scholarly journals Introducing CatchU TM : A Novel Multisensory Tool for Assessing Patients’ Risk of Falling †

2021 ◽  
Author(s):  
Jeannette R. Mahoney ◽  
Claudene J. George ◽  
Joe Verghese
Keyword(s):  
Older Adults ◽  
Clinical Practice ◽  
Multisensory Integration ◽  
Screening Tool ◽  
Mobility Limitations ◽  
Healthy Older Adults ◽  
Research Perspective ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Cognitive Attention

To date, only a few studies have investigated the clinical translational value of multisensory integration. Our previous research has linked the magnitude of visual-somatosensory integration (measured behaviorally using simple reaction time tasks) to important cognitive (attention) and motor (balance, gait, and falls) outcomes in healthy older adults. While multisensory integration effects have been measured across a wide array of populations using various sensory combinations and different neuroscience research approaches, multisensory integration tests have not been systematically implemented in clinical settings. We recently developed a step-by-step protocol for administering and calculating multisensory integration effects to facilitate innovative and novel translational research across diverse clinical populations and age-ranges. In recognizing that patients with severe medical conditions and/or mobility limitations often experience difficulty traveling to research facilities or joining time-demanding research protocols, we deemed it necessary for patients to be able to benefit from multisensory testing. Using an established protocol and methodology, we developed a multisensory falls-screening tool called CatchU TM (an iPhone app) to quantify multisensory integration performance in clinical practice that is currently undergoing validation studies. Our goal is to facilitate the identification of patients who are at increased risk of falls and promote physician-initiated falls counseling during clinical visits (e.g., annual wellness, sick, or follow-up visits). This will thereby raise falls-awareness and foster physician efforts to alleviate disability, promote independence, and increase quality of life for our older adults. This conceptual overview highlights the potential of multisensory integration in predicting clinical outcomes from a research perspective, while also showcasing the practical application of a multisensory screening tool in routine clinical practice.

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 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 Two-Item Fall Screening Tool Identifies Older Adults at Increased Risk of Falling after Emergency Department Visit

2020 ◽  
Vol 21 (5) ◽  
Author(s):  
Christopher Solie ◽  
Morgan Swanson ◽  
Kari Harland ◽  
Christopher Blum ◽  
Kevin Kin ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Emergency Department Visit ◽  
Screening Tool ◽  
Risk Of Falling ◽  
Increased Risk ◽  
Fall Screening

scholarly journals Development of a Dementia-Focused End-of-Life Planning Tool: The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia)

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Kara Dassel ◽  
Rebecca Utz ◽  
Katherine Supiano ◽  
Sara Bybee ◽  
Eli Iacob
Keyword(s):  
Older Adults ◽  
Clinical Practice ◽  
Focus Groups ◽  
End Of Life ◽  
Family Caregivers ◽  
Early Stage ◽  
Healthy Adults ◽  
Planning Tool ◽  
Healthy Older Adults ◽  
Life Planning

Abstract Background and Objectives To address the unique characteristics of Alzheimer’s disease and related dementias (ADRD) that complicate end-of-life (EOL), we created, refined, and validated a dementia-focused EOL planning instrument for use by healthy adults, those with early-stage dementia, family caregivers, and clinicians to document EOL care preferences and values within the current or future context of cognitive impairment. Research Design and Methods A mixed-method design with four phases guided the development and refinement of the instrument: (1) focus groups with early-stage ADRD and family caregivers developed and confirmed the tool content and comprehensiveness; (2) evaluation by content experts verified its utility in clinical practice; (3) a sample of healthy older adults (n = 153) and adults with early-stage ADRD (n = 38) completed the tool, whose quantitative data were used to describe the psychometrics of the instrument; and (4) focus groups with healthy older adults, family caregivers, and adults with early-stage ADRD informed how the guide should be used by families and in clinical practice. Results Qualitative data supported the utility and feasibility of a dementia-focused EOL planning tool; the six scales have high internal consistency (α = 0.66–0.89) and high test–rest reliability (r = .60–.90). On average, both participant groups reported relatively high concern for being a burden to their families, a greater preference for quality over length of life, a desire for collaborative decision-making process, limited interest in pursuing life-prolonging measures, and were mixed in their preference to control the timing of their death. Across disease progression, preferences for location of care changed, whereas preferences for prolonging life remained stable. Discussion and Implications The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia) has the potential to facilitate discussion and documentation of EOL values and care preferences prior to loss of decisional capacity, and has utility for healthy adults, patients, families, providers, and researchers.

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.

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 Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing

2002 ◽  
Vol 5 (5) ◽  
pp. 655-662 ◽  
Author(s):  
Elaine Bannerman ◽  
Michelle D Miller ◽  
Lynne A Daniels ◽  
Lynne Cobiac ◽  
Lynne C Giles ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Weight ◽  
Longitudinal Study ◽  
Waist Circumference ◽  
Physical Function ◽  
South Australia ◽  
Self Report ◽  
Mobility Limitations ◽  
Australian Longitudinal Study ◽  
Increased Risk

AbstractObjective:To evaluate, in terms of function and mobility, the predictive value of commonly adopted anthropometric ‘definitions’ used in the nutritional assessment of older adults, in a cohort of older Australians.Design:Prospective cohort study – Australian Longitudinal Study of Ageing (ALSA).Setting:Adelaide, South Australia (1992–1994).Subjects:Data were analysed from 1272 non-institutionalised (685 males, 587 females) older adults ≥70 years old in South Australia. Seven ‘definitions’ commonly used in the anthropometric assessment of both under- and overnutrition (including four using body mass index (BMI), waist-to-hip ratio, waist circumference and percentage weight change) were evaluated at baseline, for their ability to predict functional and mobility limitation assessed (by self-report questionnaire) at two years follow-up. All questionnaires were administered and anthropometry performed by trained investigators. The associations between the definitions and decline in mobility and physical function were evaluated over two years using multiple logistic regression.Results:A BMI >85th percentile or >30 kgm−2 or a waist circumference of >102 cm in males and >88 cm in females increased risk of functional and mobility limitations. Over two years, a loss of 10% body weight significantly increased the risk of functional and mobility limitations.Conclusion:Maintaining weight within older adults, irrespective of initial body weight, may be important in preventing functional and mobility limitations. Excessive weight is associated with an increased risk of limitation in function and mobility, both key components of health-related quality of life.

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.

scholarly journals Prevalence and Determinants of Falls among Older Adults in Ecuador: An Analysis of the SABE I Survey

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos H. Orces
Keyword(s):  
Public Health ◽  
Older Adults ◽  
Coastal Region ◽  
Public Health Problem ◽  
Linear Increase ◽  
Andes Mountains ◽  
Major Public Health Problem ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Nationally Representative

The present study based on a nationally representative sample of older adults living in the Andes mountains and coastal region of the country indicates that 34.7% of older adults had fallen in the previous year in Ecuador. Among fallers, 30.6% reported a fall-related injury. The prevalence of falls was higher in women and among older adults residing in the rural Andes mountains. In the multivariate model, women, subjects with cognitive impairment, those reporting urinary incontinence, and those being physically active during the previous year were variables found independently associated with increased risk of falling among older adults in Ecuador. Moreover, a gradual and linear increase in the prevalence of falls was seen as the number of risk factors increased. Falls represent a major public health problem among older adults in Ecuador. The present findings may assist public health authorities to implement programs of awareness and fall prevention among older adults at higher risk of falls.

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