criteria). Results In total, 539 (52.7%) CHS participants recovered from disability within 1 year. Almost two-thirds of nonfrail persons recovered, while less than two-fifths of the frail recovered. In the HRS, 234 (34.2%) participants recovered from disability within 2 years. Approximately half of the nonfrail recovered, while less than one-fifth of the frail recovered. After adjustment, prefrail and frail CHS participants were 16% and 36% less likely to recover than the nonfrail, respectively. In the HRS, frail persons had a 41% lower likelihood of recovery than the nonfrail. Conclusions Frailty is an independent predictor of poor recovery from disability among nondisabled older adults. These findings validate frailty as a marker of decreased resilience and may offer opportunities for individualized interventions and geriatric care based on frailty assessment.

scholarly journals Biochemical markers of bone turnover and risk of incident hip fracture in older women: the Cardiovascular Health Study

2019 ◽  
Vol 30 (9) ◽  
pp. 1755-1765
Author(s):  
D. Massera ◽  
S. Xu ◽  
M. D. Walker ◽  
R. J. Valderrábano ◽  
K. J. Mukamal ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Bone Turnover ◽  
Older Women ◽  
Biochemical Markers ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Markers Of Bone Turnover

Determinants, circumstances and consequences of injurious falls among older women living in the community

2020 ◽  
pp. injuryprev-2019-043499
Author(s):  
Elizabeth A Phelan ◽  
Eileen Rillamas-Sun ◽  
Lisa Johnson ◽  
Michael J LaMonte ◽  
David M Buchner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Older Women ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Logistic Regression Models ◽  
The Past ◽  
Injurious Falls ◽  
Injurious Fall

ObjectiveTo identify the risk factors of women who fell with injury relative to women who did not fall or fell without injury and to describe the circumstances and consequences of injurious and non-injurious falls.MethodsWe analysed 5074 older women from the Objective Physical Activity and Cardiovascular Health Study who prospectively tracked their falls using a 13-month calendar. Women with a reported fall were phone interviewed about fall-related details, including injuries. Risk factors were identified from surveys and clinical home visits. Logistic regression models were used to calculate adjusted ORs and 95% CIs for injurious falls relative to not falling or falling without injury. Circumstances of injurious and non-injurious falls were compared.ResultsAt least one fall was experienced by 1481 (29%) participants. Of these, 1043 were phone interviewed, of whom 430 (41%) reported at least one injurious fall. Relative to not falling, the risk factor most strongly associated with experiencing an injurious fall was having fallen ≥2 times (OR 4.0, CI 2.7 to 5.8) in the past year. Being black was protective for fall-related injury (OR 0.6, CI 0.4 to 0.9). No strong associations in risk factors were observed for injurious relative to non-injurious falls. Injurious falls were more likely to occur away from and outside of the home (p<0.05). Over half of those who injured self-managed their injury.ConclusionFalling repeatedly is a powerful risk factor for injurious falls. Those who have fallen more than once should be prioritised for interventions to mitigate the risk of an injurious fall.

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