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.     

Gait speed and risk assessment for falls among men aged 80 years and older: A prospective cohort study in Taiwan

PurposeTo evaluate the effectiveness of adding gait speed to the history of falls in predicting falls among men aged 80 years and older in Taiwan.MethodsThis prospective cohort study recruited 230 ambulatory men aged 80 years and older in 2012 and followed for 12 months. In addition to demographic characteristics and history of falls, a comprehensive geriatric assessment was performed for all study subjects. Gait speed was obtained by the 6-m walk and three different cut-offs (< 0.5, ≤ 0.8 and < 1.0 m/s) were tested in improving the ability of predicting subsequent falls by using history of falls.ResultsAmong all subjects (mean age: 85.5 ± 4.0 years), 26.1% (60/230) reported falls during follow-up period. Univariate analysis showed that polypharmacy, urinary incontinence, history of falls, pain, poorer baseline physical function, depressive mood, and gait speed < 0.5 m/s were associated with falls. Logistic regression showed that history of falls (OR: 4.255, 95% CI 2.089–8.667; P < 0.001), pain (OR: 2.674, 95% CI 1.332–5.369; P = 0.006), older age (OR: 1.128, 95% CI 1.031–1.234; P = 0.008), and slow gait speed (OR: 2.964, 95% CI 1.394–6.300; P = 0.005) were all independent risk factors for falls. Fast gait speed (defined as ≥ 1 m/s) was a protective factor for falls, even among subjects with history of falls, but slow gait speed (defined as < 0.5 m/s) was an independent risk factor even among subjects without history of falls.ConclusionsCombined history of falls and gait speed is a simple and effective tool in risk assessment of falls among older old population.     

Hypovitaminosis D is an independent associated factor of overactive bladder in older adults

Aim of the studyUrinary incontinence and vitamin D deficiency are common problems encountered in geriatric population. We aimed to investigate if there is a relationship between these conditions.Subjects and methodAmong 2281 patients who were admitted to our geriatric medicine outpatient clinic spanning the last three years, 705 patients with known vitamin D status, urinary incontinence and subtype, and calcium plus vitamin D therapy data were included in statistical analysis. Patients who are using calcium plus vitamin D therapy were excluded. SPSS (Statistical Package for Social Sciences) version 15.0 for Windows was used for statistical analysis and p < 0.05 was considered as statistically significant.ResultsMean age of the study population was 72.3 ± 6.4 years and 62.8% were female. Plasma vitamin D level (OR: 0.968, 95%CI: 0.943–0.993, p = 0.013), MMSE (Mini Mental State Examination) score (OR: 0.944, 95%CI: 0.902–0.989, p = 0.014), and serum ALP (Alkaline Phosphatase) level (OR: 0.995, 95%CI: 0.992–0.998, p = 0.001) were found to be inversely correlated factors, and serum calcium level (OR: 1.772, 95%CI: 1.008–2.888, p = 0.022) was found to be a positively correlated factor of overactive bladder. Considering the different clinical subtypes of urinary incontinence, only urgency incontinence was associated with lower plasma vitamin D level (p = 0.013).ConclusionsVitamin D deficiency and insufficiency are independent associated factors for overactive bladder in older adults. This is explicable by effects of vitamin D on muscle growth and function.     

An investigation of multimorbidity measures as risk factors for pneumonia in elderly frail patients admitted to hospital

ObjectivesTo investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients.Design and methodsWith a retrospective cohort design, all clinical records of frail (Rockwood ≥ 5) nonterminal patients ≥ 65 years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia.Results1199 patients (546 M, median age 81.9, IQR 72.8–87.9 years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001–1.062, p = 0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41–2.73, p < 0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9–3.6, p < 0.001) and dementia (OR 2.3, 95% CI 1.7–3.3, p < 0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not.ConclusionsIn a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.     

