跌倒恐惧在老年终末期肾脏病患者衰弱与生活质量间的中介效应

目的 探讨跌倒恐惧及衰弱对老年ESRD患者生活质量的影响，并分析跌倒恐惧在老年ESRD患者衰弱与生活质量间的中介作用，为提高患者生活质量提供参考。方法 采用Tilburg衰弱量表(TFI)、修订版跌倒效能量表(MFES)与SF - 36生活质量量表对245名老年ESRD患者进行调查，利用SPSS 21.0对数据进行统计分析。结果 老年ESRD患者生活质量与其衰弱程度呈负相关(r = - 0.452，P＜0.01)，且跌倒恐惧水平越高，生活质量越低（r = 0.572，P＜0.01）。跌倒恐惧在衰弱与生活质量间起中介作用，中介效应占总效应的44.90%。结论 跌倒恐惧是老年ESRD患者衰弱与生活质量间的中介变量，医务人员制定干预措施时应关注患者跌倒恐惧，以期提高患者生活质量。     

Evaluating an intervention to reduce fear of falling and associated activity restriction in elderly persons: design of a randomised controlled trial [ISRCTN43792817]

Background  

Fear of falling and associated activity restriction is common in older persons living in the community. Adverse consequences of fear of falling and associated activity restriction, like functional decline and falls, may have a major impact on physical, mental and social functioning of these persons. This paper presents the design of a trial evaluating a cognitive behavioural group intervention to reduce fear of falling and associated activity restriction in older persons living in the community.     

Severe Fear of Falling Is Associated With Cognitive Decline in Older Adults: A 3-Year Prospective Study

ObjectivesFear of falling (FOF) is common in older adults. We investigated whether FOF affects development of cognitive decline over a 3-year period in community-dwelling older adults with intact cognition.DesignRetrospective, cohort, observational.Setting and participantsData for 4280 older adults with normal cognition at baseline from the Survey of Living Conditions and Welfare Needs of Korean Older Persons (2008 and 2011).MethodsHistory of falls and severity of FOF (no fear, somewhat fearful, or very fearful) were assessed at baseline (2008). We evaluated cognitive function using the Korean version of the Mini-Mental State Examination in 2008 and 2011, and defined cognitive decline as a decrease of ≥3 points over the 3-year study period. Multivariable logistic regression analysis was performed to examine the association between FOF and cognitive decline.ResultsThe prevalence of being somewhat fearful of falling was 54.6% and that of being very fearful was 9.7%. The participants who were somewhat fearful of falling had a 1.2-fold higher risk of cognitive decline; this finding lost significance in adjusted models. The participants who were very fearful of falling had a 1.45-fold higher risk of cognitive decline than those with no FOF after adjusting for confounders [odds ratio (OR) 1.45, 95% confidence interval (CI) 1.08–1.95]. When we divided the participants according to age, sex, and baseline cognitive function, the association was significant in men (OR 2.29, 95% CI 1.24–4.25), participants age >70 years (OR 1.57, 95% CI 1.06–2.33), and those with a Mini-Mental State Examination score <30 (OR 1.45, 95% CI 1.07–1.98).Conclusions and implicationsBeing very fearful of falling increased the risk of cognitive decline in older Korean adults. Physicians should be aware of the risk of development of cognitive impairment in older individuals with FOF.     

Feasibility of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity in community-living older people: a process evaluation

Background  

Fear of falling and associated avoidance of activity are common among older people and may have negative consequences in terms of functional decline, quality of life and institutionalisation. We evaluated the effects of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity among older persons. This intervention showed favourable effects on fear of falling, avoidance of activity, daily activity, and several secondary outcomes. The aim of the present study is to assess the feasibility of this cognitive behavioural group intervention for participants and facilitators.     

Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling

Background  

Fear of falling and avoidance of activity are common in old age and are suggested to be (public) health problems of equal importance to falls. Earlier studies of correlates of fear of falling and avoidance of activity did hardly differentiate between severe and mild levels of fear of falling and avoidance of activity which may be relevant from clinical point of view. Furthermore, most studies focused only on socio-demographics and/or health-related variables and hardly incorporated an extensive range of potential correlates of fear of falling including psychosocial variables. This study analyzes the univariate and multivariate associations between five socio-demographic, seven health-related and six psychosocial variables and levels of fear of falling and avoidance of activity in older persons who avoid activity due to fear of falling.     

