bluuebunny/crossref_metadata_2025 huggingface dataset:
157 Diabetes Self-Management Training with a Mobile APP among Older Adults in Taiwan: Comparative and Longitudinal Program Effectiveness
Authors: Wu Shinyi
Published: December 2019

Diabetes is a prevalent chronic disease and a major medical disability worldwide. It affects 1 in 5 older people in Taiwan. Use of mobile computing technology has become increasingly prevalent among older adults but its potential to improve diabetes self-management and social integration is only begun to be realized.

This presentation will introduce the Intergenerational Mobile Technology Opportunities Program (IMTOP) designed to motivate and train older adults with diabetes to use mobile technology for diabetes self-management. The IMTOP curriculum taught participants about diabetes self-management combined with tablet and Internet skill training. Patients were taught a diabetes self-management app to activate self-monitoring and behavior change. College students participated as volunteer tutors to provide intergenerational and technological support. The program was delivered in 8 weekly sessions of 2-hour long small group classes. To understand the program effects, a wait-list control trial with 350 age 55+ adults with diabetes was conducted in 2 Taiwanese hospital outpatient settings. Patients were assessed at baseline and every 4 months for up to 12 months post intervention. After participating in the intervention, the pre-post changes for the intervention group were significantly better than the waitlist group at 4-month in terms of physical health status, diabetes self-care, use of mobile technology, and overall quality of life. In addition, the intervention group was less depressed compared to its counterpart. The longitudinal effects were evaluated using linear mixed-effects models including contrasts compared mean estimates at each follow-up to the baseline. The results indicate a stable overtime improvement in overall diabetes self-care (p<.0001). Specifically, patients reported more blood-glucose testing, foot-care, and risk reduction (all with p<.0001), specific diet (p=.04), and reduced frequency of smoking (p=.03). Both the WHO-QOL physical health (p=.03) and self-rated general health (p=.001) were enhanced. The findings support the effectiveness of IMTOP intervention for older adults with diabetes.
16 Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review with Stakeholders’ Consultation
Authors: Ainuddin Husna Ahmad , Romli Muhammad Hibatullah , Salim Mazatulfazura S F , Hamid Tengku Aizan Tengku Abd , Mackenzie Lynette
Published: December 2019

Introduction

Stroke is a serious problem in Southeast Asia. Falls are common among stroke survivors especially within one-year post-stroke and the implication is devastating. Rehabilitation for stroke survivors is important especially to prevent falls. However, literature in Southeast Asia pertaining to the topic is sparse. This study aims to systematically identify literature related to stroke and falls in Southeast Asia.

Methods

This scoping review followed Levac, Colquhoun and O’Brien’s framework. Systematic searching was conducted on four databases (MEDLINE, CINAHL, Scopus, ASEAN Citation Index) on August 2019. Generation of review question and keyword, and selection criteria were developed according to the Patient Intervention Comparison and Outcome (PICO) method. Consultation via several focus group discussions with stakeholders (i.e. stroke survivors, caregivers and therapists) were conducted and integrated with the synthesis of the review.

Results

Initial search yielded 2412 articles after removing the duplicates; however, only 19 were accepted in the final analysis. Most of the articles focused on physical rehabilitation and using conventional therapies. While the literatures may reflect the practice in Southeast Asia, stakeholders perceived that the literature is inadequate to show the true practice, lack to inform and missed several aspects such as functional, cognitive and psychological intervention in managing falls. Home hazards are considered as contributing factors but not deemed important.

Discussion

Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Only several articles were mainly written by physiotherapists while others are from medical physicians and engineers but negligible from other healthcare practitioners (i.e. occupational therapists, speech therapists, psychologists) or other disciplines interested with falls.

Conclusion

Falls prevention among stroke survivors received lack of attention and just an indirect goal in stroke rehabilitation. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
160 Gait Adaptability in Older People and People with PD
Authors: Lord Stephen , Caetano Joana , Menant Jasmine
Published: December 2019

The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This presentation will present findings from a series of studies that have investigated cognitive, physical and psychological factors associated with gait adaptability required for obstacle and stepping target negotiation in older people and people with Parkinson’s disease (PD). The first studies involved fifty healthy older adults (mean±SD: 74±7 years). The gait adaptability protocol required them to either (a) avoid an obstacle at usual step distance or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. The primary findings were that gait adaptability was significantly associated with high risk of falls and that executive function, increased concern about falling and weaker quadriceps strength contributed significantly to this relationship. The second studies involved 54 people with PD (mean±SD: 67±67 years) who also completed the gait adaptability protocol. In this group, superior executive function, effective reactive balance and good muscle power were associated with successful gait adaptability. Furthermore, executive function and reactive balance appeared to be particularly important for precise foot placements; and cognitive capacity for step length adjustments for avoiding obstacles. These findings help elucidate mechanisms for why older people and people with PD fall. Training gait adaptability directly, as well as addressing the above associated factors through cognitive, behavioural and physical training may maximise fall prevention efficacy for these populations.
162 Walking, Thinking and Daily-Life Activity in Older People with Dementia
Authors: Taylor Morag , Toots Annika , Close Jacqueline C T , Van Schooten Kim , Brodie Matthew , Delbaere Kim
Published: December 2019

