bluuebunny/crossref_metadata_2025_split huggingface dataset:
52 Should Physiotherapists and Occupational Therapists be Part of the Comprehensive Geriatric Assessment Clinics within the Outpatient Setting?
Authors: Denning-Kemp Alexandra , Melville Hannah , Meldrum Teresa , Wood Carrie-Ann 
Published: December 2019

Abstract

Introduction
The British Geriatric Society (2015) recommends a multidisciplinary team (MDT) Comprehensive Geriatric Assessment (CGA) framework as the Gold standard of care for frail older adults with complex needs. There are currently five Consultant and Nurse-led outpatient CGA clinics in the Older Persons’ Assessment Unit (OPAU), which refer into Physiotherapy (PT) and Occupational Therapy (OT) following their assessments. The aim was to improve the care of patients across the CGA pathway by auditing to establish whether therapists should be involved in the initial assessment of patients in these clinics. Of all new CGA patients in a six month period, only 8% and 2% were referred to PT and OT respectively, warranting further investigation due to the known complexity of this population.

Methods
Set criteria were established, incorporating the core domains of CGA, designed to highlight patients needing therapy assessment, and were screened using patient questionnaires and medical notes review over a three week period.

Results
53 patients were screened against the CGA domains. Rate of completion amongst CGA domains was highly variable: polypharmacy (89%); social (66%); falls (43%); nutrition (43%); continence (25%); mood (23%); cognition (21%); vision (13%); and timed up and go (9%). During the audit, consultants referred four patients to PT and none to OT, compared with screening against the established criteria, which highlighted 28 patients to PT and 22 to OT. Overall, 86% of those screened required therapy intervention.

Discussion
This project identified a substantial number of patients are failing to receive full, effective CGA including onward therapy intervention, which is key in identifying and managing frailty and improved patient outcomes.

Conclusions
This audit highlights the value and need for a multi-disciplinary approach, including PT and OT assessment, within CGA outpatient clinics, to ensure a holistic review of and intervention in the complex needs of older adults.
55 Association between Inflammatory Biomarkers and Severity of Osteoarthritis
Authors: Tong Lynell Roderica Yiu Shyern , Arvindran Vishnu , Mat Sumaiyah , Kioh Sheng Hui , Tan Maw Pin 
Published: December 2019

Abstract

Introduction
Previous studies have found that older adults with osteoarthritis (OA) were more likely to fall. However, the role of inflammation in OA severity, impaired physical function and increased risk of fall remains unclear. Therefore, the aim of this study is to explore the association between the inflammatory biomarkers and OA severity.

Method
This is a cross sectional case-control study which includes 69 individuals aged 55y recruited from orthopaedic clinics, geriatric clinics, primary care and senior citizen groups. Demographic characteristics, medical history, lifestyle factors, Knee Injury and Osteoarthritis Outcome Scores (Koos) were obtained through computer-assisted questionnaires and physical performance were measured. Blood samples were drawn after an overnight fast for a routine laboratory panel. The 20 inflammatory markers were measured and quantified using validated enzyme linked immunosorbent assays included TGFA, IFNG, IL1ra, IL1A, IL1B, IL2, IL3, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12P40, IL12P70, IL13, IL15, IL17A and TNFA.

Results
Of the 69 participants, mean (SD) age being 66.67 (7.605) and 71% women, 18 (26.1%) reported severe, 13(18.8%) moderate, 20 (29.0%) mild and 18 (26.1%) no OA, women. Significant differences in BMI (p-value&lt;0.01), timed-up and go (p-value=0.01), handgrip strength (p-value&lt;0.05), and all KOOS domain scores (p-value&lt;0.01) were found between the four OA severity groups. Of the 20 inflammatory biomarkers tested, only three biomarkers – TGF-A (p=0.01), IL-6 (p&lt;0.01) and IL-8(p=0.03) were significantly associated with severity of osteoarthritis.

