Associations between obesity and overweight and fall risk,health status and quality of life in older people

Objectives: To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers. Methods: A representative sample of community‐based individuals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12‐month period. Results: Obese individuals had a 31% higher risk of having fallen, but no higher risk of a fall‐related injury compared to healthy‐weight individuals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls; a 41% higher risk of using four or more medications; a 30% higher risk of experiencing moderate or extreme pain or discomfort; were 26% less likely have walked for two or more hours in the last week; and were less likely to think they were doing enough physical activity. Conclusions: Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight. Implications: A decrease in sedentary lifestyle and regular weight‐bearing exercise may reduce fall risk in older obese individuals.     

Prevalence of risk and protective factors for falls in the home environment in a population-based survey of young and middle-aged adult New Zealanders

Objective: To estimate the prevalence of hazards in the home environment that may contribute to unintentional falls among young and middle-aged New Zealanders.
Methods: A random sample of 352 young and middle-aged people (25-60 years) residing in Auckland was drawn from the electoral roll. The prevalence of environmental factors that may have an impact on risk of falls was investigated using a structured interviewer-administered questionnaire.
Results: Potential risk factors for falls were common in the study population (ladder use in the past year – 64%; inability to reach a light from bed – 21%; lack of handrails for stairs – 54%). Only 9% and 11% of baths and showers, respectively, had grab or hand rails; 42% and 56% had anti-skid mats/surfaces. Compared to those reporting no socio-economic deprivation characteristics, respondents reporting one or more such characteristics were less likely to use a ladder and have indoor stairs, but more likely to have outdoors stairs. There was no significant relationship between socio-economic status and presence of a grab/handrail or antiskid mats/surfaces in or near showers/baths.
Conclusion and implications: Structural hazards that are likely to result in falls at home are common in New Zealand. The greater prevalence of some environmental risk factors for falls among the least socially deprived population may account for the inconsistent association between socio-economic deprivation and fall-related injuries reported in previous research. Information regarding the contribution of these and associated factors to the occurrence of falls can help target and reduce the risks involved.     

Elderly women's experiences of living with fall risk in a fragile body: a reflective lifeworld approach

The purpose of this qualitative study was to explore the lived experience of fall risk from a lifeworld perspective in elderly women with previous fragility fractures. Thirteen elderly women with a high risk of fall and fracture, aged 76–86, living in their own homes in rural areas, were recruited from a voluntary fracture prevention programme. All women had a history of fragility fractures and were interviewed in their homes from spring to autumn 2004. A phenomenological reflective lifeworld approach was chosen to analyse in-depth interview data. The study was conducted within an interdisciplinary research group inspired by dialogical research. Elderly women's life space has been narrowed due to advanced age, physical injury or by efforts to prevent new injuries leading to changes in self-perception. However, the women seek strategies to challenge limitations and insecurity, and strive to retain mobility and daily life routines. The four major constituents of the phenomenon 'elderly women's experiences of fall risk' emerged in this study: a changing body, living with precaution, ambiguous dependency and influence and need for understanding. Employing the women's thoughts and resources in trust-based dialogues with caregivers may strengthen their concord and the prospects to continue an active life. Elderly women seek strategies to challenge limitations and feelings of insecurity, and strive to maintain mobility and daily life routines. A trust-based care respecting the preferences of the women seemed to stimulate behavioural change in maintaining an active life.     

The impact of geographical location on trends in hospitalisation rates and outcomes for fall‐related injuries in older people

Objective : This population‐based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall‐related injury in older adults, adjusting for age, sex and comorbidities. Methods : A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall‐related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths‐of‐stay, 28‐day readmissions, and 30‐day mortalities. These were standardised for age, sex, comorbidity, and remoteness. Results : Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28‐day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30‐day mortality (5.0% vs 4.9%, p=0.0046). Conclusions : Over the study period, rural residents of NSW had lower rates of fall‐related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length‐of‐stay, but higher rates of readmission and mortality. These differences existed following standardisation. Implications : This study highlights the need for further research to characterise and explain this variability.     

