Gait, cognition and falls over 5 years, and Motoric Cognitive Risk in New Zealand octogenarians: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS

Abstract Introduction Understanding falls risk in advanced age is critical with people over 80 a rapidly growing demographic. Slow gait and cognitive complaint are established risk factors and together comprise the Motoric Cognitive Risk Syndrome (MCR).Objectives To examine trajectories of gait and cognition, and associations with falls over 5 years, and to document MCR in Māori and non-Māori of advanced age living in New Zealand.Method Falls frequency was ascertained retrospectively at annual assessments. Gait speed (3m), cognition (3MS) and MCR were reported. Gait and cognition trajectories were modelled and clusters identified from Latent Class Analysis. GEE examined association between changes in gait, cognition, MCR and falls.Results At baseline, 138 of 408 Māori (34%) and 205 of 512 non-Māori (40%) had fallen. Mean (SD) gait speed (m/s) for Māori was 0.66 (0.29) and 0.82 (0.26) for non-Māori. Respective 3MS scores were 86.2 (15.6) and 91.6 (10.4). Ten (4.3%) Maori participants met MCR criteria, compared with 7 (1.9%) non-Māori participants. Māori men were more likely to fall (OR 1.56; 95% CI 1.0 – 2.43 ( P = 0.04) whilst for non-Māori slow gait increased falls risk (OR 0.40; 95% CI 0.24 – 0.68( P <0.001). Non-Māori with MCR were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06 – 5.68 ( P = 0.03).Conclusions Māori and non-Māori of advanced age show a mostly stable pattern of gait and cognition over time. Risk factors for falls differ for Māori, and do not include gait and cognition.

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Gait, cognition and falls over 5 years, and Motoric Cognitive Risk in New Zealand octogenarians: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ

10.21203/rs.2.16800/v2 ◽

2019 ◽

Author(s):

Sue Lord ◽

Simon Moyes ◽

Ruth Teh ◽

Waiora Port ◽

Marama Muru-Lanning ◽

...

Keyword(s):

Risk Factors ◽

New Zealand ◽

Gait Speed ◽

Latent Class ◽

Linear Models ◽

Advanced Age ◽

Falls Risk ◽

Cognitive Risk ◽

Cognitive Complaint ◽

Risk Factors For Falls

Abstract Background Understanding falls risk in advanced age is critical with people over 80 a rapidly growing demographic. Slow gait and cognitive complaint are established risk factors and together comprise the Motoric Cognitive Risk Syndrome (MCR). This study examined trajectories of gait and cognition and their association with falls over 5 years, and documented MCR in Māori and non-Māori of advanced age living in New Zealand. Method Falls frequency was ascertained retrospectively at annual assessments. 3 metre gait speed was measured and cognition was assessed using the Modified Mini-Mental Status Examination (3MS). Frequency of MCR was reported. Gait and cognition trajectories were modelled and clusters identified from Latent Class Analysis. Generalised linear models examined association between changes in gait, cognition, MCR and falls. Results At baseline, 138 of 408 Māori (34%) and 205 of 512 non-Māori (40%) had fallen. Mean (SD) gait speed (m/s) for Māori was 0.66 (0.29) and 0.82 (0.26) for non-Māori. Respective 3MS scores were 86.2 (15.6) and 91.6 (10.4). Ten (4.3%) Maori participants met MCR criteria, compared with 7 (1.9%) non-Māori participants. Māori men were more likely to fall (OR 1.56; 95% CI 1.0 – 2.43 (P = 0.04) whilst for non-Māori slow gait increased falls risk (OR 0.40; 95% CI 0.24 – 0.68(P <0.001). Non-Māori with MCR were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06 – 5.68 (P = 0.03). Conclusions Māori and non-Māori of advanced age show a mostly stable pattern of gait and cognition over time. Risk factors for falls differ for Māori, and do not include gait and cognition.

