Problems and fall risk determinants of quality of life in older adults with increased risk of falling

Introduction: The progressing aging process and comorbidities worsen the efficiency of the balance system in the elderly, which leads to a weakening of stability and, as a consequence, to falls and injuries. The first ones lead to: worsening of functioning, reduced mobility, an increased risk of disease and mortality, therefore systematic physical activity and shaping the balance using physiotherapy, which can prevent dangerous falls is very important. Aim: Assessment of the therapeutic effect of physiotherapy on minimizing imbalances in geriatric patients. M aterial and Methods: The study group consisted of 46 people, including 32 women (69.6%) and 14 men (30.4%); average age of respondents – 72.5 years. They were patients of the Department of Rehabilitation of Poddębice Health Center, Ltd. The researchers used a self-made questionnaire, body mass to height index (BMI) and the Tinetti Test. Results: Patients with an elevated BMI (89.1%), as well as those taking more than 4 medication (78.3%), have had more falls over the past year (respectively 91.4% and 81.4%). After the use of comprehensive therapy, none of the patients achieved a worse result than before the physiotherapy while 91.3% of the respondents had an increase in the number of points scored in the Tinetti Test. The percentage of patients at high risk of falling reduced from 67.4% to 37%. There was also a decrease in the fear of walking (in 58.7%), falling (in 57.7%) and climbing stairs (in 47.9%). According to 78.3% of respondents, physiotherapy positively affected their independence and quality of life. Conclusions: The use of comprehensive physiotherapy reduces the fear of walking, climbing stairs and falling, which can be a good predictor of prevention. Both polypragmasia and an elevated body mass index (BMI) increase the risk of falling. Comprehensive physiotherapy of geriatric patients helps to improve balance and gait stereotype. Physiotherapy for the elderly helps improve the quality of life, independence, minimize imbalances, and thus reduce the risk of falls. Balance exercises play an important role in preventing falls.

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Biopsychosocial Patterning of Multimorbidity and Its Consequences

The Oxford Handbook of Integrative Health Science ◽

10.1093/oxfordhb/9780190676384.013.14 ◽

2018 ◽

pp. 220-236

Author(s):

Elliot Friedman ◽

Beth LeBreton ◽

Lindsay Fuzzell ◽

Elizabeth Wehrpsann

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Functional Outcomes ◽

The United States ◽

Chronic Medical Conditions ◽

Quality Of Life Research ◽

Increased Risk ◽

Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

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Biosocial and disease conditions affecting the quality of life among older adults in Eastern Nepal

10.21203/rs.2.20273/v1 ◽

2020 ◽

Author(s):

Uday Narayan Yadav ◽

Tarka Bahadur Thapa ◽

Sabuj Kanti Mistry ◽

Saruna Ghimire ◽

Godfred O. Boateng ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Older Adults ◽

Poor Quality ◽

Chronic Obstructive ◽

Cluster Sampling ◽

Ageing Population ◽

Increased Risk ◽

Lower Likelihood

Abstract Background The ageing population in most low-and middle-income countries is accompanied by an increased risk of non-communicable diseases culminating in a poor quality of life. However, the factors accelerating this poor quality of life (QOL) have not been fully examined. Therefore, this study examined the factors influencing the quality of life of Nepali older adults.Methods Data from a previous cross-sectional study, conducted between January and April 2018 in eastern Nepal, was used. The analytical sample included 794 older adults aged ≥60 years, selected by a multi-stage cluster sampling approach. QOL was measured using the Older People’s Quality of Life tool; dichotomized as poor and good QOL. Other measures used included age, gender, ethnicity, religion, marital status, physical activity and chronic diseases such as osteoarthritis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and depression. The factors associated with quality of life were examined using mixed-effects logistic regression.Results Seven in ten respondents (70.4%) reported a poor quality of life. At the bivariate level, increasing age, unemployment, intake of alcohol, lack of physical activity as well as osteoarthritis, COPD and depression were significantly associated with a lower likelihood of a good quality of life. The adjusted model showed that older age (AOR=0.50, p<0.05), the Christian religion (AOR=0.38, p<0.01), and being from an Indigenous, Dalit, or Madheshi background were associated with a lower likelihood of good quality of life. However, higher income of >Nrs 10,000 (AOR=3.34, p<0.001), daily physical activity (AOR=3.33, p<0.001), and the absence of osteoarthritis and depression were associated with a higher odds ratio of good quality of life.Conclusion The findings of this study echo the need to develop and implement policies aimed at improving the socio-cultural and disease conditions that catalyse poor quality of life in this population.

