Depressive Symptoms, Subjective Cognitive Decline, and Subjective Sleep Quality Are Associated with Slips and Falls: Data from the Community Health Survey in Korean Adults

<b><i>Background:</i></b> Identifying the risk factors for falls among the elderly population is arguably one of the most imperative public health issues in the current aging society. <b><i>Objectives:</i></b> This study aimed to determine the associations between depressive symptoms, subjective cognitive decline (SCD), and poor subjective sleep quality and the risk of slips/falls in a Korean older population. <b><i>Methods:</i></b> This cross-sectional study involved 228,340 elderly individuals living in Korea. Measurements included self-reported depressive symptoms, SCD, and self-reported sleep quality. The risk of slips/falls was dichotomized depending on whether slips/falls had occurred during the past year, and the associations between different risk factors and slips/falls were explored. Multiple logistic regression was used to obtain the odds ratios (ORs) and 95% confidence intervals (CIs). Complex sampling methods were used to estimate the weighted value of each participant. <b><i>Results:</i></b> The risk of slips/falls was significantly associated with high levels of depressive symptoms (adjusted OR 1.06, 95% CI: 1.05–1.07) and SCD (adjusted OR 1.33, 95% CI: 1.19–1.50). Regarding each sleep quality component, the adjusted ORs for slips/falls were 1.85 for very poor sleep quality, 1.49 for long sleep latency, 1.04 for &#x3c;5 h of sleep duration, 1.32 for low sleep efficiency, 2.78 for high sleep disturbance, 1.52 for the use of sleep medication ≥3 times a week, and 1.82 for high daytime dysfunction due to sleep problems compared to the respective good sleep conditions. <b><i>Conclusions:</i></b> Our results demonstrated that depressive symptoms, SCD, and poor subjective sleep quality are independent factors affecting the occurrence of slips/falls. Thus, efforts to manage depressive symptoms and cognitive decline early and to improve sleep quality can be an alternative strategy to decrease the likelihood of falls.

Dynamic Performance-exposure Algorithm for Falling Risk Assessment and Fall Prevention in Community-dwelling Older Adults

Background: Several models and algorithms were designed to identify older adults at risk of falling supported on an intrinsically and extrinsically traditional approach. However, the dynamic interaction between multiple risk factors for falls must be considered. The present study aimed to design a dynamic performance-exposure algorithm for falling risk assessment and fall prevention in community-dwelling older adults.Methods: The study involved 1) a cross-sectional survey assessing retrospective falls, performance-related risk factors for falls (sociodemographic such as gender and age, cognitive, health conditions, body composition, physical fitness, and dual-task outcomes), exposure risk factors (environmental hazards and (in)physical activity), and performance-exposure risk factors (affordance perception), and 2) follow-up survey assessing prospective falls. Participants were Portuguese community dwellings (≥ 65 years). Data were reported based upon descriptive statistics, curve estimation regression, binary logistic regression, and ROC curve.Results: The selected and ordered outcomes included in the algorithm and respective cutoffs were: (1) falls in previous year (high risk: n>1, moderated: n=1, low risk: n=0); (2) health conditions (high risk: n >3, moderated: n=3, low risk: n<3); (3) multidimensional balance (high risk: score <32 points, moderated risk: 32 points ≤ score ≤33 points, low risk: score>33); (4) lower body strength (high risk: rep/30s< 11, moderated risk: 11≤ rep/30s ≤14, low risk: rep/30s >4); (5) perceiving action boundaries (high risk: overestimation bias, moderated risk: not applied, low risk: underestimation bias); (6) fat body mass (high risk: % fat >38, moderated risk: 37≤ % fat ≤38, low risk: % fat <7); (7) environmental hazards (high risk: n>5, moderated risk: n=5, low risk: n<5); (8) rest period (high risk: hours/day >4.5, moderated risk: 4≤ hours/day ≤4.5, low risk: hours/day <4); (9) physical activity metabolic expenditure (high risk: MET-min/week <2300 or >5200, moderated risk: 2300≤ MET-min/week <2800, low risk: 2800≤ MET-min/week ≤5200).Conclusions: Results demonstrated a dynamic relationship between older adults’ performance capacity and the exposure to falls opportunity, supporting the build algorithm’s conceptual framework. Fall prevention measures should consider the above factors that most contribute to the individual risk of falling, relative weights, and their distance from low-risk value, as proposed in the dynamic algorithm.

Exploratory Analysis Using Machine Learning of Predictive Factors for Falls in Persons with Type 2 Diabetes: A Longitudinal Study

We aimed to investigate the status of falls and to identify important risk factors for falls in persons with type 2 diabetes (T2D) including the non-elderly. Participants were 316 persons with T2D. They were assessed for medical history, laboratory data and physical capabilities during the hospitalization and given a questionnaire on falls one year after discharge. Two different statistical models, logistic regression and random forest classifier were used to investigate important predictors of falls. The response rate to the survey was 72%; of the 226 respondents, there were 129 males and 97 females (median age 62 years). The fall rate during the first year after discharge was 19%. Logistic regression revealed that knee extension strength (β= -0.698, P = 0.002), fasting C-peptide (F-CPR) level (β= 0.492, P = 0.009) and dorsiflexion strength (β= -0.432, P = 0.047) were independent predictors of falls. The random forest classifier placed knee extension strength, grip strength (0.234), F-CPR level and dorsiflexion strength in the top 4 important variables for falls. Lower extremity muscle weakness as well as elevated F-CPR levels and reduced grip strength was shown to be important risk factors for falls in T2D.

