bluuebunny/crossref_metadata_2025 huggingface dataset:
115 How does Model Identity Influence Observational Learning in Information Technology? Insights from Older Adults
Authors: Ma Qi , Teh Pei-Lee , Chan Alan H S
Published: December 2019

Introduction

Older people are known as digital immigrants who are not born in the digital age and face many difficulties to effectively use information technology (IT). Therefore, the role of behavioral intervention such as observational learning becomes increasingly salient to assist older people to learn IT skills for better technology adoption. This study aimed to investigate the effectiveness of observational learning through behavior modeling in enhancing older adults’ IT acceptance. It is also expected that model identity from generational perspective (i.e., child, young, peer) would moderate the observational learning outcomes.

Method

Drawing from the social cognitive theory, observational learning experiment was conducted using a between-group design, wherein 59 community-dwelling Chinese older adults from Hong Kong completed all tasks. Three learning groups with different behavior models were set, viz, a child model group (21 older learners), a young model group (19 older learners), and a peer model group (19 older learners). Training outcomes were measured through objective quiz and subjective questionnaire. The pre and post learning differences, between group differences, and the effects of learning outcomes on usage intention were analyzed using paired t-test, ANOVA test, and multiple linear regression, respectively.

Results

This study affirmed the effectiveness of observational learning in improving older adults’ technology knowledge, self-efficacy, outcome expectations, and sense of social connectedness of using IT (all with p < 0.01). From generational perspectives, peer model is more influential than young or child model in increasing older adults’ self-efficacy (F = 3.878; p < 0.05) and willingness regarding using IT (F = 6.031; p < 0.01).

Conclusion

Results of this study contribute to the innovation of behavior intervention techniques for older adults to enhance their IT adoption. From the practical aspect, the results offer fresh insights for practitioners and trainers who design and deliver technology training programs for older adults.
116 Knowing what Older Adults Want: A Soft Service Robot in Object Retrieval Tasks
Authors: Lee Loong Yi , Hossen Ismaiil S , Syadiqeen Omar Ali , Teh Pei-Lee , Tan Chee Pin , Nurzaman Surya G
Published: December 2019

Introduction

An ageing society in this period of technological development may benefit from having service robots assist them in daily tasks. To that end, service robots that are equipped with soft grippers have the potential to handle the unstructured nature of objects such as eye-glasses and cutlery at homes. Drawing from Technology Acceptance Model, this paper aims to analyse technology adoption of a “soft service robot” for object retrieval tasks among older adults.

Method

A video demonstrating the operational functions of an in-house developed soft service robot was shown to 30 participants aged 60 and above. The video shows that the soft service robot can be remotely controlled through the internet to move around and pick up various household objects delicately. The soft service robot also enables users to interact with another individual through an integrated tablet. Thirty participants completed a survey measuring perceived ease of use, perceived usefulness, attitude towards the soft service robot and behavioural intention using seven-point Likert scales. Multiple regression analysis was performed to test the hypothesized model.

Results

Our study showed that the behavioral intention of older adults was jointly determined by the perceived usefulness (β=0.401; p-value< 0.01) and the attitude of the older adults towards the soft service robot (β=0.530; p-value<0.01). Interestingly, this study found a non-significant perceived ease of use-intention relationship (β=-0.167; p-value>0.05) in the model.

Conclusion

Our findings indicated that making a soft service robot easier-to-use has little or no impact on the formation of intentions. Essentially, a soft service robot that is perceived to be useful will be accepted by older adults. From a practical standpoint, it is of significant importance for service robotics designer and developers to build soft service robot with useful functions to enhance greater adoption of such technology among older adults.
120 Communicating Medication-Related Fall Risk via a Patient Portal: What is Important According to Older Fallers in Europe?
Authors: Ploegmakers Kim , Linn Annemiek , Medlock Stephanie , Van der Velde Nathalie , Van Weert Julia
Published: December 2019

Background

Falls are the leading cause of injury and functional decline in older adults. Medication is a leading cause of falls, second only to mobility impairments. Older adults with Fall Risk Increasing Drug (FRID) use are not aware of having a risk of falling and most of them don’t relate fall risk to their drug use. With this European survey we explored if: 1) older adults want to know their personal fall risk, 2) if they want this to be shown via a patient portal, 3) what other elements a patient portal should contain and 4) what potential barriers and facilitators exist for usage of a patient portal.

Methods

We distributed a questionnaire in 10 European countries that was filled in by 58 older fallers (mean age 75,5 years) who visited a geriatric outpatient clinic.

Results

Most participants wanted to know their fall risk (82,8%). The most important elements for the Portal, besides fall risk, were information on FRIDs and patient’s illnesses (62%) and access to the medical record (57%). Paying for the system (63%) and privacy issues (53%) were the most important barriers for using the Portal. A user-friendly Portal (57%), the ability to share information with the doctor (47%) and recommendation by doctors (47%) were the most important facilitators.

