bluuebunny/crossref_metadata_2025_split huggingface dataset:
33 Cognitive Domain Associations with Balance Performance in Community – Dwelling Older People with Cognitive Impairment
Authors: Taylor Morag , Lord Stephen , Toots Annika , Jacqueline Close 
Published: December 2019

Abstract

Aims
Investigate the relationship between global cognition and cognitive domain function and balance performance in a large sample of older people with cognitive impairment.

Methods
Three hundred and nine community-dwelling older people (mean age=82 years; 47% female) with cognitive impairment were recruited for the iFOCIS fall prevention randomised controlled trial. Baseline assessments completed before randomisation were used for analyses and included the Addenbrooke’s Cognitive Examination-III (ACE-III; global cognitive function) and its individual cognitive domains (attention; memory; verbal fluency; language; visuospatial ability) and executive function, further examined using the Frontal Assessment Battery (FAB). Balance performance was derived by averaging postural sway on floor and foam, maximal balance range (reverse z-score) and co-ordinated stability z-scores. With balance performance as the dependent variable, global cognition and each cognitive domain were entered into multivariate linear regression models.

Results
Mean (± standard deviation) ACE-III and FAB scores were 62.8±19.2 and 11.4±4.6 respectively. In linear regression analyses adjusted for covariates, global cognitive function and each cognitive domain were significantly associated with balance performance. Executive function (verbal fluency; β=-.248, p&lt;0.001, adjusted R2=0.376) and visuospatial ability (β=-.250, p&lt;0.001, adjusted R2=0.381) had the strongest and memory the weakest (β=-.119, p=0.018, adjusted R2=0.334) association with balance. Visuospatial ability remained significantly associated with balance performance when adjusted for attention, memory, language, verbal fluency and the FAB. Executive function (verbal fluency) remained significantly associated with balance when adjusted for attention, memory, language and visuospatial ability. Conversely, attention, memory, and language did not withstand adjustment for visuospatial ability or executive function.

Conclusions
Poorer global cognition and performance in each cognitive domain were associated with poorer balance performance in this large sample of community-dwelling older people with cognitive impairment. Visuospatial ability and executive function were independently associated with balance, highlighting the role higher-level cognitive processes and spatial perception and processing play in postural control.
36 Altered Prefrontal Cortex Responses in Older Adults with Subjective Memory Complaints and Dementia During Dual-Task Gait: An Fnirs Study
Authors: Teo Wei-Peng , Rantalainen Timo , Macpherson Helen 
Published: December 2019

Abstract
In this study, we investigated the effects of walking during single-task and dual-task gait (STG and DTG) conditions, on left prefrontal cortex (LPFC) activation in older adults with subjective memory complaints (SMC) and Dementia.
A total of 72 older adults (aged 65-94 yrs; 33 Healthy; 28 SMC; 11 Dementia) were recruited from the community and assisted living facilities. A portable 7m zeno walkway gait analysis mat was used to measure stride, velocity, length and duration during 4 passes of STG and DTG each. A portable single-channel functional near-infrared spectroscopy (fNIRS) device (Portalite, Artinis Medical Systems) was placed over the LPFC to measure changes in oxyhaemoglobin response (O2Hb) during STG and DTG. One-way analysis of variance (ANOVA) with bonferroni post-hoc t-test for multiple comparisons was used to determine differences between groups.
Our results showed that stride velocity, duration and length during STG (all p&lt;0.05) and DTG (all p&lt;0.000) were significantly impaired in the Dementia group compared to Healthy and SMC groups, while no significant differences were observed between Healthy and SMC groups. For STG, a greater increase in O2Hb (p&lt;0.05) was observed in the Dementia group compared to the Healthy and SMC groups, while no differences were observed between Healthy and SMC. However, a significant increase and decline in O2Hb was observed during DTG in the SMC and Dementia groups respectively, compared to Healthy.
Our findings indicate an altered pattern of cerebral haemodynamic response of the PFC in people with SMC and Dementia that may be indicative of cognitive demands of gait. Our findings may have implications for the use of DTG and fNIRS as a potential early biomarker for cognitive declines in older adults.
43 State Mental Energy Influences Posture During Vision-Occluded States
Authors: Boolani Ali , Yager Chelsea , Smith Matthew Lee , Mondal Sumona , Sathiyakumar Thevasha , Senarathna Dinushani , Teymouri Seema , Vogel-Rosbrook Christina , Alvarez Julieth , Taladay Phylicia , Martin Rebecca 
Published: December 2019