Gait has been linked with cognition in cognitively healthy and impaired older people. However, the studies in cognitively impaired people have been small, have not contrasted the strength of cognitive domain associations and have reported inconsistent findings. We examined baseline data of 309 older people with mild-moderate cognitive impairment (age 82±6 years; 47% female) who were participating in a large fall prevention randomised controlled trial. Gait speed was measured at usual pace over 2.4m and cognitive performance was assessed with the Addenbrooke’s Cognitive Examination-III (ACE-III). The ACE-III assesses cognitive domain performance (attention; memory; verbal fluency; language; visuospatial ability). Executive function (EF) was additionally examined using the Frontal Assessment Battery (FAB). Each cognitive domain was associated with gait speed in separate models adjusted for confounders. EF (verbal fluency and the FAB) demonstrated the strongest association which withstood adjustment for attention, memory, language and visuospatial ability. In contrast, visuospatial ability was the only cognitive domain to withstand adjustment for EF (verbal fluency, not the FAB). These findings support higher-order gait regulation.

Characterising individuals at risk of negative health outcomes can assist in identifying effective prevention strategies. Forty-five older people with mild-moderate dementia were age-sex matched to two (n=90) healthy controls and all participants (age 81±6 years, 42% female) wore triaxial accelerometers (MoveMonitor, McRoberts) on their lower back for 7-days. Daily-life gait quantity and quality were estimated from the MoveMonitor. Steady-state clinical walking speed was assessed at usual pace over 2.4 to 10.0m. Participants with dementia had reduced gait quantity, slower clinical, habitual daily-life and maximum daily-life walking speeds and multi-domain gait impairment compared to controls. In participants with dementia, clinical walking speed more closely represented habitual daily-life walking speed, whereas in controls, it more closely represented maximum daily-life walking speed. These findings have assessment, functional (e.g. crossing roads) and training/treatment implications.
17 Evidence for Combined Falls and Syncope Assessment in Older Patients
Authors: Kenny Rose Anne
Published: December 2019

Syncope is a transient loss of consciousness due to cerebral hypoperfusion (reduced blood flow through the brain). Thirty percent of older persons who have syncope are unaware of loss of consciousness and the majority of events are not witnessed. In these cases, the patient presents with non-accidental/unexplained falls (Parry SW et al., 2005). Many of these events are not recognised. Given that most causes of syncope can be treated and further events prevented, the new ESC guidelines for syncope recommends inclusion of falls in syncope risk stratification (Brignole M et al., 2018) in older patients. These new risk stratification recommendations will be reviewed coupled with new prevalence and comorbidity information for falls in community samples and the long term consequences of hypotensive syndromes on cerebral function.
18 Utilisation of Head CT to Determine Rates of Intracranial Injury Following Inpatient Falls in the Medical Department, Hospital Kuala Lumpur (HKL)
Authors: Karthigayan Aruna , Tarmizi Noor Azleen Ahmad , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Yau Weng Keong , Lee Fatt Soon
Published: December 2019

Introduction

Inpatient falls are associated with serious and life–threatening injuries in 4-6% of cases1. This includes Intracranial Injury (ICI). Imaging of the Head is required to detect and manage patients with head injury2; however there are no specific guidelines to facilitate utilisation of Head CT after Inpatient Falls.

Objective

The goal of this study is to review the utilisation of Head CT to determine rates of intracranial injury (ICI) following inpatient falls.

Methodology

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

Results

152 patients, with an average age of (61.65±15.51) years were included in this study. Of these 94 (61.8%) were male, 85 (55.9%) were ≥ 65 years. 45 (29.6%) patients had a Head CT after inpatient fall. Median time to request for Head CT was 130 (IQR 30–582.50) minutes from the time of fall. Head CT was more likely in patients with Direct impact to head during fall (Adj.OR;4.71(95%CI 1.39 – 15.85). Fifty-seven (37.5%) patients sustained Direct impact to head during fall, however only 32/57(71.1%) had a Head CT as inpatient. Patients who had Direct impact to head during fall, were more likely to develop Giddiness (Adj.OR;5.96(95%CI 1.94-18.30) and Hematoma (Adj.OR;6.186(95%CI 1.59 – 24.03) after fall. Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT. Patients with (ICI) had an average age of (74.00 ±7.906) years. All 5 patients were reviewed by the Neurosurgical team. Of these, 1/5 (20%) patient died during hospitalisation and 1/5 (20%) patient was discharged in a terminally ill condition.