Conclusion

More knowledge dissemination is needed to make older fallers aware of medications that can cause falls. This can be done via a Patient Portal. For a successful implementation, the barriers and facilitators should be taken into account.
128 Getting Healthcare Students to be More Empathatic for Geriatric Patients: The Impact of Simulation Suit on Pharmacy Students
Authors: Lee Shaun , Teh Pei-Lee
Published: December 2019

Introduction

The world’s population worldwide is greying, and it is important that health care professionals such as pharmacists are able to gain proficiency in working with older adults who may be suffering from both physical and mental illnesses. One of the challenges for many schools that offer healthcare related courses is the need to support continued empathy towards this ageing population so that they can offer better healthcare services. Recently, ageing suits which are an immersive simulation suit designed to simulate the effects of ageing have been introduced to enable nursing students to experience what older adults face in health care situation.

Method

In this randomised controlled study, all year 1 students enrolled in the Bachelor of Pharmacy course (n=120) at our institution were assigned to either a polypharmacy only workshop or use an ageing suit together with polypharmacy workshop (intervention). The intervention group was tasked to perform a series of exercises, including walking a flight of stairs, picking up a coin as well as filling up a form. All participants completed the Jefferson Empathy Scale and semi-structured questionnaire.

Results

At the end of exercise, intervention group participants had a marginal improvement in their self-reported empathy levels, with an improvement of 1.7 +14.5 points compared to 1.2 + 9.4 points in control (p=0.81). Participants in the intervention reported changes in physical performance consistent with the expected changes associated with ageing. They also reported a change in attitude and were able to empathize better with older adults especially on issues related to patient communication.

Conclusion

As such, future research should also include and involve a wider range of students to ensure that they become health advocates for the health care needs of older adults. This will enable them to deliver better healthcare services to meet the needs of the older adults.
13 Characteristics, Circumstances, and Clinical Outcomes of Inpatient Falls in the Medical Department, Hospital Kuala Lumpur (HKL)
Authors: Karthigayan Aruna , Tarmizi Noor Azleen Ahmad , Chong Elizabeth Gar Mit , Mazzuin Rizah , Yau Weng Keong , Lee Fatt Soon
Published: December 2019

Introduction

Falls among hospital inpatients are common, generally ranging from 2.3 to 7 falls per 1000 patient bed days1. Around 30% of falls as inpatient are injurious2. Falls are associated with a longer length of stay in hospital and greater utilization of healthcare facilities3.

Objective

The goal of this study is to describe patient characteristics, circumstances of fall and clinical outcomes after inpatient fall

Methodology

This is a retrospective, descriptive study of all patients admitted to the Medical Department in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL.

Results

162 patients, with an average age of (61.82±15.50) years were included in this study. Of these, 103(63.58%) were male and 74(45.68%) were ≥65 years. 120(74.1%) were walking unaided prior to admission. 146(90.1%) patients were admitted with an acute medical illness and 13(8.0%) with an acute fall.

Median time to first fall was 5(IQR 3-8) days after admission. 160(98.77%) falls occurred in the ward. 79(48.77%) falls occurred between 9:00pm to 6:59am. 75(46.3%) patients fell near their bed and 56(34.6%) fell in the toilet. 47(29.01%) had an injurious fall; 32(19.7%) had minor injury, 9(5.6%) had moderate injury and 6(3.7%) had severe injury. Patients with injurious falls were more likely to have “Direct Impact to Head” during fall [OR; 12.73 (95%CI 5.62 – 28.82)]. They were also more likely to have a Head CT after fall [(OR; 6.41 (95%CI 3.02 – 13.62)]. 18(11.1%) patients died during hospitalisation. Median time to death was 9(IQR 4-16.25) days after fall. 144(88.9%) patients were discharged alive at median 6(IQR 3.75 – 9.25) days after fall. Upon discharge, only 49(30.2%) patients were walking unaided.

Conclusion

Inpatient falls affects patients of all age groups, regardless of gender. Our data shows that Inpatient falls can cause increased morbidity due to falls related injuries; however, there is no difference in age, gender, length of stay or death as inpatient between patients with injurious and non-injurious falls.
130 Impact of Balance Training in Virtual Reality on Body Balance in Patients after Total HIP Replacement
Authors: Hadamus Anna , Białoszewski Dariusz , Kowalska Aleksandra Justyna , Urbaniak Edyta , Boratyński Rafał , Marczyński Wojciech
Published: December 2019

Introduction

Virtual Reality (VR) training is becoming an increasingly popular form of exercise aiding in re-education of body balance. Many reports have demonstrated its effectiveness, greater patient involvement in exercise and better outcomes compared to traditional rehabilitation [1]. The aim of this study was to assess the impact of the additional training in VR on body balance in patients after total hip replacement.

Material and Methods

56 patients randomly assigned to an experimental group (30 people) and a control group (26 people) was included in the study. All patients had undergone THR within 2 to 12 weeks before the beginning of the study. The control group underwent standard post-operative rehabilitation, while a VR training programme was used in the experimental group as an additional rehabilitation tool. Balance was assessed with the VBC system and the AMTi AccuSway plate. The results were considered significant for p <0.05.

Results

CoP displacement in the frontal plane was reduced in both groups in tests with eyes closed (p<0.05). Other parameters in standing tests remain the same. The maximum forward deflection test has shown a significant increase in the range of forward movement in the experimental group (p <0.05). In the control group, the duration of the forward movement phase was reduced, but the range remained the same. The rhythmic sway test showed an increase in the average speed of movements in the experimental group (p <0.05). There were no changes in the control group.

