scholarly journals The motor repertoire of older adult fallers may constrain their response to balance perturbations

2018 ◽  
Vol 120 (5) ◽  
pp. 2368-2378 ◽  
Author(s):  
Jessica L. Allen ◽  
Jason R. Franz
Keyword(s):  
Older Adults ◽  
Visual Perception ◽  
Older Adult ◽  
Balance Control ◽  
Lateral Instability ◽  
Increased Risk ◽  
Motor Module ◽  
Risk Of Falls ◽  
History Of ◽  
Walking Balance

Older adults are at a high risk of falls, and most falls occur during locomotor activities like walking. This study aimed to improve our understanding of changes in neuromuscular control associated with increased risk of falls in older adults in the presence of dynamic balance challenges during walking. Motor module (also known as muscle synergy) analyses identified changes in the neuromuscular recruitment of leg muscles during walking with and without perturbations designed to elicit the visual perception of lateral instability. During normal walking we found that a history of falls (but not age) was associated with reduced motor module complexity and that age (but not a history of falls) was associated with increased step-to-step variability of module recruitment timing. Furthermore, motor module complexity was unaltered in the presence of optical flow perturbations. The specific effects of a history of falls on leg muscle recruitment included an absence and/or inability to independently recruit motor modules normally recruited to perform biomechanical functions important for walking balance control. These results suggest that fallers do not recruit the appropriate motor modules necessary for well-coordinated walking balance control even in the presence of perturbations. The identified changes in the modular control of walking balance in older fallers may either represent a neural deficit that leads to poor balance control or a prior history of falls that results in a compensatory motor adaptation. In either case, our study provides initial evidence that a reduced motor repertoire in older adult fallers may be a constraint on their ability to appropriately respond to balance challenges during walking. NEW & NOTEWORTHY This is the first study to demonstrate a reduced motor repertoire during walking in older adults with a history of falls but without any overt neurological deficits. Furthermore, using virtual reality during walking to elicit the visual perception of lateral instability, we provide initial evidence that a reduced motor repertoire in older adult fallers may be a constraint on their ability to appropriately respond to balance challenges during walking.

Balance Control and Peripheral Muscle Function in Aging: A Comparison Between Individuals with Acromegaly and Healthy Subjects

2017 ◽  
Vol 25 (2) ◽  
pp. 218-227 ◽  
Author(s):  
Telassin Silva Homem ◽  
Fernando Silva Guimarães ◽  
Maurício Santos Soares ◽  
Leandro Kasuki ◽  
Mônica Roberto Gadelha ◽  
...  
Keyword(s):  
Older Adults ◽  
Muscle Function ◽  
Balance Control ◽  
Peak Torque ◽  
Total Work ◽  
Lateral Instability ◽  
Peripheral Muscle ◽  
Risk Of Falls ◽  
Paired Control ◽  
Older Subjects

Advances in the knowledge of acromegaly are leading to an increase in the survival rate of acromegalic subjects. This study was conducted to evaluate balance control, risk of falls, and peripheral muscle function in acromegalic older adults. Seventeen older subjects with acromegaly (67 [63–73] years) and 20 paired control subjects were evaluated with balance scales, force platform, and knee isokinetic dynamometry tests. There were significant differences between the groups on several balance and gait scales, with a worse performance and greater risk of falls in the acromegalic older adults. Acromegalic older adults had lower values for peak torque, maximum repetition of the total work, and total work during extension at 240°/s. The acromegalic older adults had higher values in the medial-lateral range. Acromegaly subjects had lateral instability that compromises their body balance and increases the risk of falls. Moreover, there was a propensity for muscle fatigue in these individuals.

scholarly journals Analysis of Falls in Older Adults with Multiple Myeloma Undergoing First-Line Therapy

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5886-5886
Author(s):  
Kelly L. Schoenbeck ◽  
Tanya M. Wildes ◽  
Mark A. Fiala
Keyword(s):  
Older Adults ◽  
Multiple Myeloma ◽  
Peripheral Neuropathy ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Falls In Older Adults ◽  
First Line Treatment