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Proposals for continued research to determine older adults’ falls risk

Journal of Frailty Sarcopenia and Falls ◽

10.22540/jfsf-05-089 ◽

2020 ◽

Vol 05 (04) ◽

pp. 89-91

Author(s):

Beatrice Pettersson ◽

Ellinor Nordin ◽

Anna Ramnemark ◽

Lillemor Lundin-Olsson

Keyword(s):

Older Adults ◽

Risk Assessment ◽

Fall Risk ◽

Assessment Tools ◽

Risk Of Falling ◽

Self Assessment ◽

Preventative Measures ◽

Increased Risk ◽

Risk Assessment Tools ◽

Falls Prediction

Early detection of older adults with an increased risk of falling could enable early onset of preventative measures. Currently used fall risk assessment tools have not proven sufficiently effective in differentiating between high and low fall risk in community-living older adults. There are a number of tests and measures available, but many timed and observation-based tools are performed on a flat floor without interaction with the surrounding. To improve falls prediction, measurements in other areas that challenge mobility in dynamic conditions and that take a persons’ own perception of steadiness into account should be further developed and evaluated as single or combined measures. The tools should be easy to apply in clinical practice or used as a self-assessment by the older adults themselves.

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Sarcopenia and its Association with Geriatric Syndromes and Quality of Life in Older Indian Outpatients – A Cross-sectional Pilot Observational Study

10.35262/jiag.v15i2.66-74 ◽

2019 ◽

Vol 15 (2) ◽

pp. 66-74

Author(s):

Sunny Singhal ◽

Gevesh Chand Dewangan ◽

Rishav Bansal ◽

Ashish Datt Upadhyay ◽

Sada Nand Dwivedi ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Dual Energy ◽

Stepwise Logistic Regression ◽

Care Hospital ◽

Geriatric Syndromes ◽

Dxa Scan ◽

X Ray ◽

Increased Risk

Background: Despite the huge clinical impact of sarcopenia, there is very little to no data from Indian subcontinent regarding sarcopenia in older adults. We conducted this study to assess the frequency of sarcopenia in Indian older outpatients and its characteristics and associations with various geriatric syndromes and quality of life in Indian older adults. Methods: 100 participants above the age of 65 years were recruited from the outpatient department of Geriatric Medicine of a tertiary care hospital in India. Muscle mass, muscle strength and physical performance was measured by DXA scan (Dual Energy X-ray Absorptiometry), hand-held dynamometer and 4 m gait speed respectively. Sarcopenia was identified using an Asian working group for sarcopenia (AWGS) criteria. Many geriatric syndromes such as osteoporosis, dementia, depression and malnutrition were assessed using DXA scan (Dual Energy X-ray Absorptiometry), HMSE (Hindi Mental State Questionnaire), GDS-5 (Geriatric Depression scale – 5 item questionnaire) and MNA (Mini Nutritional Assessment) respectively. Quality of life was assessed using the OPQOL-brief questionnaire. Results: The preval nce of sarcopenia in our study population was 53% (49.3% in males, 61.3% in females). Hypothyroidism, neurological disease and osteoporosis were the only comorbidities found to be positively associated with sarcopenia. Among geriatric syndromes, nutrition and cognition were negatively associated with sarcopenia. Sarcopeniawas also negatively related to the quality of life. Multivariate stepwise logistic regression analysis showed that osteoporosis (OR: 5.43; 95% CI: 1.57-18.81; p-value: <0.01) was significantly associated with sarcopenia. Conclusion: Sarcopenia was common among Indian older outpatients with increased risk of geriatric syndromes and poor quality of life, therefore, a regular sarcopenia assessment may be considered in elderly patients.

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Health-related quality of life in relation to mobility and fall risk in 85-year-old people: a population study in Sweden

Ageing and Society ◽

10.1017/s0144686x15000896 ◽

2015 ◽

Vol 36 (9) ◽

pp. 1982-1997 ◽

Cited By ~ 5

Author(s):

EVA TÖRNVALL ◽

JAN MARCUSSON ◽

EWA WRESSLE

Keyword(s):

Quality Of Life ◽

Body Mass Index ◽

Fall Risk ◽

Health Related Quality ◽

Risk Of Falling ◽

Old People ◽

Related Quality ◽

Health Related ◽

Lower Hrqol

ABSTRACTOptimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.

