Fear of falling as a risk factor of mobility disability in older people at five diverse sites of the IMIAS study

BackgroundFear of falling (FoF) is a common health problem among older adults. Although the relationship between FoF and limitation in daily activities has been reported, FoF’s relationship to mobility disability, a transitional phase to end-stage disability, is not yet understood. We examined the relationship between FoF and mobility disability among community-dwelling older adults and explored the differences in this relationship among socio-culturally diverse sites.DesignCross-sectional study.SettingCommunity.Participants1875 participants (65–74 years) were recruited from five sites and included in the analysis (Kingston, Canada: 394; St-Hyacinthe, Canada: 397; Tirana, Albania: 359; Manizales, Colombia: 341; and Natal, Brazil: 384).MeasurementFoF was quantified using the Falls Efficacy Scale-International (FES-I, range: 16–64). Mobility disability was defined as difficulty climbing a flight of stairs or walking 400 m without assistance.ResultsOverall, 21.5% of participants reported high FoF (FES-I > 27). The average FoF scores were significantly different between the sites (p < 0.001) and higher in women (p < 0.001). In general, 36.2% of participants reported mobility disability. The distribution of mobility disability was significantly different at the five study sites (ranged from 19.8% at Kingston, Canada to 50.7% at Tirana, Albania, p < 0.001). After adjusting for covariates, those with high and moderate FoF had about 3 times (95% CI: 2.59–3.83) and 2.5 times (95% CI: 1.99–2.91) higher risk of mobility disability, respectively, compared to those with no/low FoF.ConclusionsFoF was significantly associated with risk of mobility disability across the sites. The strength of this relationship appears to be different between the five sites.     

The circumstances,orientations, and impact locations of falls in community-dwelling older women

ObjectiveWe sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women.MethodsFor this longitudinal, observational study, 125 community-dwelling women age ≥ 65 years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires.ResultsMore than half (59%) of participants fell, with 30% of participants falling more than once (fall rate = 1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41% of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR = 12.6; 95% CI: 4.7–33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR = 2.6; 95% CI: 1.2–5.9).ConclusionFalls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.     

Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study

BackgroundOrthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore.MethodsData was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status.ResultsThe prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26–4.30; p = 0.007) compared to those aged 75–84 years (OR: 1.76; 1.08-2.85; p = 0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56–5.88, p = 0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p = 0.007).ConclusionsOlder age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult’s functional capacity and quality of life to prevent injury.     

Tailored education program using home floor plans for falls prevention in discharged older patients: A pilot randomized controlled trial

ObjectiveTo investigate the effect of a tailored education program using home floor plans on falls prevention in discharged older patients.DesignA single-center, parallel, pragmatic, pilot randomized controlled trial with equal allocation to the intervention and control groups.SettingDischarged hospital patients were followed-up in their home settings.ParticipantsAll discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n = 60).InterventionsBoth groups received standard care (exercises) and the intervention group also received a tailored education program for falls prevention using home floor plans.MeasurementsFalls and near-falls at the participants’ homes using a 1-month fall calendar during the 1-month period after discharge. The evaluators were blinded at the baseline assessment.ResultsNine participants were withdrawn from the study, leaving 51 of 60 (85%) participants for the final analyses. No falls occurred in the intervention group (n = 25) during follow-up. However, 2 participants (7.7%) fell in the control group (n = 26). Near-falls were reported by 7 participants (28.0%) in the intervention group and 13 participants (50.0%) in the control group. The intervention group had 75% less near-falls compared with the control group, as assessed using a Cox proportional hazards model (hazard ratio, 0.25; 95% confidence interval, 0.09–0.75).ConclusionsThe tailored education program using home floor plans at the hospital was effective for reducing falls and near-falls among discharged orthopedic patients.Registration of clinical trials: This study was registered with the Research Ethics Committee of University Hospital Medical Information Network (UMIN) Center (000018201).     

