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Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta-analysis
- Authors:
- GUO Jong-Long, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(7), 2014, pp.661-669.
- Publisher:
- Wiley
Objective: This exploratory meta-analysis aimed to examine and compare the effective interventions to prevent falls among institutionalized/non-institutionalised older adults without cognitive impairment with interventions to prevent falls for older adults with cognitive impairment. Design: A database search identified 111 trials published between January 1992 and August 2012 that evaluated fall-prevention interventions among institutionalised/non-institutionalised older adults with and without cognitive impairment as measured by valid cognition scales. Results: Exercise alone intervention was similar effective on reducing the numbers of falls among older adults without cognitive impairment regardless of setting (non-institutionalized: OR = 0.783, 95% confidence interval (CI) = 0.656–0.936; p = 0.007 institutionalized: OR = 0.799, 95% CI = 0.646–0.988, p = 0.038). Vitamin D/calcium supplementation had a positive effect on the reduction of numbers of falls among non-institutionalized older adults without cognitive impairment (OR = 0.789, 95% CI = 0.631–0.985, p = 0.036), as did home visits and environment modification (OR = 0.751, 95% CI = 0.565–0.998, p = 0.048). Exercise alone, exercise-related multiple interventions, and multifactorial interventions were associated with positive outcomes among both institutionalised and non-institutionalized older adults with cognitive impairment, but studies are limited. Conclusions: Single exercise interventions can significantly reduce numbers of falls among older adults with and without cognitive impairment in institutional or non-institutional settings. Vitamin D and calcium supplementation, home visits, and environment modification can reduce the risk of falls among older adults in non-institutional settings. Exercise-related multiple interventions and multifactorial interventions may only be effective for preventing falls in older adults with cognitive impairment. (Edited publisher abstract)
The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis
- Authors:
- MUIR Susan W., GOPAUL Karen, ODASSO Manuel M. Montero
- Journal article citation:
- Age and Ageing, 41(3), 2012, pp.299-308.
- Publisher:
- Oxford University Press
The results of this systematic review and meta-analysis of 26 prospective studies provide strong evidence that cognitive impairment, assessed using global measures of cognition, are associated with serious fall-related injury although there is no agreement on threshold values. Impairment in executive functioning is also associated with increased risk of falls even when global cognitive status is within normal limits and should be included in falls risk evaluations in older people.
Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis
- Authors:
- LI Fuzhong, et al
- Journal article citation:
- Age and Ageing, 50(5), 2021, pp.1557-1568.
- Publisher:
- Oxford University Press
Objective: Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. This study is an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. Methods: PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. This study included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer’s disease and related dementias, mild cognitive impairment). Results: This study identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90–1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. Conclusions: The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice. (Edited publisher abstract)
Drug cessation in complex older adults: time for action
- Authors:
- van der CAMMEN Tischa J.M., et al
- Journal article citation:
- Age and Ageing, 43(1), 2014, pp.20-25.
- Publisher:
- Oxford University Press
Background: general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available. Objectives: To identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use. Methods: Electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged ≥65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations. Results: The authors selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life. Conclusion: Little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed. The issue of systematic drug withdrawal in end-of-life cases is controversial, but is increasingly relevant in the face of rising numbers of older people of this clinical status. (Publisher abstract)
Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel
- Author:
- ROGANS-WATSON Raphael
- Journal article citation:
- Housing Care and Support, 23(3/4), 2020, pp.77-91.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess frailty, geriatric conditions and multimorbidity in people experiencing homelessness (PEH) using holistic evaluations based on comprehensive geriatric assessment (CGA) and draw comparisons with general population survey data. Design/methodology/approach: Cross-sectional observational study conducted in a London-based hostel for single PEH over 30 years old in March–April 2019. The participants and key workers completed health-related questionnaires, and geriatric conditions were identified using standardised assessments. Frailty was defined according to five criteria in Fried’s phenotype model and multimorbidity as the presence of two or more long-term conditions (LTCs). Comparisons with the general population were made using data from the English Longitudinal Study of Ageing and the Health Survey for England. Findings: A total of 33 people participated with a mean age of 55.7 years (range 38–74). Frailty was identified in 55% and pre-frailty in 39%. Participants met an average of 2.6/5 frailty criteria, comparable to 89-year-olds in the general population. The most common geriatric conditions were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%) and cognitive impairment (45%). All participants had multimorbidity. The average of 7.2 LTCs (range 2–14) per study participant far exceeds the average for even the oldest people in the general population. Originality/value: To the best of authors’ knowledge, this is the first UK-based study measuring frailty and geriatric conditions in PEH and the first anywhere to do so within a CGA-type evaluation. It also demonstrates the feasibility of conducting holistic evaluations in this setting, which may be used clinically to improve the health outcomes for PEH. (Edited publisher abstract)
Do subjective memory complaints predict falls, fractures and healthcare utilization? A two-year prospective study based on a cohort of older women recruited from primary care
- Authors:
- AL-SARI Usama A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.968-976.
