scholarly journals Association Between Medications Acting on the Central Nervous System and Fall-Related Injuries in Community-Dwelling Older Adults: A New User Cohort Study

2019 ◽  
Vol 75 (5) ◽  
pp. 1003-1009 ◽  
Author(s):  
Shelly L Gray ◽  
Zachary A Marcum ◽  
Sascha Dublin ◽  
Rod Walker ◽  
Negar Golchin ◽  
...  
Keyword(s):  
Older Adults ◽  
Central Nervous System ◽  
Nervous System ◽  
Injury Risk ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Active Medication ◽  
Increased Risk ◽  
The Central Nervous System ◽  
Community Dwelling Older Adults

Abstract Background It is well established that individual medications that affect the central nervous system (CNS) increase falls risk in older adults. However, less is known about risks associated with taking multiple CNS-active medications. Methods Employing a new user design, we used data from the Adult Changes in Thought study, a prospective cohort of community-dwelling people aged 65 and older without dementia. We created a time-varying composite measure of CNS-active medication exposure from electronic pharmacy fill data and categorized into mutually exclusive categories: current (within prior 30 days), recent (31–90 days), past (91–365 days), or nonuse (no exposure in prior year). We calculated standardized daily dose and identified new initiation. Cox proportional hazards models examined the associations between exposures and the outcome of fall-related injury identified from health plan electronic databases. Results Two thousand five hundred ninety-five people had 624 fall-related injuries over 15,531 person-years of follow-up. Relative to nonuse, fall-related injury risk was significantly greater for current use of CNS-active medication (hazard ratio [HR] = 1.95; 95% CI = 1.57–2.42), but not for recent or past use. Among current users, increased risk was noted with all doses. Risk was increased for new initiation compared with no current use (HR = 2.81; 95% CI = 2.09–3.78). Post hoc analyses revealed that risk was especially elevated with new initiation of opioids. Conclusions We found that current use, especially new initiation, of CNS-active medications was associated with fall-related injury in community-dwelling older adults. Increased risk was noted with all dose categories. Risk was particularly increased with new initiation of opioids.

Impact of anemia on hospitalization and mortality in older adults

Blood ◽  
2006 ◽  
Vol 107 (10) ◽  
pp. 3841-3846 ◽  
Author(s):  
Bruce F. Culleton ◽  
Braden J. Manns ◽  
Jianguo Zhang ◽  
Marcello Tonelli ◽  
Scott Klarenbach ◽  
...  
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Normal Kidney ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Community Dwelling Older Adults

Although anemia is common in older adults, its prognostic significance is uncertain. A total of 17 030 community-dwelling subjects 66 years and older were identified between July 1 and December 31, 2001, and followed until December 31, 2004. Cox proportional hazards analyses were performed to determine the associations between anemia (defined as hemoglobin < 110 g/L) and hemoglobin and all-cause mortality, all-cause hospitalization, and cardiovascular-specific hospitalization. Overall, there were 1983 deaths and 7278 first hospitalizations. In patients with normal kidney function, adjusting for age, sex, diabetes mellitus, and comorbidity, anemia was associated with an increased risk for death (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.55-5.12), first all-cause hospitalization (HR, 2.16; 95% CI, 1.88-2.48), and first cardiovascular-specific hospitalization (HR, 2.49; 95% CI, 1.99-3.12). An inverse J-shaped relationship between hemoglobin and all-cause mortality was observed; the lowest risk for mortality occurred at hemoglobin values between 130 to 150 g/L for women and 140 to 170 g/L for men. Anemia is associated with an increased risk for hospitalization and death in community-dwelling older adults. Consideration should be given to redefine “normal” hemoglobin values in the elderly. Clinical trials are also necessary to determine whether anemia correction improves quality or quantity of life in this population.

EVALUATING THE ASSOCIATION BETWEEN CENTRAL NERVOUS SYSTEM (CNS)-ACTIVE MEDICATION USE AND FALL-RELATED INJURIES IN OLDER ADULTS WITH DEMENTIA

2017 ◽  
Vol 13 (7) ◽  
pp. P1564-P1565
Author(s):  
Laura A. Hart ◽  
Zachary Marcum ◽  
Shelly L. Gray ◽  
Rod L. Walker ◽  
Paul K. Crane ◽  
...  
Keyword(s):  
Older Adults ◽  
Central Nervous System ◽  
Nervous System ◽  
Medication Use ◽  
Active Medication

scholarly journals Day-to-Day Variability and Year-to-Year Reproducibility of Accelerometer-Measured Free-Living Sit-to-Stand Transitions Volume and Intensity among Community-Dwelling Older Adults