Differing trends in fall-related fracture and non-fracture injuries in older people with and without dementia

ObjectivesTo explore the impact of dementia on the trends in fall-related fracture and non-fracture injuries for older people.MethodsIndividuals aged ≥65 years who were admitted to a NSW hospital for at least an over-night stay for a fall-related injury from 2003 to 2012 were identified. Age-standardised hospitalisation rates, length of stay, access to in-hospital rehabilitation, 30-day and 1-year mortality were examined. Annual percentage change (PAC) over time was calculated using negative binomial regression.ResultsOf the 228,628 fall-related injury hospitalisations, 20.6% were for people with dementia. People with dementia were more likely to be admitted with a hip fracture, and less likely to be admitted with a fracture of the forearm/wrist, and received less in-hospital rehabilitation than people without dementia. Fall-related hip-fracture rates for people with dementia decreased by 4.2% (95%CI −5.6 to −2.7, p < 0.001) per annum; there was no change over time for people without dementia (PAC-0.2%; 95%CI −0.8 to 0.5, p = 0.643). Rates for other fractures decreased by 1.2% (95%CI −1.9 to −0.5, p < 0.001) per annum in people with dementia, while rates increased by 2.2% (95%CI 1.9–2.5, p < 0.001) for people without dementia. By contrast, non-fracture injuries including traumatic brain injury increased significantly for both people with and without dementia.ConclusionRates of fall-related fracture and non-fracture hospitalisations for people with dementia remain higher than for those without dementia. However, fall-related fracture hospitalisation rates have decreased for people with dementia, while there has not been a corresponding decrease in people without dementia.     

Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial

BackgroundFalls are common in the older UK population and associated costs to the NHS are high. Systematic reviews suggest that home exercise and group-based exercise interventions, which focus on progressively challenging balance and increasing strength, can reduce up to 42% of falls in those with a history of falls. The evidence is less clear for those older adults who are currently at low risk of falls.AimProAct65+, a large, cluster-randomised, controlled trial, investigated the effectiveness of a home exercise programme (Otago Exercise Programme (OEP)) and a group-based exercise programme (Falls Management Exercise (FaME)) compared to usual care (UC) at increasing moderate to vigorous physical activity (MVPA). This paper examines the trial’s secondary outcomes; the effectiveness of the interventions at reducing falls and falls-related injuries.Setting & participants1256 community-dwelling older adults (aged 65 + ) were recruited through GP practices in two sites (London and Nottingham). Frequent fallers (≥3 falls in last year) and those with unstable medical conditions were excluded, as were those already reaching the UK Government recommended levels of physical activity (PA) for health.MethodsBaseline assessment (including assessment of health, function and previous falls) occurred before randomisation; the intervention period lasted 24 weeks and there was an immediate post-intervention assessment; participants were followed up every six months for 24 months. Falls data were analysed using negative binomial modelling.Outcome measuresFalls data were collected prospectively during the intervention period by 4-weekly diaries (6 in total). Falls recall was recorded at the 3-monthly follow-ups for a total of 24 months. Balance was measured at baseline and at the end of the intervention period using the Timed Up & Go and Functional Reach tests. Balance confidence (CONFbal), falls risk (FRAT) and falls self-efficacy (FES-I) were measured by questionnaire at baseline and at all subsequent assessment points.Results294 participants (24%) reported one or two falls in the previous year. There was no increase in falls in either exercise group compared to UC during the intervention period (resulting from increased exposure to risk). The FaME arm experienced a significant reduction in injurious falls compared to UC (incidence rate ratio (IRR) 0.55, 95% CI 0.31, 0.96; p = 0.04) and this continued during the 12 months after the end of the intervention (IRR 0.73, 95% CI 0.54, 0.99; p = 0.05). There was also a significant reduction in the incidence of all falls (injurious and non-injurious) in the FaME arm compared with UC (IRR 0.74, 95% CI 0.55, 0.99; p = 0.04) in the 12 month period following the cessation of the intervention. There was a non-significant reduction in the incidence of all falls in the OEP arm compared with UC (IRR 0.76, 95% CI 0.53, 1.09; p = 0.14) in the 12 months following the cessation of the intervention. The effects on falls did not persist at the 24 months assessment in either exercise arm. However, when those in the FaME group who continued to achieve 150 min of MVPA per week into the second post-intervention year were compared to those in the FaME group who did not maintain their physical activity, there was a significant reduction in falls incidence (IRR = 0.49, 95% CI 0.30, 0.79; p = 0.004). CONFbal was significantly improved at 12 months post intervention in both intervention arms compared with UC. There were no significant changes in any of the functional balance measures, FES-I or FRAT, between baseline and the end of the intervention period.ConclusionCommunity-dwelling older adults who joined an exercise intervention (FaME) aimed at increasing MVPA did not fall more during the intervention period, fell less and had fewer injurious falls in the 12 months after cessation of the intervention. However, 24 months after cessation of exercise, the beneficial effects of FaME on falls reduction ceased, except in those who maintained higher levels of MVPA. OEP exercise appears less effective at reducing falls in this functionally more able population of older adults.     