Conclusion
More research is needed to see whether this applies to a bigger population and more detailed research needs to be done in regards to TGF-A, IL-6 and IL-8 which shows promise as a severity biomarker for osteoarthritis.
56 Examining Fall-Related HIP Fractures in Long-Term Residential Aged Care and the Community: Trends, Health Outcomes and Treatment Costs
Authors: Mitchell Rebecca , Draper Brian , Harvey Lara , Brodaty Henry , Close Jacqueline 
Published: December 2019

Abstract

Background
Hip fracture risk is higher for older adults living in residential aged care facilities (RACF) and their health outcomes worse compared to older adults living in the community. Pre-hip fracture residential status is not well recorded within hospital records, necessitating linkage of hospital and residential aged care data to better ascertain residential location pre-fracture.

Aim
To examine temporal trends, characteristics and health outcomes following a fall-related hip fracture hospitalisation of people living in RACFs to those living in the community.

Method
A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥65 years during 2008-2013 in New South Wales, Australia. Linked hospitalisation and RACF data were examined. Negative binomial regression examined the significance of hospitalisation temporal trends.

Results
There were 28,897 hip fracture hospitalisations and 32.5% were living in RACFs at time of fracture. The hospitalisation rate was 2,180 per 100,000 (95%CI: 2,097.0-2,263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for the community-living. Over 5 years, the hospitalisation rate for RACF residents declined by 2.9% annually (95%CI: -4.3 to -1.5). Hospital treatment cost for hip fractures was $958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had &gt;1 Charlson comorbidity (37.6% vs 35.6%), and had dementia (58.2% vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community.

Conclusions
RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve health outcomes should be examined.
59 Falls among the Older Adults: Demographics and Risk Factors Analysis in a Clinic-Based Study
Authors: Pang Gordon Hwa Mang , Quah Jing Yao , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Lee Fatt Soon , Yau Weng Keong 
Published: December 2019

Abstract

Background
The aim of the present study was to analyse the demographic pattern, fall circumstances and identify risk factors associated with the occurrence of falls among older adults presenting to falls clinic Hospital Kuala Lumpur

Setting and design
A clinic-based cross-sectional study in Falls Clinic Hospital Kuala Lumpur

Subjects and Method
Medical records of 113 patients attending the Falls Clinic Hospital Kuala Lumpur were analysed. Data on falls circumstances, socioeconomic/demographic factors were collected, and possible risk factors were tested for possible association with outcome, i.e. Recurrent falls using univariate and multivariate analysis.

Results
Of the 113 patients studied, 37.2% (42) were aged more than 80, female predominant 60.2 % (68). 73.5% (83) had recurrent falls and 80.5% (91) had indoor falls. The 3 most common mechanism of falls were tripped/slipped 39.8% (45), loose balance 38.9% (44) and dizziness 31% (35). 67.3% (76) sustained injuries, of which 27.6% (21) were major injuries. Among major injuries, 76.2% (16) had fractures and 23.8% (5) had ICH. The 3 commonest risk factors are poly-pharmacy (5 or more meds) 83.2% (94), poor vision 77.9% (88) and multiple co-morbidities (3 or more) 77%. After multiple logistic regression analysis, ‘usage of anti-hypertensives’ achieved statistically significance with OR of 3.85 (p value 0.008, 95% CI 1.41-10.52).

Conclusion
The usage of anti-hypertensives is associated with almost 4 times more likely to have recurrent falls after removing cofounding factors from our clinic based study. We should prioritise falls prevention on older adults with polypharmacy, poor vision and multiple comorbidities especially those with anti-hypertensives.
64 Association between Risk of Osteoporotic Fractures with Spinal Morphology, Muscle Strength and Physical Performance
Authors: Chua Siew Kuan , Devinder  , Singh KA , Rajaratnam Bala S , Mokhtar Sabarul Afian , Raymond Lee YW 
Published: December 2019