Conclusion

Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT and they were more likely to be ≥ 65years. Head CT was more likely in patients with Direct impact to head, headache, hematoma and confusion after inpatient fall.
21 Fall Risk Assessment Outcomes in Community Dwelling Elderly Patients on Warfarin (FRAIL-W)
Authors: Ain Syarifah Nurul , Bang Liew Houng , Subramaniam Premala , Kheen Ho Hee
Published: December 2019

Background

Elderly patients on warfarin are prone to experience severe bleeding complications when they fall. In warfarin clinic, they are not routinely screened for falls risk before starting on warfarin therapy. The purpose of our study was to determine the incidence of fall and its associated factors, severity of injury following fall and grading of falls risk among community dwelling elderly patients on warfarin in two tertiary hospitals in Sabah.

Methods

This is a cross-sectional study conducted in warfarin outpatient clinic, Hospital Queen Elizabeth and Hospital Queen Elizabeth II for 10 weeks (Mac-May 2019). Inclusion; patients aged ≥60 years old, on lifelong warfarin therapy. Exclusion; dementia, psychosis, severe cognitive impairment, institutionalised, inability to stand. Face-to-face interviews were done using Falls Risk for Older People – Community (FROP-Com) and Timed Up and Go (TUG) test.

Results

Out of 162 patients, majority were males (65.4%), Chinese (50.6%), married (93.2%), stays with family (96.9%) and had secondary education (42.6%). Mean age was 70 years old. 82.1% of them had atrial fibrillation; 63.2% had low CHA2DS2VASC score (less than 4) and 91.7% had low HAS-BLED score (less than 3). 22 patients (13.6%) experienced actual fall in past 12 months; only 1 patient experienced major injury. FROP-Com showed majority 133 patients (82.1%) were at low risk of fall. Risk factors of fall include polypharmacy and comorbidity affecting balance and mobility. Mean TUG test score was high; 13.7 seconds.

Conclusion

Fall incidence among patients on warfarin is substantial. Risk factors include polypharmacy and comorbidity affecting balance and mobility. This interim analysis showed majority patients had low fall risk (82.1% on FROP-Com, 58.0% on TUG test). Among fallers, FROP-Com risk score was moderate-high in 10 patients (45.5%). Further analysis could reveal potential value of these tests in refining fall risk assessment in this group of patients.
22 A Mixed-Method Study on Older Adults’ Adherence to Home Exercise Programme: Patients’ and Physiotherapists’ Perspective
Authors: Timmons Suzanne , Aziz Siti Khalijah Abdul
Published: December 2019

Background

Regular exercise and physical activities have shown to be beneficial especially in older adults to maintain their function. To reap these benefits, recommended exercises need to be adhered to. However, there is lack of consistency in the literature on what is the degree of adherence to home exercise programmes (HEPs) among older adults.

Objective

The purpose of this study was to explore factors affecting older adult patients’ adherence to HEP prescribed to them and how HEP was perceived by both older adults and physiotherapists.

Design

A mixed-method study design was used in this study

Methods

28 older adults attending outpatient physiotherapy clinic were given an exercise journal to record their adherence to HEP prescribed by their physiotherapists for six weeks. Subsequently, semi-structured interviews were conducted with seven older adults and five physiotherapists. The interviews were audio recorded and transcribed. After which, the interviews were analysed using content analysis.

Results

14 participants returned their exercise journal. The rate of adherence out of 42 days of HEP prescribed was 79.8% or 5.6 days per week. Only medium inverse correlation was found between risk of depression and HEP adherence. No significant correlation was found for cognitive function, self-efficacy to exercise, quality of life and mobility status. Four key themes consisting of perception to HEP, mode of delivery to HEP, barriers and facilitators of HEP adherence emerged from the data.

Conclusion

Older adults’ internal motivation is important to improve HEP adherence. External factors such as family support, companion while exercising, physiotherapists’ support in terms of designing likeable and easy HEPs, investigating reasons for non- adherence, modifying exercises and education on importance of adherence to HEPs could affect HEP adherence of older adults. Additionally, having more community based exercise classes are factors that could potentially promote adherence.
23 Arterial Stiffness and Falls in Older People: Cross-Sectional Data from the Malaysian Elders Longitudinal Research Study (MELoR)
Authors: Tan Maw Pin , Mat Sumaiyah , Kamaruzzaman Shahrul Bahyah , Mohktar Mas Sahidayana , Ibrahim Fatimah
Published: December 2019

Background

Cardiovascular problems such as orthostatic hypotension are common risk factors for falls in older persons. Arterial stiffness has been suggested as the key determinant of cardiovascular risk. Published evidence to support the assumption on the associations between arterial stiffness parameters and falls remains limited.

Aim

To determine the association between arterial stiffness and falls in older people.

Methods

This was a cross-sectional analysis of MELoR first wave data. Of 446 participants included, 103 reported at least one falls in the past 12 months. The assessment of arterial pulse wave components was performed by non-invasive applanation tonometry of radial artery a SphygmoCor device (AtCor Medical, Sydney, Australia).

Result

Participants with mean age 68.28 (7.28) and 60% female were included in this study. Fallers showed significant higher central arterial pressure percentage at heart rate 75bpm compared to the non-fallers [mean (SD): 16.61 (8.16) vs 14.79 (6.89), p=0.026]. The association remained significant after adjustment for age and hypertension. In addition, peripheral diastolic pressure in fallers was significantly lower than non-fallers (p-value=0.049).