Predictors of length of hospital stay among older adults admitted to acute care wards: a multicentre observational study

BackgroundReduction in length of hospital stay (LOS) is considered as a potential strategy to optimize resource consumption and reduce health care costs. We analysed predictors of increased LOS among older patients admitted to acute care wards according to type of admission (through the Emergency Room [ER] or elective).MethodsWe analysed data of 1123 older patients, aged 65 years or older, consecutively admitted to seven acute care wards. LOS was defined as the number of days from admission to discharge (or death) and categorized according to its median value (10 days).ResultsMean age of participants was 81 ± 7 years and 56% were women. Patients admitted through ER had a shorter LOS compared with those elective (10.4 ± 6.7 vs. 12.0 ± 6.7 days; p < 0.0001). Factors associated with LOS > 10 days, for patients admitted through ER, were female gender (OR 0.58; 95% C.I. 0.37–0.90), erythrocyte sedimentation rate (OR 1.02; 95% C.I. 1.01–1.03), and excessive polypharmacy (use of ≥ 10 drugs during stay) (OR 3.60; 95% C.I. 1.40–9.25). Predictors for elective patients were chronic alcohol consumption (OR 0.54; 95% C.I. 0.32–0.93), walking speed ≥ 0.8 m/s (OR 0.31; 95% C.I. 0.14–0.72), excessive polypharmacy (OR 4.78; 95% C.I. 1.92–11.90), pressure ulcers (OR 2.60; 95% C.I. 1.01–6.79), cerebrovascular disease (OR 0.49; 95% C.I. 0.24–0.99) and dementia (OR 0.18; 95% C.I. 0.08–0.39).ConclusionsLOS differed between patients admitted through emergency and through elective admission. Demographic and clinical parameters can affect LOS and polypharmacy was the strongest and the only common risk factor in both groups.     

Evaluation of the nutritional status in older patients with aggressive haematological malignancies using the MNA-SF

BackgroundMalnutrition is common both after the age of 70 and in many types of cancer, being responsible for poor quality of life, poor treatment response and a shorter survival time. Patients with haematological malignancies face specific challenges regarding nutrition because of intensive treatments they endure. Early detection of nutritional problems is important to allow interventions.ObjectivesTo assess the nutritional status of a group of older patients with aggressive haematological malignancies before the onset of systemic therapy using the MNA-SF.SettingThe haematology department of a university hospital.ParticipantsPatients ≥ 70 years, with newly diagnosed aggressive haematological malignancies.MethodsObservational single centre study. Patients were screened for malnutrition before and two months after start of therapy using the Mini Nutritional Assessment Short Form (MNA-SF).ResultsSeventy patients were included. Mean age was 77.4 ± 4.7 years (range 70.0–91.0). At baseline, 20% (CI₉₅ = 11–31%) were malnourished and 61% (CI₉₅ = 49–73%) were at risk for malnutrition. Recent weight loss and declined food intake were the most recorded MNA-SF parameters. Mean Body Mass Index (BMI) was 26.3 ± 4.1 (range 19.8–41.1) and 41% (n = 29) of patients had a BMI < 25.ConclusionsUsing the MNA-SF, most of the older patients with an aggressive haematological malignancy are at risk for malnutrition. Therefore, nutritional assessment with individualised dietary advice and follow-up during treatment should be recommended as an integrated part of the treatment plan.     

Predicting falls among Egyptian nursing home residents: A 1-year longitudinal study

Background/PurposeFalls and their related complications are serious health problems among the institutionalized older population. This study aimed to evaluate the incidence of falls and the risk factors among nursing home residents in Cairo, Egypt.MethodsA one-year prospective cohort study was done in three nursing homes in Cairo. Overall, 84 residents aged over 60 years participated in this study. Baseline demographic characteristics and results of comprehensive geriatric assessments, e.g. cognition, depression, functional and nutritional status, previous falls, fear of falling, assistive device use, and assessment by the timed up-and-go test (TUG) test were collected. All falling accidents were recorded by the nursing home staff during the study period.ResultsDuring the study period, 163 incident falls (1940 falls/ 1000 resident-years) were identified in 53 fallers (631 fallers/1000 resident-years) were recorded. On average, fallers may fall twice a year (mean ± SD 2.0 ± 2.1 episodes, range 1–6). Compared to nonfallers, fallers were older, more likely to have hadprevious falls, fear of falling, frailty, impaired instrumental activities of daily living, poor cognitive status, malnutrition or its risk, assistive device use, and slower TUG. The most sensitive (86.8%) and specific (90.3%) predictor for falls in this study was TUG >14 seconds.ConclusionSixty-three percent of Egyptian nursing home residents may fall during one year follow-up with the incidence of 1019 falls/1000 resident-years. The most important predictive factor for falls in this study was the TUG >14 seconds.     

