Determinants of uptake of home modifications and exercise to prevent falls in community‐dwelling older people

Objective: To examine the age‐specific population prevalence and predictors of uptake of home modifications and exercise to prevent falls in the NSW older population. Methods: A total of 5,681 respondents were asked questions on fall prevention activities as part of the 2009 NSW Falls Prevention Survey. Results were weighted to represent the NSW population. Regression analysis was used to determine factors associated with uptake of interventions. Results: Overall, 28.9% of the older population have modified their home, and 35.1% increased exercise to prevent falls. Main predictors of home modification were being aged 85+ (RR 2.04, 95% CI 1.76–2.35) and physiotherapy/occupational therapy intervention (RR 1.57, 95% CI 1.22–2.01). Main predictors of increasing exercise were physiotherapy/OT intervention (RR 2.12, 95% CI 1.86–2.42) and medical advice (RR 1.45, 95% CI1.32–1.60). Older respondents (RR 0.68, 95% CI 0.57–0.81) and those with fair/poor health (RR 0.86, 95% CI 0.77–0.96) were less likely to report increased exercise. Conclusion: More than one‐quarter of the older population of NSW report having made modifications to their home and one‐third increased exercise to prevent falls. There was a clear gradient of increased uptake of home modifications with increasing age, with the reverse trend for increased exercise. Implication: Although fall prevention initiatives are having an impact at the population level, targeted strategies for high‐risk groups are still required.     

Falls in community‐dwelling prefrail older adults

Frailty has been established as a risk factor for falls, and prefrailty also seems a risk; however, few studies have focused on the association between falls and each of the five components of frailty proposed by Fried. In the present study, we sought to elucidate the association between prefrailty and falls, and moreover, the association of frailty component with falls. Participants were community‐dwelling older people who had cognitive complaints but not dementia (N = 447, male 54.6%). Prefrailty was defined as exhibiting one or two of the five Fried criteria. Frail individuals were excluded. Background characteristics were compared between the prefrail and robust groups, and multiple regression analysis was performed to investigate the associations between fall history within the past year and factors that were significantly different between the groups. We also performed logistic regression analysis with adjustment for age, education and gender to assess associations with frailty components. We found that prefrailty was associated with fall history. Depressed mood was also significantly associated with fall history. Among the five frailty criteria, exhaustion was significantly associated with falls. Prefrailty, especially the criteria of exhaustion, and depressed mood were associated with fall history.     

Associations between nutrition risk status,body composition and physical performance among community‐dwelling older adults

Objective : To investigate the associations between nutrition risk status, body composition and physical performance among community‐dwelling older New Zealanders. Methods : This cross‐sectional study enrolled 257 community‐dwelling older adults (median age 79 years). Assessments included the Mini Nutritional Assessment‐Short Form (MNA®‐SF) for nutrition risk; the Eating Assessment Tool‐10 for dysphagia risk; bioimpedance analysis for body composition (free fat mass (FFM) and percentage body fat) and gait speed for physical performance. A multiple logistics regression analysis was conducted, to determine factors associated with lower odds [OR (95% CI)] for nutrition risk. Results : Every yearly increase in age was associated with higher odds 1.09 (1.01–1.17) for nutrition risk. Additionally, nutrition risk was less likely to occur among participants of age <85 years 0.30 (0.11–0.79), with no dysphagia 0.29 (0.09–0.97) and those with a healthy gait speed 0.29 (0.09–0.97). Lower odds for nutrition risk were also found with increasing values of FFM index 0.51 (0.34–0.77), and percentage body fat 0.81 (0.72–0.90). Gait speed was positively correlated with FFM index (r=0.19 p<0.022), percentage body fat (r=0.23, p=0.006) and BMI (r=0.29, p<0.001). Conclusion : Among these participants, associations between nutrition risk, body composition and physical performance were found. Implications for public health : Routine screening of nutrition risk and/or physical performance among vulnerable older adults is key towards identifying those in need of assessment and dietary intervention. Alongside strategies to encourage physical activity, this may help to slow losses of FFM and protect physical performance.     