Conclusion

Augmented index at the heart rate of 75bpm was associated with falls in older people. Thus, this study suggests that this parameter could be the determinants in assessing risk of falls. A prospective study is therefore recommended to determine temporal associations between arterial stiffness and falls.
26 Initial Orthostatic Hypotension in Older Persons: Results from the Malaysian Elders Longitudinal Research Study
Authors: Saedon Nor Izzati , Frith James , Goh Choon-Hian , Kamaruzzaman Shahrul Bahyah , Khor Hui Min , Kamaruzzaman Shahrul Bahyah , Tan Maw Pin , Chin Ai-Vyrn , Ahmad Wan Azman Wan , Tan Kit Mun
Published: December 2019

Objectives

Initial orthostatic hypotension (IOH) is defined as a reduction in systolic or diastolic blood pressure (1) of 40 mmHg or 20 mmHg or greater within 15 seconds of standing. However, little is known about the characteristics of individuals with IOH and its relevance in the older population. The present study aimed to determine factors associated with IOH and classical orthostatic hypotension (COH) and their relationship with physical, functional and cognitive performance.

Design

Cross-sectional observational study.

Setting and Participants

Individuals aged ≥55 years were recruited through the Malaysian Elders Longitudinal Research (MELoR) study and continuous non-invasive BP was monitored over five minutes of supine rest and three minutes of standing.

Measures

Physical performance was measured using timed up and go, functional reach (FR), hand grip (HG) and Lawton’s functional ability scale; cognition was measured with Montreal Cognitive Assessment (MoCA). BP response to standing was categorized as non-OH, COH, IOH or COH and IOH

Results

1245 participants were recruited, 623 (50%) had COH, 165 (13%) had IOH and 145 (12%) met the criteria for COH and IOH. COH was associated with increasing age, hypertension, transient ischemic attacks, diabetes mellitus, anti-hypertensive medications and reduced functional reach compared to individuals without COH. IOH was associated with younger age, normo-tension, and the absence of cerebrovascular disease or diabetes. Individuals with IOH had significantly better TUG, FR and HG scores compared to individuals without IOH.

Conclusions

This study suggests that IOH is associated with better physical performance. Further research is now required to fully elucidate the clinical relevance of IOH and its relationship to COH, as well as determine appropriate clinical cut-offs.
28 Cardiorespiratory Regulation and Aerobic Fitness in Older People – A New Approach for Falls Interventions?
Authors: Koschate Jessica , Lau Sandra , Zieschang Tania , Hoffmann Uwe
Published: December 2019

Introduction

Guidelines for physical activity give recommendations for moderate to vigorous aerobic training 2-3 times per week. Aerobic exercise, like walking, shows mixed effects in regard to falls prevention. However, after high intensity exercise postural stability is decreased and better aerobic fitness might be relevant to minimize this fall risk in older individuals. So far, the association of aerobic fitness and falls has not been examined in older people. Feasible methodology is lacking. Aerobic fitness can be assessed measuring cardiorespiratory (heart rate [HR] and oxygen uptake [V’O2]) regulation in response to changing submaximal work rate (WR) intensities. For cycle ergometry (cycling) cardiorespiratory regulation correlated with aerobic fitness. Since treadmill walking (TMW) is closer to daily life activities, TMW is tested for feasibility in older people and compared to data during cycling.

Methods

17 participants (65±6 years, 23.9±3.8 kg∙m-2) were tested for V’O2 and HR regulation during cycling (30W, 80W) and TMW (1.9 km·h-1, 5 km·h-1). Inclination during TMW was matched to WR during cycling. Additionally, WR was further increased until the first ventilatory threshold (VT1) was reached. Kinetics were assessed applying cross-correlation functions (CCF). Higher maxima in CCF (CCFmax () in a.u.) imply faster system responses. T-tests were applied to calculate differences between the exercise modes. Correlations were computed using Pearson tests.

Results

Significant differences for CCFmax (V’O2) were identified between cycling and TMW (0.51±0.10 vs. 0.45±0.08; p=0.032), but not for CCFmax (HR) (cycling: 0.62±0.13; TMW: 0.60±0.10; p=0.623). CCFmax (HR) during TMW correlated with V’O2 at VT1 during TMW (r=0.538, p=0.013).

Discussion

TMW is feasible to adequately determine cardiorespiratory regulation and correlated with aerobic fitness in older people and has a better applicability. Hence, cardiorespiratory regulation might be an important factor to assess in the context of falls.
30 Dementia and Falls
Authors: Close Jacqueline
Published: December 2019

Cognitive impairment is a risk factor for falls and injury in older people. The profile of people with dementia reflects both physical and cognitive contributors to overall risk of falls. Over the years there have been a number of studies looking at falls and injury prevention in this high risk population. The approaches to intervention have varied with exercise being the most common modality of treatment. This presentation will unpack the role of cognition in postural stability and review the latest literature in the prevention of falls in older people with dementia. It will include presentation of data from a recently completed randomised controlled trial looking at a combined physiotherapy and occupational therapy intervention tailored to the participants’ cognitive abilities as well as pilot data looking at the feasibility of iPAD technology to deliver exercise to people with dementia in the home environment.
34 Gender Difference in the Association between Handgrip Strength and Cognitive Performance of Older Adults in Rural Malaysia
Authors: Mohan Devi , Stephan Blossom C M , Allotey Pascale , Reidpath Daniel D
Published: December 2019

Introduction

Handgrip strength is an easy and safe measurement to evaluate the physical functioning of older adults. Lower hand grip strength is associated with cognitive decline, and can be used as an effective method for early detection of cognitive impairment.