Abstract

Background
Fatigue has been postulated to influence postural control, which may lead to an increased risk for falling among older adults.1 Mental and physical energy and fatigue have recently been reported to be four distinct mood states.2,3 Thus, to test Grobe’s1 theory of the influence of fatigue on postural control, we must examine all four mood states.

Objective
This study examined the influence of mental and physical energy and fatigue on postural control.

Methods
Adults (N=133, Males=50, Females=83, Age=25.8±7.96, BMI=24.8±3.8) aged 18-69 years were recruited from the community and asked to complete a series of surveys that measured their current mental and physical energy and fatigue states. After the completion of the surveys, subjects were instructed to complete the modified Clinical Test of Sensory Interaction in Balance (mCTSIB) using the APDM mobility monitors. Necessary assumptions were verified, and four multivariate multiple regression models were developed.

Results
Analyses yielded a significant association between posture and state mental energy (p=.048), but only when subjects were standing with their eyes closed while on a foam surface. Increased feelings of mental energy were associated with decreased total frequency dispersion (b=-358.62) and increased jerk in the coronal plane (b=11.78). No other associations were found.

Discussion
Results of our study suggest that as mental energy decreases there is a concomitant decrease in postural control when subjects are placed in conditions where they are unable to rely on visual feedback on unstable surfaces to maintain balance. Progressive increases in postural instability lead to increased risks of falls, most commonly in the elderly population. Falls are a significant risk factor for mortality. This study supports the clinical recommendation either to: (1) improve integration of vestibular and somatosensory input into postural control; or (2) train compensatory strategies for low lighting environments during episodes of decreased mental energy.
44 Association between Falls and Cognitive Frailty among Community Dwelling Older Adults: A Cross Sectional Study
Authors: Murukesu Resshaya Roobini , Singh Devinder Kaur Ajit , Mokhtar Noor Izyani , Ing Janet Bong May , Subramaniam Ponnusamy , Rasdi Hanif Farhan Mohd , Rivan Nurul Fatin Malek , Shahar Suzana 
Published: December 2019

Abstract

Introduction
The presence of either frailty or cognitive impairment have been determined as precursors of falls among older adults. However, the association between falls and cognitive frailty has yet to be established.

Objective
To investigate the association between falls and cognitive frailty among community dwelling older adults.

Methods
A total of 246 Malaysian community dwelling older adults aged 60 years and above residing in the state of Selangor participated in this cross-sectional study. Sociodemographic details and clinical characteristics including the history of falls were obtained via interview. The presence of cognitive frailty was identified using the Clinical Dementia Rating Scale and Fried Frailty Index. Data analysis was carried out via binary logistic regression.

Results
The prevalence of falls and cognitive frailty in this study were 21.2% and 21.9% respectively among community dwelling older adults (mean age 72.39±5.40). No significant relationship between falls and cognitive frailty [OR:1.187, 95% C.I: 0.493-2.856, p=0.702] was demonstrated. However, older women [OR:2.663, 95% C.I, 1.136-6.239, p=0.024] and the presence of multi-morbidities [OR: 1.431, 95% C.I, 1.026-1.997, p=0.035] were significantly associated with falls which corroborates with existing literature.

Conclusion
Cognitive frailty was not a significant risk factor of falls among community dwelling older adults in this study. Further research is required in prospective, longitudinal, population-based studies to confirm this result.
53 The Development and Education of Fall Prevention Program Through the Multidisciplinary Approach
Authors: Kim Mi Hyun , Go Chang Hee , Lee Jung Min , Kang Ji-Young , Lim Jae-Young 
Published: December 2019

Abstract

Introduction
To reduce the rate of falls in the rehabilitation ward, fall prevention program was developed and educated for physical and occupational therapists, which increased the attitude towards falls and knowledge towards fall prevention activities.