Decline in the performance of activities of daily living over three years of follow-up in nonagenarians: The NonaSantfeliu study

PurposeAmong individuals of similar age, some appear to be resistant to decline in physical function while others appear more vulnerable. This paper aimed to identify the risk factors that serve as predictors of loss in basic and instrumental activities of daily living (ADL) in nonagenarians without a previously severe disability over a 36-month follow-up.Subjects and methodsA sample of 63 nonagenarians with a Barthel Index (BI) > 59 and Lawton Index (LI) ≥ 1 was evaluated. Subjects with a 10-point or greater decline in the BI over the follow-up period were compared with the remainder. Those with a decline of greater than 1 point on the LI were also compared with the rest. Finally, subjects who showed a decline on both measures were compared with the remainder.ResultsBI scores decreased by 57.1%. Multiple logistic regression analysis showed a significant association between prior poor LI score and less functional loss on the BI (OR 0.62, 95% CI 0.46–0.83). A decline with respect to the LI was observed in 52.3% of cases. Regression analysis showed an association between lower baseline LI score and functional decline on the LI (OR 0.28, 95% CI 0.15–0.51). Twenty-five (39.6%) nonagenarians experienced a decrease on both (BI and LI). Regression analysis showed that patients with lower LI experienced less functional decline on the BI and in terms of instrumental ADL (OR 0.46, 95% CI 0.31–0.66).ConclusionAmong nonagenarians, subjects with higher prior scores on instrumental ADL scales are the most likely to show a more important loss in their functional status.     

Faecal incontinence in inflammatory bowel disease: Associations and effect on quality of life

Background and aimsNo previous study has reported on faecal incontinence (FI) amongst people with IBD. We aimed to determine the frequency and severity of FI in people with IBD, its association with known FI risk factors, and the effect on quality of life.MethodWe randomly sampled 10,000 members of a national Crohn's and Colitis organisation over 18 years old. Demographic information, medical history, FI (ICIQ-B), urinary continence (ICIQ-UI), quality of life (IBD-Q) and free text responses about FI were collected. Current disease activity was reported using the Harvey Bradshaw Index for Crohn's Disease (CD), and the Walmsley Index for ulcerative colitis (UC). Data were managed using Excel, Stata and SPSS 18.Results4827 responses were received: 3264 were complete and included (32.6% response). 2178 respondents were female (66.7%); mean age 50.26 yrs (range 19–92); CD 1543 (46.98%); UC 1599 (48.97%); other IBD 126 (3.85%); no diagnosis given 6 (0.18%).74% (2391) of respondents reported FI (95% CI 72–75). Nine percent (299) reported regular FI. No association was found between FI and diagnosis. Significant associations were found in multivariable analysis between FI and age (p = 0.005), gender (p < 0.001), anal stretch (p = 0.004), anal fistula surgery (p < 0.001), colo-rectal surgery (p = < 0.001), and urinary incontinence (p = < 0.001), but not with vaginal delivery. Quality of life was significantly affected by FI (p < 0.001).ConclusionEven if all non-respondents are continent, FI affects 24% of people with IBD. In our sample 74% reported FI, which can occur without active disease. There is a large currently unmet need for continence care in people with IBD.     

Morphofunctional characteristics of the foot in patients with diabetes mellitus and diabetic neuropathy

AimsTo determine the structural and biomechanical characteristics associated with the conditions diabetes mellitus and diabetic neuropathy.MethodsObservational study of 788 patients conducted between February 2007 and February 2009, which included subjects with and without diabetes mellitus who had no active ulcer at enrollment. Demographic variables and the general and specific history of diabetes mellitus were recorded. The patient's foot type according to the Foot Posture Index, joint mobility and deformity were recorded.ResultsNo associations were found between the different foot types (neutral, pronated and supinated) and the structural and demographic variables at a general level, except for the pronated foot that was associated with a higher body mass index, longer suffering from diabetes and the presence of neuropathy [p < 0.001, OR (95% CI): 6.017 (4.198–8.624); p < 0.001, OR (95% CI): 1.710 (1.266–2.309); p = 0.010, OR (95% CI): 0.759 (0.615–0.937), respectively].ConclusionsThe confluence of risk factors such as neuropathy, body mass index, duration of diabetes and limited joint mobility in patients with diabetes mellitus and pronated foot may be a high-risk anthropometric pattern for developing associated complications such as Charcot foot. A prospective analysis of these patients is required to define the risk for developing Charcot neuroarthropathy.     