Sensors ◽  
2021 ◽  
Vol 21 (18) ◽  
pp. 6068
Author(s):  
Antti Löppönen ◽  
Laura Karavirta ◽  
Erja Portegijs ◽  
Kaisa Koivunen ◽  
Taina Rantanen ◽  
...  
Keyword(s):  
Older Adults ◽  
Angular Velocity ◽  
Functional Disability ◽  
Intraclass Correlation ◽  
Living Environment ◽  
Community Dwelling ◽  
Free Living ◽  
Sit To Stand ◽  
Increased Risk ◽  
Community Dwelling Older Adults

(1) Background: The purpose of this study was to evaluate the day-to-day variability and year-to-year reproducibility of an accelerometer-based algorithm for sit-to-stand (STS) transitions in a free-living environment among community-dwelling older adults. (2) Methods: Free-living thigh-worn accelerometry was recorded for three to seven days in 86 (women n = 55) community-dwelling older adults, on two occasions separated by one year, to evaluate the long-term consistency of free-living behavior. (3) Results: Year-to-year intraclass correlation coefficients (ICC) for the number of STS transitions were 0.79 (95% confidence interval, 0.70–0.86, p < 0.001), for mean angular velocity—0.81 (95% ci, 0.72–0.87, p < 0.001), and maximal angular velocity—0.73 (95% ci, 0.61–0.82, p < 0.001), respectively. Day-to-day ICCs were 0.63–0.72 for number of STS transitions (95% ci, 0.49–0.81, p < 0.001) and for mean angular velocity—0.75–0.80 (95% ci, 0.64–0.87, p < 0.001). Minimum detectable change (MDC) was 20.1 transitions/day for volume, 9.7°/s for mean intensity, and 31.7°/s for maximal intensity. (4) Conclusions: The volume and intensity of STS transitions monitored by a thigh-worn accelerometer and a sit-to-stand transitions algorithm are reproducible from day to day and year to year. The accelerometer can be used to reliably study STS transitions in free-living environments, which could add value to identifying individuals at increased risk for functional disability.

scholarly journals Prevalence of frailty syndrome and its associated factors among community-dwelling elderly in East Coast of Peninsular Malaysia

2018 ◽  
Vol 6 ◽  
pp. 205031211877558 ◽  
Author(s):  
Fairus Asma Mohd Hamidin ◽  
Siti Nur’Asyura Adznam ◽  
Zuriati Ibrahim ◽  
Yoke Mun Chan ◽  
Nur Hafizah Abdul Aziz
Keyword(s):  
Older Adults ◽  
Binary Logistic Regression ◽  
Peninsular Malaysia ◽  
Clinical Syndrome ◽  
Community Dwelling ◽  
Frailty Syndrome ◽  
Increased Risk ◽  
Health Related ◽  
Prevention Programmes ◽  
Community Dwelling Older Adults

Objective: Frailty is a clinical syndrome with increased risk of poor health outcomes and particularly prevalent in older adults and community population. The study’s aim was therefore to determine the prevalence of frailty and its association with sociodemographic and socioeconomic characteristics, health-related status, and anthropometric measurements among community-dwelling older adults. Methods: A total of 279 older adults aged 60 years and above were randomly selected. Respondents were classified as non-frail (<2 criteria) or frail (≥3 criteria) based on the ‘phenotype of frailty’. A binary logistic regression was used to determine predictors of frailty. Results: The prevalence of frailty was 18.3%. The frail older adults were positively associated with advanced age, being unmarried, hospitalisation in the previous year, poor self-rated health, and lower body mass index. Discussion: These results give an overview on underlying effects and guiding actions for prevention programmes functioning to reverse and minimise the adverse effects of frailty syndrome.

Conclusion

2020 ◽  
pp. 237-238
Author(s):  
John F. Peppin ◽  
Joseph V. Pergolizzi ◽  
Robert B. Raffa ◽  
Steven L. Wright
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Side Effects ◽  
Mechanism Of Action ◽  
Term Treatment ◽  
Risk Of Death ◽  
Increased Risk ◽  
Treatment Plans ◽  
The Central Nervous System ◽  
System Data

The authors summarize the harmful and understudied aspects of the overuse of benzodiazepines. Increased and longer-term use of benzodiazepines has been observed to lead to side effects such as sedation, cognitive issues, abuse, and dependence, as well as many other unanticipated side effects that do not fit their known mechanism of action in the central nervous system. Data also shows a correlation between concomitant use of benzodiazepines and opioids and increased risk of death from overdose. The authors advocate for stricter guidelines for prescribing benzodiazepines, as well as close clinical monitor and shorter-term treatment plans.