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Mobility Impairment in Patients New to Dialysis

American Journal of Nephrology ◽

10.1159/000509225 ◽

2020 ◽

Vol 51 (9) ◽

pp. 705-714

Author(s):

Ranjani N. Moorthi ◽

William F. Fadel ◽

Alissa Cranor ◽

Judy Hindi ◽

Keith G. Avin ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Gait Speed ◽

Handgrip Strength ◽

Health Utility ◽

Mixed Effects ◽

Mobility Impairment ◽

Lower Health ◽

Over Time

Background: Impaired mobility is associated with functional dependence, frailty, and mortality in prevalent patients undergoing dialysis. We investigated risk factors for mobility impairment, (poor gait speed) in patients incident to dialysis, and changes in gait speed over time in a 2-year longitudinal study. Methods: One hundred eighty-three patients enrolled within 6 months of dialysis initiation were followed up 6, 12, and 24 months later. Grip strength, health-related quality of life, and comorbidities were assessed at baseline. Outcomes were (a) baseline gait speed and (b) change in gait speed over time. Gait speed was assessed by 4-meter walk. Multivariate linear regression was used to identify risk factors for low gait speed at baseline. For longitudinal analyses, linear mixed effects modeling with gait speed modeled over time was used as the outcome. Results: Participants were 54.7 ± 12.8 years old, 52.5% men, 73.9% black with mean dialysis vintage of 100.1 ± 46.9 days and median gait speed 0.78 (0.64–0.094) m/s. Lower health utility and grip strength, diabetic nephropathy, and walking aids were associated with lower baseline gait speed. Loss of 0.1 m/s gait speed occurred in 24% of subjects at 1 year. In multivariate mixed effects models, only age, walking aid use, lower health utility, and lower handgrip strength were significantly associated with gait speed loss. Conclusions: In our cohort of incident dialysis patients, overall gait speed is very low and 54.2% of the subjects continue to lose gait speed over 2 years. Older age, lower handgrip strength, and quality of life are risk factors for slowness. Patients at highest risk of poor gait speed can be identified at dialysis initiation to allow targeted implementation of therapeutic options.

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Changes in housing among older women: Latent class analysis of housing patterns in older Australian women

Urban Studies ◽

10.1177/0042098016661309 ◽

2016 ◽

Vol 55 (4) ◽

pp. 917-934 ◽

Cited By ~ 8

Author(s):

Julie Byles ◽

Cassie Curryer ◽

Kha Vo ◽

Peta Forder ◽

Deborah Loxton ◽

...

Keyword(s):

Older Women ◽

Latent Class ◽

Later Life ◽

Aged Care ◽

Residential Aged Care ◽

Administrative Records ◽

Stable Pattern ◽

Retirement Village ◽

New Evidence ◽

Over Time

Scant research exists on the patterns of changes in older women’s housing, and whether and when women transition into residential aged care (RAC). This study aimed to identify groups of women with different housing patterns (latent classes) over time, with a secondary aim to describe socio-demographic and health characteristics of women in each class. We analysed linked data for 9575 women born 1921–1926 from the Australian Longitudinal Study of Women’s Health (ALSWH), Australian National Death Index, and Residential Aged Care (RAC) administrative records for the years 1999 through to 2011. Seven distinct housing patterns (classes) were identified over time. Four classes showed a stable pattern: living in a house for most surveys (47.0%), living in a house but with earlier death (13.7%), living in an apartment (12.8%), living in a retirement village (5.8%). One class showed a pattern of downsizing: moving from a house to retirement village (6.6%). Two patterns showed transition: from an apartment or retirement village, to RAC and death (7.8%), and from house to RAC (6.4%). This study provides new evidence about socio-demographic and health influences on housing patterns and entry into residential care in later life. These findings can inform policy and aged care planning for women in later life, by identifying patterns of transition into residential aged care, or alternatively, remaining in the community.

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Falls Risks and Prevention Behaviors Among Community-Dwelling Homebound and Non-Homebound Older Adults

Journal of Applied Gerontology ◽

10.1177/0733464816672043 ◽

2016 ◽

Vol 37 (9) ◽

pp. 1085-1106 ◽

Cited By ~ 4

Author(s):

Carri Casteel ◽

Jennifer Jones ◽

Paula Gildner ◽

James M. Bowling ◽

Susan J. Blalock

Keyword(s):

Risk Factors ◽

Older Adults ◽

Negative Binomial ◽

Community Dwelling ◽

Falls Prevention ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Falls Risk ◽

Homebound Older Adults ◽

Risk Factors For Falls

The objectives were to examine falls risk factors to determine how the magnitude of risk may differ between homebound and non-homebound older adults, and to describe falls prevention behaviors and participation in falls prevention education. A cross-sectional survey was conducted with convenience samples of community-dwelling older adults recruited through Meals on Wheels programs (homebound, n = 80) and senior centers (non-homebound, n = 84) in North Carolina. Data were collected during home visits and included an interview and medication inventory. Multivariate negative binomial regression with robust variance estimation modeled risk factors for falls. Risk factors for falls observed in both the homebound and non-homebound populations are consistent with what is known in the literature. However, the magnitude of the risk was higher in the homebound than in the non-homebound population with respect to vision impairments, number of high-risk and over-the-counter medications, and use of walking aids .Few participants reported participating in a falls prevention program.