Facteurs de risque de mortalité hospitalière au cours de l’embolie pulmonaire en milieu de pneumologie

ObjectivesThe objective of our work is to identify the risk factors for hospital mortality during pulmonary embolism in a pneumology department.Material and methodAll patients admitted to the pneumology department of Habib-Bourguiba hospital between 2014 and 2019, with a final diagnosis of PE are analyzed.ResultsOne hundred patients were included, 62% of whom were female, with an average age of 63 ± 16 years. Pulmonary fibrosis was noted in eight patients. On admission, the mean Simplified Pulmonary Embolism Severity Index score was 1.46 ± 1.05. The mean duration of hospitalization was 10.6 ± 7 days. The hospital mortality rate was 12%. The independent risk factors for intra-hospital mortality were arterial hypotension (OR: 6.13; 95% CI: 2.88–14.35; p = 0.001), cancer (OR: 2.66; 95% CI: 1.22–9.54; p = 0.026), a VD/LV ratio at echocardiography > 0.9 (OR: 1.84; 95% CI: 1.06–7.69; p = 0.039) and severe hypoxemia (OR: 4.86; 95% CI: 2.19–11,34; p = 0.006).ConclusionPulmonary embolism mortality remains high despite improvements in diagnostic and therapeutic management. It is important for our country to take these results into consideration for a better management of patients admitted for pulmonary embolism, and to improve survival.     

Urinary MCP-1 and RBP: Independent predictors of renal outcome in macroalbuminuric diabetic nephropathy

BackgroundAlbuminuria has been considered a sine qua non condition for the diagnosis of diabetic nephropathy (DN) and has been widely used as a surrogate outcome of chronic kidney disease (CKD). However, recent data suggest that albuminuria may fail as a biomarker in a subset of patients, and the search for novel markers is intense.MethodsWe analyzed the role of urinary RBP and of serum and urinary cytokines (TGF-beta, MCP-1 and VEGF) as predictors of the risk of dialysis, doubling of serum creatinine or death (primary outcome, PO) in 56 type 2 diabetic patients with macroalbuminuric DN.ResultsMean follow-up time was 30.7 ± 10 months. Urinary RBP and MCP-1 were significantly higher in patients presenting the PO, whereas no difference was shown for TGF-β or VEGF. In the Cox regression, urinary RBP, MCP-1 and VEGF were positively associated and serum VEGF was inversely related to the risk of the PO. However, after adjustments for creatinine clearance, proteinuria, and blood pressure only urinary RBP (OR 11.6; 95% CI 2.7–49.2, p = 0.001 for log RBP) and urinary MCP-1 (OR 11.0; 95% CI 1.6–76.4, p = 0.02 for log MCP-1) remained as significant independent predictors of the PO.ConclusionUrinary RBP and MCP-1 are independently related to the risk of CKD progression in patients with macroalbuminuric DN. Whether these biomarkers have a role in the setting of normoalbuminuria and microalbuminuria in DN should be further investigated.     

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.     

Malnutrition in elderly patients with renal failure: Importance of pre-dialysis period

Background and aimsIn elderly, renal failure is one of the major comorbidities. Malnutrition is another clinical problem in these patients’ follow-up. In this study, we compared nutritional states of elderly patients with different renal functions.MethodsEighty-three predialysis and 121 hemodialysis (HD) patients of 65 years and older and as control group, 46 elderly patients with no renal failure were compared. Blood urea nitrogen, creatinine, thyroid stimulating hormone, vitamin B12 and folic acid levels were measured in every patient. Nutritional status of all patients was evaluated with Mini Nutritional Assessment Short Form (MNA-SF). One-way ANOVA, post-hoc Tukey and Pearson correlation analysis were used for statistics.ResultsThe mean MNA-SF of pre-dialysis patients was 8.67 ± 3.00. In HD patients, it was 11.44 ± 2.43 and in control, it was 11.48 ± 2.27. In HD patients, a weak correlation was detected between higher BUN, creatinine and higher MNA-SF (r = 0.181, P = 0.047), (r  =  0.181, P = 0.046). In HD patients, vitamin B12 levels were higher than pre-dialysis and control group (P < 0.001).ConclusionIn elderly patients with renal failure, malnutrition starts in pre-dialysis period and MNA-SF can be a reliable technic for these patients’ nutritional evaluation.     