Background: Patients with multiple myeloma are frequently treated with bortezomib, a proteasome inhibitor, which is associated with treatment-related peripheral neuropathy. Older adults are at increased risk of falls compared to the general population, often leading to associated morbidity and mortality. While an association between peripheral neuropathy and falls in older adults is well-established, the relationship between bortezomib and falls in older multiple myeloma patients is unknown. Our primary aim was to determine if older patients with multiple myeloma treated with bortezomib as first-line therapy had an increased incidence of falls within the first 12 months after starting treatment. Our secondary aim was to assess the overall survival of patients who fell compared to those who did not among patients who lived more than 12 months after initiating treatment. Methods: We analyzed the SEER-Medicare database for all patients 65 years old or older diagnosed with multiple myeloma between 2007 and 2013 and were enrolled in fee-for-service Medicare part A, B and D plans. The patients' corresponding Medicare claims data were analyzed through 2014 for myeloma treatments, fall claims, and covariates of interest. The primary outcome was accidental falls (E880-E888) occurring between 14 days to 12 months after starting multiple myeloma treatment. First-line therapy was defined as any anti-myeloma treatment administered within 14 days of starting multiple myeloma treatment, with bortezomib treatment being the focal independent variable. Cox regression was performed to determine the relative risk of having a fall after controlling for other covariates. Patients who started bortezomib after first-line therapy were censored at time of bortezomib commencement. The survival analysis included only patients who survived more than 12 months of starting treatment to allow landmark analysis of falls in the first year. Results: Of 4,084 older adults with new multiple myeloma diagnoses undergoing first-line therapy, the median age was 75 (range 65-97) with 51% males. Bortezomib was used in first-line therapy for 2,052 (50%) patients, of which 157 (8%) patients experienced a fall within 12 months after starting treatment compared to 102 (5%) of patients not receiving bortezomib (p < 0.001). Bortezomib was associated with a 28% increase risk of falls (HR 1.29; 95% CI 1.00-1.65; p = 0.047). In multivariate analysis, bortezomib was not associated with an increased incidence of falls after controlling for age, gender, race, proxies for Charlson Comorbidity Index (CCI) and poor performance status, pre-existing peripheral neuropathy, falls within the 12 months prior to starting first-line myeloma treatment, depression, polypharmacy, and first-line treatment with lenalidomide (Table 1). Advancing age, history of fall(s), depression, and polypharmacy (defined as more than 10 unique prescription medications at initiation of first-line treatment), were all associated with an increased risk of falls, consistent with prior literature. In a landmark analysis of those who survived 12 months following the start of treatment, a fall was associated with a 26% increased risk of hazard for death (aHR 1.26; 95% CI 1.02-1.56; p = 0.033) after controlling for other covariates. The median OS of those with a fall was 35.7 months (95% CI 29.1-48.4) compared to 49.1 months (95% CI 47.1-52.8) for those without (p < 0.0001). Conclusion: In older adults with multiple myeloma, treatment with bortezomib was not associated with increased risk of a patient having a diagnostic code for falls. However, experiencing a fall within the year after starting treatment was associated with decreased overall survival. Limitations of the study include that the incidence of falls is likely underestimated in billing data, given prior data from our group showing a rate of self-reported falls of 26% in the year after diagnosis. Additional research, including prospective trials involving fall assessments, should be considered in older patients with multiple myeloma. Disclosures Wildes: Janssen: Research Funding; Carevive: Consultancy. Fiala:Incyte: Research Funding.

scholarly journals The Experience and Perception of Physiotherapists in Nigeria re: Fall Prevention in Recurrent-Faller Older Adults

2019 ◽  
Author(s):  
Perpetua Obi ◽  
Henrietha Nwankwo ◽  
Diaemeta Emofe ◽  
Isreal Adandom ◽  
Michael Kalu
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Fall Prevention ◽  
Developing World ◽  
Phenomenological Approach ◽  
Developing Nations ◽  
Prevention Strategies ◽  
Face To Face ◽  
Rehabilitation Professionals ◽  
History Of