Recurrent falls in Parkinson’s disease after one year of follow-up: A nested case-control study

The aims of this study were to compare clinical and fall characteristics of single and recurrent falls among persons with PD and to evaluate factors associated with recurrent falls. A total of 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited. Occurrence of falling was registered during one year. Each person was given a “fall diary” with the aim at writing characteristics of the fall and contacted by telephone each month. Over one year of follow-up 42 persons with PD (35.0%) reported falling. Of 42 persons, 19 (45.2%) went on to become single and 23 (54.8%) went on to become recurrent fallers. Indoor falls were more common among single fallers, whilst outdoor falls were more common among recurrent fallers (p = 0.017). Slipping and freezing of gait was more common among single fallers (p = 0.035 and p = 0.024, respectively). Lower extremity weakness was more frequent among recurrent fallers (p = 0.023). The most common injury both among single and recurrent fallers was the soft-tissue contusion. The only factor associated with recurrent falling among persons with PD, who did not fall in past 6 months before the start of follow-up, was worse motor performance as measured by the UPDRS III score (odds ratio [OR] = 1.06, 95% confidence interval [CI] 1.01–1.11, p = 0.022). These results could be used in selection of persons with PD to enroll in fall prevention programs.     

Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study

ObjectivesThis study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia.MethodsOne hundred and seventy-seven older people with dementia (Mini-Mental State Examination 11–23; Addenbrooke’s Cognitive Examination-Revised <83) residing in the community or low level care facility completed baseline neuropsychological, physical and functional assessments. Of these, 134 participants agreed to reassessment of the above measures one year later.ResultsOverall, many neuropsychological, physical and functional performance measures declined significantly over the one year study period. Baseline gait speed was significantly associated with decline in verbal fluency (B(109) = 2.893, p = 0.046), specifically phonemic/letter fluency (B(109) = 2.812, p = 0.004) while controlling for age, education, dementia drug use and baseline cognitive performance. There was also a trend for an association between baseline gait speed and decline in clock drawing performance (B(107) = 0.601, p = 0.071).ConclusionsOlder people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition.     

Conversion pattern and predictive factor of mild cognitive impairment in elderly Koreans

ObjectiveWe aimed to understand conversion characteristics of mild cognitive impairment (MCI) in elderly Koreans.MethodsWe analyzed clinical data of 760 individuals who participated in a two-year follow-up study. Neuropsychological assessments and clinical examination were conducted in the follow-ups. Logistic regression model was used to estimate predictive risk factors of MCI conversion.ResultThe participants at baseline (n = 760) represented 462 cognitively normal individuals (60.8%), 286 individuals with MCI (37.6%), and 12 individuals with dementia (1.6%). Among the cognitively normal individuals (n = 462), 108 (23.4%) progressed to MCI during the two-year follow-up period, including 92 with amnestic mild cognitive impairment (aMCI; 19.9%) and 16 with non-amnestic mild cognitive impairment (non-aMCI; 3.5%). Interestingly, 3.7% of participants with aMCI converted to non-aMCI, while 45.5% of participants with non-aMCI converted to aMCI. Moreover, a higher proportion of non-aMCI (27.3%) reverted to a cognitively normal state, compared to aMCI participants (18.6%), indicating that non-amnestic cognitive impairment is more unstable than amnestic cognitive impairment, and probably converges toward aMCI. Additionally, we found that weight loss was associated with incident MCI and future MCI. Weight loss was negatively correlated with Clinical Dementia Rating (p = 0.005), and significantly associated with a higher risk of MCI conversion from a cognitively normal state (OR = 1.10, 95% CI: 1.00–1.21, p = 0.042).ConclusionThis study supports that non-amnestic MCI is prone to converge toward amnestic MCI, and the elderly people with weight loss are at risk for developing cognitive decline.     