Conclusions

1. Postural stability training in VR primarily involves dynamic aspects of the maintenance of balance.

2. Improvement in functional tests may indicate a better clinical outcome of rehabilitation in patients who have additionally trained in VR.

3. The improvement obtained in static tests most probably results from improvement in muscle strength and static stability resulting from the rehabilitation.
131 Impact of Virtual Reality Training in Patients After HIP Arthroplasty on Pressure Distribution in Standing and Walking
Authors: Hadamus Anna , Białoszewski Dariusz , Urbaniak Edyta , Kowalska Aleksandra Justyna , Wydra Kamil , Marczyński Wojciech
Published: December 2019

Introduction

Patients after hip arthroplasty (THR) load the feet asymmetrically during standing or walking. Many reports indicate effectiveness of the Virtual Reality (VR) training in reeducation of postural stability, gait parameters and symmetry. The aim of this study was to assess if VR training programme based on non-walking exercises improve gait parameters or change foot pressure distribution.

Materials and methods

56 patients after THR were randomly assigned to an experimental group (30 people) and a control group (26 people). The control group (CG) attended a standard post-operative rehabilitation programme, while 12 sessions of VR training were added to the standard programme in the experimental group (EG). Each patient performed standing with eyes opened and gait test on Zebris FDM-T treadmill. We calculated spatio-temporal parameters, foot pressure distribution and CoP displacement. The results were considered significant for p <0.05.

Results

In the static tests, the force on the forefoot and the rearfoot of the operated limb increased in EG (p<0.05). The force on the non-operated-side foot decreased and the force of the foot on the operated side increased in CG (p <0.05). No differences were found in the CoP movement in both groups.

Most of the gait parameters improved significantly in both groups (p<0.05). However, EG obtained superior results in comparison to CG (p <0.05) after rehabilitation with regard to step time in the operated limb, stride time, cadence and maximum force in the midfoot area in the operated limb.

Conclusions

1. The significantly better gait performance parameters obtained in the experimental group indicate a better movement capacity in these patients. This suggests that using VR in motor re-education in patients after THR may enhance the effects of rehabilitation.

2. Further studies are necessary to assess the influence of VR training on pressure distribution both in static and dynamic tests.
137 Fall-Risk Increasing Drugs
Authors: Van Der Velde Nathalie
Published: December 2019

Use of certain drugs (psychotropic and cardiovascular) has been indicated as one of the major risk factors for falls. However, in clinical practice, physicians struggle with withdrawal of fall-risk-increasing drugs. At the heart of this struggle lies the inadequacy of our knowledge pertaining to the effectiveness of drug withdrawal for individual patients. Complex interactions between risk factors for falls can be expected, especially for drug-related fall incidents, as both drug-drug interactions as well as drug-disease interactions are known to be of clinical relevance. Also, specific biomarkers may be of importance, such as genetic variations as was recently shown by our group. By lowering drug-related fall risk, loss of quality of life, institutionalization and death can be prevented. For optimal drug withdrawal in clinical practice, better understanding and prediction of drug-related fall risk is essential. The presentation will address identification of fall-risk increasing drugs and specifically predictive factors that may be of clinical relevance such as the effect of genetic variation on medication-related falls.
144 Polypharmacy and Anticholinergic Burden in Older People in Brunei Darussalam
Authors: Yeo Su Ying , Choo Sanny Zi Lung , Rosli Nadzirah , Koh Eng Chong , Teo Shyh Poh
Published: December 2019

Introduction

Polypharmacy and anticholinergic burden are associated with falls in older people. A longitudinal study found patients with five or more drugs had 21% increased falls over 2 years. [Dhalwani, Fahami, Sathanapally et al, BMJ Open, 2017,7(10), e016358]. A cohort study identified a 1.51 odds of recurrent falls with anticholinergic medication, while taking multiple anticholinergics resulted in 100% likelihood of recurrent falls. [Marcum, Wirtz, Pettinger, et al, BMC Geriatrics, 2016,16,76].

Methods

Retrospective study of polypharmacy in older people in Brunei based on data from Bru-HIMS, the Brunei public healthcare sector electronic prescribing and pharmacy management system. In this national study, stratified sampling was done by district, with patients randomly selected within each district. Active medications were identified from Bru-HIMS. The Anticholinergic Cognitive Burden (ACB) Scale was used to calculate anticholinergic burden. Findings for two districts (Tutong and Temburong) are described.

Results

For the 327 patients, 142 (43%) were male and 185 (57%) female. Median age was 72 years (Range 65 to 103 years). 234 (72%) had 5 drugs or more prescribed. Of the 2332 prescriptions, 268 (11.5%) had anticholinergic activity on the ACB scale. Median ACB score was 1. The most commonly prescribed were Orphenadrine, Chlorpheniramine, Diphenhydramine, Cinnarizine and Amitriptyline. There was a positive correlation between polypharmacy and anticholinergic burden (r = 0.4593).