Background: Effective fall prevention practices are essential for reducing falls among older adults. Rehabilitation professionals like physiotherapists are essential members of the fall prevention team, yet little is known about the experiences of physiotherapists practicing fall prevention in developing nations. Objective: To explore the experiences of physiotherapists in Nigeria who practice fall prevention among older adults. Method: We adopted a phenomenological approach to the traditional qualitative design in this study. We purposefully selected and conducted face-to-face interview with twelve physiotherapists who have treated at least one older adult who reported falling two or three times within last six months. Data was analyzed using thematic analysis. Results: Four themes emerged from our participants: characteristics of recurrent fallers, fall prevention practices, hindrances to fall prevention, and strategies to promote fall prevention practices. In practice, understanding the characteristics (risk factors) of older adults with a history of recurrent falls is important for effective fall prevention practices among physiotherapists. Among other characteristics, our participants believed that older adults who have patronized “traditional bone setters/healer” are at the higher risk of having multiple falls. Conclusion: This study adds to the sparse amount of literature concerning the experience of physiotherapist in fall prevention practices in the developing world. More importantly, the findings of this study will strengthen or stimulate discussion around development of fall prevention strategies specific to the developing world context.

scholarly journals Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Burcin M. Atak ◽  
Gulali Aktas ◽  
Tuba T. Duman ◽  
Ozge Kurtkulagi ◽  
Satilmis Bilgin ◽  
...  
Keyword(s):  
Older Adults ◽  
Inappropriate Medication ◽  
Bleeding Risk ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Tertiary Referral Hospital ◽  
Inappropriate Use ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Inappropriate Medications

Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.

scholarly journals Reliability of HOME FAST BRAZIL—Self-Reported Version for Community-Dwelling Older Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Karina Stella Aoki Ferreira ◽  
Tamires Terezinha Gallo da Silva ◽  
Jarbas Melo Filho ◽  
Natacha Verônica Bazanella ◽  
Audrin Said Vojciechowski ◽  
...  
Keyword(s):  
Older Adults ◽  
Cross Sectional Study ◽  
Environmental Risks ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Rater Reliability ◽  
Risk Of Falls ◽  
History Of ◽  
Spearman Test ◽  
Community Dwelling Older Adults

Objective: Verify the intra- and inter-rater reliability of the HOME FAST BRAZIL—Self-reported version and correlate household environmental risks with the history of falls by community-dwelling older adults.Method: Cross sectional study with 50 community-dwelling older adults who were screened by the cut-off point of the Mini Mental State Exam and replied to the HOME FAST BRAZIL—Self-reported version using two evaluators, on three occasions. The reliability analysis was determined by the Intra-class Correlation Coefficient (ICC), considering ICC &gt; 0.70 as adequate. To test the correlations, the Spearman test was used.Results: The mean age of the participants was 73.2 ± 5.8 years. The inter- rater reliability of HOME FAST BRAZIL—Self-reported version was ICC 0.83 (IC95%, 0.70–0.90) and the Intra- reliability ICC 0.85 (IC95%, 0.74–0.91). A risk of falls was verified in 88% of the sample and four environmental risks presented significant correlations with the history of falls.Conclusions: The HOME FAST BRAZIL—Self-reported version presented adequate reliability for the evaluation of household environmental risks for community-dwelling older adults. Risks such as inadequate armchairs/ sofas, the absence of anti-slip mats in the shower recess, the presence of pets and inadequate beds require attention in the evaluation of household risks, due to their correlation with the occurrence of falls.

Opioid Use and the Risk of Falls, Fall Injuries and Fractures among Older Adults: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 75 (10) ◽  
pp. 1989-1995 ◽  
Author(s):  
Aya Yoshikawa ◽  
Gilbert Ramirez ◽  
Matthew Lee Smith ◽  
Margaret Foster ◽  
Anas K Nabil ◽  
...  
Keyword(s):  
Older Adults ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Opioid Use ◽  
Fall Injuries ◽  
Risk Of Death ◽  
Management Interventions ◽  
Risk Estimates ◽  
Increased Risk ◽  
Risk Of Falls