Objective

This study aimed to evaluate the gender differences in association between hand grip strength and cognitive performance among older adults in rural Malaysia

Methods

This was a cross-sectional study done among 200 community dwelling older adults (100 men and 100 women) aged ≥ 50 years. The study was embedded in the ongoing longitudinal study of South East Asia Community Observatory (SEACO) in Segamat district of Johor, Malaysia. Data was collected by trained data collectors during home visits. Cognitive performance was assessed using Mini Mental State Examination (MMSE). Hand grip strength was measured using digital grip dynamometer.

Results

The mean age of study participants was 61.5 years (SD= 8.4). Women had lower mean hand grip strength (19.8, SD=5.6) compared to men (33.4, SD= 8.2). The mean MMSE score for women and men were 23 (SD= 4.5) and 25.1(SD=3) respectively. Cognitive impairment was detected in 26% of men and 21% of women. Hand grip strength showed positive association with MMSE score, among women (ß coefficient= 0.302, p<0.001), but not among men (p= 0.077). Hand grip strength was significantly association with MMSE score among women (ß coefficient=0.162, 95% CI = 0.026- 0.298; p=0.02) after controlling for age, level of education and body mass index.

Conclusion

The study shows that lower hand grip strength is associated with poor cognitive performance among women, while hand grip strength is not associated with cognitive performance among men.
37 Postural Instability in Parkinson’s Disease: The Association of Cognitive Impairment and Non-Motor Symptoms
Authors: Khoo Tien K , Cusso Melanie , Sewram Allka , Pountney Dean , Donald Kenneth
Published: December 2019

Introduction

Parkinson’s disease (PD) is the second most common neurodegenerative condition after Alzheimer’s. Historically considered as a movement disorder, the multitude of non-motor symptoms (NMS) are now a recognised cause of significant disease burden. This study aimed to explore the relationship between postural instability and NMS in PD.

Methodology

We recruited individuals (n=100) in South East Queensland with a pre-existing diagnosis of idiopathic PD into this prospective observational study. Motor assessment was performed via the Movement Disorders Society-revised Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Assessment of postural instability was based on the Hoehn & Yahr Scale (H&Y) with a score of ≥3 considered indicative of postural instability. NMS were assessed via the Non-Motor Symptoms Scale (NMSS). Further neuropsychiatric and affective assessment was evaluated with the Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI), Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI) and Montreal Cognitive Assessment (MoCA).

Results

Cohort demographics comprised of 62% male and 38% female with a mean age of 69.1 years (SD 7.35) and mean H&Y 2.34 (SD 0.59). Sixty four participants were H&Y 1 & 2 whilst 36 participants were H&Y ≥3. Participants with postural instability were significantly older (p = 0.033) and had lower MoCA scores (p=0.039). Among the MoCA domains, only the Visuospatial / Executive domain was associated with postural instability (p= 0.005). Among the NMSS domains, only the sexual function domain was significantly associated with the latter group (p=0.029). GDS scores tended to be higher in the postural instability group (p=0.054) but there was no significance in major depressive disorder (p=0.436).

Conclusion

Postural instability in PD is significantly associated with age and cognitive impairment, in-particular frontal lobe function. The association of sexual dysfunction is supportive of the notion that disorders in dopaminergic and non-dopaminergic systems underpin the pathophysiology substrate of postural instability.
39 A Model of Gait and Falls in Older Adults with Dementia
Authors: Zhang Weihong , Low Lee-Fay , Schwenk Michael , Mills Nicholas , Gwynn Josephine Diana , Clemson Lindy
Published: December 2019

Background

Older people with cognitive impairment are at increased risk of falls; however, fall prevention strategies have limited success in reducing fall risks in this population (Fernando E, Fraser M, Hendriksen J et al. Physiotherapy Canada. 2017; 69: 161–170). We aim to present a model of factors contributing to gait and falls in older adults with dementia.

Methods

The model was developed based on an in-depth review of literature on fall risk factors particularly in people with dementia, and the relationship between cognition and gait, and their joint impact on risk of falls.

