A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study

Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time.

Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment.

Setting: Research laboratory and community.

Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78?±?13.89 years, lived with SCI for 17.06?±?14.6 years; 61.1% were female.

Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control.

Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life – short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST).

Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P?=?0.047, d_{z ?}=?0.507) and FIST scores improved (P?=?0.035, d_z? =?0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P?=?0.05, d_{z ?}=?1.566) and Psychological (P?=?0.040, d_{z ?}=?0.760) domains.

Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.     

The Joint Occurrence of Osteoporosis and Sarcopenia (Osteosarcopenia): Definitions and Characteristics

ObjectivesWe sought to examine the associations of osteosarcopenia with physical performance, balance, and falls and fractures in community-dwelling older adults. Additionally, we aimed to determine which clinical outcomes are associated with specific components of osteosarcopenia.DesignCross-sectional study.Setting and Participants253 participants (77% women; aged 77.9 ± 0.42 years) who presented for a falls and fractures risk assessment in Melbourne, Australia.MethodsParticipants were mobile, community-dwelling older adults (≥65 years) free of cognitive impairment. Body composition (via dual-energy x-ray absorptiometry), physical performance [via Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB)], and balance [via Four-Square Step test (FSS) and posturography] were examined. Falls in the past year and fractures in the past 5 years were self-reported. Osteosarcopenia was defined as (1) low bone mineral density (BMD) [T score <–1 standard deviation (SD)] combined with sarcopenia and (2) osteoporosis (BMD T score ≤–2.5 SD) combined with severe sarcopenia. For sarcopenia, we employed the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP1), the revised criteria (EWGSOP2), and that of the Foundation for the National Institutes for Health (FNIH). Kruskal-Wallis and logistic regression tests were used for statistical analysis.ResultsOsteosarcopenia was associated with worse SPPB, TUG, FSS, limit of stability, and falls and fractures history. Additionally, osteosarcopenia (using the severe sarcopenia classification) conferred an increased rate of falls [odds ratios (ORs) from 2.83 to 3.63; P < .05 for all] and fractures (ORs from 3.86 to 4.38; P < .05 for all) when employing the EWGSOP2 and FNIH definitions, respectively.Conclusions and ImplicationsCompared with the nonosteosarcopenic group, those with osteosarcopenia had greater impairment of physical performance and balance. The EWGSOP2 and FNIH criteria resulted in the strongest associations with physical performance and self-reported falls and fractures.     

电针联合右美托咪定对骨科老年患者术中应激的影响研究

目的：探讨电针联合右美托咪定对老年骨科患者术中应激的影响。方法：选取拟行手术治疗的老年下肢骨折患者56例为研究对象，采用随机数字表法分为单纯全麻组、电针复合全麻组（简称复合电针组）、右美托咪定复合全麻组（简称复合右美组）及电针联合右美托咪定复合全麻组（简称针药复合组），各14例。记录各组各时间点血压、心率、血氧饱和度等各项监护指标，术前、术后神经心理学指标（简易智力检查评分和疼痛视觉模拟评分）及各时间点血糖水平，术中心血管活性药物使用情况及患者住院天数。结果：术后各时间点针药复合组简易智力检查评分高于单纯全麻组（P＜0.05）；术后72 h内，针药复合组疼痛评分低于其他三组（P＜0.05）；针药复合组术中循环系统指标及血糖水平更稳定；针药复合组术后意识恢复时间最短（P＜0.05）；四组术后呼吸恢复时间与住院天数比较，差异无统计学意义（P＞0.05）；四组心血管活性药物使用率比较，差异无统计学意义（P＞0.05）。结论：老年骨科患者手术中采用电针联合右美托咪定治疗，能够稳定围术期血糖、术中循环系统指标水平，减少术后认知功能障碍发生率，显著降低术中应激水平。     

Midlife falls are associated with increased risk of mortality in women: Findings from the National Health and Nutrition Examination Survey III

ObjectivesFalls are a public health concern for older adults but are also common among midlife adults. However, the consequences of falls occurring during midlife are not well understood.MethodsThis investigation assessed the relationship between falls and mortality among midlife adults using survey data from the Third National Health and Nutrition Examination Survey (n = 1,295), linked to the National Death Index. The relationship between recurrent falls (≥2 falls) in the past year and 10-year death rate was assessed using survey-weighted Cox regression.ResultsNearly 20 % of adults who died within 10 years of their interview date were recurrent fallers at the time of interview. For women only, recurrent fallers had more than 4-fold increased hazard of death within 10 years compared to non-recurrent fallers (HR = 4.41; 95 % CI:2.24,8.68).ConclusionsFindings suggest that midlife women are particularly vulnerable to adverse outcomes following recurrent falls. Fall prevention efforts should include efforts targeted at midlife women.