scholarly journals Longitudinal Associations Between Gait, Falls, and Disability in Community-Dwelling Older Adults With Type II Diabetes Mellitus: Findings From The Irish Longitudinal Study on Ageing (TILDA)

2020 ◽  
Author(s):  
Orna A Donoghue ◽  
Siobhan Leahy ◽  
Rose Anne Kenny
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Type Ii Diabetes ◽  
Step Length ◽  
Community Dwelling ◽  
Type Ii ◽  
Diabetes Status ◽  
Increased Risk ◽  
Community Dwelling Older Adults ◽  
Task Step

Abstract Background Diabetes is associated with gait deficits, future falls, and disability; however, it is unclear if associations remain after controlling for relevant confounders. This study investigated (i) the effects of type II diabetes on spatiotemporal gait parameters in community-dwelling older adults and (ii) if diabetes status was independently associated with future falls and disability, after controlling for gait and other confounders. Method Baseline data were obtained from 2608 community-dwelling adults (≥60 years) participating in The Irish Longitudinal Study on Ageing (TILDA). Diabetes was identified from self-reported doctors’ diagnosis, medications, and glycated hemoglobin levels. Gait characteristics were obtained during single- and dual-task walking using a GAITRite mat (n = 2560). Incident falls and disability were collected over 4 years follow-up (n = 2473). Associations between diabetes status and gait (cross-sectional) and falls and disability (longitudinal) were investigated using regression analysis, adjusting for medications, cardiovascular health, neuropsychological function, and fall-related factors. Results Diabetes (prevalence = 9.1%) was cross-sectionally associated with shorter dual-task step length after adjusting for covariates (β = −1.59, 95% CI: −3.10, −0.08, p &lt; .05). Diabetes was independently associated with increased risk of future instrumental activity of daily living (IADL) difficulty in those with no prior difficulty (incidence rate ratio [IRR] = 1.51, 95% CI: 1.08, 2.11, p &lt; .05) although dual-task step length was an important confounder in all disability models. No independent associations between diabetes and falls were observed. Conclusions Diabetes was independently associated with shorter dual-task step length and increased risk of future IADL difficulty. Multidimensional interventions addressing poor health and function in those with diabetes may help reduce the risk of gait deficits and future disability.

scholarly journals Cryptococcosis in Patients following Kidney Transplantation: A 9-Year Retrospective Clinical Analysis at a Chinese Tertiary Hospital

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Meifang Yang ◽  
Xuan Zhang ◽  
Jianhua Hu ◽  
Hong Zhao ◽  
Lanjuan Li
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Kidney Transplantation ◽  
Tertiary Hospital ◽  
Clinical Analysis ◽  
High Dose ◽  
Kidney Transplant Recipients ◽  
Pulmonary System ◽  
Increased Risk ◽  
The Central Nervous System

Background. Cryptococcosis following kidney transplantation (KT) is rare but is associated with considerably increased risk of mortality. At present, data on the association between cryptococcosis and KT in mainland China remain relatively limited. Objectives. This study aims to review our experience related to the management of cryptococcosis following KT at a Chinese tertiary hospital. Methods. All patients with cryptococcosis following KT admitted to our hospital from January 2010 to December 2018 were reviewed. Results. A total of 37 patients with cryptococcosis were enrolled (males: 62.2%). The mean age of the patients was 49.5 ± 9.38 (20–64) years. The average time to infection following KT was 7.0 ± 5.50 years (5 months to 21 years), and 30 patients (81.1%) had cryptococcosis onset >2 years following transplantation. The most common site of infection was the central nervous system, followed by the pulmonary system and skin. Most patients received fluconazole or voriconazole with or without flucytosine as their initial treatment regimen at our hospital. The 2-week mortality rate was 8.1% (3/37), and five patients (13.5%) died within 6 months of being diagnosed with cryptococcosis. Remarkably, all patients who received high-dose fluconazole (800 mg daily) or voriconazole ± flucytosine survived. Conclusions. Cryptococcosis in kidney transplant recipients is typically a late-occurring infection, with most patients having cryptococcosis onset >2 years following KT at our hospital. The central nervous system, pulmonary system, and skin are the main sites of infection. Voriconazole or high-dose fluconazole can be used as an alternative therapy for post-KT cryptococcosis.

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