Conclusion

There was a high rate of polypharmacy in older people, with anticholinergic drug burden identified. It may be useful to educate clinicians and patients regarding risks of polypharmacy and anticholinergic burden, including falls.
145 Antihypertensive Medications and Falls in the Older Person
Authors: Quah Jing Yao , Nadarajah Reena , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Lee Fatt Soon , Yau Weng Keong
Published: December 2019

Background

There have always been concerns about the increased risk of falls in the older person taking antihypertensive medications. This retrospective study is aimed to determine whether different classes and number of antihypertensive medication used were associated with increased risk of falls in the older person.

Methods

Data was obtained from the geriatric clinic database in HKL from 2015-2018. The data for fallers were extracted from the Falls Clinic while data for the control group of non-fallers were extracted from the General Geriatric clinic. Socio-demographic details, types of falls, types of medications, and risk factors of falls were analysed.

Results

117 of the cases who were fallers and 39 cases of non-fallers were analysed. Univariate logistic regression revealed that age, Parkinson’s disease and hypertension to have significant association with falls. The fallers were then analysed to assess falls risk with the use of antihypertensive medications. Those on one anti-hypertensive medication had an increased risk of recurrent falls (AOR = 3.16; 95% CI: 1.47–6.82) compared to those without antihypertensive medications (AOR = 0.37; CI: 0.13-1.03) and those with two or more antihypertensive medications (AOR = 0.56; CI: 0.27-1.16). Multivariate logistic regression also revealed that the use of all antihypertensive classes were not associated with recurrent falls and injuries from falls. However, patients who were on diuretics had significant odds of admission for falls (AOR 3.05; 95% CI 1.14-8.21) compared to ACE inhibitors or angiotensin receptor blockers (AOR 0.88; CI 0.38-2.10), beta blockers (AOR 0.88; CI 0.35-2.24), calcium channel blockers (AOR 0.96; CI 0.42-2.23) or alpha blockers (AOR 0.41; CI 0.09-1.99).

Conclusion

Older person with advanced age and Parkinson’s disease should be screened for risk of falling. In addition, all older people on antihypertensive medications especially diuretics should also be monitored for increased risk of falls.
147 Prevalence and Drug Classes of Medication Discrepancies among Elderly Patients Discharged from a Tertiary Hospital
Authors: Zaki Izzati Abdul Halim , Razali Rizah Mazzuin , Karuppannan Mahmathi , Gnanasan Shubashini , Alias Rosmaliah
Published: December 2019

Introduction

Medication-related hospital admission may lead to the development of harmful and unwanted side effects that increase the risk of mortality and morbidity. Multiple steps are being executed to overcome the medication errors and one of the strategies is through conducting the medication reconciliation process. This process involves creating an accurate list of patient’s medications which to be compared with the current medications list upon transfer from different point of care or discharge. Any differences detected are categorized as medication discrepancies either being intentional or unintentional. This study aims to determine the prevalence and drug classification of medications discrepancies among patient discharged from a geriatric ward.

Method

This study was conducted retrospectively for three months in a geriatric ward. Comparisons were made between medications list on admission from the Medication History Assessment Form with the in-patient medication chart and medications upon discharge by a pharmacist to detect any discrepancies. Descriptive analysis was used to identify prevalence and the drug classification of medication discrepancies among elderly patients discharged from tertiary hospital.

Results

1056 medications for 74 patients were screened for discrepancies. 689 (65.3%) discrepancies were detected with a mean of 9.31 ± SD 4.02. The highest number of intentional and unintentional medication discrepancies were detected in cardiovascular drugs (29.1%, n = 155) and (36.5%, n = 57). The drugs on admission and upon discharged that involved in discrepancies were diuretics, antihypertensives and antilipemic agents.

Conclusion

The number of medication discrepancies was found to be common among elderly patients discharged from the geriatric wards. Findings from this study have highlighted the importance of comprehensive medication reconciliation process prior to discharge in preventing medication discrepancies.
150 Falls in Malaysia: Magnitude, Risk, Disparities, and Solutions
Authors: Tan Maw Pin , Mat Sumaiyah , Alex Deepa , Kamaruzzaman Shahrul Bahyah
Published: December 2019

The Malaysian Elders Longitudinal Research (MELoR) study found 1 in 4 residents aged 65 years and over living in the Klang Valley of Malaysia fall at least once a year in their survey conducted between 2013 and 2015. Recent figures obtained from the First Older Persons’ National Health and Morbidity Survey conducted in 2018 revealed that 15% of Malaysians aged 60 years and over fall at least once a year. In a 10-year follow-up study involving 200 individuals who presented to the emergency department over a six-month period in 2002, 22% were no longer alive at one year, and 80% had died at 10 years. Older age, indoor falls, subsequent hospital admission and functional impairment predicted death at one year. Cross-sectional data from MELoR revealed ethnic differences in fall prevalence, with the ethnic Indians more likely to report falls in the past 12 months compared to the ethnic Malays. Independent risk factors for falls identified from MELoR were urinary incontinence, reduced grip strength, hearing impairment, comorbidities and reducing walking speed. The ethnic differences in falls in our population remain unexplained. Lifestyle and cultural practices may well be the underlying rationale, but genetic influences cannot currently be ruled out. The results of a randomized controlled trial on multifactorial interventions, the Malaysian Falls Assessment and Intervention Trial (MyFAIT), was published last year. Mo differences in falls outcomes with an individualized multifactorial intervention were observed, despite improvements in physical performance and psychological status in the intervention group compared to the control group. The research group has now secured two-year funding to evaluate post-fall behavior in our setting in the Life After Falls (LiAF) study. In addition, dissemination and upskilling efforts are underway through training workshops, formation of the Malaysian Falls Network (MyFalls) and collaborations with the private sector to increase awareness on falls and increase fall prevention efforts throughout the country.
158 Is it Just an Idea…Or More? Gerontechnology Research in Monash University Malaysia
Authors: Teh Pei-Lee
Published: December 2019