- Publisher:
- Wiley
Objective: A proportion of older individuals report subjective memory complaints (SMCs), which can predict the development of cognitive impairment and dementia. Previous studies based on secondary care suggest that SMC is also associated with other adverse health consequences, including falls, fractures and increased healthcare utilization. In this study, the authors aimed to establish whether similar findings are observed in the wider population. Methods: Prospective analysis of the Cohort for Skeletal Health in Bristol and Avon, a population-based cohort recruited from primary care, was carried out. Data were collected by self-completion questionnaire at baseline and 2 years. SMC was assessed at baseline. Fractures, measures of falls, mobility and healthcare utilization were assessed 2 years later. A random 5% subsample of data was validated against electronic general practitioner records. Logistic regression was used to identify independent associations, following adjustment for a range of confounders assessed at baseline. Results: Data were available on 3184 women. Three hundred and fifty participants (11.0%) reported SMC. They were older (73.3 ± 4.5 vs 72.0 ± 4.2 years) and less mobile compared with those not reporting SMC. SMCs at baseline were associated with an increased risk of upper limb fractures over the following 2 years (OR 1.72, 95% CI 1.02–2.90). SMCs were also associated with an increased risk of falls (OR 1.83, 95% CI 1.41–2.38) and increased healthcare utilization (OR for hospital appointments 2.20, 95% CI 1.26–3.86). No association was observed with bone mineral density at any site. Conclusions: Subjective memory complaints are important markers of adverse health outcomes and should prompt interventions to reduce fractures such as physiotherapy-led fall reduction programmes. (Edited publisher abstract)
Prospective cohort study of adverse events in older people admitted to the acute general hospital: risk factors and the impact of dementia
- Authors:
- WATKIN L., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(1), January 2012, pp.76-82.
- Publisher:
- Wiley
Reported adverse events (RAEs) in hospitals include falls, drug and equipment related errors. The aim of this study was to determine the prevalence of RAEs in older acute medical inpatients and to investigate factors present at the time of hospital admission, in particular cognitive impairment or dementia, which may be associated with an increased risk of adverse events. A longitudinal cohort study took place in a large North London general hospital. The participants were 710 people aged over 70 years undergoing emergency medical admission. The participants were assessed using standardised tools for dementia and cognitive impairment. Data on adverse events was supplied independently by the hospital clinical risk department. The findings showed that 8.6% of patients experienced an RAE; 5.9% were patient-related and 2.7% system-related. Patient-related RAEs were associated with male gender, delirium, mild/moderate cognitive impairment and dementia. Staff comments on incident forms indicated an apparent lack of understanding of the impact of cognitive impairment. The article concludes that RAEs were common and associated with risk factors identifiable at admission.
Qualitative study on the impact of falling in frail older persons and family caregivers: foundations for an intervention to prevent falls
- Authors:
- FAES Miriam C., et al
- Journal article citation:
- Aging and Mental Health, 14(7), September 2010, pp.834-842.
- Publisher:
- Taylor and Francis
The main aim of this study was to explore the impact of falling for frail community-dwelling older persons with and without cognitive impairments who have experienced a recent fall and their primary family caregivers. In addition, the study aimed to define components for a future fall prevention programme. Interviews based on grounded theory were undertaken with 10 patients and 10 caregivers. Three of the patients were cognitively unimpaired, four had mild cognitive impairment and three had dementia. All the patients described a fear of falling and social withdrawal. Caregivers reported a fear of their care recipient falling. Most patients were unable to name a cause for the falls. The patients rejected the ideas that falling is preventable and that the fear of falling can be reduced. Some caregivers believed that a prevention programme would not be useful because of the care recipients' cognitive impairment, physical problems, age and personalities. The article concludes that a fall prevention programme should focus on reducing the consequences of falling and on promoting self-efficacy and activity. The causes of falls should be discussed. The programme should include dyads of patients and caregivers. Before beginning such a programme, providers should transform negative expectations about the programme into positive ones. Finally, caregivers must learn how to deal with the consequences of their care recipients’ falling as well as their cognitive impairment.
Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture
- Authors:
- LENZE Eric J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.472-478.
- Publisher:
- Wiley
This study examines the effects of depression and cognitive impairment in elderly hip fracture patients receiving inpatient rehabilitation. Our goal was to determine whether any association of depression and cognitive impairment with rehabilitation outcome is accounted for by more immediate effects of these variables on rehabilitation participation. The authors measured depression using the Hamilton Rating Scale for Depression (Ham-D), cognition using the Mini Mental State Examination (MMSE), and rehabilitation outcomes using the motor scale of the Functional Independence Measure (motor FIM) in a prospective observational study of 57 elderly rehabilitation hospital patients admitted to a university-affiliated, freestanding rehabilitation hospital with primary diagnosis of hip fracture. We also assessed rehabilitation participation, to determine whether this accounted for (mediated) any relationship of depression and cognitive impairment with rehabilitation outcome. Baseline Ham-D and MMSE scores were correlated with motor FIM efficiency - those with higher depressive symptoms had lower efficiency (r = -0.44, p < 0.001); similarly, those with more cognitive impairment had lower motor FIM efficiency (r = 0.52, p < 0.001). Rehabilitation participation was a mediator of this association: greater depressive symptoms and cognitive impairment predicted poorer rehabilitation participation which, in turn, predicted lower motor FIM efficiency. Ham-D and MMSE scores were predictors of discharge location: subjects with high depressive symptoms and greater cognitive impairment were more likely to go to a nursing home or personal care home upon discharge.
What is the prevalence of environmental hazards in the homes of dementia sufferers and are they associated with falls
- Authors:
- LOWERY K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(10), October 2000, pp.883-886.
- Publisher:
- Wiley
Falls in the elderly are a leading cause of disability, distress, admissions to supervised care and death. The current study examined environmental hazards in the home environments of cognitively impaired elderly people. The authors hypothesized that a substantial number of hazards would be identified and that they would be significantly associated with the number of falls.