Abstract
Osteoporotic related fractures (OF) are associated with functional impairments and declined quality of life. Low bone mineral density is one of the main risk factor for OF. However, there is limited information regarding the association of spinal morphology, muscle strength and physical performance with OF. The aim of the study was to examine association between risk of osteoporotic fractures with spinal morphology (thoracolumbar curvature and back extensors muscle strength), muscle strength and physical performance. 105 adults aged 50 years and above (69.3+ 8.5 years) were recruited for this cross-sectional study from a spine orthopaedic clinic. Thoracolumbar curvature, back extensors (BEMS) and handgrip (HGS) muscle strength were measured using an electromagnetic tracking system, a load-cell system and hand-held dynamometer respectively. Physical performance was assessed using Short Physical Performance Battery (SPPB). Participants were categorised for major osteoporotic fracture risk (major OF) with cut-point 10% using fracture risk calculator (FRAX®) with BMD. Student t-test analysis demonstrated that there is a significant (p&lt;0.05) difference between participants with low risk and moderate to high risk of major OF for BEMS, HGS, and SPPB. Adjusted logistic models (forward and backward), showed that lower HGS and physical performance were associated with increased risk of major OF (HGS: OR = 0.18 [95% CI, 0.07–0.48]; SPPB: OR = 0.32[95% CI, 0.13–0.80]). Our study results suggest that declined muscle strength and physical performance is associated with higher risk of OF. It is important to promote optimum muscle strength and physical performance among older adults in the prevention of OF.
65 Fragility Fracture Network (FFN) Malaysia - A Call to Action for Better Outcome in Malaysia
Authors: Khor Hui Min , Lee Joon Kiong , Ch'ng Alan Swee Hock , Khoh Hong , Lee Lawrence , Jalil Elyana , Chong Elizabeth Gar Mit , Kumar C Sankara , Choong Qian Yi , Engkasan Julia anak Patrick , Nadarajah Sivapathasundaram C , Bong Chin Pei , Chung Wai Mun 
Published: December 2019

Abstract

Introduction
The incidences of hip fractures are increasing worldwide and over 50% of all hip fractures are projected to occur in Asia. Malaysia is predicted to have the highest rate of increase in numbers of hip fracture in Asia Pacific by 2050. Despite the health and economic burden associated with fragility fractures, there is limited systematic guidance or nationwide interventions set up to address this foreseeable tsunami in Malaysia. This has called for the formation of a national Fragility Fracture Network to bring together experts from different disciplines nationally to drive policy change and improve quality of care in patients with fragility fracture.

Method
The Asia Pacific Regional Fragility Fracture Summit held in Singapore in May 2018 brought together representatives of regional societies from geriatrics, orthopedic, osteoporosis and rehabilitation to share key challenges in providing optimal fragility fracture care. Three clinicians from Malaysia representing three different societies in Asia Pacific who attended the summit initiated the idea of forming a national multidisciplinary network to focus on improving acute hip fracture care, post-acute care rehabilitation and secondary fracture prevention.

Results
After the first meeting held in June 2018 with only 4 members in Kuala Lumpur, the network has expanded to include members from 7 different states in Malaysia. This has led to the formation of the Fragility Fracture Network (FFN) Malaysia in August 2018. The key goals of the network include the development of clinical hip fracture care pathway, initiating national hip fracture registry and fracture liaison service.

Conclusion
FFN Malaysia serves as a platform to unite healthcare providers and policy makers in prioritizing and having co-ownership in improving fragility fracture care in the country.
66 Short Term Outcomes Following Fragility HIP Fracture in Malaysia
Authors: Khor Hui Min , Teh Hui Xin , Tan Fang Chin , Shanmugam Tharshne , Kumar Sankara C , Tan Kit Mun , Singh Simmrat , Saedon Nor' Izzati , Chin Ai Vyrn , Kamaruzzaman Shahrul B , Tan Maw Pin 
Published: December 2019

Abstract

Introduction
Hip fracture carries huge burden to the older person with 40% of patients unable to walk independently after a year and mortality risk of 30% at one year. The study aims to report short-term outcomes following hip fracture from the experience of a tertiary center in Kuala Lumpur.

Methods
A prospective study was performed in University of Malaya where consecutive patients admitted to the orthopaedic wards with fragility hip fracture from March 2016 to August 2018 were recruited. Information on basic socio-demographics, comorbidities, functional status, pre and post-operative assessments, and discharge details were recorded. Outcome measures include the ability to return to pre-fracture mobility status and mortality in 6 months post fracture.

Results
A total of 302 patients with mean age of 79.8 (SD 7.28) years old were included in the study. 276 (91.4%) underwent surgery with mortality rate of 7% in 30days and 14.4% in 6 months. 16.4% of patients underwent surgery within 48hours of admission. Time to surgery was not associated with morbidity or mortality outcome in our study. In 6 months follow up, 23.6% of patients were freely mobile, 27.1% were mobile with one aid, 35.5% required walking frame and 13.8% were immobile. 41.6% of patients managed to regain prefracture mobility status. Multivariate analysis showed that age, length of hospitalization and prefracture mobility statuses were predictors of mobility recovery after hip fracture.