Malaysia is set to become an ageing population by 2030, when older people aged 65 years and above will constitute over 7% of the total population. In a bid to prepare for rapid ageing, Monash University Malaysia took the lead to establish the Gerontechnology Laboratory in 2016, the first of its kind in Malaysia. The aims of the Gerontechnology Laboratory are to translate research into new products, change existing business models and services, and shape public policies to improve the health and wellbeing of older people and those who care for them. The Gerontechnology Laboratory is a multidisciplinary research platform that brings together students, researchers, business partners, universities, government and the broader community to lead on research and innovations for older people within the five domains of human activity: health and self-esteem, housing and daily living, mobility and transport, communication and governance, and work and leisure. The lab also serves as a centre for education and training, assessment and consultation concerning gerontechnology, home safety, and independent living environment. Examples of external engagement include Gerontechnology Symposium (2017, 2018), Monash-Petrosains Gerontechnology Challenge (2018) and Monash Gerontechnology Lab Volunteer Community (2017-present). At the international level, the Monash University Malaysia’s Gerontechnology Lab was recognised as one of 21 international AACSB Innovations that Inspire 2019. This seminar will share how Monash University Malaysia builds the gerontechnology hub and leads the research and development for the study of gerontechnology in Malaysia.
161 Brain Activation Assessed with Functional Near-Infrared Spectroscopy (FNIRS) During Stepping and Gait in Older People and Those with PD
Authors: Menant Jasmine , Pelicioni Paulo , Okubo Yoshiro , Canning Colleen , Sturnieks Daina , Lord Stephen
Published: December 2019

Background and Aim

Past research has shown that compared with healthy peers, people with Parkinson’s Disease (PD) generate poorer stepping responses and display reduced ability to adapt gait to unexpected targets and obstacles. However, the neural basis of these impairments in PD is unclear. Here, we aimed to investigate cortical activation in pre-frontal and motor areas using functional near-infrared spectroscopy (fNIRS) during stepping and gait adaptability in people with PD, compared with healthy adults.

Methods

Forty-four people with PD (>40 years, Hoen & Yahr stage 1-3) and 44 healthy age and sex-matched healthy adults performed three cognitively-demanding stepping tasks and a test of gait adaptability. We recorded relative changes in oxy-haemoglobin (HbO) and deoxy-haemoglobin (HbR) concentrations in the dorsolateral prefrontal cortex, supplementary motor area, premotor cortex and primary cortex using fNIRS.

Results

Data collection is ongoing with >75% participants already assessed. We will conduct between group-comparisons to compare HbO and HbR concentrations in the selected regions of interest in the stepping and the gait adaptability tests. Physical and cognitive predictors of brain activation in each task in each group will also be computed using regression models.

Conclusion

Based on the results of our recent systematic review of fNIRS-recorded brain activation during walking tasks (1), we hypothesise that compared with healthy-aged matched peers, people with PD will show increased prefrontal and motor cortices activation during stepping and gait adaptability tests. This would suggest that people with PD require more attentional resources for safe walking.

Reference

(1) Pelicioni et al. Prefrontal cortical activation measured by fNIRS during walking: effects of age, disease and secondary task. Peer J 2019; 7: e6833.
164 Increasing Uptake and Adherence in Falls Prevention Interventions
Authors: Todd Chris
Published: December 2019

There is compelling evidence from Cochrane reviews that strength and balance exercise delivered with fidelity to the evidence and that is to dose, challenging, progressive and regular prevents falls. A core issue is found in these requirements since unless the exercise is done it will not work.

First we consider the various definitions used in the uptake and adherence literature (completion/ retention; drop-out; attendance; duration adherence; intensity adherence; uptake) revealing there is no standard approach (Hawley-Hague et al 2016. http://dx.doi.org/10.1136/bmjopen-2016-011560)

Improving uptake and adherence is deeply rooted in psychology, since at its essence is the issue of how to change behaviour. Over recent years a number of theories and approaches have been developed to behaviour change. We have recently developed an approach to aimed at improving uptake and adherence to exerciser based on the Health Action Process Approach (HAPA) (Boulton et al 2019 https://doi.org/10.1016/j.pcad.2019.01.003).

This paper describes the HAPA model and how it has been implemented in a paper and pencil based intervention as well as in a smartphone App version of the same intervention (aLiFE/eLiFE) and how this could be extended to the field of fall prevention in the future.
19 The Efficacy, Safety and Acceptability of Non-Pharmacologic Therapy for Orthostatic Hypotension in Older People: A Mixed Methods Study
Authors: Frith James , Robinson Lisa , Newton Julia
Published: December 2019

Introduction

First-line treatment for OH is typically with non-pharmacologic therapy. However, the current evidence base is poor, particularly in older people.