北京市社区老年人跌倒发生现况及危险因素分析

目的 了解北京市社区老年人跌倒的发生特点与规律,并对造成跌倒发生的危险因素进行分析,为进一步开展老年人跌倒的预防工作提供依据.方法 本次调查覆盖北京市某街道所辖的12个社区,在每个社区内符合条件的60岁及以上老年人中,采用系统抽样方法分别抽取100名老年人进行人户调查.结果 在被调查的老年人中,1年内共有169位老年人发生过258次跌倒,跌倒发生率为15.6％,其中男性跌倒发生率为14.7％ (96人次),女性跌倒发生率为16.4％(162人次);老年人跌倒大多发生在室内.不同性别的老年人跌倒发生地点的构成差异有统计学意义(x2=8.05,P=0.045);社区老年人跌倒损伤部位以四肢最多见,其次为躯干和头面部,导致内脏损伤较少见,只有5人,不同性别的老年人跌伤部位的构成差异有统计学意义(x2=7.99,P=0.046);年龄高(OR=2.395,95％ CI:1.902～3.001)、担心跌伤(OR=1.433,95％ CI:1.120～1.833)、家庭不和睦(OR=1.238,95％ CI:1.047～2.049)为社区老年人跌倒的危险因素.结论 北京市社区老年人跌倒发生率较高,严重威胁着老年人的身心健康.     

Psychosocial risk factors at work associated with the level of physical activity among motorcycle taxi drivers

Abstract

Objective: To analyze the association of psychosocial risk factors at work, sociodemographic, and occupational characteristics with the level of physical activity among motorcycle taxi drivers.

Methods: Cross-sectional study with 750 male motorcycle taxi drivers from the municipality of Jequié, Bahia, Brazil. A form containing sociodemographic and occupational characteristics was utilized. The psychosocial risk factors at work were evaluated by the Job Content Questionnaire and the level of physical activity by the International Physical Activity Questionnaire. The adjusted associations were analyzed by means of the Poisson regression with robust variance. Results: the prevalence of an insufficiently active level of physical activity was of 59.6%. The crude prevalence ratios (PR) showed an association between physical inactivity in motorcycle taxi drivers and high strain job (PR: 1.31), with 5 or more years of experience (PR: 1.67), in night shifts (PR: 1.36) and 40 or more years old (PR: 1.77). In the multivariate model, adjusted by income, work in high strain is kept associated to a situation of being insufficiently active (PR: 1.13), duration of employment of five or more years raised by 51.0% the frequency of insufficiently active physical activity (PR: 1.51) and the work in predominantly nocturnal shifts increased it by 26.0% (PR: 1.26). It is made evident that age was an effect modifier (p?<?0.001) and its interaction was evaluated by including the corresponding product term (job Demand–Control model), which shows that the association between highly straining work and being insufficiently active was observed only among the youngest (21–39?years old) (PR: 1,21).

Conclusions: the age and exposure to unfavorable working conditions, like long duration of employment, night work and work under high psychological demand and low control, have an influence on the insufficient physical activity among motorcycle taxi drivers.     

上海市闸北区社区独居老人居家致跌环境调查

目的通过对社区老年人居家环境进行安全性评估,促进居家致跌危险环境改造和降低老年人跌倒的发生提供依据。方法对上海市某社区2008年8月1日—2009年8月1日期间全部80岁以上独居老人共395户、481人进行居家致跌危险环境的入户评估和老年人跌倒情况回顾性调查。结果跌倒发生率为17.05%,发生次数发生率为24.32%,其中发生2次以上跌倒占32.93%,因跌倒住院占5.19%。居家致跌环境主要包括在地面或通道未使用防滑地砖(38.23%)、室内照明亮度不够(47.85%)、浴缸(淋浴房)未使用防滑垫(62.78%)和浴缸(淋浴房)旁未安装扶手(70.89%)等。结论独居老人是发生跌倒的高危人群,居家致跌环境因素增加了老人跌倒发生的风险,开展有针对性的居家危险环境评估其意义重大。     

The burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria: a database study

