bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract
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

Abstract
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract
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

Abstract

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&lt;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

Abstract

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

Abstract

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.