Method
Participants of this study include 17 therapists currently employed at a university-affiliated hospital located in Gyeongg-do, South Korea. Systematic protocol for fall prevention with the emphasis in the roles of rehabilitation teams was developed. This standardized protocol consists of educating therapists with adequate assistive device use, safe ambulation techniques, and client-centered transfer techniques. The therapists then record the paitent's status related to fall prevention and or risks, which is then shared with other medical professionals including registered nurses and medical doctors. Paper-based questionnaires regarding 9 questions on attitude towards falls and 12 questions on knowledge towards fall prevention activities were done by the participants after the education of systematic protocol. The rate of falls was then compared with the change of attitudes in participants. Rate of falls was calculated by dividing the number of fall by the patient bed days and multiplying by 1000.

Result
After the education of fall prevention program, the mean score of attitude towards falls significantly increased (t=-3.99, p=0.001). The mean score of knowledge towards fall prevention activities significantly increased (t=-4.79, p&lt;0.001). The rate of falls decreased from 4.2 to 1.4. The effectiveness of systematic protocol regarding therapists' change in attitude and the resulting change in rate of falls was mainly seen in patients' ward. The decline in rate of falls was observed when patients transferred from bed to wheelchair.

Conclusion
In order to effectively convey the fall prevention education program, the multidisciplinary approach showed promising results in this study. Implications for future research include translation of this program to the community, such as long term care facility.
54 Patient Safety Culture at a Teaching Hospital in Kuala Lumpur
Authors: Krishnasamy Karthikayini , Tan Maw Pin , Zakaria Mohd Idzwan 
Published: December 2019

Abstract

Introduction
Patient safety, such as inpatient falls, is a global problem, accounting for increasing compensation costs from our healthcare facilities. The aim of this study was to evaluate the patient safety culture among healthcare providers.

Method
An online survey was developed within the hospital staff portal at the University of Malaya Medical Centre, with a dialogue box appearing on the launching of the portal website inviting the members of staff to participate in the survey. The survey contained a safety assessment questionnaire (SAQ) which measures the patient safety culture. The SAQ consists of 36 items measuring the six domains: teamwork climate, job satisfaction, safety climate, stress recognition, working conditions, and perception of management. Each domain is assigned a percentage score, and comparisons of scores according to healthcare disciplines were then made.

Results
5275 (80%) responded to the online SAQ which was sent out to all 6562 healthcare professionals employed, by the hospital. The teamwork and safety climate was poor among supporting staff, with scores of 56.7 and 59.8 respectively. Job satisfaction (62.9), perception of ward management (56.8), and hospital management (53.2), and working conditions (44.7) were less among the clinicians. Stress recognition (36.5) was in alarmingly low among the nurses.

Conclusion
A comprehensive unit-based safety programme will be conducted in response to the SAQ findings, and should incorporate objective falls the outcome in order to convince the hospital hierarchy of the need for urgent solutions to lower the rates of inpatient falls.
57 The Use of the Physiological Profile Assessment to Improve Prediction of Fragility Fractures in Community-Dwelling Older People
Authors: Harvey Lara , Taylor Morag , Delbaere Kim , Lord Stephen , Brodaty Henry , Kochan Nicole , Sachdev Perminder , Mitchell Rebecca , Close Jacqueline 
Published: December 2019

Abstract

Introduction
The Physiological Profile Assessment (PPA) is a validated composite measure of sensorimotor function, known to predict falls with 75% accuracy. This work aimed to investigate whether PPA is also associated with fragility fractures.

Method
Participants were 489 community-dwelling older people (age=70-90) enrolled in the longitudinal population-based Sydney Memory and Ageing Study. Participants underwent comprehensive assessments at enrolment, including the 5-item PPA (visual contrast sensitivity, lower limb proprioception, knee extension strength, simple reaction time and postural sway). Participant records were linked to emergency department, hospital and death records (2005-2014) to identify fragility fractures following baseline assessment, with median follow-up duration of 7.5 years. Negative binomial regression, with observation time as the offset, was used to assess factors associated with fractures.