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The Relationships Between Fall Risk, Depression, Executive Dysfunctions and Daily Life of Older Adults

10.21203/rs.3.rs-55453/v1 ◽

2020 ◽

Author(s):

Batya Engel Yeger ◽

Yael Zilbershlag

Keyword(s):

Quality Of Life ◽

Older Adults ◽

High Risk ◽

Daily Activity ◽

Fall Risk ◽

Daily Life ◽

Daily Activities ◽

Activity Performance ◽

Executive Dysfunctions

Abstract Background: Falling is a major problem in older adults that may significantly reduce health and quality of life (QOL). Body dysfunctions that include depression, cognitive decline and executive dysfunctions may elevate fall risk and impair daily activities and QOL. Yet, most studies evaluate these body dysfunctions using laboratory measures in clinical settings. The present study aimed to: (1) compare these body dysfunctions between high/low risk fallers (2) examine the relationship between these body dysfunctions among the high risk fallers (3) explore the specific contribution of fall risk as a mediator between depression, executive dysfunctions and daily life. Methods: Participants were 123 older adults who live in the community. Depression and cognitive status were measured by the GDS-15 and the MoCA. Fall risk was determined by a questionnaire supported by the Time Up and Go test (TUG). Executive functions (EF) were assessed by the BRIEF-A and the aEFPT medication management assessment. Daily activity performance was measured by the Barthel Index of ADL and the Instrumental ADL Scale. QOL was measured by the World Health Organization Quality of Life Brief Questionnaire. Results: High fall risk was prevalent among 32% of the sample. High risk fallers had significantly lower cognitive level, higher depression, lower EF, lower daily activity performance and lower QOL. Among the high risk group, lower EF as measured in BRIEF-A scales correlated with lower performance of daily activities and lower QOL. SEM model revealed that fall risk mediated between depression, executive dysfunctions and daily life. Conclusions: Depression and executive dysfunctions are more prevalent in older adults with high fall risk and are significantly related to their daily activity performance and to their QOL. Community fall-prevention and rehabilitation programs should screen for fall risk and related body dysfunctions as expressed during daily activity performance and understand their impacts on people’s QOL.

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Usability of a Fall Risk mHealth App for People With Multiple Sclerosis: Mixed Methods Study

JMIR Human Factors ◽

10.2196/25604 ◽

2021 ◽

Vol 8 (1) ◽

pp. e25604 ◽

Cited By ~ 1

Author(s):

Katherine Hsieh ◽

Jason Fanning ◽

Mikaela Frechette ◽

Jacob Sosnoff

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Risk Score ◽

Fall Risk ◽

Risk Of Falling ◽

System Usability Scale ◽

System Usability ◽

Mhealth Apps ◽

User Centered

Background Multiple sclerosis (MS) is a chronic, neurodegenerative disease that causes a range of motor, sensory, and cognitive symptoms. Due to these symptoms, people with MS are at a high risk for falls, fall-related injuries, and reductions in quality of life. There is no cure for MS, and managing symptoms and disease progression is important to maintain a high quality of life. Mobile health (mHealth) apps are commonly used by people with MS to help manage their health. However, there are limited health apps for people with MS designed to evaluate fall risk. A fall risk app can increase access to fall risk assessments and improve self-management. When designing mHealth apps, a user-centered approach is critical for improving use and adoption. Objective The purpose of this study is to undergo a user-centered approach to test and refine the usability of the app through an iterative design process. Methods The fall risk app Steady-MS is an extension of Steady, a fall risk app for older adults. Steady-MS consists of 2 components: a 25-item questionnaire about demographics and MS symptoms and 5 standing balance tasks. Data from the questionnaire and balance tasks were inputted into an algorithm to compute a fall risk score. Two iterations of semistructured interviews (n=5 participants per iteration) were performed to evaluate usability. People with MS used Steady-MS on a smartphone, thinking out loud. Interviews were recorded, transcribed, and developed into codes and themes. People with MS also completed the System Usability Scale. Results A total of 3 themes were identified: intuitive navigation, efficiency of use, and perceived value. Overall, the participants found Steady-MS efficient to use and useful to learn their fall risk score. There were challenges related to cognitive overload during the balance tasks. Modifications were made, and after the second iteration, people with MS reported that the app was intuitive and efficient. Average System Usability Scale scores were 95.5 in both iterations, representing excellent usability. Conclusions Steady-MS is the first mHealth app for people with MS to assess their overall risk of falling and is usable by a subset of people with MS. People with MS found Steady-MS to be usable and useful for understanding their risk of falling. When developing future mHealth apps for people with MS, it is important to prevent cognitive overload through simple and clear instructions and present scores that are understood and interpreted correctly through visuals and text. These findings underscore the importance of user-centered design and provide a foundation for the future development of tools to assess and prevent scalable falls for people with MS. Future steps include understanding the validity of the fall risk algorithm and evaluating the clinical utility of the app.