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´Feet are second class citizens`: exploring the perceptions of Scottish and Portuguese older adults about feet, falls and exercise- a qualitative study

Journal of Foot and Ankle Research ◽

10.1186/s13047-020-00434-8 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Monserrat Conde ◽

Gordon J. Hendry ◽

Jim Woodburn ◽

Dawn A. Skelton

Keyword(s):

Risk Factors ◽

Older Adults ◽

Qualitative Study ◽

Community Dwelling ◽

Falls Prevention ◽

Main Theme ◽

Foot And Ankle ◽

Falls Risk ◽

Risk Factors For Falls

Abstract Introduction Foot problems are likely to contribute to falls risk in older adults. Foot and ankle exercises may be beneficial, but uptake may be influenced by cultural factors. Few studies have explored the views of older adults from different cultural backgrounds about foot-specific falls risk factors, and foot and ankle falls prevention exercises. Objectives To explore the views of Scottish and Portuguese community-dwelling older adults who have experienced a fall, about any foot risk factors for falls, and foot and ankle exercises. Methods Cross-cultural qualitative study with (n = 6) focus groups exploring the perceptions of Scottish (n = 10, mean age 76 yrs) and Portuguese older adults (n = 14, mean age 66 years) aged, applying thematic analysis. Results One main theme `evolving awareness about feet and falls prevention´ and three subthemes; (i) Feet are often forgotten, (ii) the important role of footwear, (iii) need to look at my feet and do the exercises were identified. Scottish participants had more experience of falls prevention but there was a lack of knowledge surrounding foot-specific falls risk factors, and the role of ankle and foot exercise in the prevention of falls. Portuguese participants exhibited a fatalistic approach to falls. Conclusions Older adults from both nations had little knowledge of foot-specific falls risk factors, being initially unaware of the functional status of their feet and of the role of exercise in foot care and falls management. There were differences between national groups that should be accounted for when developing culturally adequate interventions.

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Future Directions for Psychology in Critical Care

10.1093/oso/9780190077013.003.0017 ◽

2021 ◽

pp. 373-388

Author(s):

Dorothy Wade ◽

Julie Highfield

Keyword(s):

Risk Factors ◽

Critical Care ◽

International Perspective ◽

Future Directions ◽

Body Of Knowledge ◽

The United Kingdom ◽

Cognitive Risk ◽

Practice Of Medicine ◽

The Impact ◽

Over Time

This chapter outlines the authors’ thoughts about the way critical care psychology will develop and increase its impact, for the benefit of patients, families, and staff, in the future. They review the current body of knowledge regarding the patient experience, psychological and cognitive risk factors, outcomes, and interventions in critical care and discuss how it can be strengthened and translated from testimony and theory into practice. The authors discuss the changes required in the philosophy and practice of medicine, as well as in societal trends. An international perspective is offered that briefly discusses differences between countries and how these practices might influence one another over time. The impact and unique challenges encountered during the recent COVID-19 pandemic are used to emphasize how an increased role for the critical care psychologist had already taken root more firmly in the United Kingdom than in many other countries.

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A Latent Class Approach to Modeling Trajectories of Health Care Cost in Pediatric Cystic Fibrosis

Medical Decision Making ◽

10.1177/0272989x19859875 ◽

2019 ◽

Vol 39 (5) ◽

pp. 593-604 ◽

Cited By ~ 1

Author(s):

Joseph F. Levy ◽

Marjorie A. Rosenberg

Keyword(s):