Results
At baseline assessment, 281 (57.5%) participants were assessed as having low/mild fall risk [PPA&lt;1] and 208 (42.5%) as moderate/marked/very marked fall risk [PPA score &gt;1]. Over the study period, 72 (14.7%) individuals sustained 1 fracture, and a further 39 (8.0%) sustained 2 or more fractures.
Univariate analysis showed that increasing age (Incidence Rate Ratio (IRR) 1.1, 95%CI 1.0-1.1, p=0.0026), being female (IRR 1.8, 95%CI 1.3-2.8, p=0.0033), having osteoporosis (IRR 1.7, 95%CI 1.1-2.6, p=0.0340) and moderate/marked/very marked PPA (IRR 1.8, 95%CI 1.2-2.7, p=0.0025) were associated with fractures. In the multivariate analysis, only moderate/marked/very marked PPA (IRR 1.6, 95%CI 1.1-2.5, p=0.0159) and being female (IRR 1.8, 95%CI 1.1-2.8, p=0.0121) remained independently associated with fractures.

Conclusion
These findings show that people at increased risk of falls based on the Physiological Profile Assessment are also at increased risk of future fragility fractures regardless of the presence of osteoporosis. Early identification of this high risk population provides the opportunity to intervene with evidence based strategies to minimize falls risk as well as considering pharmacological management of bone health.
60 Obesity in Older Adults in the Epic Norfolk Study is Associated with Reduced 20-Year Falls Hospitalization
Authors: Kioh Sheng Hui , Sumaiyah Mat , Myint Phyo , Tan Maw Pin 
Published: December 2019

Abstract

Background
One in three older adults fall each year leading to increased disability, hospitalizations and mortality. Recent studies suggested an increased risk of falls among obese individuals which may correlate with increased rates of falls hospitalizations. However, there is not much information supporting the hypothesis that obesity may influence the risk of falls related hospitalizations.

Aims
To prospectively investigate whether body mass index (BMI) is a predictor for falls hospitalization by age group in the population of the EPIC-Norfolk Study.

Methods
Body height and weight were measured at baseline and BMI calculated. Falls hospitalization status over 20 years’ follow-up was ascertained using data linkage with centralized NHS records. Participants were categorized into the four BMI groups: underweight (BMI &lt;18.5kg/m2 ), normal (18.5 ≤ BMI &lt; 25.0 kg/m2), overweight ( 25.0 ≤ BMI &lt; 30.0 kg/m2 ) and obese ( BMI ≥ 30.0kg/m2 ), and according to three age groups ( &lt; 55 years, 55-64 years, ≥ 65 years).

Results
Data from 25636 individuals, (54.7%) women and (45.3%) men, mean age 59.2 ± 9.3 years, were included. For individuals within the under 55-year age group at baseline, individuals who were overweight (HR = 1.25; 95% CI= 1.01-1.56) and obese (HR = 1.54; 95% CI= 1.17-1.81) were at higher risk of falls hospitalization compared with those with normal BMI. As for individuals aged ≥ 65 years at recruitment, individuals who were obese were less likely to be hospitalized after a fall (HR = 0.85; 95% CI= 0.74 – 0.97) compared to those with normal BMI.

Conclusions
The relationship between obesity and falls hospitalization over 20 years differed between those aged &lt;55years and 65years, with an increased risk observed for those &lt;55years and reduced risk in those 65years. The underlying rationale for this finding will need to be evaluated in future studies.
70 Benefits and Potential Pitfalls of Exercise for Falls and Frailty
Authors: Skelton Dawn 
Published: December 2019