Thirty-day prevalence of delirium among very old people: A population-based study of very old people living at home and in institutions

Delirium has mainly been studied in various patient samples and in people living in institutions. The present study investigates the 30-day prevalence of delirium in a population-based sample of very old people in northern Sweden and Finland. Seven hundred and eight persons aged 85 years and older from the GErontological Regional DAtabase (GERDA) were assessed. Information was also collected from relatives, carers and medical records. Assessments performed were among others the Organic Brain Syndrome (OBS) scale, the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 (GDS-15). Delirium, depression and dementia diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The prevalence of delirium was 17% among 85 year-olds, 21% among 90 year-olds and 39% among participants aged 95 years and older (p < 0.001). Delirium prevalence among individuals without dementia was lower than among those with dementia (5% vs. 52%, p < 0.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression (Odds Ratio (OR) = 2.0, 95% Confidence Interval (CI) = 1.2–3.3), heart failure (OR = 2.1, 95% CI = 1.2–3.7), institutional living (OR 4.4, 95% CI = 2.4–8.2) and prescribed antipsychotics (OR = 3.0, 95% CI = 1.5–6.0).Delirium is highly prevalent among very old people with dementia. Depression, heart failure, institutional living and prescribed antipsychotic medication seem to be associated with delirium.     

Barriers to and promoters of screening for falls in elderly community-dwelling patients by general practitioners: a large cross-sectional survey in two areas of France

The objective was to determine the factors affecting French GPs' implementation of annual screening for falls among patients of 75 years old and over. We conduct a cross-sectional study in two areas in the South-east of France (Savoie and Isère). An anonymized survey was sent by e-mail and/or post in May 2008 to all GPs with a large practice. Reminder letters were sent to GPs who hadn't answered between June and July 2008. Potentials barriers were measured by dichotomous scale. On GPs characteristics (socio-demographic, knowledge, attitude and practice), a multiple logistic regression was performed to identify others factors affecting falls screening. 493 questionnaires were analyzed (26.8%). 65.3% of respondents considered annual screening for falls to be useful, though only 28.8% of them implemented it each year and 9.3% every two to five years. Barriers to achieving annual screening included patient selecting (56.3%), forgetting to screen (26.6%), unsuitable working conditions (18.5%), lack of time (13.3%), of knowledge (13.3%), or of financial compensation (11.1%). Perception of the usefulness of annual screening for falls (OR = 5.38 (2.07–14.08); p = 0.001), satisfaction with medical care for falls (OR = 1.34 (1.09–1.65); p = 0.006) and increased consultation time (OR = 2.65 (1.37–5.13); p = 0.004), were found to have a significant impact on the implementation of annual screening for falls. Asking your patient each year if s/he has had any falls, inquiring about gait and balance disturbance is not time consuming. Finally, to improve a health-related quality of life, GPs should consider fall assessment as a fundamental feature of medical care.     