Older fallers attended to by an ambulance but not transported to hospital: a vulnerable population at high risk of future falls

Objective : This prospective cohort study describes older non‐transported fallers seen by the Ambulance Service of New South Wales (ASNSW), quantifies the level of risk and identifies predictors of future falls and ambulance use. Methods : Participants were 262 people aged 70 years or older with a fall‐related ASNSW attendance who were not transported to an emergency department. They completed a questionnaire about health, medical and physical factors previously associated with falling. Falls were monitored for six months after ambulance attendance with monthly fall calendars. Results : Participants had a high prevalence of chronic medical conditions, functional limitations and past falls. During follow‐up, 145 participants (58%) experienced 488 falls. Significant predictors of falls during follow‐up were three or more falls in the past year, being unable to walk more than 10 minutes without resting, and requiring assistance for personal‐care activities of daily living (ADLs). Sixty‐two participants (25%) required repeat, fall‐related ambulance attendance during the study. Predictors of repeat ambulance use were: 3+ falls in past year, requiring assistance for personal‐care ADLs and having disabling pain in past month. Conclusions : Older, non‐transported fallers seen by the ASNSW are a vulnerable population with high rates of chronic health conditions. Implications : Onward referral for preventive interventions may reduce future falls and ambulance service calls.     

Relationship between the physical environment and physical activity in older adults: a systematic review

Previous reviews on children, adolescents and adults have reported consistent relationships between several physical environmental characteristics and physical activity (PA). This systematic review aims to provide a comprehensive overview of the literature concerning the relationship between the physical environment and PA in older adults. A systematic literature search resulted in the inclusion of 31 articles. Results were inconsistent but most of the studied environmental characteristics were reported not to be related to PA. More studies in different contexts utilizing longitudinal designs, standardized, reliable and validated PA and environmental measurements and investigating possible moderating effects are definitely warranted.     

Coffee consumption and colorectal cancer risk: a dose-response meta-analysis on prospective cohort studies

Abstract

Evidence regarding the influence of coffee drinking on colorectal cancer (CRC) is limited, and it remains unclear whether coffee consumption is associated with the risk of the disease. To clarify this association, a comprehensive meta-analysis was performed. The risk of CRC was compared between the categories of coffee consumption, and a dose-response relationship was studied using restricted cubic splines. We did not find evidence for the association between coffee consumption and CRC risk. Among alternative study inclusions, when using pooled projects, coffee consumption was related with a decreased risk of colon cancer in a subgroup analysis of never-smokers and in Asian countries, and with an increased risk of rectal cancer in an analysis of the general population and after restriction to women, never-smokers, and European countries. In conclusion, the association between coffee consumption and CRC risk is controversial and should be clarified in further cohort studies.     

Caffeinated and decaffeinated coffee consumption and melanoma risk: a dose-response meta-analysis of prospective cohort studies

To determine the association between total, caffeinated and decaffeinated coffee consumption and melanoma risk a dose-response meta-analysis on prospective cohort studies were performed. Eligible studies were identified searching PubMed and EMBASE databases from the earliest available online indexing year to March 2017. The dose-response relationship was assessed by random-effects meta-analysis and the shape of the exposure-outcome curve was modelled linearly and using restricted cubic splines. A total of seven studies eligible for meta-analysis were identified that comprised 1,418,779 participants and 9211 melanoma cases. A linear dose-response meta-analysis showed a significant association between total coffee consumption and melanoma risk. An increase in coffee consumption of one cup per day was associated with a 3% reduction in melanoma risk (RR 0.97; 95% CI 0.95–0.99). Our findings suggest that coffee intake may be inversely associated with incidence of melanoma. Nevertheless, further studies exploring also the role of confounding factors are needed to explain the heterogeneity among studies.     

Cognitive Frailty as a Predictor of Future Falls in Older Adults: A Systematic Review and Meta-Analysis