Falls and motor behavior in older adults

This mini-review focuses on intrinsic risk factors for falls, particularly the changes in motor behavior of faller older adults. Our purpose is to present evidence that faller older adults exhibit motor behavior changes beyond the typically investigated standing and walking tasks. We showed initially that postural control alterations with more prominent differences for fallers than non-fallers seem to depend on postural demands, availability of sensory information, and tasks performed concomitantly with the balancing task. We also provided evidence that walking speed is the most consistent aspect to differentiate fallers from non-fallers. This reduction in walking speed may be a strategy to improve gait stability to avoid a fall. More recent studies have shown that fallers presented modifications in the control of the prehension movement. These changes suggest that fallers have changes in movement categories other than balancing and walking, suggesting that fallers’ difficulties are broader than previously thought. The fact that faller older adults have modifications in the control of upper and lower limbs is indicative of a change in motor behavior involving gross and fine motor behaviors. The understanding of a faller as an individual with global changes in motor behavior has important implications for fall prevention and rehabilitation programs for these individuals.

Predictors of Falls in Older Adults With and Without Dementia

Persons living with dementia (PLWD) have up to twice the risk for falling and three-times the risk of serious fall-related injuries as those without dementia. Falls are a leading cause of hospitalizations among PLWD, who are more likely to incur high costs and experience negative health consequences (e.g, delirium, in-hospital falls) than persons without dementia. Few studies have examined risk factors for falls comparing Americans with and without dementia. We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study (n=5,581) to prospectively identify risk factors for a single fall and recurrent (2+) falls over a 12-month period among community-living older adults ≥65 years with and without dementia in a series of bivariate logistic regressions. Overall, we identified fewer predictors of single or recurrent falls among PLWD compared to persons without dementia. For example, socioeconomic indicators (e.g., income, financial hardship) predicted recurrent falls in persons without dementia, but not in PLWD. Among PLWD, falling in the previous year was associated with both single (odds ratio (OR): 3.38, 95% confidence interval (CI): 1.77, 6.49) and recurrent falls (OR: 6.19, 95% CI: 3.50, 10.93). PLWD who experienced recurrent falls were also more likely to be identified as having a fear of falling (OR: 2.17, 95% CI: 1.33, 3.54), physical function impairments, depression symptoms (OR: 2.23, 95% CI: 1.34, 3.71), and anxiety symptoms (OR: 1.73, 95% CI: 1.14, 2.62). Further study of fall-risk factors could inform screening, caregiver education and support, and prevention strategies for PLWD.

Increased recurrent falls experience in older adults with coexisting of sarcopenia and knee osteoarthritis: a cross-sectional study

Background Sarcopenia and knee osteoarthritis (OA) are two major risk factors for falls in older adults. The coexistence of these two conditions may exacerbate the risk of falls. This cross-sectional study aimed to test the hypothesis that older adults with coexisting sarcopenia and knee OA displayed an increased risk of falls experience. Methods Participants recruited from an orthopedic clinic were divided into four groups according to the presence of sarcopenia and radiographic knee OA: isolated sarcopenia, isolated knee OA, sarcopenia + knee OA, and control (i.e., non-sarcopenia with non-OA) groups. We used questionnaires to assess falls experience in the prior 12 months. We performed logistic regression analyses to evaluate the relationship between the four groups and falls experience. Results Of 291 participants (age: 60–90 years, 78.7% women) included in this study, 25 (8.6%) had sarcopenia + knee OA. Participants with sarcopenia + knee OA had 4.17 times (95% confidence interval: 0.84, 20.6) higher odds of recurrent falls (≥2 falls) than controls after adjustment for age, sex, and body mass index. The increased recurrent falls experience was not clearly confirmed in participants with isolated sarcopenia and isolated knee OA. Conclusions People with coexisting of sarcopenia and knee OA displayed increased recurrent falls experience. This study suggests a new concept, “sarcopenic knee OA”, as a subgroup associated with higher risk of falls, which should be validated in future large cohort studies. Trial registration. Not applicable.

