bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract
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

Abstract
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

Abstract
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

Abstract

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

Abstract

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

Abstract
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

Abstract
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

Abstract

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.
61 HIP Fracture Management of Older Adults in a Public Tertiary Hospital in Kuala Lumpur: Analysis and Comparison with the Standard of Care in UK
Authors: Pang Gordon Hwa Mang , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Lee Fatt Soon , Yau Weng Keong 
Published: December 2019

Abstract

Background
There has been rapid improvement in evidence-based care for hip fracture in UK in which prompt, effective, multidisciplinary management has been shown to improve quality and reduce costs. The aim of this study was to evaluate the current outcome of hip fractures in our hospital, and to compare it to the outcome of evidence-based management of hip fractures in UK.

Methods
A cross-sectional study of all hip fracture patients aged 60 and above, admitted from 1st March 2018 until 28th Feb 2019. Medical records of 105 patients obtained from a hip fracture registry were reviewed. Clinical data such as patients’ sociodemographics, fall circumstances, fractures, peri-operative details, complications and mortality were extracted and analysed.

Results
The surgery rate was 67% (96.5% in UK). Among the 37 patients (35.2%) not operated, 15 refused operation. Rate of early surgery was only 9.3% (71.3% in UK). Medical stabilisation (28.2%) and no operating time (40.8%) were the main reasons for surgical delay. None had falls assessment (98% in UK) and only 7.6% was started on bone protection prior to discharge (60% in UK). The average length of stay was 17 days (15.8 days in UK). The 30 day mortality was 9.5% (8.5% in UK).

Discussion
Our results showed that there was no significant difference in length of stay and 30 day mortality compared to UK. However, this may be due to our small sample size. Lack of awareness of falls assessment and bone protection suggests that our current model of care needed improvement.

Conclusion
Our results highlighted the need to implement proactive strategies to improve the management of hip fracture in our centre. Ortho-geriatrics shared-care in hip fracture management was subsequently implemented in an effort to improve patient care and service. Further studies need to be done to re-evaluate the outcomes post implementation.
62 Are Junior Doctors aware about Risks of Falls in the Hospital
Authors: Chen Ng Chai , Chong Gar Mit , Karthigayan Aruna 
Published: December 2019

Abstract

Introduction
Falls are a leading cause of hospital acquired injuries. Junior doctors play a role as part of the multidisciplinary team, to prevent in-hospital falls and reduce harm following a fall. This study is to determine junior doctors’ level of knowledge regarding in-hospital falls.

Methods
A self-constructed and validated questionnaire was delivered to junior doctors during their weekly teaching session in the first 2weeks of May2019. It comprised of 1) Demography of participants 2) In- hospital falls prevention 3) In-hospital falls management. Correct responses from junior doctors working less than 1year and those more than 1year were compared.

Results
46% of the junior doctors responded to the questionnaire. Only 9.5% (n=23) had exposure to a course on management of falls. 82% of them (n=218) were not aware of Malaysia National Falls Guideline, whilst only a quarter of the responders (n=67) heard about the presence of Fall Intervention Team. Less than 50% junior doctors were aware of the use of Morse Fall Scale as a standardised risk assessment tool.
More than 50% of the correct responses are from more experienced junior doctors. 63.4% answered “Depression is a risk factor for falls” correctly, which represented the lowest of all the items. The second lowest item was “lines/catheters is a risk factor for falls”. The item which had the highest percentage of correct answers was “dizziness/vertigo is a risk factor for falls”, accounting for 260 subjects (98%). 56% of housemen considered physical restraints as part of fall intervention in hospital.

Conclusion
The more experienced junior doctors had better knowledge about falls in the hospital, however from this study it is shown that it is still lacking. Continuing medical education should be an avenue where in-hospital falls is emphasized, and their knowledge is regularly updated.
63 Impact of an Orthogeriatric Service on Osteoporosis Management in HIP Fracture Patients
Authors: Amini Homaira , Ong Kevin , Strivens Edward 
Published: December 2019

Abstract

Background
Osteoporosis which is now treatable is the major risk factor for hip fractures in the elderly. Having a hip fracture increases morbidity and mortality. Hip fractures are costly. Incidence increases with age.

Aims
To examine how introduction of an orthogeriatric service (OGS) improves osteoporosis management.

Method
A dedicated OGS was established in the orthopaedic unit in an Australian tertiary teaching hospital in July 2014. Retrospective analyses were undertaken to compare osteoporosis diagnosis and treatment rates in patients ≥ 65 years old presenting with minimal trauma hip fractures (MTHF) before and after the OGS was established.

Results
1. 108 MTHF (mean age 81 years) and 107 MTHF (mean age 82 years) were admitted in 2014 respectively before and after the OGS was established.
2. New osteoporosis diagnoses increased by 27%, new calcium &/or vitamin D prescription increased by 17% and new antiresorptive treatment increased by 30%, after the OGS was established.
3. The odds ratio for receiving a new diagnosis of osteoporosis post MTHF with the OGS compared to pre-OGS was 4.4 (2.1 – 9.0), p&lt;0.0001.
4. The odds ratio for initiating new antiresorptive treatment post fractured NOF with OGS compared to pre-OGS was 6.2 (3.0 – 12.7), p&lt;0.0001.
5. Rates of new diagnoses of osteoporosis and initiation of antiresorptive treatments with the OGS were not affected by age or gender.

Conclusion
1. Introduction of a dedicated OGS improved osteoporosis diagnoses and initiation of antiresorptive treatments.
2. Patients who received a new diagnosis of osteoporosis and/or started on antiresorptive treatment were also likely to be prescribed calcium and/or vitamin D supplements as well.
3. There did not appear to be any age or gender bias towards giving more new diagnoses of osteoporosis and/or more new antiresorptive treatments with a dedicated OGS.
4. These results may be useful for benchmarking and comparison purposes.
67 Determine Risk of Fall in Medical Ward: An Exploratory Study
Authors: Embong Julaida , Lee L K , Nawawi M A , Razali R M , Chong E C M , Keong Y W , Rajadurai S 
Published: December 2019

Abstract

Introduction
Patient fall is very common in hospital. It is the biggest reason of hospitalization, morbidity and mortality. However there were few evidence on risk of fall. Thus, the aim of this study was to determine risk of fall and factor associated.

Method
A Cross-sectional study has been carried out from 3 January until 7 June 2019. A total number of 151 subject were recruited from selected medical ward. Data on Socio-demographic, medication, medical related history, vision and hearing impairment were collected. The outcome measures used were Hand Grip Strength, Timed Up and Go (TUG), and Berg Balance Score (BBS).

Result
There were significant difference between risk of fall with balance (p=0.00), right and left grip strengths (p=0.004&0.001), osteoarthritic Knee (p=0.006) and Functional reach (p=0.000).

Conclusion
The results show greater risk of fall associated with balance, grip strengths, osteoarthritic knee and Functional reach.