Modifiable risk factors for nursing home admission among individuals with high and low dementia risk

BackgroundStrategies to prevent or delay nursing home admission in individuals with cognitive impairment are urgently needed. We hypothesized that physical inactivity, not consuming alcohol (as opposed to moderate alcohol use), and having a history of smoking predict nursing home admission among individuals with normal cognitive function, but these behavioral factors would have attenuated associations with nursing home admission among individuals with impaired cognition.MethodsWe performed a prospective cohort study among 7631 Health and Retirement Study participants aged 65+ at baseline. Baseline dementia risk (high versus low, based on brief psychometric assessments and proxy reports) and modifiable risk factors (physical inactivity, ever smoking, and not consuming alcohol) were used to predict nursing home admission in pooled logistic regression models. We evaluated whether estimated effects of modifiable factors varied by dementia risk, comparing both relative and absolute effects using interaction terms between dementia risk and each modifiable risk factor.ResultsLow dementia probability was associated with lower nursing home admission risk (RR = 0.49; 95% CI: 0.41, 0.59). Physical inactivity (RR = 1.27; 95% CI: 1.15, 1.41), ever smoking (RR = 1.12; 95% CI: 1.01, 1.25), and not consuming alcohol (RR = 1.28; 95% CI: 1.13, 1.45) predicted increased relative risk of nursing home admission regardless of cognitive status. The relative effects of modifiable risk factors were similar for those with low and high dementia risk.ConclusionAlthough cognitive impairment associated with incipient dementia strongly predicts nursing home admission, this risk can be partially ameliorated with modifiable risk factors such as physical activity.     

Self-management groups for people with dementia and their spousal caregivers. A randomized,controlled trial. Baseline findings and feasibility

BackgroundNo previous studies have investigated the effectiveness and feasibility of self-management groups for people with dementia and their caregivers.PurposeWe present the baseline findings of a randomized controlled trial examining the effectiveness of a psychosocial group intervention to enhance self-management skills of persons with dementia and their spouses and have evaluated the feasibility of the intervention.Subjects and methodsAltogether 136 individuals with dementia living with their spousal caregivers in the community were recruited from the memory clinics. They were randomized into two arms: group-based self-management intervention (n = 67 couples) and controls (n = 69 couples). The patients and spouses met in separate closed groups once a week for 8 weeks. Intervention sessions were based on discussions, including topics according to participants’ preferences. Their aim was to enhance participants’ self-efficacy, problem-solving skills and peer support. Anonymous feedback from the intervention group was collected at 3 months.ResultsThe mean age of participants with dementia was 76.8 years, 51 (38%) were females, and 98 (72%) were at a mild stage of dementia. Cognitive status was poorer in the intervention group than in controls [MMSE; 19.9 (SD 5.7) vs. 21.7 (SD 3.7), P = 0.04]. The participation rate in-group sessions was high among patients (93%, range 86–98%) and caregivers (93%, range 86–99%). Participants described the group sessions as beneficial and supportive.ConclusionWe have successfully randomized 136 dyads in a self-management group rehabilitation trial. The feedback from participants was favourable, and the drop-out rate during the first 3 months was low.     

Comparison of sit-to-stand strategies used by older adults and people living with dementia

Physiotherapists routinely retrain sit-to-stand (STS) during rehabilitation using strategies such as sliding forward, moving the feet backwards, leaning forward, and pushing through the armrests. It is unknown if people living with dementia use the same strategies as other older adults and if a table positioned in front alters their performance. Twenty participants 65 years or older (10 with Alzheimer's disease or mixed dementia; 10 without dementia) performed six STS trials from a standard chair with armrests, including three trials without and three with a table in front. Trials were digitally recorded and the starting position and type and order of strategies used were rated by a blinded assessor. Starting position was similar between the groups. The most common strategy was leaning forward (119 out of 120 trials) while the least used was sliding forward (four out of 120 trials). People living with dementia used significantly more strategies (p = 0.037), pushed through the armrests more than older adults (p = 0.038) and moved feet backwards more frequently in trials without the table in front (p = 0.010). Presence of the table had no significant effect on STS performance of older adults (p > 0.317). Our results demonstrated that people living with dementia had a similar starting position but used more strategies to stand up, pushing through their arms more than older adults without dementia and moved their feet backwards more often when no table was in front. People living with dementia should be provided with chairs with armrests and space to move feet backwards.     