The Effects of Mild Cognitive Impairment on Fall Severity in Older Adults

Falls affect more than 30% of older adults and are one of the leading causes of injury, hospitalization, and mortality in this populations. Mild cognitive impairment (MCI) is one of the risk factors for falls in older adults. The purpose of this study is to determine if older adults with MCI have increased fall severity than older adults without MCI. Participants (n: 81: age: 79 ± 6) completed a Montreal Cognitive Assessment (MoCA) and a Hopkins Falls Grading Scale, a tool used to grade the severity of falls on a scale of 1-4 (1 = loss of balance without fall; 4 = fall requiring hospital admission). Participants were categorized as having MCI (score &lt;26: N: 44: age: 81 ± 6.4) or non-MCI (score ≥26: n: 37: age: 77 ± 6). Groups were analyzed using a one-way ANOVA in SPSS to compare the severity of falls within the previous 12 months. There were no differences between groups for fall grade 1 (p =.22) or fall grade 2 (p =.45). There was a significant difference between groups for fall grade 3 (p =.04) and fall grade 4 (p =.05) with the MCI group having more of these falls compared to the non-MCI group. Older adults with MCI had a higher number of falls requiring medical attention than older adults without MCI. Although falls are a risk in all older adults, those with MCI may be at higher risk of more injurious falls than older adults without MCI.

Falls As a Problem of an Aging Population, a Modern Look at Risk Factors and Assessment Methods. Role of Fear of Falls in Increasing their Risk

The article presents modern views on the problem of falls in the elderly. There is a global trend of changing the demographic situation - the permanent increase in the proportion of elderly and senile people in the general population, the issues of geriatrics as one of the medical specialties are becoming the most relevant. Among the problems that geriatricians and all specialists involved in the treatment of elderly patients have to solve, one of the most serious is the problem of falls. The article provides a medical review of the assessment of the frequency of falls depending on gender, age, diseases and external factors. The main risk factors for falls and their prevention measures are discussed in detail. Special attention is given to the fear of falls as a significant risk factor. The methods of validation the risk factor with the use of unified questionnaires - “The scale of assessment of the fear of fa lls” and “the Falls efficacy scale” are presented. The purpose of this article is to attract the attention of practitioners to the problem of falls and the fear of falls as one of the significant risk factors, methods of its identification and prevention

Prevalence, Circumstances, and Risk Factors of Falls Among Community Dwelling Members of University of the Third Age

Objective: Study aimed to identify the prevalence of falls and associated contributory factors among older Malaysians.Methods: A cross sectional study among community dwelling older adults aged 50 years and above. Self-administered questionnaires on history of falls in the previous 12 months, physical assessment and computerized and clinical measures of balance were assessed on a single occasion.Results: Forty nine (31.0%) participants fell, with 4.4% reported having multiple falls within the previous 12 months. Slips were the most prevalent cause of falls, accounting for 49% of falls. More than half (54.5%) of falls occurred in the afternoon while participants walked inside the home (32.7%), outside home (30.6%), and 36.7% were in community areas. More than half of respondents were identified as having turning instability. Step Test, turn sway, depression, physical activity level and edge contrast sensitivity were significantly worse for fallers (p &lt; 0.05). Multiple logistic regression analysis showed that turning performance, visual acuity and back pain were significantly associated with falls risk, accounting for 72% of the variance of risk factors for falls among studied population.Conclusion: Falls are common among community dwelling older Malaysians. The findings provide information of falls and falls risk factors among community dwelling older adults in Malaysia. Future intervention studies should target locally identified falls risk factors. This study has highlighted the importance of instability during turning as an important fall risk factor.

Multifactorial interventions to prevent falls in older adults

BACKGROUND: Falls are one of the most common syndromes in old age. An estimated 646,000 deaths from falls occur each year worldwide. Moreover, most fatal falls occur in people over 65 years of age. Most falls are the result of the interaction of several factors. AIMS: To examine the long-term effectiveness of multifactorial interventions in preventing falls in elderly and senile patients. MATERIALS AND METHODS: A sample of patients territorially attached to the Family Medicine Center of the North-Western State Medical University named after I.I. Mechnikov was established four years ago. Individual fall prevention programs were developed for all study participants (n = 260) because they had different falls risk factors. Patient follow-up was continued for 12 months. The results of the multifactorial intervention were evaluated after 12 months and after 3 years, 2 times in total, the last study in a random subsample of patients (n = 84). Aging asthenia screening, questionnaires, assessment of emotional status, and presence of sleep disturbances were performed to assess the risk of falls. The effectiveness of multifactorial interventions was assessed based on repeated assessment of risk factors for falls. RESULTS: Participants with a history of falls were significantly more likely to have symptoms of depression, anxiety, symptoms of frailty, visual and hearing impairment (p 0.05). On average, each participant in the group with falls had 6.1 2.1 risk factors for falls and 3.8 2.3 in the group without falls (p = 0.000). During the follow-up period after the interventions, the incidence of falls decreased 9-fold after one year (from 28.5% to 3.1%) and then increased to 23.8%. All patients who fell after the multifactorial intervention had a history of cognitive impairment and falls. In addition, in the group of patients with falls, fall risk factors such as low levels of physical activity, hearing impairment, and the presence of a traumatic environment at home were not eliminated. As a result of the interventions, fear of falls disappeared in 9 patients, 95% CI (2.35-65.89), p = 0.039. CONCLUSIONS: The study demonstrated a decrease in the effectiveness of multifactorial interventions to prevent falls at three years. A less persistent effect was seen in patients with a history of falls. A history of falls, symptoms of frailty, complaints of fear of falls, sleep disturbances, and anxiety symptoms were factors that increased the risk of falls. Individualized fall prevention programs resulted in decreased fear of falls.