Risk Factors ◽

Cystic Fibrosis ◽

Bayesian Estimation ◽

Latent Variables ◽

Latent Class ◽

Low Cost ◽

Risk Profile ◽

Cost Of Care ◽

Class Membership ◽

Over Time

Introduction. Estimating costs of medical care attributable to treatments over time is difficult due to costs that cannot be explained solely by observed risk factors. Unobserved risk factors cannot be accounted for using standard econometric techniques, potentially leading to imprecise prediction. The goal of this work is to describe methodology to account for latent variables in the prediction of longitudinal costs. Methods. Latent class growth mixture models (LCGMMs) predict class membership using observed risk factors and class-specific distributions of costs over time. Our motivating example models cost of care for children with cystic fibrosis from birth to age 17. We compare a generalized linear mixed model (GLMM) with LCGMMs. Both models use the same covariates and distribution to predict average costs by combinations of observed risk factors. We adopt a Bayesian estimation approach to both models and compare results using the deviance information criterion (DIC). Results. The 3-class LCGMM model has a lower DIC than the GLMM. The LCGMM latent classes include a low-cost group where costs increase slowly over time, a medium-cost group with initial higher costs than the low-cost group and with more rapidly increasing costs at older ages, and a high-cost group with a U-shaped trajectory. The risk profile-specific mixtures of classes are used to predict costs over time. The LCGMM model shows more delineation of costs by age by risk profile and with less uncertainty than the GLMM model. Conclusions. The LCGMM approach creates flexible prediction models when using longitudinal cost data. The Bayesian estimation approach to LCGMM presented fits well into cost-effectiveness modeling where the estimated trajectories and class membership can be used for prediction.

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Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up

Neurosurgery ◽

10.1093/neuros/nyaa190 ◽

2020 ◽

Author(s):

Sophie J M Rijnen ◽

Elke Butterbrod ◽

Geert-Jan M Rutten ◽

Margriet M Sitskoorn ◽

Karin Gehring

Keyword(s):

Risk Factors ◽

At Risk ◽

Risk Factor ◽

Cognitive Impairment ◽

Regression Models ◽

Cognitive Domains ◽

Cognitive Risk ◽

Postoperative Cognitive Impairment ◽

Over Time ◽

Cognitive Risk Factors

Abstract BACKGROUND Pre- and postoperative cognitive deficits have repeatedly been demonstrated in patients with glioblastoma (GBM). OBJECTIVE To identify presurgical risk factors that facilitate the identification of GBM patients at risk for postoperative cognitive impairment. METHODS Patients underwent neuropsychological assessment using Central Nervous System Vital Signs 1 d before (T0) and 3 mo after surgery (T3). Patients’ standardized scores on 7 cognitive domains were compared to a normative sample using one-sample z tests. Reliable change indices with correction for practice effects were calculated to assess cognitive changes in individual patients over time. Logistic regression models were performed to assess presurgical sociodemographic, clinical, psychological, and cognitive risk factors for postoperative cognitive impairments. RESULTS At T0, 208 patients were assessed, and 136 patients were retested at T3. Patients showed significantly lower performance both prior to and 3 mo after surgery on all cognitive domains compared to healthy controls. Improvements and declines over time occurred respectively in 11% to 32% and 6% to 26% of the GBM patients over the domains. The regression models showed that low preoperative cognitive performance posits a significant risk factor for postoperative cognitive impairment on all domains, and female sex was a risk factor for postoperative impairments in Visual Memory. CONCLUSION We demonstrated preoperative cognitive risk factors that enable the identification of GBM patients who are at risk for cognitive impairment 3 mo after surgery. This information can help to inform patients and clinicians at an early stage, and emphasizes the importance of recognizing, assessing, and actively dealing with cognitive functioning in the clinical management of GBM patients.

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For Falls Sake: Older Carers' Perceptions of Falls and Falls Risk Factors

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2007.1160 ◽

2007 ◽

Author(s):

Shylie Mackintosh ◽

Caroline Fryer ◽

Michele Sutherland

Keyword(s):

Risk Factors ◽

Falls Prevention ◽

Prevention Strategies ◽

Risk Of Falling ◽

Older Patient ◽

Falls Risk ◽

Pavement Maintenance ◽

Related Risk ◽

Risk Factors For Falls ◽

Balance Problems

Purpose: Older carers play an important role in falls prevention through their influence over their dependent’s actions and by their own behaviour. This study aimed to determine the perceptions of falls and fall-related risk factors by older carers in an Australian metropolitan community to inform the development of effective falls prevention strategies in this population. Method: A questionnaire was mailed to all members of a carers group in January 2003 and responses from carers aged 60 years or above were included in the study (n=121). Results: The majority of older carers (85%) understood that falls are a problem for their age group and that falls can be prevented (74%). Poor pavement maintenance and balance problems were rated as the most important risk factors for falls. The importance of unsafe behaviour as a falls risk was undervalued. The majority of respondents (74%) indicated they would talk to their doctor if they were concerned about falling. Conclusions and Recommendations: The results of this study indicate that older carers in a metropolitan community acknowledge falls are both important and preventable. The awareness of unsafe behaviour as a falls risk factor needs to be raised. Health professionals are trusted by older carers and should discuss falls prevention strategies with both the older patient and their carer. The next stage is to explore if older carers understand how they can reduce the risk of falling for themselves and their dependents, and how to effectively engage and enable older carers to do this successfully.

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