Low Hemoglobin Levels and Recurrent Falls in U.S. Men and Women: Prospective Findings from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort

BackgroundThere are few data available on low hemoglobin and incident falls in the general U.S. population.MethodsOf 30,239 black and white U.S. adults ≥45 years in the population-based REasons for Geographic And Racial Differences in Stroke study, 16,782 had hemoglobin measured at baseline and follow-up data on falls. Hemoglobin was categorized by 1.0 g/dL increments relative to the World Health Organization anemia threshold (<13.0 g/dL for men, <12.0 g/dL for women). Recurrent falls (≥2 falls in the 6 months after baseline) were assessed during a telephone interview.ResultsRecurrent falls occurred in 3.9% of men and 4.8% of women. Compared with those with a hemoglobin level 1 to 2 g/dL above the anemia cut-off, multivariable adjusted odds ratios (95% confidence intervals) for recurrent falls associated with hemoglobin levels ≥3, 2 to <3 and 0 to 1 g/dL above the cut-off point, and 0 to <1 and ≥1 g/dL below the cut-off point were 0.73 (0.45–1.19), 0.84 (0.57–1.24), 1.29 (0.88–1.90), 1.32 (0.0.80–1.2.18) and 2.12 (1.23–3.63), respectively, among men (linear trend P < 0.001), and 1.59 (1.10–2.3), 1.24 (0.95–1.62), 1.42(1.11–1.81), 1.28 (0.91–1.80) and 1.76 (1.13–2.74), respectively, among women (linear trend P = 0.45; quadratic trend P = 0.016).ConclusionsAmong men, lower hemoglobin levels were associated with an increased risk for recurrent falls. Although our findings suggest an increased risk for recurrent falls at both lower and higher hemoglobin levels among women, these findings should be confirmed in subsequent studies.     

Risk factors associated with adverse drug events among older adults in emergency department

BackgroundLittle is known about the emergency department (ED) visits from drug-related injury among older adults in Taiwan. This study seeks to identify risk factors associated with adverse drug events (ADEs) leading to ED visits.MethodsWe prospectively conducted a case–control study of patients 65 years and older presenting to the ED. ED visits between March 1, 2009 and Feb 28, 2010 identified by investigators for suspected ADEs were further assessed by using the Naranjo Adverse Drug Reaction probability scale. For each patient with an ADE, a control was selected and time-matched from the ED population of the study hospital. The association between the risk of adverse drug events and triage, age, gender, serum alanine transaminase (ALT), serum creatinine, number of medications, and Charlson Comorbidity Index scores were analyzed using logistic regression.ResultsOf 20,628 visits, 295 ADEs were physician-documented in older adults. Independent risk factors for ADEs included number of medications (adjusted odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.4–6.9 for 3–7 drugs; adjusted OR = 6.4; 95% CI 3.7–11.0 for 8 or more drugs) and increased concentration of serum creatinine (adjusted OR = 1.5; 95% CI 1.1–2.2). Diuretics, analgesics, cardiovascular agents, anti-diabetic agents and anticoagulants were the medications most commonly associated with an ADE leading to ED visits.ConclusionsThis study suggests that prevention efforts should be focused on older patients with renal insufficiency and polypharmacy who are using high risk medications such as anticoagulants, diuretics, cardiovascular agents, analgesics, and anti-diabetic agents.     