Results

Cognitive and motor functions are closely related as they share neuroanatomy (Rosso AL, Studenski SA, Chen WG et al. J Gerontol A Biol Sci Med Sci. 2013; 68: 1379–1386). This close relationship has been confirmed by imaging, observational and interventional studies. Executive function is the cognitive domain most commonly associated with gait dysfunction (Cohen JA, Verghese J, Zwerling JL. Maturitas. 2016; 93: 73-77). The sub-domains of executive function(Sachdev PS, Blacker D, Blazer DG et al. Neurology. 2014; 10: 634-642) - attention, sensory integration and motor planning affect risk of falls through gait dysfunction; whereas other non-gait associated sub-domains of executive function - cognitive flexibility, judgement and inhibitory control affect risk of falls through risk taking behaviour.

Conclusion

Gait, cognition and falls are closely related. The comoridity and interaction between gait abnormality and cognitive impairment may be the underlying mechanism behind the high prevalence of falls in older adults with dementia. Gait and cognitive assessment with particular focus on executive function, should be integrated in fall risk screening. Assessment results should inform interventions developed by a multidisciplinary team and may include strategies such as customised gait training and behavioural modulation. A comprehensive multidisciplinary approach could be more effective in reducing fall risks in older adults with dementia.
40 The Association between Apathy, Decline in Physcal Performance, and Falls
Authors: Henstra Marieke , Rhebergen Didi , Lisette De Groot  , Van Schoor Natasja , Van der Velde Nathalie
Published: December 2019

Background

Symptoms of apathy are common in older persons. Negative effects on physical performance and fall risk are plausible, considering the pathophysiology of apathy. However, literature is scarce.

Aim

To longitudinally assess the association between apathy and 1) decline of physical performance and 2) the number of falls in older community-dwelling persons.

Methods

The ‘B-vitamins for the PRevention Of Osteoporotic Fractures’ study (B-PROOF) provided data on 2919 older persons over a period of two years. Apathy was assessed using the Geriatric Depression Scale3. A physical performance score (PPS) was calculated using three performance tests. Falls were registered prospectively. We calculated adjusted odds ratios (ORs), Incidence Rate Ratios (IRRs) their 95% confidence intervals (CI). Effect-modification by age and gender was investigated. We also investigated mediation by baseline PPS for the association between apathy and the number of falls.

Results

Apathy and decline of PPS were independently associated. After stratification, the effect only remained in men. Age was an effect modifier; higher ORs for decreasing age. Apathy was also independently associated with the number of falls. After stratification, women had higher IRRs than men. Age modified the association in the opposite direction: higher IRRs for increasing age. Baseline PPS was a mediator in the association.

Conclusion

The impact of apathy on physical performance and fall-incidents varied with age and gender. Potentially, in older individuals with apathy, fall risk is preceded by a decline in physical performance. In clinical practice, identifying apathy in older persons might be useful to target mobility preserving interventions.
41 Age Modifies the Association between Apathy ANND Recurrent Falling in Dutch Ambulant Older Persons with a High Fall Risk
Authors: Henstra Marieke , Houbolt Carin , Seppala Lotta , De Rooij Sophia , Rhebergen Didi , Stek Max , Van der Velde Nathalie
Published: December 2019

Apathy, a common and disabling behavioural syndrome in older persons, has been associated with impaired physical performance and executive dysfunction. Both are fall risk factors and they share pathophysiological pathway. We cross-sectionally examined the association between apathy and recurrent falling (≥2 falls in the past 12 months) and number of falls in the past 12 months in 243 outpatients aged ≥ 65 years with ≥3 fall risk-factors visiting a fall-clinic after a fall. We calculated Odds Ratio’s (ORs), Incidence Rate Ratio’s (IRRs) and their 95% Confidential Intervals (CI95) using multivariable regression and negative binomial regression analyses. We adjusted for cognitive functioning, depression, the use of fall risk increasing drugs, visual impairment, urine incontinence, comorbidity, smoking, use of alcohol, body mass index (BMI), and the number of months between assessment of fall risk and of apathy. We assessed effect modification by age and gender.

In our study, apathy was independently associated with recurrent falling in patients aged 65-75 years: OR 2.8 (CI95 1.0-7.7). Overall, patients with apathy experienced 1.46 times as many falls in the past 12 months compared to patients without apathy (IRR 1.46 (CI95 1.0-2.1).

To conclude, in high fall-risk older outpatients, apathy was cross-sectionally associated with recurrent falling in patients aged 65-75 years and the number of falls. Apathy appeared to be especially relevant in relation to falling in this age group. Whether apathy predicts recurrent falling is yet to be determined.
42 Fall Brain: Cognitive and Biological Perspectives
Authors: Verghese Joe
Published: December 2019

While many fall prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest. Current falls research in aging is mostly focused on clinical predictors of falls. Hence, there is a knowledge gap regarding the underlying biological and neural mechanisms of falls. Emerging evidence from our and other studies implicates biological derangements in inflammation, oxidative stress, and vascular pathways in the occurrence of disorders of gait, balance, and cognition, which in turn are major risk factors for falls in older adults. A growing understanding of the relationship between cognitive and mobility processes in aging opens up the possibility of novel interventions to improve mobility and reduce risk of falls.
45 The Association between Sensory Impairment and the Incidence of Fall among Indonesian Elderly
Authors: Nugraha Susiana , Hapsari Indri , Sabarinah  , Pengpid Supa , Peltzer Karl
Published: December 2019