Abstract Background There is increasing concern about opioid use as a pain treatment option among older adults. Existing literature implies an association between opioid use and fracture, increasing the risk of death and disabilities; yet, this relationship with other fall-related outcomes has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes of falls, fall injuries, and fractures among older adults. Methods A systematic literature search was conducted using nine databases: Medline, Embase, CINAHL, PsycInfo, Global Health, Northern Light Sciences Conference Abstracts, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We log-transformed effect sizes (relative risk [RR], odds ratio [OR], and hazard ratio [HR]) to compute pooled risk estimates comparable across the studies. The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Meta-regressions explored differences in risk estimates by analysis method, study design, setting, and study quality. Results Thirty studies, providing 34 relevant effect sizes, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with falls, fall injuries, and fractures, with effect sizes ranging from 0.15 to 0.71. In meta-regressions, no selected factors explained heterogeneity. Conclusion While heterogeneity is present, results suggest an increased risk of falls, fall injuries, and fractures among older adults who used opioids. Findings highlight the need for opioid education and nonopioid-related pain management interventions among older adults to decrease fall-related risk.

Antipsychotic Polypharmacy in Older Adult Asian Patients With Schizophrenia: Research on Asian Psychotropic Prescription Pattern

2019 ◽  
Vol 32 (6) ◽  
pp. 304-311 ◽  
Author(s):  
Min Dong ◽  
Liang-Nan Zeng ◽  
Qinge Zhang ◽  
Shu-Yu Yang ◽  
Lian-Yu Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Multiple Logistic Regression Analysis ◽  
Mainland China ◽  
Careful Consideration ◽  
Drug Induced ◽  
Prescription Pattern ◽  
Asian Patients ◽  
Increased Risk ◽  
Collection Form

Background and Objective: Antipsychotic polypharmacy (APP) is a controversial topic in the treatment of older adults with schizophrenia. The objective of this study was to examine the use of APP in older adult Asian patients with schizophrenia and its associated demographic and clinical factors. Methods: This study was based on the fourth survey of the consortium known as the Research on Asian Psychotropic Prescription Pattern for Antipsychotics. Fifteen Asian countries/territories participated in this survey, including Bangladesh, Mainland China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam. Basic demographic and clinical characteristics were collected using a standardized data collection form. Results: Among the 879 older adults with schizophrenia included in the survey, the rate of APP was 40.5%. Multiple logistic regression analysis revealed that higher antipsychotic doses ( P < .001, odds ratio [OR] = 1.003, 95% confidence interval [CI]: 1.002-1.003), longer duration of illness ( P = .02, OR = 1.845, 95% CI: 1.087-3.132), and the prescription of anticholinergics ( P < .001, OR = 1.871, 95% CI: 1.329-2.635), second-generation antipsychotics ( P = .001, OR = 2.264, 95% CI: 1.453-3.529), and first-generation antipsychotics ( P < .001, OR = 3.344, 95% CI: 2.307-4.847) were significantly associated with APP. Conclusion: Antipsychotic polypharmacy was common in older adult Asian patients with schizophrenia. Compared to the results of previous surveys, the use of APP showed a declining trend over time. Considering the general poor health status of older patients with schizophrenia and their increased risk of drug-induced adverse events, the use of APP in this population needs careful consideration.

Changes in the Dynamic Stability of Walking in Active Healthy Older Adults Independent of Changes in Walking Speed

2008 ◽  
Author(s):  
Hyun Gu Kang ◽  
Jonathan B. Dingwell
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Dynamic Stability ◽  
Walking Speed ◽  
Age Groups ◽  
Leg Strength ◽  
Age Related ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Walking Speeds

Older adults commonly walk slower, which many believe helps improve their walking stability. However, they remain at increased risk of falls. We investigated how differences in age and walking speed independently affect dynamic stability during walking, and how age-related changes in leg strength and ROM affected this relationship. Eighteen active healthy older and 17 younger adults walked on a treadmill for 5 minutes each at each of 5 speeds (80–120% of preferred). Local divergence exponents and maximum Floquet multipliers (FM) were calculated to quantify each subject’s responses to small inherent perturbations during walking. These older adults exhibited the same preferred walking speeds as the younger subjects (p = 0.860). However, these older adults still exhibited greater local divergence exponents (p&lt;0.0001) and higher maximum FM (p&lt;0.007) than young adults at all walking speeds. These older adults remained more unstable (p&lt;0.04) even after adjusting for declines in both strength and ROM. In both age groups, local divergence exponents decreased at slower speeds and increased at faster speeds (p&lt;0.0001). Maximum FM showed similar changes with speed (p&lt;0.02). The older adults in this study were healthy enough to walk at normal speeds. However, these adults were still more unstable than the young adults, independent of walking speed. This greater instability was not explained by loss of leg strength and ROM. Slower speeds led to decreased instability in both groups.