Aim

Determine the safety, efficacy and acceptability of single and combination therapies for OH in older people.

Methods

A three-stage, mixed-methods study consisting of a phase 2 efficacy study with a nested qualitative study. Stage One calculated response rates to therapy (defined as an improvement in standing systolic blood pressure (SSBP) by ≥10 mmHg). Stage Two explored the tolerability of therapies in qualitative interviews. Stage Three evaluated response rates to combinations of the most efficacious and tolerable therapies. All participants were aged ≥60 years, had OH and were recruited from a UK Falls and Syncope Service.

Results

Stage One. Response rates to therapies were evaluated in 25 older people (74 years, 60-92): Bolus-water drinking 56% (95%CI 35, 76); abdominal compression 52% (95%CI 31, 72), physical counter-maneuvers 44% (PCM, 95%CI 24, 65), full-leg length compression 32% (95%CI 15, 54).

Stage Two. PCM was considered an acceptable therapy as no equipment is required, is only needed during postural change and can be performed conspicuously. Water was largely acceptable but there were concerns around urinary frequency. Compression stockings were considered unacceptable due to cosmesis, practicalities and discomfort. There were mixed views on the tolerability of abdominal compression. There were no adverse events.

Stage Three. Response rates to combination therapy were evaluated in 37 older people (71 years, 60-94). Bolus water drinking + PCM 38% (95%CI 22, 55); water + PCM + abdominal compression 46% (95%CI 29, 63).

Conclusions

Due to its superior efficacy, safety and acceptability, bolus water drinking should become standard first-line therapy. Conversely, compression stockings should be disregarded in this population, as they are the least efficacious and most unacceptable treatment. Surprisingly, there is no additional benefit of combining therapies.
20 Optic Flow Stimuli Effects on Standing Balance in Young and Older People with Low and High Fall Risk
Authors: Sturnieks Daina , Tan Brandon , Persiani Michela , Brodie Matthew , Lord Stephen
Published: December 2019

Introduction

Optic flow stimuli can destabilise postural control, especially those with increased visual field dependence. This study aimed to examine the effects of optic flow stimuli on postural stability between: 1) younger and older adults; and 2) low-falls-risk and high-falls-risk older adults.

Methods

76 participants were grouped into ‘young’ (20-40 years, n=25), and ‘old’ (≥65 years, n=51); the latter was further stratified into ‘old-LFR’ (low fall risk, n=27) and ‘old-HFR’ (high fall risk, n=24). Participants stood on a force platform in a dark room with motion capture markers on the head, torso and lower limb. Optic flow stimuli were projected on a large screen encompassing the field of view as moving white dots for 30 seconds in four different conditions: radial expansion, radial contraction, circular (roll vection) anticlockwise and circular clockwise. Postural control was calculated from center of pressure (COP) and lower limb joint and trunk angles; changes between baseline (static dots) and optic flow conditions were compared between groups.

Results

Optic flow stimuli led young and older participants to shift their COP in the expected direction for each stimulus condition (forward for expansion, backward for contraction, left for anticlockwise, right for clockwise). For radial expansion, significantly increased anteroposterior sway was found in old-LFR and old-HFR (p≤0.001) but not \young (p≥0.17). Similar results were seen for radial contraction. For circular clockwise, significantly increase mediolateral sway was found in old-HFR (p=0.002) but not young (p=0.912) or old-LFR (p=0.749). Results differed for circular anticlockwise, with greater changes seen in anteroposterior sway compared with mediolateral, particularly in old-HFR. No stimuli by group interaction effects were seen in body kinematics.

Conclusions

Optic flow stimuli have a more destabilising effect on balance in older than younger adults, particularly those at increased risk of falling.
27 Cerebral Autoregulation Associated with Falls in Older Persons with Orthostatic Hypotension?
Authors: Saedon Nor Izzati , Hian Goh Choon , James Frith , Adnan Wan Azman Wan , Pin Tan Maw
Published: December 2019

Background

It is considered well-established that orthostatic hypotension (OH) is associated with falls, population-based studies have found that a large proportion of community-dwelling older adults fulfill the criteria for OH without experiencing falls. It is therefore postulated that older individuals with OH may only experience fall if cerebral autoregulation, which is the mechanism by which the brain blood flow is maintained constant through a autoregulatory range, is impaired.

Objective

To evaluate the relationship between cerebral autoregulation and OH in older individuals with and without a history of falls.

Method

Individuals aged 3 60 years were recruited from medical clinics, by word of mouth, and from existing research registries. Baseline sociodemographics, detailed medical history and medication history were obtained. Bilateral middle cerebral artery (MCA) blood flow were recorded using transcranial Doppler ultrasound (TCD) synchronized with non-invasive continuous blood pressure and ECG recordings. Synchronized brain blood flow signals, heart trace and blood pressure signals were first recorded during 10 minutes’ supine rest.

Participants were then be asked to perform a standard set of mathematical calculations, a Valsalva maneuver and to stand up from a seated position.