Fall is the biggest caused of injury among elderly. It can be markers of poor health and declining function, and they are often associated with significant morbidity moreover it cause disability in the elderly that may increase health funding. The prevalence of fall among elderly in Indonesia is 8.2%. Most of them occur at home and the environment (63.7%), on the highway (18.9%) and the workplace (8.8%) (Ministry of Health Republic Indonesia, 2019). The normal changes of aging, like poor eyesight or poor hearing, considered as the risk of fall among the elderly. This condition has been linked to all-cause of mortality through three mediating variables i.e. disability in walking, cognitive impairment, and self-rated health (WHO, 2007) . This study aimed to assess the association between sensory impairment (hearing impairment and visual impairment) and the incidence of falls among the Indonesian elderly.

This study conducted in cross sectional setting. Populations of this study are the elderly from 3 provinces namely Jakarta, West Java and Yogyakarta and selected in cluster random sampling. A total of 427 elderly (those who are above 60 years old) are participated this study. Hearing impairment is evaluated in self-reported and observation and visual acuity test performed to identify the visual impairment. The incidence of fall is identified by self-reported fall in the last 12 months.

The multiple regression analysis identifies the model predictor for fall is statistically significant. The result showed that after adjusted to age and gender, elderly with vision impairment likely to have 2.054 times (95%CI 1.265 -3.335) to fall, the elderly with hearing impairment have 1.66 higher odds to fall (95%CI 1,005 - 2,793); Male Gender OR =0.46 (95% CI 0,288 -0,783) and Ages OR=1.84 (95%CI 1.1.67 -2.894).

This finding indicates that after adjusted to ages and gender sensory impairments are increase the risk of fall among Indonesian elderly.
46 The Relationship between Cognitive Function and Physical Performance among Older Adults Attending a Falls and Syncope Service in Kuala Lumpur
Authors: Jong Sun Zek , Saedon Norizzati , Kiyu Sarah , Tan Pey June , Tan Maw Pin
Published: December 2019

Introduction

Recent studies identified a relationship between gait difficulties and risk of developing dementia, a condition now termed motoric cognitive risk. We interrogated a clinical dataset to determine the relationship between cognitive assessment scores and physical performance scores to identify the strength of association between these two types of measures.

Methods

Consecutive patients referred to the falls and syncope service and the University of Malaya Medical Centre were recruited. The cognitive function of consenting individuals was assessed using the Montreal Cognitive Assessment (MoCA) and Visual Cognitive Assessment Tool (VCAT). Physical performance was assessed using hand grip strength (HGS), timed-up-and-go (TUG) and functional reach (FR).

Results

One hundred and forty-seven individuals, mean age (standard deviation,SD)=76.1 (7.8) years, 85 (58%) women were included. The mean (SD) for right and left HGS, FR and TUG scores for the overall population were 19.1 (7.0)kg, 19.0 (12.1)kg, 28.9 (39.7)cm, TUG 19.2 (11.0)s respectively. The mean MoCA and VCAT scores were 21.1 (7.1) and 20.3 (6.3) respectively. Right HGS correlated moderately with MoCA (r=0.367) and VCAT scores (r=0.397). Left HGS had a weak to moderate correlation with MoCA (r=0.281) and VCAT (0.271). FR, however, was not correlated with either MoCA (r=0.073) and VCAT (0.020). TUG scores were moderately negatively correlated with MoCA (-0.3206) but weakly correlated with VCAT (-0.175)

Conclusion

Our evaluation of the relationship between cognitive scores and physical performance in a falls and syncope clinic setting found that a relationship exists between muscle strength measured with grip strength and composite assessment of gait and balance using the TUG. Dynamic balance measured with functional reach, however, was not associated with cognitive function. Future studies will need to identify the possible mechanisms linking cognitive function with strength and gait in order to establish cognitive function as a modifiable risk factor for falls in older adults.
47 Dual Tasking in Older Women: Physical Activity or Else?
Authors: Muhaidat Jennifer , Al-Yahya Emad , Mohammad Maha , Qutishat Dania , Okasheh Rasha , AL-Khlaifat Lara , Dawes Helen , Lawrie Sophie , Esser Patrick
Published: December 2019

Background

The interplay between gender, Physical Activity (PA) and Dual Task (DT) gait in older adults is unclear. This study aimed to address DT gait based on gender and PA level in older adults.

Methods

Gait measures were collected using an Inertial Measurement Unit (IMU) during the 10-meter and Timed Up and Go (TUG) tests in single and DT conditions. Global Physical Activity Questionnaire (GPAQ) was used to measure PA. A total of 120 community-dwelling older adults (81 women and 39 men) took part. Participants were divided according to gender and PA level into four groups (women achieving (WA = 31), women not achieving (WN = 50), men Achieving (MA = 29) and men not achieving (MN = 10)). The achievement of PA was determined by total Metabolic Equivalent (MET) – Minute/week ≥ 600. Cognition, health-related quality of life, falls history and health status was measured.