Physical frailty and body composition in obese elderly men and women

OBJECTIVE: To evaluate the prevalence of frailty and interrelationships among body composition, physical function, and quality of life in community-dwelling obese elderly (OE) persons. RESEARCH METHODS AND PROCEDURES: Fifty-two OE, 52 nonobese frail, and 52 nonobese nonfrail subjects, matched for age and sex, were studied. Subjective and objective measures of functional status were evaluated by using the physical performance test, exercise stress test, lower extremity (LE) strength, gait speed, static and dynamic balance, functional status questionnaires, and health-related quality-of-life questionnaire (Medical Outcomes Short Form). Body composition was evaluated by using DXA, and muscle quality was evaluated by determining the ratio of LE strength to LE lean mass. RESULTS: Among OE subjects, 96% met our standard criteria for mild to moderate frailty. Compared with the nonobese nonfrail group, the OE and nonobese frail groups had lower and similar scores in physical performance test, peak aerobic power, and functional status questionnaire, and exhibited similar impairments in strength, walking speed, balance, and health-related quality of life. Although absolute fat-free mass (FFM) was greater, the percentage body weight as FFM and muscle quality was lower in the OE group than in the other two groups. DISCUSSION: Physical frailty, which predisposes to loss of independence, is common in community-living OE men and women. Physical frailty in OE subjects was associated with low percentage FFM, poor muscle quality, and decreased quality of life. These findings suggest that weight loss therapy may be particularly important in OE persons to improve physical function, in addition to improving the medical complications associated with obesity.     

Older persons afraid of falling reduce physical activity to prevent outdoor falls

OBJECTIVE: The aim of this study was to test the assumption that the level of outdoor physical activity mediates the relationship between fear of falling and actual outdoor falls according to the Task Difficulty Homeostasis Theory. METHOD: A prospective follow-up study of 10 months conducted in the year 2000 in three municipalities in the province of Friesland, The Netherlands. The participants were 1752 people aged 65 and older, living independently, in the community. Main baseline data were age, sex, outdoor physical activities (walking, bicycling), and fear of outdoor falls. The number of people who fell outdoors was recorded. RESULTS: People with a high fear of falling were more often low to moderately active or active compared with people who had no such fears and were more often very active. Fear of falling was not associated with outdoor falls, but it was after taking the level of physical activity into account. CONCLUSIONS: Outdoor physical activity mediates the relationship between fear of falling and actual outdoor falls. This implies that the incidence of falls as an outcome in studies does not adequately represent the impact of risk factors for falls and that level of physical activity should be taken into account.     

Impact of Fear of Falling in Long Term Care: An Integrative Review

Long term care elders with fear of falling may restrict their activity resulting in declines in function and excess disability. To further explore this problem, a review of the literature was conducted. The search yielded 26 studies on the epidemiology of fear of falling in nursing homes and assisted living as well as intervention studies in these settings. Fear of falling is common, affecting more than 50% of long term care elders and is associated with negative outcomes, including falls, functional impairments, depression, and poor quality of life. Longitudinal studies are rare. There were few intervention studies, with most testing exercise programs, including balance training, such as t’ai chi, and little research testing other approaches. Few conclusions can be drawn about interventions, as most sample sizes were small and the interventions and measurement varied widely. Additional research is needed to identify long term care residents most in need of intervention, and the best ways to reduce fear of falling and its consequences.     