Conclusion
Fragility hip fracture has devastating consequences from our study. There is an urgent call to improve acute hip fracture care and post-acute care rehabilitation in Malaysia.
69 Falls: A Manifestation of Frailty and Sarcopenia
Authors: Woo Jean 
Published: December 2019

Abstract
Falls is one of the major adverse outcomes of frailty and sarcopenia, and may be considered a downstram consequence of these emerging geriatric syndromes. Frailty consists of both physical and cognitive components, which lead to increased falls risk. Community screening for frailty and sarcopenia may be included as an important public health measure, to be followed by more detailed falls risk assessment requiring various measurements. At the same time falls prevention or rehabilitation programs need to take into account the presence of frailty and/or sarcopenia and their appropriate management, to achieve optimal results.
75 Functional Mobility and Balance Confidence as Correlates of Fall Risk in Older Adults Attending a Primary Health Care Clinic
Authors: Ponvel Pavapriya , Singh Devinder Kaur Ajit , Ng Ee San , Selvam Sheela Bai Pannir 
Published: December 2019

Abstract

Background
Fall is one of the leading cause of unintentional injury among older adults. Information regarding functional mobility and balance confidence as correlates of fall risk in older adults attending a primary health care clinic is limited. This information is vital for fall screening and prevention. We aimed to examine if functional mobility and balance confidence were correlates of fall risk in older adults attending a primary health care clinic.

Methods
106 older adults (≥60 years old) attending a primary health care clinic at Cheras, Malaysia participated in this cross-sectional study. Socio-demographic details and falls history were obtained using a structured questionnaire. Functional mobility and balance confidence were assessed using Timed Up and Go (TUG) test and Activities-Specific Balance Confidence (ABC) scale respectively. Fallers were categorised based on history of at least a fall in the past 12 months. Differences between faller and non-faller groups were distinguished using Independent T and Mann Whitney tests. Binomial logistic regression and receiver operating curve were performed to identify if functional mobility and balance confidence were correlates of falls risk and the cut off values for measures were obtained.

Results
TUG test and ABC scores differed significantly between the two groups (p&lt; 0.05). Both TUG test and ABC scale were identified as correlates of falls risk with r, R2 of 0.98, 0.26 (p&lt; 0.001) and 0.95, 0.12 (p&lt; 0.05) respectively. Cut off value of 9.02 seconds and above for TUG test and 82.81% and below for ABC score were identified as risk factor of falls among older adults.

Conclusion
The cut off values obtained from our study can be used as reference to screen older adults at risk of falls in Malaysian primary health care settings. Early fall risk screening and management is a part of falls prevention strategy in older adults.
76 Comparison of Physical Performance in Older Fallers with and without Mild Cognitive Impairment
Authors: Heaw Yu Chi , Singh Devinder Kaur Ajit , Tan Maw Pin , Kumar Saravana 
Published: December 2019

Abstract

Introduction
While mild cognitive impairment (MCI) is a risk factor for falls in older adults, the effects of MCI on physical performance associated with MCI have not been adequately characterised. The aim of the study was to profile physical performance patterns associated with MCI.

Methodology
53 older fallers (31 females, 22 males) from the Falls Clinic at Universiti Malaya Medical Centre, aged 60 years and above (76.5±6.6) were screened and categorised into 2 groups – with MCI and non-MCI – using a Visual Cognitive Assessment Test (VCAT) cut-off score of ≥23. Participants’ sociodemographic data were recorded. Participants performed the Senior Fitness Test that consisted of a battery of physical performance tests.

Results
Older fallers with MCI (n=26) had significantly (p&lt;0.05) poorer physical performance compared to the non-MCI (n=27) group in handgrip strength (16.7±4.8 vs 20.7±7.9 kg), Timed Up-and-Go (17.3±9.91 vs 9.54±2.10 s) and 2-minute walk (79.3±29.8 vs MCI 106.3±33.1 m) tests. There were no significant (p&gt;0.05) differences for the 30-second chair stand, chair sit-and-reach and back scratch tests.