Results

36 participants have been evaluated to date (13 fallers, 23 non-Fallers). There is no statistically significant difference in gender, ethnicity or height and weight between groups. Fluctuations in MCA flow velocity were observed with spontaneous fluctuations in blood pressure at rest and with induced blood pressure changes during the challenge maneuvers. Visual inspection of the signals obtained suggested that changes in MCA flow velocity were more marked among fallers and non-fallers.

Conclusion

Synchronization of cerebral blood flow and continuous blood pressure signals opens up numerous new possibilities in research and clinical practice. Our preliminary findings suggest that cerebral autoregulation does play a role in determining the presence of symptomats in older individuals with OH.
31 Evidence, Assumptions, and Emerging Treatments for Falls Prevention
Authors: Montero-Odasso Manuel
Published: December 2019

Falls is a common geriatric syndrome that increases morbidity and mortality. Much of our understanding of falls mechanisms derives from studies that excluded or did not evaluate cognitively impaired older adults. This has limited the evidence for managing falls in this population and generated gaps in our understanding of how cognitive processes affect the pathophysiology of falls. This presentation will provide an overview of the role of cognition in falls with potential implications for managing and preventing falls in older adults. A thorough review of observational and interventional studies addressing the role of cognition on falls will be appraised. The importance of the gait-cognition relationship in aging and neurodegeneration is revised to highlight the role of brain motor control deficits in fall risk. The benefits of dual-task gait assessments as a marker of fall risk is reviewed. Therapeutic approaches for reducing falls by improving certain aspects of cognition will be also appraised.
32 Effect of Dual Task Training Regarding to Postural Stability in the Healthy Elderly
Authors: Yingyongyudha Anyamanee , Ramrong Thanakorn , Yodkue Piyatip , Jamjit Korawit , Suchart Pawaris , Ritdate Kittima
Published: December 2019

Introduction

Postural instability problem in the elderly is associated the cognitive impairment. The ageing process is directly linked to impairments in postural stability. Dual task activity is a commonplace to most activities of daily living. The elderly who has a postural instability and cognitive decline that are mechanisms which lead to an increased risk of falls in the elderly.

Objective

To investigate the effect of dual task training on postural stability in the healthy elderly.

Methods

The sixty-six healthy elderly were selected based on the inclusion criteria. With randomized 33 participants in each experimental and control group. The experimental group received dual task training for 6 weeks delivered three days per week. The control group received education for postural stability and aerobic exercise. Their postural stability was assessed using the Mini-BESTest in before and after training.

Results

The score of the Mini-BESTest compare between before and after 6 weeks were significantly different in postural stability and cognitive from that before in experimental group (p<0.001).

Conclusions

The finding support the dual task training program can improve postural stability in the elderly. Therefore, the dual task training program should be implemented with the elderly to be a choice of exercises for the elderly with postural instability.
35 The Impact of Postural Hyperkyphosis on Postural Stability and Cognition
Authors: Burns Krista
Published: December 2019

Background

Postural Hyperkyphosis results from flexor dominant posture habits. Flexor dominance occurs due to dysfunction of the pontomedullary reticular formation (PMRF) of the brainstem and the vestibular system. The role of the PMRF is to inhibit anterior flexion above T6 spinal level, and the vestibular system stimulates upright postural extension and balance.

When patients present with flexor dominance they have a Postural Hyperkyphosis postural distortion pattern and abnormal muscle activation patterns. To correct flexor dominance, practitioners should perform brain-based exercises, not just structural exercises. Brain based stimulation of the vestibular system and the brainstem stimulates upright extension of the Posture System and inhibition of anterior flexion to reduce Postural Hyperkyphosis.

Postural Hyperkyphosis contributes to multiple health discrepancies. According to Cohen, Vasavada, and Wiest et al. (2016) in the Frontiers of Neuroscience, Postural Hyperkyphosis is associated with a lower state of cognition. According to Kado, Huang, and Nguyen et al. (2007) in the Journals of Gerontology hyperkyphosis is associated with poor balance and injurious falls in the elderly. Brainstem and vestibular activation reduces flexion and improves extension for better postural correction outcomes.

Results

Brain Based exercises reduce Postural Hyperkyphosis and improve postural stability and cognition of elderly patients. Brain Based exercises are safe for the elderly to perform and can be easily implemented into physical rehabilitation treatment plans for better postural correction results.

Conclusion

Correcting Postural Hyperkyphosis to improve Postural Stability and cognition requires a Brain Based treatment protocol.
38 Process Evaluation of the Praised 2, A Multi-Centre Randomised Controlled Trial (RCT) Testing the Clinical and Cost-Effectiveness of a Therapy Intervention Designed to Promote Activity and Independence Amongst People with Early Dementia or Mild Cognitive Impairment
Authors: Di Lorito Claudio , Pollock Kristian , Harwood Rowan , Booth Vicky , Goldberg Sarah , Van der Wardt Veronika
Published: December 2019

Introduction

The 'Promoting Activity, Independence and Stability in early dementia and cognitive impairment' (PrAISED 2) is a randomised controlled trial testing the effectiveness of an exercise and physical activity programme for people with mild cognitive impairment and early dementia. Parallel to the trial, our team is conducting a process evaluation, whose aims are to: 1. Determine the extent to which the programme is being delivered according to plan; 2. Gather feedback from the primary stakeholders on the quality of programme implementation. Here we present preliminary results from the PrAISED 2 process evaluation.