中国老年人衰弱状况及其影响因素分析

目的 分析中国老年人衰弱状况及其影响因素,为制定干预措施提供借鉴。方法 利用中国健康与养老追踪调查2011－2015年全国随访调查数据,以衰弱指数（FI）评价≥60岁老年人的衰弱状况。使用logistic回归分析进行影响老年人衰弱患病率的多因素分析。结果 中国老年人2011、2013、2015年的衰弱患病率分别为18.7%、20.6%和28.4%。女性、高龄的老年人FI更高。髋关节骨折、跌倒、饮酒>1次/月及不参加社会活动可能是衰弱的危险因素。结论 中国老年人衰弱患病率较高,且呈逐年上升的趋势。衰弱受不良事件和生活方式等多种因素的影响,应及早采取综合干预策略,延缓衰弱进程。     

What is the evidence of the experience of having a fall across the life course? A qualitative synthesis

BackgroundAlleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived.ObjectiveTo address the question: what is the evidence of the experience of having a fall across the life course?MethodA qualitative evidence synthesis with key electronic databases searched from 1990 to 2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of ‘incidents’ related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations.ResultsThe initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors' systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults' perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit ‘Fear.’ Consequences are related to notions of ‘Control’ and ‘Social standing.’ Recovery work involves ‘Adaptation,’ ‘Implications,’ ‘Social standing’ and ‘Control.’ ‘Explanation’ is sought.ConclusionsHow and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.     

Fragility, fear of falling, physical activity and falls among older persons: some theoretical considerations to interpret mediation

BACKGROUND: In their letters to the editor, Lacherez et al. [Lacherez, P.F., Wood, J.M., Kerr, G.K., 2007. Does activity level mediate or suppress the association between fear of falling and falls? Prev. Med. 31; (Electronic publication ahead of print)] and Hafeman and Schwartz [Hafeman, D., Schwartz, S., 2007. Assessing mediation: The necessity of theoretical considerations. Prev. Med. 26; (Electronic publication ahead of print)] questioned the correctness of using the term 'mediation' in our paper [Wijlhuizen, G.J., Jong, R. de, Hopman-Rock, M., 2007. Older persons afraid of falling reduce physical activity to prevent outdoor falls. Prev. Med. 44, 260-264.]. In this paper, we concluded that (outdoor) Physical activity mediates the relationship between Fear of falling and outdoor Falls. We investigated whether the term 'inconsistent mediation' might be a more appropriate term to use in this context. METHODS: Based on literature, we describe the relationship between fear of falling, physical activity, and falls within a causal model. RESULTS: Two causal pathways between Fear and Falls exist, with the causal pathway going from Fear of falling via Physical activity to Falls counteracting (is inconsistent with) the causal pathway going from Fear of falling via Hesitancy to Falls. CONCLUSION: The term 'inconsistent mediation' might be more appropriate to describe the causal relationships between Fear of falling, Falls, and Physical activity.     

Nutritional status of school-age children - A scenario of urban slums in India

Objectives

This article aims at describing, in a Belgian town, the frequency of the fear of falling and of subsequent activity restriction among non-institutionalised people aged 65 years and over, and at identifying persons affected by these two issues.

Methods

Cross-sectional survey conducted in Fontaine l'Evêque (Belgium) in 2006, using a self-administered questionnaire.

Results

The participants could fill in the questionnaire on their own or with the help of a third party if needed. The latter were not taken into account in this article. Analyses covered 419 questionnaires. Fear of falling and activity restriction were reported by, respectively, 59.1% and 33.2% of participants. They were more frequent among fallers but also affected non-fallers. In logistic regression analyses: gender, the fact of living alone and the number of falls were significantly associated with fear of falling; gender, age and the number of falls were significantly associated with activity restriction.

Conclusions

Our study, despite various limitations, shows the importance of fear of falling and of subsequent activity restriction among older people, among fallers as well as among non-fallers. It also provides information, though limited, concerning persons affected by these two issues in Belgium, and in other contexts as well. Given the ageing of our populations, it is important to take these problems into account when caring for older people.     