ObjectivesTo examine the association between cognitive frailty and the risk of future falls among older adults.DesignSystematic review and meta-analysis.Setting and ParticipantsOlder people aged ≥60 years with cognitive frailty from community, hospital, or both.MethodsPubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until June 14, 2022. Stata 16.0 software was used to perform the meta-analysis. A random effects model was used to pool the prevalence of falls in older adults over age 60 years with cognitive frailty and the strength of the association between cognitive frailty and falls [odds ratios (ORs) and 95% CIs]. Quality assessment, heterogeneity, and sensitivity analyses were also conducted. A study protocol was registered in PROSPERO (CRD42022331323).ResultsThe review included 18 studies in qualitative synthesis, 14 of which were in meta-analysis. Eleven sets of cross-sectional data involving 23,025 participants and 5 sets of longitudinal data involving 11,924 participants were used in the meta-analysis. The results showed that the overall prevalence of falls in 1742 people with cognitive frailty was 36.3% (95% CI 27.9-44.8, I² = 93.4%). Longitudinal study results showed that cognitively frail individuals had a higher risk of falls (OR 3.02, 95% CI 2.11-4.32, I² = 0.0%, P = .406), compared to robust participants without cognitive impairment; physically frail people (alone) had a moderate risk of falls (OR 2.16, 95% CI 1.42-3.30, I² = 9.7%, P = .351); cognitively impaired people (alone) had a lower risk of falls (OR 1.36, 95% CI 1.03-1.79, I² = 0.0%, P = .440). Among cross-sectional studies, cognitive frailty was associated with the risk of falls (OR 2.74, 95% CI 2.20-3.40, I² = 53.1%, P = .019). Although high heterogeneity was noted among 11 cross-sectional studies reporting ORs, the sensitivity analysis showed that no single study significantly affected the final pooled results.Conclusions and ImplicationsThis systematic review and meta-analysis confirms the findings that cognitive frailty was demonstrated to be a significant predictor of future falls in older adults. However, further prospective investigations are warranted.     

LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults

Background:  Exercise as a falls prevention strategy is more complex with people at risk than with the general population. The Lifestyle approach to reducing Falls through Exercise (LiFE) involves embedding balance and lower limb strength training in habitual daily routines.
Methods:  A total of 34 community-residing people aged ≥70 years were randomised either into the LiFE programme or into a no-intervention control group and followed up for six months. Inclusion criteria were two or more falls or an injurious fall in the past year.
Results:  There were 12 falls in the intervention group and 35 in the control group. The relative risk (RR) analysis demonstrated a significant reduction in falls (RR = 0.23; 0.07–0.83). There were indications that dynamic balance ( P  = 0.04 at three months) and efficacy beliefs ( P  = 0.04 at six months) improved for the LiFE programme participants. In general, secondary physical and health status outcomes, which were hypothesised as potential mediators of fall risk, improved minimally and inconsistently.
Conclusions:  LiFE was effective in reducing recurrent falls in this at-risk sample. However, there were minimal changes in secondary measures. The study was feasible in terms of recruitment, randomisation, blinding and data collection. A larger randomised trial is needed to investigate long-term efficacy, mechanisms of benefit and clinical significance of this new intervention.     

Dietary approach to stop hypertension diet and risk of coronary artery disease: a meta-analysis of prospective cohort studies

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet can lower blood pressure, but its role in preventing coronary artery disease (CAD) remains in debate. Thus, we performed a meta-analysis of prospective cohort studies to address this issue. We carried out a systematical search in databases of PubMed and Embase to screen out eligible publications. Relative risks (RRs) of CAD in the included studies were summarised using random-effect meta-analysis. Dose-response association between DASH diet score and CAD risk was also evaluated. Seven prospective studies were finally included, with a total of 377,725 participants and 15,074 CAD cases. Compared to lower adherence, higher adherence to the DASH diet was associated a decreased risk of CAD (RR 0.82, 95% confidence interval [CI]: 0.78–0.87). Subgroup and sensitivity analyses supported the preventive effects of DASH diet against CAD, and there was no indication of publication bias. For a curvilinear dose-response pattern, the RRs (95% CIs) of CAD for the 4 knots (5th, 35th, 65th and 95th percentiles) of DASH diet score were 0.93 (0.89–0.98), 0.87 (0.80–0.95), 0.81 (0.72–0.90) and 0.74 (0.68–0.82), respectively. For a linear dose-response manner, each 4-point increase in the DASH diet score could reduce the risk of CAD by 5% (RR 0.95, 95% CI: 0.94–0.97). The results of our study indicate that higher adherence to the DASH diet confers a reduced risk of developing CAD.     