Objective : To estimate the burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria. Methods : We analysed fall‐related, person‐identifying hospital discharge data and patient‐level hospital treatment costs for community‐dwelling older people aged 65+ years from Victoria between 1 July 2005 and 30 June 2008, inclusive. Key outcomes of interest were length of stay (LOS)/episode, cumulative LOS (CLOS)/patient and inpatient costs. Results : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria was 284,781 hospital bed days in 2005–06, rising to 310,031 hospital bed days in 2007–08. Seventy‐one per cent of episodes were multiday. One in 15 acute care episodes was a high LOS outlier and 14% of patients had ≥1 episode classified as high LOS outlier. The median CLOS/patient was nine days (interquartile range 2–27). The annual costs of inpatient care, in June 2009 prices, for fall‐related injury in community‐dwelling people aged 65+ years in Victoria rose from $213 million in 2005–06 to $237 million in 2007–08. The burden of hospitalised fall‐related injury in community‐dwelling older women, people aged 85+ years and those with comorbidity was considerable. Conclusions : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria is significantly more than previously projected. Importantly, this study identifies that women, patients with comorbidity and those aged 85+ years account for a considerable proportion of this burden. Implications : A corresponding increase in falls prevention effort is required to ensure that the burden is properly addressed.     

江苏省老年人跌倒发生情况及危险因素分析

目的探讨江苏省老年人跌倒的流行病学特征及危险因素,为制定相应的干预措施提供科学依据。方法采用多阶段分层整群抽样的方法,以问卷方式调查江苏省老年人过去1年跌倒发生情况。结果共调查6 245人,跌倒发生率为2.79%。家庭是老年人跌倒的好发地点。随着年龄的增长,跌倒发生率增高。单因素Logistic回归分析结果显示,年龄高、生活在农村、丧偶、文化程度低、家庭经济状况较差、住房类型为楼房、体育锻炼较少、行走能力较差为老年人跌倒的危险因素。结论老年人跌倒是一个严重的公共卫生问题,与许多因素相关,对于高危人群应该采取一系列针对性的预防措施。     

石家庄市社区老年人跌倒危险因素分析

目的 了解河北省石家庄市老年人跌倒流行状况及其危险因素,为老年人跌倒预防提供依据。方法 采用随机抽样方法,在石家庄市2个基本条件相当的社区抽取1 609名≥60岁老年人进行跌倒危险因素调查。结果 被调查的1 609名老年人中,180人在过去1年中发生跌倒,跌倒率为11.2%;多因素logistic回归分析结果表明,女性(OR=1.483)、高龄(OR=1.340)、静态平衡能力下降(OR=1.550)、动态平衡能力下降(OR=1.560)、有跌倒史(OR=10.461)、患有脑血管疾病(OR=2.298)、患有骨质增生(OR=1.996)、连续服药≥3个月(OR=1.604)、马桶旁没有扶手(OR=1.929)、骨质疏松高危人群(OR=1.903)、有骨折病史(OR=2.466)等是老年人跌倒的危险因素。结论 石家庄市老年人跌倒是多种因素综合作用的结果,其中有跌倒史的老年人发生跌倒的危险性最高,应采取综合措施预防跌倒。     

Mixed care networks of community‐dwelling older adults with physical health impairments in the Netherlands

As part of long‐term care reforms, home‐care organisations in the Netherlands are required to strengthen the linkage between formal and informal caregivers of home‐dwelling older adults. Information on the variety in mixed care networks may help home‐care organisations to develop network type‐dependent strategies to connect with informal caregivers. This study first explores how structural (size, composition) and functional features (contact and task overlap between formal and informal caregivers) contribute to different types of mixed care networks. Second, it examines to what degree these network types are associated with the care recipients' characteristics. Through home‐care organisations in Amsterdam, the Netherlands, we selected 74 frail home‐dwelling clients who were receiving care in 2011–2012 from both informal and formal caregivers. The care networks of these older adults were identified by listing all persons providing help with five different types of tasks. This resulted in care networks comprising an average of 9.7 caregivers, of whom 67% were formal caregivers. On average, there was contact between caregivers within 34% of the formal–informal dyads, and both caregivers carried out at least one similar type of task in 29% of these dyads. A principal component analysis of size, composition, contact and task overlap showed two distinct network dimensions from which four network types were constructed: a small mixed care network, a small formal network, a large mixed network and a large formal network. Bivariate analyses showed that the care recipients’ activities of daily living level, memory problems, social network, perceived control of care and level of mastery differed significantly between these four types. The results imply that different network types require different actions from formal home‐care organisations, such as mobilising the social network in small formal networks, decreasing task differentiation in large formal networks and assigning co‐ordination tasks to specific dyads in large mixed care networks.     