Adverse outcomes of frailty in the elderly: the Rotterdam Study

To investigate the prevalence of frailty in a Dutch elderly population and to identify adverse health outcomes associated with the frailty phenotype independent of the comorbidities. Cross-sectional and longitudinal analyses within the Rotterdam Study (the Netherlands), a prospective population-based cohort study in persons aged ≥55 years. Frailty was defined as meeting three or more of five established criteria for frailty, evaluating nutritional status, physical activity, mobility, grip strength and exhaustion. Intermediate frailty was defined as meeting one or two frailty criteria. Comorbidities were objectively measured. Health outcomes were assessed by means of questionnaires, physical examinations and continuous follow-up through general practitioners and municipal health authorities for mortality. Of 2,833 participants (median age 74.0 years, inter quartile range 9) with sufficiently evaluated frailty criteria, 163 (5.8 %) participants were frail and 1,454 (51.3 %) intermediate frail. Frail elderly were more likely to be older and female, to have an impaired quality of life and to have fallen or to have been hospitalized. 108 (72.0 %) frail participants had ≥2 comorbidities, compared to 777 (54.4 %) intermediate frail and 522 (44.8 %) non-frail participants. Adjusted for age, sex and comorbidities, frail elderly had a significantly increased risk of dying within 3 years (HR 3.4; 95 % CI 1.9–6.4), compared to the non-frail elderly. This study in a general Dutch population of community-dwelling elderly able to perform the frailty tests, demonstrates that frailty is common and that frail elderly are at increased risk of death independent of comorbidities.     

Characteristics of urban community-dwelling elderly women with multiple symptoms of the geriatric syndrome and related factors

OBJECTIVE: The present study was performed to comprehensively investigate the prevalence of multiple symptoms of the geriatric syndrome, characteristics and related factors in urban community-dwelling elderly women. METHODS: Among 669 women aged 70 years and above living in 5 areas of Itabashi-ku, who attended the Otassha Kenshin (comprehensive health check for the elderly) in November 2004 and gave consent to participate in this study, 668 had no missing data and their interview and physical fitness data were analyzed. The criteria for the geriatric syndrome were: (1) functional decline: a score of 10 points or below for the 13 items of the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence; (2) falls: "have fallen" once or more in the last year; and (3) urinary incontinence: frequency of urine leakage of "1 to 3 times in a month" in daily life. The interview and physical fitness data were compared between healthy persons, persons with one symptom and persons with multiple symptoms. Multiple logistic regression models were used to analyse related factors. RESULTS: The prevalence of multiple geriatric syndromes was 15.3%; comprising 2.2% with "functional decline+falls", 6.0% with "functional decline+urinary incontinence", 5.1% with "falls+urinary incontinence", and 2.0% with "functional decline+falls+urinary incontinence". The group reporting multiple symptoms had poor self-rated health, had a high percentage currently taking three or more medications, had a fear of falling and had a significantly (P < 0.05) higher likelihood of a history of stroke and urinary disease. In addition, the group with multiple symptoms were older, and had significantly (P < 0.05) poorer results for grip strength, usual walking speed, maximum walking speed, functional reach, knee extension strength, and one leg standing time with eyes open. Within this group, the "functional decline+falls" subgroup had the lowest level of physical fitness. Analysis of factors related to the presence (1) or absence (0) of multiple symptoms identified fear of falling and usual walking speed as two significant variables. CONCLUSION: This study showed that: (1) physical fitness is significantly lower in the group with multiple symptoms of the geriatric syndrome compared with healthy persons, and was the lowest in the subgroup with "functional decline+falls"; and (2) fear of falling and usual walking speed were two factors related to multiple geriatric syndromes. These results suggest directions for future intervention strategies.     

Home hazards and falls in the elderly: the role of health and functional status.

OBJECTIVES. This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls. METHODS. A 1-year prospective study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year. Composite measures of home safety and of frailty were derived using principal components analysis. Participants were divided into vigorous and frail groups, and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups. RESULTS. Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up (rate ratio [RR] = 2.24; 95% confidence interval [CI] = 1.54, 3.27). In the study group as a whole, falls were not strongly associated with the presence of home hazards. However, when compared with vigorous older persons living with fewer home hazards, vigorous older persons living with more home hazards were more likely to fall. The increased risk for falls among vigorous elderly was limited to falls where home hazards were present. By contrast, living with more home hazards was not associated with increased likelihood of falls among frail older persons. CONCLUSIONS. While frail older persons experience higher overall fall rates, vigorous older persons should not be overlooked in fall prevention projects.     

