Malnutrition and falls risk in community-dwelling older adults

Background and Aims

Falls and fall-related injuries result in reduced functioning, loss of independence, premature nursing home admissions and mortality. Malnutrition is associated with falls in the acute setting, but little is known about malnutrition and falls risk in the community. The aim of this study was to assess the association between malnutrition risk, falls risk and falls over a one-year period in community-dwelling older adults.

Methods

Two hundred and fifty four subjects >65 years of age were recruited to participate in a study in order to identify risk factors for falls. Malnutrition risk was determined using the Mini Nutritional Assessment-Short Form.

Results

28.6% had experienced a fall and according to the Mini Nutritional Assessment-Short Form 3.9% (n=10) of subjects were at risk of malnutrition. There were no associations between malnutrition risk, the risk of falls, nor actual falls in healthy older adults in the community setting.

Conclusions

There was a low prevalence of malnutrition risk in this sample of community-dwelling older adults and no association between nutritional risk and falls. Screening as part of a falls prevention program should focus on the risk of developing malnutrition as this is associated with falls.     

Timed Up and Go test and risk of falls in older adults: a systematic review

Objective  

To assess the association and the predictive ability of the Timed Up and Go test (TUG) on the occurrence of falls among people aged 65 and older.     

秦皇岛市城市社区老年人跌倒的危险因素

  目的  了解河北省唐山市社区高龄老年人跌倒风险与睡眠和运动的关系,为采取应对的干预措施提供参考依据。  方法  于2016年7月 — 2017年1月采用分层随机整群抽样方法在唐山市抽取3 448名 ≥ 75岁社区高龄老年人进行问卷调查。  结果  唐山市社区高龄老年人跌倒风险得分为（8.19 ± 6.74）分;多元线性回归分析结果显示,年龄较高、分居或离异、不经常运动、睡眠质量较差、夜间异醒或早醒次数多、催眠药物使用次数较多和睡眠导致疼痛次数较多的唐山市社区高龄老年人跌倒风险较高。  结论  有睡眠问题或不经常运动均会增加唐山市社区高龄老年人的跌倒风险。     

老年人跌倒的危险因素与风险评估研究进展

跌倒是老年人常见的意外事件,随着老龄化的加剧,老年人跌倒已成为一个日益严重的公共卫生问题。发达国家[1]研究发现,居住在社区的65岁及以上的老人大约有1/3在1年中发生过跌     

Exercise and global well-being in community-dwelling adults with fibromyalgia: a systematic review with meta-analysis

Background  

Exercise has been recommended for improving global-well being in adults with fibromyalgia. However, no meta-analysis has determined the effects of exercise on global well-being using a single instrument and when analyzed separately according to intention-to-treat and per-protocol analyses. The purpose of this study was to fill that gap.     

社区老年人运动认知风险综合征患病率及相关因素的系统评价和Meta分析

目的 对社区老年人运动认知风险综合征的患病率和相关因素进行系统评价和meta分析。方法 计算机检索Pub Med、Embase、Web of Science、CINAHL、Sino Med、Cochrane Library、Psyc Info、知网、万方和维普等数据库,检索时限为建库至2022年5月。纳入有关社区老年人运动认知风险综合征患病率及其相关因素的研究。横断面研究采用美国卫生保健质量和研究机构推荐的质量评价标准进行评价。队列研究和病例对照研究使用纽卡斯尔-渥太华量表进行质量评价。使用Stata 15.0软件对提取的数据进行meta分析。结果 共纳入16篇文献,涉及51 364例社区老年人。结果显示,社区老年人运动认知风险综合征总患病率为8.0%(95%CI:7.0%～10.0%)。亚组分析结果显示,美洲、亚洲和欧洲患病率分别为8.9%(95%CI:6.9%～10.8%)、9.0%(95%CI:7.2%～10.7%)和5.1%(95%CI:0.1%～10.0%)。中国社区老年人运动认知风险综合征患病率为10.2%(95%CI:7.5%～12.9%)。社区老年人运动认知风险综合征的...     

Effects of medication adherence interventions for older adults with chronic illnesses: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to understand the characteristics of medication adherence interventions for older adults with chronic illnesses, and to investigate the average effect size by combining the individual effects of these interventions. Data from studies meeting the inclusion criteria were systematically collected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The results showed that the average effect size (Hedges’ g) of the finally selected medication adherence interventions for older adults with chronic illnesses calculated using a random-effects model was 0.500 (95% confidence interval [CI], 0.342−0.659). Of the medication adherence interventions, an implementation intention intervention (using face-to-face meetings and telephone monitoring with personalized behavioral strategies) and a health belief model–based educational program were found to be highly effective. Face-to-face counseling was a significantly effective method of implementing medication adherence interventions for older adults with chronic illnesses (Hedges’ g=0.531, 95% CI, 0.186−0.877), while medication adherence interventions through education and telehealth counseling were not effective. This study verified the effectiveness of personalized behavioral change strategies and cognitive behavioral therapy based on the health belief model, as well as face-to-face meetings, as medication adherence interventions for older adults with chronic illnesses.     

Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis

Quality of Life Research - Frailty is an important predictor of adverse health events in older people, and improving quality of life (QOL) is increasingly recognised as a focus for services in this...     

Effects of vibration training on quality of life in older adults: a preliminary systematic review and meta-analysis

Quality of Life Research - Older adults experience reduced quality of life (QOL). Vibration training has been applied in older adults. However, it remains inconclusive whether vibration training...     

Prevalence and risk factors of the co-occurrence of physical frailty and cognitive impairment in Chinese community-dwelling older adults

This cross-sectional study aimed to determine the prevalence of the co-occurrence of physical frailty and cognitive impairment and to identify its associated demographic, psychosocial and behavioural factors. Participants were recruited from 32 neighbourhoods using multistage sampling method in Xuhui District, Shanghai, China. A total of 1585 older adults were included who lived in community, were 75 years or older and without a clinical diagnosis of dementia. Based on the presences of frailty (using the modified frailty phenotype criteria) and/or cognitive impairment (using Chinese version Mini-Mental Status Examination stratified by educational level), the participants were classified into four groups: normal, cognitive impairment alone, frailty alone and co-occurrence. Multinomial logistic regression analyses were conducted to identify the demographic, psychosocial (depression, social participation and social support) and behavioural (sedentary lifestyle and sleep problems) characteristics associated with the co-occurrence of physical frailty and cognitive impairment. The prevalence of frailty alone, cognitive impairment alone and the co-occurrence of physical frailty and cognitive impairment in the study sample were 7%, 26.94% and 7.19% respectively. The results of multinomial logistic regression show the following characteristics significantly associated with the co-occurrence of physical frailty and cognitive impairment: advanced age (81–85 years old, Odds Ratio, OR = 1.99, 95% CI = 1.10–3.59; 86 years or older, OR = 6.43, 95% CI = 3.66–11.29), number of co-morbidities (OR = 1.34, 95% CI = 1.01–1.77), depression (OR = 3.88, 95% CI = 2.39–6.29), social participation (OR = 0.61, 95% CI = 0.39–0.96), sedentary lifestyle (OR = 2.69, 95% CI = 1.66–4.34) and sleep problems (insomnia occasionally, OR = 1.84, 95% CI = 1.07–3.17; insomnia every day, OR = 2.38, 95% CI = 1.33–4.26). The co-occurrence of physical frailty and cognitive impairment is a prevalent health issue in oldest old community-dwelling older adults. Advanced age, co-morbidity, depression, sedentary lifestyle and sleep problems are risk factors for cognitive frailty while good social participation may have a protective effect on it.     

A systematic review and meta-analysis on the safety of newly adjuvanted vaccines among older adults

IntroductionNew adjuvants have been developed to improve the efficacy of vaccines and for dose-sparing capacity and may overcome immuno senescence in the elderly. We reviewed the safety of newly-adjuvanted vaccines in older adults.MethodsWe searched Medline for clinical trials (CTs) including new adjuvant systems (AS01, AS02, AS03, or MF59), used in older adults, published between 01/1995 and 09/2017. Safety outcomes were: serious adverse events (SAEs); solicited local and general AEs (reactogenicity); unsolicited AEs; and potentially immune-mediated diseases (pIMDs). Standard random effects meta-analyses were conducted by type of safety event and adjuvant type, reporting Relative Risks (RR) with 95% confidence intervals (95% CI).ResultsWe identified 1040 publications, from which we selected 7, 7, and 12 CTs on AS01/AS02, AS03 and MF59, respectively. 47,602 study participants received newly-adjuvanted vaccine and 44,521 control vaccine, or placebo. Rates of SAEs (RR = 0.99, 95% CI = 0.96–1.02), deaths (RR = 0.99, 95% CI = 0.92–1.06) and pIMDs (RR = 0.94, 95% CI = 0.79–1.1) were comparable in newly-adjuvanted and control groups. Vaccine-related SAEs occurred in <1% of the subjects in both groups. The reactogenicity of AS01/AS02 and AS03 adjuvanted vaccines was higher compared to control vaccines, whereas MF59-adjuvanted vaccines resulted only in more pain. Grade 3 reactogenicity was reported infrequently, with fatigue (RR = 2.48, 95% CI = 1.69–3.64), headache (RR = 2.94, 95% CI = 1.24–6.95), and myalgia (RR = 2.68, 95% CI = 1.86–3.80) occurring more frequently in newly-adjuvanted groups. Unsolicited AEs occurred slightly more frequently in newly-adjuvanted groups (RR = 1.04, 95% CI = 1.00–1.08).ConclusionsOur review suggests that, within the clinical trial setting, the use of new adjuvants in older adults has not led to any safety concerns, with no increase in SAEs or fatalities. Higher rates for solicited AEs were observed, especially for AS01/AS02 and AS03 adjuvanted vaccines, but AEs were mostly mild and transient. Further evidence will need to come from the use of new adjuvants in the real-world setting, where larger numbers can be studied to potentially detect rare reactions.     