老年人在家中跌倒的流行病学特征及其危险因素研究

目的了解上海市长宁区社区老年人家中跌倒发生情况及其危险因素。方法采用分层随机抽样的方法选择居住在上海市长宁区的I〉60岁常住居民2250人,应用自行设计的调查表对研究对象过去1年在家中跌倒的情况及相关因素进行调查。结果调查对象中男性1075人（47．8％）,女性1175人（52．2％）。207位老年人过去1年至少发生1次家中跌倒,跌倒发生率为9．2％。多因素非条件Logistic回归分析显示,平衡能力、居住状态和家居环境与老年人发生家中跌倒相关。平衡能力差、家居环境中致跌危险因素多、独居是老年人发生家中跌倒的危险因素。结论老年人家中跌倒的发生与多维度因素有关。提高老人的平衡能力,减少其家居环境的致跌危险因素,加强对独居老人的日常照顾是预防家中跌倒的主要措施。     

Factors associated with the use of publicly funded services by Hong Kong Chinese older adults

This article analyzes cross-sectional data collected from a representative community sample of 2003 Chinese elderly people aged 60 or above in Hong Kong. We examined whether the use of publicly funded health services by older adults is equitable under the framework of Andersen model. A number of predisposing, enabling, and need factors were assessed as predictors of utilization in four categories of services including hospital admission, emergency room, general outpatient clinics, and specialist outpatient clinics. It was found that utilization of these four health services was consistently correlated with need factors. Specifically, self-rated health status and particular types of chronic illness were consistently and significantly related to utilization for all four of services in Hong Kong. On the other hand, age and family support were related to hospital admission whereas functional impairment was associated with the use of emergency room and general outpatient clinics. Findings suggest that publicly funded health services in Hong Kong are used equitably by elderly people.     

江苏省老年人伤害流行状况及其危险因素分析

目的阐明老年人伤害发生现状,探讨老年人伤害发生的主要危险因素,为预防和控制老年人伤害提供依据。方法本研究资料来源于第4次国家卫生服务调查江苏省调查资料,该调查采用多阶段分层整群抽样方法,采用入户问卷调查,获得研究对象一般人口学信息、身体健康状况以及伤害的发生状况。采用Access建立数据库,利用SAS 8.0软件进行统计分析,运用描述性分析,单因素分析方法分析伤害在老年人中流行状况以及影响老年人伤害发生的危险因素。结果江苏省60岁及以上老年人年伤害发生率为44.52‰,老年人的前5位伤害原因按发生率大小依次为跌落、交通伤害、动物咬伤、锐器伤和硬物砸伤。伤害发生的主要地点是道路和家庭。大部分伤害属于轻伤,不需要住院和门诊治疗。影响老年人伤害发生的危险因素有丧偶或单身、受教育水平低、经济状况低下、居住在农村、饮酒以及吸烟。结论江苏省老年人伤害的发生高于其他年龄组,跌倒是江苏省老年人最重要伤害,丧偶与单身的老年人是伤害的高危人群。老年人的伤害谱、发生率明显不同于其他人群,针对老年人的伤害干预应采用年龄特定的策略。     

Predisposing and precipitating factors for falls among older people in residential care

Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.     

Bathroom modifications among community-dwelling older adults who experience falls in the United States: A cross-sectional study

Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, we examined factors associated with bathroom modifications among older adults with at least one fall in the United States. We analysed the nationally representative 2016 Medicare Current Beneficiary Survey Public Use File of Medicare beneficiaries aged ≥65 years with ≥1 fall (n = 2,404). A survey-weighted logistic model was used to examine associations between bathroom modifications and factors including socio-demographic characteristics, health-related conditions, and fear of falling. Among Medicare beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts and aging-in-place.     

Prevalence of influenza vaccination and associated factors among pregnant women in Hong Kong

A total of 568 pregnant women in Hong Kong were interviewed. Of them, 85.4% had heard of influenza vaccine, 21.3% had ever been vaccinated, 3.9% self-reported receiving influenza vaccination (IV) in the 2005/2006 flu season, and 33% were inclined toward receiving IV in the coming year. Multivariate analysis showed that those who had been recommended by health care professionals to receive IV during pregnancy were more likely than others to have received IV. Other variables related to the Health Belief Model were significantly associated with having ever been vaccinated or inclined toward receiving IV in the coming year.