The prevalence of falls and associated factors among the elderly according to ethnicity

The historical and cultural characteristics reflect the Brazilian population. Elderly blacks are disadvantaged in socio-economic and demographic, clinical, functional and psychosocial aspects, reducing their social autonomy and functional independence. The decline in functional status due to variables associated with age and ethnicity can contribute to disabling events, such as falls. Socio-demographic, clinical and functional aspects related to falls were analyzed; Mobility, functional status and cognition were measured, with a statistical significance of pd"0.05. The sample of 196 elderly people was 48.5% white, 28% brown, 23.5% black, with an average of 69.9 years. There was reduced mobility classified as a medium risk for falls in 60% (p<0.013) among the elderly. With reference to groups analyzed, there were significant differences between variables for family income (p <0.029), the occurrence of falls (p <0.006), fear of falls (p <0.023) and near-falls (p <0.000). Blacks fall more often (p <0.03). Statistical significance was revealed between ethnicity and self-reported occurrence of falls, fear of falling and the occurrence of near-falls, functional limitation and medium risk falls due to reduced mobility, with increased frequency of falls for elderly blacks.     

社区老年人跌倒及危险因素调查

目的对社区老年人跌倒情况及危险因素进行调查,为社区干预提供科学依据。方法采用随机整群抽样方法,对某街道随机抽取的3 440户中的60岁及以上所有老年人在2007年1月1日—12月31日间发生跌倒的情况进行回顾性调查。结果 60岁以上的1 967名调查对象中,跌倒伤害发生率为2.54%;其中男性跌倒发生率为1.68%,女性跌倒发生率为3.35%。61.54%跌倒发生在家中;57.69%跌倒是因地面潮湿和地面不平等环境因素造成的。年龄、平衡失调、步态不稳、身体状况差、慢性病等是老年人跌倒的主要危险因素(P0.05)。结论跌倒受老年人的身心健康和环境因素共同影响,加强对跌倒危险因素的干预是今后老年人预防跌倒的工作重点。     

The influence of falls on the quality of life of the aged

The objective of this study is to analyze the effect of falls and their consequences on the quality of life of elderly people living in a low-income community in the city of Rio de Janeiro. This article is part of an explorative research conducted at CLAVES, using quantitative and qualitative methods. In this study we used quantitative data about falls and quality of life. 72 elderly aged over 60 years participated in the study. 51,4% of them were females, 20,8% lived alone and 37,5% admitted having suffered a fall during the last year. Among the most frequently mentioned consequences were fractures (24,3%), the fear of falling (88,5%), abandonment of activities (26,9%), change of habits (23,1%) and immobilization (19%). The analysis showed that falls have influence upon in the quality of life of the aged. The WHOQOL-Bref domain scores showed a reduction in the means of the group that had suffered falls during the last year in comparison to those who didn't fall, and the difference was more significant in the psychological field. In short, falls are frequent among the elderly and bring consequences that change the quality of life of these people in a negative way. Their incidence can be avoided by identifying the causes and developing appropriate preventive measures.     

Social status, life changes, housing conditions, health, functional abilitiesand life-style as risk factors for recurrent falls among the home-dwelling elderly

Objective

To define the risk factors for recurrent falls in the home-dwelling elderly.

Design

A prospective population-based study covering two years.

Setting

Five rural municipalities around the city Oulu, northern Finland.

Participants

All home-dwelling elderly persons (N = 1,016) aged 70 years or older living in the municipalities.

Outcome measures

The risk factors of recurrent falling by variables related to social status, life changes,housing conditions, health, functional abilities and life style, using cross-tabulations and multivariate analyses.

Results

The recurrent fallers (at least two falls within 365 days after the examination day) consisted of 17 men (6% of the men) and 71 women (14%). Logistic regression analyses showed female sex, urinary urgency, frequent fear of falling, dizziness, a poor pulse rate rise 30 seconds after standing up and falling during the previous year to be risk factors for recurrent falls. After the variable representing previous falls had been removed from the analysis, urinary incontinence and a change in housing conditions during the past two years emerged and urinary urgency dropped out of the model.

Conclusions

Women particularly are a target group for the prevention of falls among the elderly. Urinary urgency and urinary incontinence, fear of falling, dizziness and changes in the housing conditions should be inquired about to identify the elderly at risk for falling and to take preventive interventions. In addition to testing blood pressure changes after standing up, the changes in pulse rate should be determined to identify and treat elderly people who have orthostatic conditions.