中国社区老年人肌少症患病率的Meta分析

目的 分析中国社区老年人的肌肉减少症的患病率。方法 系统检索PubMed、EMbase、Cochrane、万方数据库、维普中文科技期刊数据库、中国知网数据库等中英文文献库,纳入2010 - 2018年6月发表的相关文献。采用stata 14.0软件进行Meta分析。结果 共纳入16篇文献,总共纳入18 570人。中国社区老年人的肌肉减少症患病率为12%（95%CI: 10%～15%）。亚组分析结果显示,中国大陆社区老年人的肌少症患病率为17%（95%CI: 13%～21%）,非大陆地区（港台）患病率为6%（95%CI: 4%～7%）,2亚组之间存在统计学差异（P = 0.019）。对性别、肌量评估方法、诊断标准进行亚组分析,结果提示肌少症患病率无统计学差异。结论 中国大陆地区的社区老年人的肌少症患病率较高,需要引起更多重视。     

Prevalence of rotavirus among older children and adults with diarrhea: A systematic review and meta-analysis

BackgroundOlder children and adults are susceptible to rotavirus, but the extent to which rotavirus affects this population is not fully understood, hindering accuracy of global rotavirus estimations.ObjectiveTo determine what proportion of diarrhea cases are due to rotavirus among persons ≥ 5 years old and to estimate this proportion by age strata.MethodsWe conducted a systematic review and meta-analysis using the PRISMA guidelines. We included studies that reported on conditional rotavirus prevalence (i.e., percent of diarrhea due to rotavirus) in persons ≥ 5 years old who were symptomatic with diarrhea/gastroenteritis and had laboratory confirmation for rotavirus infection. Studies on nosocomial infections and outbreak investigations were excluded. We collected age group-specific conditional rotavirus prevalence and other variables, such as study geography, study setting, and study type. We calculated pooled conditional rotavirus prevalence, corresponding 95% confidence intervals (95% CI), heterogeneity (I²) estimates, and prediction intervals (PI).ResultsSixty-six studies from 32 countries met the inclusion criteria. Conditional rotavirus prevalence ranged from 0% to 30% across the studies. The total pooled prevalence of rotavirus among persons ≥ 5 years old with diarrhea was 7.6% (95% CI: 6.2–9.2%, I² = 99.6%, PI: 0–24%). The pooled prevalence of rotavirus among older children and adolescents was 8.7% (95% CI: 6.2–11.7%, I² = 96%, PI:0–27%), among younger adults was 5.4% (95% CI: 1.4–11.8%, I² = 96%, PI:0–31%), and among older adults was 4.7% (95% CI: 2.8–7.0%, I² = 96%, PI:0–16%). Pooled conditional rotavirus prevalences did not differ by other variables.ConclusionIn this systematic review and meta-analysis of rotavirus among persons ≥ 5 years old with diarrhea, we found relatively low pooled conditional rotavirus prevalence compared to what is typically reported for children < 5 years; however, results should be interpreted with caution as the wide prediction intervals suggest large heterogeneity.     

An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study

Abstract: Seven hundred and four women aged between 65 and 99 years (mean age 74.6 years), who were randomly selected from the community, took part in a study to determine whether health and lifestyle factors were associated with falls. In the 12 months before the survey, 66.1 per cent of the subjects experienced no falls, 19.7 per cent fell once and 14.2 per cent fell on two or more occasions. The proportion of women who fell outside the home decreased with age, with a corresponding increase in the proportion who fell inside the home on a level surface. The most common causes of falls reported were trips, slips and loss of balance. Some (27 per cent) suffered injuries as a result of a fall, and the proportion suffering injuries increased with age. Those who rated their health and balance as impaired, those with a limitation in activities of daily living, those receiving community services, those taking psychoactive drugs, and those taking four or more drugs had significantly more falls. On the other hand, those taking part in planned exercise and those active for seven or more hours per week had fewer falls. Smoking and alcohol consumption were not significantly associated with falls. Stepwise logistic regression analysis revealed poor vision, inactivity and subjective fall risk as variables that were independently and significantly associated with falling. These findings highlight possible intervention strategies for reducing falls risk in older people.     

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.