Results

Women had poorer performance in time, gait velocity and stride length regardless of PA level. The cognitive condition had the greatest effect on gait parameters in all groups, except for stride length which decreased more under the motor condition. Women who did not achieve the PA guidelines had poorer perceived health-related quality of life than men who achieved and did not achieve the guidelines.

Conclusions

The findings suggest that women, regardless of PA level, experience greater deterioration under ST and DT conditions in 10-meter walk and TUG tests in terms of time and gait measures such as velocity and stride length. This interplay cannot be explained by PA alone since it could be reflective of poorer perceived health and frailty in older women. These findings are considered of importance when planning DT and PA interventions that aim to increase PA levels and promote function in older women.
48 Systematic Approaches to Fragility Fracture Care and Prevention: A Global Perspective
Authors: Mitchell Paul
Published: December 2019

Fracture begets fracture. Since the 1980s, we have known that approximately half of individuals who sustain a hip fracture break another bone in the months or years before breaking their hip. More recently, investigators in Australia, the United Kingdom and the United States have reported similar findings. Meta-analyses have demonstrated that a prior fracture at any site is associated with a doubling of future fracture risk.

Individuals who sustain fragility fractures usually present to healthcare services to seek medical attention and, as such, represent an obvious group to target for osteoporosis assessment and falls prevention. However, a persistent and pervasive care gap is evident in the secondary prevention of fragility fractures throughout the world. The care gap is well documented in countries in Asia-Pacific.

A Fracture Liaison Service (FLS) is a system to ensure fracture risk assessment, and treatment where appropriate, is delivered to all patients with fragility fractures. A FLS is usually comprised of a dedicated case worker, often a clinical nurse specialist, who works to pre-agreed protocols to case-find and assess fracture patients. While FLS are usually based in hospital, some primary care based FLS have been developed. A FLS requires support from a medically qualified practitioner.

The FLS model of care has been endorsed and advocated for by governments, healthcare professional organisations and national osteoporosis societies, and national alliances comprised of these and other groups.

This presentation will provide a global perspective on implementation of FLS as a central component of a broader systematic approach to fragility fracture care and prevention.

References

Fracture Liaison Services (FLS) Toolbox for Asia Pacific. Asia Pacific Bone Academy. 2017.
49 Falls and the Prediction of Fragility Fractures
Authors: Gregson Celia
Published: December 2019

Fragility fractures carry high health and social care costs for patients, families, and health systems. Falls are a fundamental risk factor for sustaining a fragility fracture, and hence fracture risk assessment is an intrinsic component of any falls evaluation. I will review the relationship between falls and incident fracture and outline strategies for assessing fracture risk. I will review the different fracture risk assessment tools available, including FRAX. I will discuss approaches to fracture risk assessment in the context of falls. Sarcopenia is an important risk factors for falls. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) updated their diagnostic criteria for sarcopenia, placing a greater emphasis on muscle strength and physical performance. Whilst measures of muscle mass may not add to the clinical prediction of fractures over an above a tool such as FRAX, I will discuss the value of tests of muscle function, impairment of which characterises sarcopenia, in the prediction of fracture risk. I will further present data on patient’s own perception of fracture risk and how this might be influenced by a history of falls.
58 Epidemiology of Falls and HIP Fractures among the Elderly Community Dwellers in Malaysia
Authors: Yeak Raymond , Yap Yee Yee , Nasir Nizlan M
Published: December 2019

Introduction

Elderly community dweller has a high risk of falls. It has a high incidence of morbidity and mortality if it involves hip fractures. Our aim is to report the incidence of falls presenting with hip fractures to a Malaysian tertiary centre.

Method

We have collected data from a Malaysian tertiary centre. The incidence of falls involving elderly patients aged 65 and above from January 2018 till December 2018 was examined. The falls were divided based on the time of fall, place and the type of fracture. Time of fall was divided into day (0800 to 1559), evening (1600 to 2359), night (0000 to 0759). The place was either outdoor or indoor.

Results

There were 114 falls that involved hip fractures recorded over the past 12 months. There were 85 female cases versus 29 male cases. The average age was 77.3 years. There was a higher incidence in the Chinese (n=59) followed by the Malay (n=40) and Indian (n=15). There were no cases of nursing homes falls that involved hip fractures. Most of the falls with hip fractures occurred indoor with only 11 cases that occurred outdoor. The falls tend to occur in the day (n=65) followed by evening (n=31) and night (n=18). October recorded the highest number of falls with 14 cases followed by April (n=13), and December (n=12). The type of fracture in descending order were intertrochanteric fracture (n=61), neck of femur fracture (n=47), subtrochanteric fracture (n=4) and acetabular fracture (n=2).

Conclusion

Asians generally care for their aging parents in the family home. Although falls were reported to be higher in nursing homes, this differs in the Asian population. Therefore, fall prevention measures should be implemented at home as falls is a significant cause of morbidity and mortality in the elderly especially if it involves hip fractures.