Methods

The process evaluation comprises two studies: 1. An implementation study, examining the extent to which the programme is being delivered according to plan, which investigates Fidelity (i.e. the consistency of what is implemented with the planned intervention), Adaptations (i.e. alterations made to achieve better contextual fit), Dose (i.e. how much intervention is delivered) and Reach (i.e. the extent to which agents come into contact with the intervention). 2. A study on the mechanisms of impact and context, gathering feedback on the quality of implementation thorugh qualitative interviews with participants with dementia and their carers (as dyads) and therapists delivering the intervention.

Results

The process evaluation is ongoing and results will be available in Autumn 2019.

Conclusion

Results from the PrAISED 2 process evaluation will: enable the identification of the active ingredients within the intervention and explain how they are exerting their effect; explain discrepancies between expected and observed outcomes; help to understand how context influences outcomes; provide crucial insights to aid implementation. Findings from this study will represent transferable knowledge for researchers interested in the mechanisms that affect the success of physical interventions for people with frailty.
50 Sociodemographic, Physical Performance and Fear of Falls Profile of Older Adult Fallers and Non Fallers: A Preliminary Study
Authors: Ibrahim Azianah , Hassan Nur Aimuni Abu , Hassan Halizahanim
Published: December 2019

Introduction

It is important to identify older adult fallers in order to implement early prevention management also prevent recurrent falls. This study aimed to explore the profiles of older adult fallers and non-fallers in regards to socio-demographic, physical performance, fear of falls that includes the activities that were feared in regard to falls.

Analysis

Descriptive and mean comparison test.

Methodology

Participants for this study were recruited among individuals aged 60 years and above, able to walk 3m, able to stand independently for longer than 1min and able to comprehend and follow instructions. Exclusion criteria include recent vertebral or lower limb fracture (less than 6months), unstable angina, unable to follow command and severe hearing and vision impairment. Design: Cross-sectional study.

Results

A number of 27 older adults were screened for falls. Based on Timed Up and Go test (cut off 11.18s), 8 (29.6%) of them were identified as fallers. Fallers were majority females (10, 37%), had visual impairment (4,14.8%), older (77.4±2.9years versus 68.4±5.7years) and had slightly higher in fear of falls score (13.2±5.5 versus 12.0±7.0). In view of physical performance, fallers were slower in Timed Up and Go test (13.6±2.4 versus 9.1±1.4), weaker in hand grip strength (14.3±2.5kg versus 21.5±19.3kg) and weaker in sit-to-stand performance (13.3±2.7s versus 10.7±2.7s). Age (p<0.05) and sit-to-stand performance (p<0.05) significantly differed between fallers and non-fallers. Among seven activities assessed using short Falls Efficacy Scale-International, non-fallers were found to have more fear during various activities compared to fallers.

Implication

Exploration of falls risk profiles in older adults will hopefully allow better understanding and further improvement in developing falls prevention management plans.
51 A Prospective Study on Falls Efficacy and Functional Outcomes after HIP Fracture Surgery in a Singapore Orthogeriatric Programme
Authors: Goh Kiat Sern , Serena Kiat Mun , Chandran Thulasi
Published: December 2019

Introduction

Fear of Falling (FoF) is common after hip fracture and associated with adverse outcomes including impaired functional recovery and recurrent falls. The objective of this study was to measure self-efficacy related to falls and its association with functional outcomes after hip fracture surgery.

Methods

A prospective cohort study was performed on 106 community-dwelling elderly aged ≥65 years without dementia, admitted to a community hospital for rehabilitation after surgery for fragility hip fracture in Singapore. They were managed in an integrated multidisciplinary orthogeriatric programme, transitioning from acute orthopaedic unit to the affiliated community hospital. Falls Efficacy Scale (FES; range 10-100) was assessed on discharge. Main outcomes measured included Parker Mobility Score (PMS) and Modified Barthel Index (MBI) at 3 months.

Results

Key characteristics of the cohort were: mean age 79.4(SD 6.38); female 74%, Chinese 83%, pre-fracture PMS 6.7(SD 2.7); pre-fracture MBI 81.1(SD 20.9); mean FES score 32.0(SD 23.7). At 3 months, mean PMS was 3.97(SD 2.51); mean MBI was 73(SD 20.1), demonstrating that the cohort overall did not regain their pre-morbid functional levels. FES was negatively correlated with both 3-month MBI and PMS with coefficients -0.592 and -0.523 respectively (p<0.001). FES was negatively associated with 3-month MBI and PMS in the multiple linear regression model, having adjusted for demographics, comorbidities, pre-fracture MBI and PMS, MMSE, geriatric depression scale, and post-operative weight-bearing status, with corresponding βs -0.26(95%CI -0.49 to -0.02;p=0.032) and -0.03(95%CI -0.06 to -0.00;p=0.044).

Conclusion

FoF is a potentially modifiable factor linked to adverse functional outcomes in hip fracture rehabilitation, indicating the necessity to address falls self-efficacy as a major component of assessment and intervention, whilst further exploring the local validity and applicability of various instruments measuring FoF. Further studies need to be conducted on the evolving patterns of FoF over time and its impact on longer-term functional and psychosocial outcomes.