Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.     

Personal health information management among healthy older adults: Varying needs and approaches

ObjectiveWith age, older adults experience a greater number of chronic diseases and medical visits, and an increased need to manage their health information. Technological advances in consumer health information technologies (HITs) help patients gather, track, and organize their health information within and outside of clinical settings. However, HITs have not focused on the needs of older adults and their caregivers. The goal of the SOARING (Studying Older Adults and Researching their Information Needs and Goals) Project was to understand older adult personal health information management (PHIM) needs and practices to inform the design of HITs that support older adults.Materials and MethodsDrawing on the Work System Model, we took an ecological approach to investigate PHIM needs and practices of older adults in different residential settings. We conducted in-depth interviews and surveys with adults 60 years of age and older.ResultsWe performed on-site in-person interview sessions with 88 generally healthy older adults in various settings including independent housing, retirement communities, assisted living, and homelessness. Our analysis revealed 5 key PHIM activities that older adults engage in: seeking, tracking, organizing, sharing health information, and emergency planning. We identified 3 major themes influencing older adults’ practice of PHIM: (1) older adults are most concerned with maintaining health and preventing illness, (2) older adults frequently involve others in PHIM activities, and (3) older adults’ approach to PHIM is situational and context-dependent.DiscussionOlder adults’ approaches to PHIM are dynamic and sensitive to changes in health, social networks, personal habits, motivations, and goals.ConclusionsPHIM tools that meet the needs of older adults should accommodate the dynamic nature of aging and variations in individual, organizational, and social contexts.     

Community violence in Jamaica: A public health issue for the health profession

Societal violence is a public health concern that confronts different countries. In this paper, the author examines the situation of community violence in Jamaica and discusses steps which could be taken by the health community to curb the pervasive and growing problem of community violence.     

Nutrition screening among community-dwelling older adults in Singapore

INTRODUCTION: This study aimed to describe responses to the DETERMINE checklist and the nutritional risk level of community-dwelling older Chinese in Singapore, aged 55 years and older. METHODS: Data was collected from a community health screening project for elderly residents in Singapore. All residents aged 55 years and older in the survey area were identified in door-to-door census surveys and were invited to participate. Participants completed a questionnaire interview conducted by research nurses. The survey also included questions which were potential predictors of nutritional risk: sociodemographic factors (age, gender, education, housing type, marital status, and living arrangement) and health-related factors (self-rated health, number of medical comorbidities, hospitalisations in the past year, functional disabilities and physical health status). RESULTS: Data for analysis was provided by 2,605 Chinese subjects aged between 55 and 98 years (mean/standard deviation 66.0/7.7). The overall prevalence of nutritional risk (according to a DETERMINE score of 3 or greater) was 30.1 percent. 1,822 (69.9 percent) subjects had no nutritional risk (scores of 2 or lower), 664 (25.5 percent) had moderate nutritional risk and 119 (4.6 percent) had high nutritional risk. The most common contributions to nutritional risks were: changing food intake due to illness (40.3 percent), taking three or more different medications daily (25.0 percent), eating alone (14.5 percent) and consuming insufficient amount of fruits, vegetables or milk products on a daily basis (9.0 percent). Respondents at nutritional risk were more likely to have three or more comorbid medical conditions, were hospitalised in the past year, were functionally dependent on one or more instrumental or basic activities of daily living, were reported to have poor or fair self-rated health, and were in the lowest tertile scores for SF-12 quality of life and depression. CONCLUSION: Self-rated general health, lowered quality of life, functional disability and depression have meaningful non-circular associations with the checklist. These support the validity of the DETERMINE checklist in predicting the risk of adverse health conditions and events.     