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Multi-System Physical Exercise Intervention for Fall Prevention and Quality of Life in Pre-Frail Older Adults: A Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093102 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3102 ◽

Cited By ~ 1

Author(s):

Jiraporn Chittrakul ◽

Penprapa Siviroj ◽

Somporn Sungkarat ◽

Ratana Sapbamrer

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Reaction Time ◽

Muscle Strength ◽

Physical Exercise ◽

Fall Prevention ◽

Fall Risk ◽

Postural Sway ◽

Frail Older Adults

Effective interventions for indicated fall prevention are necessary for older adults with frailty. We aimed to determine the effectiveness of a Multi-system Physical Exercise (MPE) for fall prevention and Health-Related Quality of Life (HRQOL) in pre-frail older adults. This randomized control trial with allocation concealment included 72 adults aged 65 and above, identified as pre-frailty and with mild and moderate fall risk scores measured by the Physiological Profile Assessment (PPA). Randomly, using block randomization, participants were divided into two groups: an MPE group (n = 36) and a control group (n = 36). The intervention consisted mainly of proprioception, muscle strengthening, reaction time, and balance training and was carried out three days per week for 12 weeks. The primary outcome was fall risk assessed using PPA at 12 weeks post-baseline and at a 24 week follow-up. Significant differences were found in the improvement in fall risk, proprioception, muscle strength, reaction time and postural sway, and fear of fall scores in the MPE group compared with controls at week 12 and 24. In addition, HRQOL had increased significantly in the MPE group in comparison to controls. The MPE program significantly increased muscle strength and improved proprioception, reaction time, and postural sway leading to fall risk reduction in older adults with pre-frailty. Therefore, the MPE program is recommended for used in day-to-day primary care practice in the pre-frail population.

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Physical Performance and Quality of Life in Older Adults: Is There Any Association between Them and Potential Drug Interactions in Polymedicated Octogenarians

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16214190 ◽

2019 ◽

Vol 16 (21) ◽

pp. 4190 ◽

Cited By ~ 1

Author(s):

Verde ◽

García de Diego ◽

Chicharro ◽

Bandrés ◽

Velasco ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Drug Interactions ◽

Physical Performance ◽

Poor Quality ◽

Potential Interaction ◽

Cognitive Status ◽

Community Dwelling ◽

Increased Risk

Older adults are at increased risk of several cytochrome P450 (CYP) drug interactions that can result in drug toxicity, reduced pharmacological effect, and adverse drug reactions. This study aimed to assess the prevalence of potential CYP interactions referring to the most clinically relevant drugs and exploring the relationship between them and quality of life and physical performance in Spanish octogenarians. Institutionalized and community-dwelling octogenarians (n = 102) treated at three primary care centers, were recruited by a research nurse. Anthropometric measurements, chronic diseases, prescribed drugs, quality of life, physical performance, mobility skills, hand grip strength and cognitive status data were collected. Potential CYP drug-drug interactions (DDIs) were selected referring to the main CYP implicated in their metabolism. The 72.2% of recruited octogenarians presented potentially inappropriate CYP inhibitor-substrate or CYP inductor-substrate combinations. Analyzing the EuroQol Visual Analogue scale (EQ-VAS) results, patients with a potential CYP DDI perceived worse health status than patients without it (p = 0.004). In addition, patients with a potential CYP DDI presented worse exercise capacity, kinesthetic abilities, or mobility than those who didn’t present a potential interaction (p = 0.01, p = 0.047, and p = 0.02, respectively). To investigate and control factors associated with loss of muscle strength and poor quality of life, polypharmacy and DDIs could help institutions in the management of physical frailty.

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