Vestibular function modulates the impact of nGVS on postural control in older adults

2020 ◽  
Author(s):  
Mujda Nooristani ◽  
Charlotte Bigras ◽  
Louise Lafontaine ◽  
Benoit-Antoine Bacon ◽  
Maxime Maheu ◽  
...  
Keyword(s):  
Older Adults ◽  
Postural Control ◽  
Path Length ◽  
Vestibular Function ◽  
Vestibular Stimulation ◽  
Sham Stimulation ◽  
Important Relationship ◽  
Increased Risk ◽  
Risk Of Falls ◽  
The Impact

Previous studies have reported an important relationship between increasing age, vestibular impairment and increased risk of falls. Recently, noisy galvanic vestibular stimulation (nGVS) has been shown to improve postural control in older adults. However, this effect of nGVS in older adults has not been examined in interaction with the integrity of the vestibular function. We aimed at determining the effect of nGVS on postural control in older adults with and without vestibular impairment and ii) at examining the sustained effect of nGVS as compared to a sham stimulation. 36 older adults were randomly assigned to the nGVS group [n=24] or the sham group [n=12]. In the nGVS group, 12 participants had normal vestibular function and 12 had vestibular impairment. Static postural control was assessed prior to stimulation, during stimulation and immediately following 30 minutes of nGVS. Results showed that nGVS induced a significant improvement in sway velocity (p<0.001) and path length (p<0.001) compared to sham stimulation. In the nGVS group, participants with vestibular impairment showed a significant decrease of sway velocity (p<0.05) and path length (p<0.05) as compared to those with normal vestibular function. Improvements in sway velocity (p<0.001) and path length (p<0.001) induced by nGVS were sustained immediately following stimulation. These findings suggest that nGVS improves postural control in older adults, and that the effect of nGVS varies depending on the integrity of the vestibular function. Results also show that nGVS effect on postural control, compared to a sham stimulation, can be sustained after the end of stimulation.

scholarly journals Risk of falls associated with antiepileptic drug use in ambulatory elderly populations

2017 ◽  
Vol 150 (2) ◽  
pp. 101-111 ◽  
Author(s):  
Mira Maximos ◽  
Feng Chang ◽  
Tejal Patel
Keyword(s):  
Older Adults ◽  
Drug Use ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Fall Risk ◽  
Case Control ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Increased Risk ◽  
Risk Of Falls

Background: Falls are a major cause of morbidity and mortality in older adults. About a third of those aged 65 years or older fall at least once each year, which can result in hospitalizations, hip fractures and nursing home admissions that incur high costs to individuals, families and society. The objective of this clinical review was to assess the risk of falls in ambulatory older adults who take antiepileptic drugs, medications that can increase fall risk and decrease bone density. Methods: PubMed, EMBASE, MEDLINE and the Cochrane Library electronic databases were searched from inception to July 2014. Case-control, quasi-experimental and observational design studies published in English that assessed quantifiable fall risk associated with antiepileptic drug use in ambulatory patient populations with a mean or median age of 65 years or older were eligible for inclusion. One author screened all titles and abstracts from the initial search. Two authors independently reviewed and abstracted data from full-text articles that met eligibility criteria. Results: Searches yielded 399 unique articles, of which 7 met inclusion criteria—4 prospective or longitudinal cohort studies, 1 cohort study with a nested case-control, 1 cross-sectional survey and 1 retrospective cross-sectional database analysis. Studies that calculated the relative risk of falls associated with antiepileptic drug use reported a range of 1.29 to 1.62. Studies that reported odds ratios of falls associated with antiepileptic drug use ranged from 1.75 to 6.2 for 1 fall or at least 1 fall and from 2.56 to 7.1 for more frequent falls. Discussion: Health care professionals should monitor older adults while they take antiepileptic drugs to balance the need for such pharmacotherapy against an increased risk of falling and injuries from falls.

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