Abstract
Group and home-based exercise programmes, delivered by trained professionals to those living in the community reduce rate of falls and risk of falling and are considered more cost effective than multifactorial or multi-component falls prevention strategies. However, the dose of highly challenging balance and progressive strength training needed to not only improve risk factors but also reduce falls means that most patients do not receive the required dose. The same can be said for interventions aimed at sarcopenia and frailty. What does this mean for their outcomes and would we do this with medications? The importance of exercise in the rehabilitation of a frailer older person for many outcomes should not be overlooked and the challenge now is to improve provision of effective interventions within practice, both in terms of linking falls prevention with bone health, increasing uptake and adherence to exercise interventions and in terms of exercise delivery. This lecture will present the evidence on falls prevention but highlight the difficulties in engaging frailer older people, who may be sarcopenic, have multiple co-morbidities and be fearful of activity in evidence based exercise. Unfortunately, frailer older people sit more and the growing evidence that sedentary behaviour has poor outcomes irrespective of activity, suggests this is a good place to start with frail fallers. Sit less, move more and progress to being strength and balance training to reduce fear of falling and progress on to meeting the physical activity guidelines for health.
71 Discriminative Ability of a Falls Screening Mobile Application in Identifying Fallers among Community Dwelling Older Adults: Preliminary Results
Authors: Goh Jing Wen , Singh Devinder Kaur Ajit , Shahar Suzana 
Published: December 2019

Abstract

Introduction
Early falls screening among community dwelling older adults is important as a part of falls prevention strategy. Falls Screening Mobile Application (FallSA) was demonstrated to be accepted, reliable and valid to be used for self-risk assessment among community dwelling older adults in an earlier study. However, its discriminative ability is unknown. We aimed to examine the discriminative ability of FallSA in classifying fallers and non-fallers among community dwelling older adults.

Methodology
A total of 182 community dwelling older adults with mean age of 71.42 ± 5.1 participated in this cross sectional study. Participants demographic and falls history data were obtained. Participants with one or more falls were categorized as fallers. FallSA was used to identify participants falls risk. Independent t-test was used to compare falls risk score among fallers and non-fallers for its discriminative ability.

Results
Approximately 20% participants were categorized as fallers. Majority of the fallers were females (66.7%), had lower physical activity level and higher scores of geriatric depression scales compared to non-fallers. There was a significant (p&lt; 0.01) different in the FallSA score between fallers (7.33±1.77) and non-fallers (4.34±1.72).

Conclusion
Our study results showed that FallSA could be used to discriminate fallers and non-fallers in community dwelling older adults. Further studies are in progress to determine the predictive validity of FallSA.
74 A Community approach to Otago Exercise: The Singapore Experience
Authors: Tay Mary Ann , Ismail Noor Hafizah Bte , Mei Lynn Lee Mei , Daoang Cheryl Marcos 
Published: December 2019

Abstract

Background
Exercise is vital towards combating sarcopenia, frailty and falls risks. Singapore’s older adults often gather at senior activity centres (SAC) for group exercises. These exercises are usually seated, low in intensity and non-progressive, posing little challenge and benefit to strength and balance.

Method
Aiming to provide evidence-based exercises to these older adults, we implemented a train-the-trainer (TTT) model to upskill community staff and volunteers to conduct the Otago Exercise Programme (OEP). Our physiotherapists conducted four classroom training days using the Later Life Training OEP course as foundation, adding modules on planning, assessment and safety considerations for group exercise. Thereafter, each leader was supplemented with an average of four On-Job-Training (OJT) sessions to provide guidance to screen participants, initiate and progress the OEP exercises suitably and safely.

Results
38 centre staff and volunteers from 13 SAC’s, were trained. Among 33 qualified community exercise leaders, 19 successfully conducted exercise classes while others were unable to commit due to various reasons. 174 older adults participated in the Otago exercises, conducted 1-2 times a week across 6 months. Participants’ outcomes reported from five of these centres showed an average of 76% attendance rate. 77% of the participants improved or maintained their Short Physical Performance Battery (SPPB) score. Participants reported that their physical function and balance improved after the OEP, enabling them to walk and climb stairs better. The OJT helped to uphold the fidelity of OEP and supported the community exercise leaders in implementing the programme. However, challenges working with centre staffs and volunteers in the community included steep learning gradient, openness to feedback, availability and turnover.

Conclusion
Community exercise leaders may be trained to conduct OEP in a group setting for older adults safely and effectively. However, OJT is essential to guide the leaders in adhering to exercise principles and safe practices.