老年糖尿病患者跌倒效能调查及影响因素分析

目的：调查研究老年2型糖尿病患者的跌倒效能及影响因素。方法采用修订版跌倒效能量表（MFES）、Morse跌倒危险评估量表（MFS）,运用调查问卷与观察测评相结合的方法,对218例老年2型糖尿病患者进行调查与分析。结果老年2型糖尿病患者跌倒效能为（8．15±2．91）分。得分最低的项目为“上下楼梯”和“上床与下床”;得分最高的项目为“更衣”和“从椅子上起落”。通过多元线性逐步回归分析发现,糖尿病病程、并发症及跌倒史是糖尿病跌倒效能的主要影响因素。结论老年2型糖尿病患者跌倒效能处于中等水平,与糖尿病病程、并发症及跌倒史密切相关。     

社区老年人跌倒的流行病学特征及医疗负担分析

目的了解社区老年人跌倒的流行病学特征及医疗负担。方法采取随机抽样的方法对石家庄市两个社区的1609名60岁及以上老年人过去一年跌倒发生情况进行回顾性调查。结果180人发生跌倒,年跌倒发生率为11.2％。女性（12.5％）高于男性（9.1％）（X2=4.618,P=0.032〈0.05）。跌倒282人次,人次跌倒发生率为17.5％。跌倒发生在家中占48.0％,家外小区内占25.6％,小区以外占38.8％;跌倒自身原因,以运动中没有保持平衡（22.9％）和注意力不集中（22.1％）为主。跌倒环境因素中,24.0％没有保护措施,18.0％地面不平,12.0％路滑,10.8％物品挡路。跌伤率36.5％。跌倒后4.8％住院,8.2％到门诊急诊处理;住院天数中位数为23d,在家卧床天数中位数为30d。受伤中骨折最多,占43.4％。跌伤后12.7％活动能力明显下降。跌倒后的医疗花费中位数为510元。结论社区老年人跌倒对健康危害较严重,造成一定的医疗负担。     

Daily activity energy expenditure and mortality among older adults

Context  Exercise is associated with mortality benefits but simply expending energy through any activity in an individual's free-living environment may confer survival advantages. Objective  To determine whether free-living activity energy expenditure is associated with all-cause mortality among older adults. Design, Setting, and Participants  Free-living activity energy expenditure was assessed in 302 high-functioning, community-dwelling older adults (aged 70-82 years). Total energy expenditure was assessed over 2 weeks using doubly labeled water. Resting metabolic rate was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of total energy expenditure. Free-living activity energy expenditure was calculated as: (total energy expenditure x 0.90) – resting metabolic rate. Participants were followed up over a mean of 6.15 years (1998-2006). Main Outcome Measures  Free-living activity energy expenditure (3 tertiles: low, <521 kcal/d; middle, 521-770 kcal/d; high, >770 kcal/d) and all-cause mortality. Results  Fifty-five participants (18.2%) died during follow-up. As a continuous risk factor, an SD increase in free-living activity energy expenditure (287 kcal/d) was associated with a 32% lower risk of mortality after adjusting for age, sex, race, study site, weight, height, percentage of body fat, and sleep duration (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96). Using the same adjustments, individuals in the highest tertile of free-living activity energy expenditure were at a significantly lower mortality risk compared with the lowest tertile (hazard ratio, 0.31; 95% confidence interval, 0.14-0.69). Absolute risk of death was 12.1% in the highest tertile of activity energy expenditure vs 24.7% in the lowest tertile; absolute risks were similar to these for tertiles of physical activity level. The effect of free-living activity energy expenditure changed little after further adjustment for self-rated health, education, prevalent health conditions, and smoking behavior. According to self-reports, individuals expending higher levels of free-living activity energy were more likely to work for pay (P = .004) and climb stairs (P = .01) but self-reported high-intensity exercise, walking for exercise, walking other than for exercise, volunteering, and caregiving did not differ significantly across the activity energy expenditure tertiles. Conclusions  Objectively measured free-living activity energy expenditure was strongly associated with lower risk of mortality in healthy older adults. Simply expending energy through any activity may influence survival in older adults.