Acute kidney injury after allogeneic hematopoietic stem cell transplantation – Predictors and survival impact: A single center retrospective study

Introduction and objectivesAcute kidney injury (AKI) is a frequent complication of hematopoietic stem cell transplantation (HSCT) and appears to be linked to increased morbidity and mortality. The aim of this study was to evaluate the incidence, etiology, predictors and survival impact of early AKI in the post-allogeneic HSCT setting.Patients and methodsWe performed a retrospective single center study that included 155 allogeneic transplant procedures from June 2017 through September 2019.ResultsAKI was observed in 50 patients (32%). In multivariate analysis, age (OR 31.55, 95% CI [3.42; 290.80], p = 0.002), evidence of disease at the time of transplant (OR 2.54, 95% CI [1.12; 5.75], p = 0.025), cytomegalovirus reactivation (OR 5.77, 95% CI [2.43; 13.72], p < 0.001) and hospital stay >35 days (OR 2.66, 95% CI [1.08; 6.52], p = 0.033) were independent predictors for AKI. Increasing age (HR 1.02, 95% CI [1.00; 1.04], p = 0.029), increasing length of hospital stay (HR 1.02, 95% CI [1.01; 1.03], p = 0.002), matched unrelated reduced intensity conditioning HSCT (HR 1.91, 95% CI [1.10; 3.33], p = 0.022), occurrence of grade III/IV acute graft-versus-host disease (HR 2.41, 95% CI [1.15; 5.03], p = 0.019) and need for mechanical ventilation (HR 3.49, 95% CI [1.54; 7.92], p = 0.003) predicted an inferior survival in multivariate analysis. Early AKI from any etiology was not related to worse survival.ConclusionPatients submitted to HSCT are at an increased risk for AKI, which etiology is often multifactorial. Due to AKI incidence, specialized nephrologist consultation as part of the multidisciplinary team might be of benefit.     

Diabetes-related foot ulcers and associated factors: Results from the Nord-Trøndelag Health Survey (HUNT3) (2006–2008)

AimTo determine the proportion of people with diabetes reporting a history of foot ulcer and investigate associated factors and healing time in the Nord-Trøndelag Health Survey (HUNT3), Norway.MethodsIn 2006–2008, all inhabitants in Nord-Trøndelag County aged ≥ 20 years were invited to take part in this population-based study; 54% (n = 50,807) attended. In participants reporting to have diabetes we examined the relationships between foot ulcers requiring more than 3 weeks to heal (DFU) and sociodemographic, lifestyle and clinical variables using logistic regression analysis.ResultsAmong participants with diabetes, 7.4% (95% confidence interval (CI) 6.2%–8.6%) reported a DFU. The median healing time was 6.0 weeks. In the final model, factors associated with a DFU were age ≥ 75 years (odds ratio (OR) 2.3, 95% CI 1.4–3.7), male sex (OR 2.0, 95% CI 1.3–3.1), waist circumference ≥ 102 cm (men) or 88 cm (women) (OR 1.95, 95% CI 1.2–3.2), insulin use (OR 2.1, 95% CI 1.3–3.4) and any macrovascular complication (OR 1.8, 95% CI 1.1–2.8).ConclusionsThe proportion of people with diabetes reporting a DFU was 7.4%, associated factors were age ≥ 75 years, male sex, waist circumference ≥ 102 cm (men) or 88 cm (women), insulin use and any macrovascular complication. The median healing time was 6 weeks.     

The Physiological Profile Assessment: Clinical validity of the postural sway measure and comparison of impairments by age

BackgroundThe Physiological Profile Assessment (PPA) assesses falls risk in older adults by measuring impairments most associated with multiple falls. To date, no study has investigated the change in PPA impairment profile with age.ObjectiveTo describe impairment profiles, by age and ability to complete the postural sway measure, of older adults fallers.ParticipantsWe note that 885 older adults referred to multidisciplinary falls clinics located within two inner London boroughs (UK).MethodsAnonymised data was extracted from the PPA falls risk database. For comparisons, data was grouped by gender, age, and ability to complete the postural Sway test.ResultsThere were significant differences between all age groups in PPA falls risk, edge contrast sensitivity, quadriceps strength (Quad), postural sway and reported falls within the previous year (P < 0.01). The oldest age group (90+) had the highest PPA falls risk (P < 0.01), yet reported significantly less falls than the youngest age group (60 to 69; P < 0.05). There was significant variability in test results, with younger age groups displaying greater variability across PPA measures, and older age groups displaying more consistency (P < 0.05); 15.1% (n = 134) of patients that were able to perform the postural sway measure received a higher risk score for this test than those unable to complete the task.ConclusionsGreater variability in younger age groups indicates that specific impairments may provide the cause of falls, whereas widespread global reduction in function and frailty may provide the cause for falls in the older age groups. The postural sway scoring does not reflect ability to perform the test.