Conclusion
Older fallers with MCI had poorer upper body muscle strength, balance and aerobic endurance compared to those with normal cognition. However, flexibility and lower body muscle strength were similar in older fallers with and without MCI. Further studies to evaluate specifically tailored interventions according to the pattern of physical impairment reported with MCI are needed.
77 Comparison between Swiss Ball Exercise and Sling Exercise on Lumbar Stability and Postural Stability in Patients with Non-Specific Chronic Low Back Pain: A Pilot Study
Authors: Jaroenlarp Apinkarn , Fuengjit Pitsinee , Sukeeyuti Jirapat , Sophap Parichart , Chirasaengthong Chadarat 
Published: December 2019

Abstract

Objective
This study was to comparison of level of lumbar stability and postural sway in sagittal plane and coronal plane between exercise with ball and sling in the patients with non-specific chronic low back pain (NCLBP).

Methodology
Twenty participants with NCLBP aged 20 to 55 years were randomly divided into exercise with ball group (BG) and exercise with sling group (SG). Both groups performed 8 exercise sessions; two times per week for four weeks. The visual analog scale (VAS), modified oswestry disability questionnaire (MODQ), modified isometric stability test (MIST) were used to measure at baseline, week 2 and week 4 after exercise. Moreover, the sway area and sway velocity were evaluated at before and after training. Both group performed exercise 15 repetitions per set for 3 sets with 1-minute resting between set. A repeated two-way ANOVA was used to analyze the difference variables between both groups.

Results
The results showed significant difference between pre and post treatment of pain intensity, functional disability, MIST and postural sway in both groups (p&lt;.001). When compared between both groups, the reduction in all parameters for the BG group was significantly higher than the SG group (p&lt;.05). Moreover, the findings represented that the postural sway in both sagittal and coronal plane showed no significant difference between both groups after complete treatment.

Conclusion
The core stabilization exercise with ball and with sling can provided reduction of pain and functional disability. Moreover, the BG group is more effective for decreasing of pain, disability and improving of lumbar stability may described by greater perturbation of the ball. During perform exercise on ball bring to unstable and increasing of neuromuscular control. These results can applied to clinical practice for choosing the appropriate exercise program in the patients with NCLBP.
78 Development of a Multifactorial Assessment of Dizziness for Middle-Aged and Older People
Authors: Menant Jasmine , Meinrath Daniela , Sturnieks Daina , Migliaccio Americo , Close Jacqueline , Lord Stephen , Delbaere Kim , Titov Nickolai 
Published: December 2019

Abstract

Background
More than 10% of people aged 50 years and older report dizziness. Despite available treatments, dizziness remains unresolved for many people due in part to sub-optimal assessment.

Aims
to identify factors associated with dizziness handicap in middle-aged and older people to identify targets for intervention to address this debilitating problem.

Methods
This secondary analysis of baseline and prospective data from a randomised-controlled trial involved 305 individuals aged 50-92 years reporting significant dizziness in the past year. Participants were classified as having either mild or no dizziness handicap (score &lt; 31) or moderate / severe dizziness handicap (score: 31-100) based on the dizziness handicap inventory (DHI). Participants completed health questionnaires and underwent assessments of psychological well-being, lying and standing blood pressure, vestibular function, strength, vision, proprioception, processing speed, balance, stepping and gait. Participants also reported dizziness episodes in monthly diaries for 6 months following baseline assessment. Participants reported dizziness episodes in monthly diaries for six months following baseline assessment.

Results
DHI scores ranged from 0-86 with 95 participants (31%) reporting moderate/severe dizziness handicap. Binary logisitic regression identified a postive Dix-Hallpike test for benign paroxysmal positional vertigo, cardiovascular medicationuse, high postural sway when standing on the floor with eyes closed and severe anxiety, as significant and independent predictors of moderate.severe dizziness handicap. Poor balance (high sway) also significantly identified participants who reported frequent (&gt; or = weekly, n=134) dizziness episodes.

Conclusion
Assessment of cardiovascular medication use, benign paroxysmal positional vertigo, anxiety and postural sway identify middle aged and older people with significant dizziness handicap. A multifactorial assessment including these facotrs may assist in tailoring evidence-based therapies to alleviate dizziness handicap in this group.