Effects of 12 weeks of probiotic supplementation on quality of life in colorectal cancer survivors: A double-blind,randomized, placebo-controlled trial

BackgroundProbiotics may help resolve bowel symptoms and improve quality of life. We investigated the effects of 12 weeks of probiotics administration in colorectal cancer patients.MethodsWe conducted a double-blind, randomized, placebo-controlled trial. The participants took probiotics (Lacidofil) or placebo twice a day for 12 weeks. The cancer-related quality of life (FACT), patient's health-9 (PHQ-9), and bowel symptom questionnaires were completed by each participant.ResultsWe obtained data for 32 participants in the placebo group and 28 participants in the probiotics group. The mean ages of total participants were 56.18 ± 8.86 years and 58.3% were male. Administration of probiotics significantly decreased the proportion of patients suffering from irritable bowel symptoms (0 week vs. 12 week; 67.9% vs. 45.7%, p = 0.03), improved colorectal cancer-related FACT (baseline vs. 12 weeks: 19.79 ± 4.66 vs. 21.18 ± 3.67, p = 0.04) and fatigue-related FACT (baseline vs. 12 weeks: 43.00 (36.50–45.50) vs. 44.50 (38.50–49.00), p = 0.02) and PHQ-9 scores (0 weeks vs. 12 weeks; 3.00 (0–8.00) vs. 1.00 (0–3.00), p = 0.01). We found significant differences in changes of the proportion of patients with bowel symptoms (p < 0.05), functional well-being scores (p = 0.04) and cancer-related FACT scores (p = 0.04) between the two groups.ConclusionProbiotics improved bowel symptoms and quality of life in colorectal cancer survivors.     

Enhanced cholesterol efflux to HDL through the ABCA1 transporter in hypertriglyceridemia of type 2 diabetes

ObjectiveOur objective was to examine the role of hypertriglyceridemia on the capacity of HDL to facilitate ABCA-1 mediated cholesterol efflux in type 2 diabetes (T2DM).MethodsHDL mediated cholesterol efflux through the ABCA-1 transporter was measured using BHK cell lines in samples of 71 participants with T2DM in the presence or absence of high triglyceride levels (TG). Additionally, HDL mediated efflux was measured in 13 diabetic and non-diabetic participants fasting and four hours after a high-fat test challenge.ResultsHDL mediated cholesterol efflux function was increased in participants with T2DM with hypertriglyceridemia when compared to participants with T2DM without hypertriglyceridemia (efflux ratio mean ± standard deviation (SD), T2DM + TG: 1.17 ± 0.25 vs. T2DM − TG: 1.03 ± 0.19, p = 0.0098). In the fat challenge study, we observed a significant increase in ABCA-1 mediated cholesterol efflux capacity following an ingestion of high-fat test meal by participants in both groups of T2DM (n = 6, efflux ratio, mean ± SD, pre: 0.86 ± 0.4 vs. post: 1.34 ± 0.6, p = 0.01) and non-diabetic participants (n = 7, efflux ratio mean ± SD pre: 1.24 ± 0.31 vs. post: 1.39 ± 0.42, p = 0.04) that was partly explained by the difference in CETP activity (r = 0.6, p = 0.03).ConclusionOur study suggests that high triglyceride levels facilitate ABCA-1 mediated efflux function of HDL in part by activating CETP.     

Outcomes of dementia: Systematic review and meta-analysis of hospital administrative database studies

IntroductionAim of the study was to compare various outcomes of dementia patients with elderly patients without dementia by conducting a systematic review of previous population-based studies.MethodsThe relevant studies were retrieved from search of electronic databases.ResultsThe pooled data from included 11 studies consisted of outcomes of 1,044,131 dementia patients compared to 9,639,027 elderly patients without dementia. Meta-analysis showed that the mortality in dementia patients was 15.3% as compared to 8.7% in non-dementia cases (RR 1.70, CI 95%, 1.27-2.28, p 0.0004). However, there was significant heterogeneity between the studies (p < 0.00001). Dementia patients had significantly increased overall readmission rate (OR 1.18; 95% CI, 1.08-1.29, p < 0.001). They had higher complication rates for urinary tract infections (RR 2.88; 95% CI, 2.45-3.40, p < 0.0001), pressure ulcers (RR 184; 95% CI, 1.31-1.46, p < 0.0001), pneumonia (RR 1.66; 95% CI, 1.36-2.02, p < 0.0001), delirium (RR 3.10; 95% CI, 2.31-4.15, p < 0.0001), and, dehydration and electrolyte imbalance (RR 1.87; 95% CI, 1.55-2.25, p < 0.0001). Dementia patients had more acute cardiac events (HR 1.16; 95% CI, 1.06-1.28, p 0.002), while fewer revascularization procedures (HR 0.12; 95% CI, 0.08-0.20, p < 0.001). Patients with dementia had lesser use of ITU (reduction by 7.5%; 95% CI, 6.9-8.1), ventilation (reduction by 5.4%; 95% CI, 5.0-5.9), and dialysis (reduction by 0.5%; 95% CI, 0.4-0.8).DiscussionCompared to older adult population, patients with dementia had poorer outcome. Despite higher mortality rate and readmission rate, they underwent fewer interventions and procedures.     

Multiple modes of assessment of gait are better than one to predict incident falls

BackgroundThough gait evaluation is recommended as a core component of fall risk assessments, a systematic examination of the predictive validity of different modes of gait assessments for falls is lacking.ObjectiveTo compare three commonly employed gait assessments – self-reported walking difficulties, clinical evaluation, and quantitative gait – to predict incident falls.Materials and methods380 community-dwelling older adults (mean age 76.5 ± 6.8 y, 55.8% female) were evaluated with three independent gait assessment modes: patient-centered, quantitative, and clinician-diagnosed. The association of these three gait assessment modes with incident falls was examined using Cox proportional hazards models.Results23.2% of participants self-reported walking difficulties, 15.5% had slow gait, and 48.4% clinical gait abnormalities. 30.3% had abnormalities on only one assessment, whereas only 6.3% had abnormalities on all three. Over a mean follow-up of 24.2 months, 137 participants (36.1%) fell. Those with at least two abnormal gait assessments presented an increased risk of incident falls (hazard ratio (HR): 1.61, 95% confidence interval (CI): 1.04–2.49) in comparison to the 169 participants without any abnormalities on any of the three assessments.ConclusionsMultiple modes of gait evaluation provide a more comprehensive mobility assessment than only one assessment alone, and better identify incident falls in older adults.     

Changes in malnutrition and quality of nutritional care among aged residents in all nursing homes and assisted living facilities in Helsinki 2003–2011

BackgroundWhile nutritional problems have been recognized as common in institutional settings for several decades, less is known about how nutritional care and nutrition has changed in these settings over time.ObjectivesTo describe and compare the nutritional problems and nutritional care of residents in all nursing homes (NH) in 2003 and 2011 and residents in all assisted living facilities (ALF) in 2007 and 2011, in Helsinki, Finland.MethodsWe combined four cross-sectional datasets of (1) residents from all NHs in 2003 (N = 1987), (2) residents from all ALFs in 2007 (N = 1377), (3) residents from all NHs in 2011 (N = 1576) and (4) residents from all ALFs in 2011 (N = 1585). All participants at each time point were assessed using identical methods, including the Mini Nutritional Assessment (MNA).ResultsThe mean age of both samples from 2011 was higher and a larger proportion suffered from dementia, compared to earlier collected samples. A larger proportion of the residents in 2011 were assessed either malnourished or at-risk for malnutrition, according to the MNA, than in 2003 (NH: 93.5% vs. 88.9%, p < 0.001) and in 2007 (ALF: 82.1% vs. 78.1%, p = 0.007). The use of nutritional, vitamin D and calcium supplements, and snacks between meals was significantly more common in the 2011 residents, compared to the respective earlier samples.ConclusionsIn 2011, institutionalized residents were more disabled and more prone to malnourishment than in 2003 or 2007. Institutions do seem to be more aware of good nutritional care for vulnerable older people, although there is still room for improvement