Falling in older people at home: Transfer limitations and environmental risk factors

A case control study was undertaken to examine the prevalence of transfer limitations and home risk factors for falls in 50 men and women aged 60 years and over who had been admitted to an acute hospital due to a fall in the previous year, and 45 age and sex matched non-fallers who were recruited from community organizations. The assessments were carried out in the homes of each subject using standardized protocols. Subjects who had fallen in the home reported significantly more difficulties with transfers than subjects who had fallen outside or non-fallers (Chi-squared = 33.9, d.f=2, P<0.001). In contrast, no significant differences were found in total home hazard scores among the home fallers (mean=2.8 hazards, s.d.=1.3), outside fallers (mean=3.4, s.d.=1.70), and non-fallers (mean=3.2, s.d.=1.70), and only one hazard (lack of a bedside light) was significantly more prevalent among the home fallers compared with the non-fallers. The findings suggest that a non-specific approach to environmental risk factors in the homes of older people may be an ineffective public health measure. Alternative strategies that include the targeting of home hazard identification and home modification for older people with physiological impairments and transfer limitations may be more effective for preventing falls. Such approaches may complement other interventions aimed at maximizing balance and mobility.     

Body fatness,diabetes, physical activity and risk of kidney stones: a systematic review and meta-analysis of cohort studies

We conducted a systematic review and meta-analysis to clarify the association between adiposity, diabetes, and physical activity and the risk of kidney stones. PubMed and Embase were searched up to April 22nd 2018 for relevant studies. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. Thirteen cohort studies were included. The summary relative risk was 1.21 (95% CI 1.12–1.30, I²?=?76%, n?=?8) per 5 unit increment in BMI, 1.16 (95% CI 1.12–1.19, I²?=?0%, n?=?5) per 10 cm increase in waist circumference, 1.06 (95% CI 1.04–1.08, I²?=?67%, n?=?3) per 5 kg increase in weight and 1.12 (95% CI 1.06–1.18, I²?=?86%, n?=?3) per 5 kg of weight gain. The summary RR was 1.16 (95% CI 1.03–1.31, I²?=?51%, n?=?10) for participants with diabetes compared to participants without diabetes, and 0.93 (95% CI 0.78–1.10, I²?=?80%, n?=?4) for high vs. low physical activity. These results suggest a positive association between adiposity and diabetes and the risk of kidney stones, but no association with physical activity.     

Folate intake and risk of bladder cancer: a meta-analysis of epidemiological studies

Epidemiological studies have reported conflicting results between folate intake and bladder cancer risk. We conducted a meta-analysis of epidemiological studies published between 1996 and June 2013 on the relationship between folate intake and bladder cancer. We quantified associations with bladder cancer using meta-analysis of risk estimates (REs) associated to the highest versus the lowest category of folate intake using random effect models. Seven cohort and six case-control studies were eligible for inclusion. A significantly decreased risk with bladder cancer was observed in overall folate intake group (RE?=?0.84; 95% CI, 0.72–0.96) and subgroup of case-control studies (RE?=?0.73; 95% CI, 0.57–0.89), but not in cohort studies (RE?=?0.96; 95% CI, 0.81–1.10) when comparing the highest with the lowest category of folate intake. No heterogeneity and publication bias were observed across studies. Although the current evidence, mainly based on data from case-control studies, supports an inverse association between folate intake and bladder cancer, additional large and well-designed cohort studies are needed before definitive conclusions can be drawn.     

Incidence, risk factors and consequences of falls among elderly subjects living in the community: A criteria-based analysis

In order to obtain an overview of the incidences, risk factorsand health consequences of falls among elderly persons livingin the community from the available literature, a Medline computersearch of publications over the period 1981–1994 was carriedout. Fourteen studies met the following inclusion criteria:i) the study is an original investigation of falls among theelderly, ii) the study deals with the incidence, risk factorsand/or consequences of falls among the elderly and iii) thestudy refers to a population at risk consisting of persons aged60 years or over belonging to a population relevant to generalpractice. The selected studies were subjected to a methodologicalassessment on the basis of 10 methodological criteria. All thestudies were independently assessed by 1 author and 1 assistantto obtain a methodological consensus. The relevant outcomesof these studies are reported. Pooling of data was not performedbecause of relevant differences between the studies. Two studiesmet all methodological criteria and 2 other studies were secondbest. These 4 studies were given preference. Approximately 30%of subjects older than 65 years fall at least once a year andapproximately 15% fall recurrently. The main risk factors forfalls among the elderly belong to the intrinsic (patient-related)risk factors: cognitive impairment, balance and gait disorders,use of sedatives and hypnotics, a history of stroke, advancedage, arthritis of the knee and a high level of dependence. Extrinsic(environment-related) risk factors did not play a significantrole in any of the studies. Not all studies dealt with the healthconsequences of falls among the elderly. Major injuries werereported in 0.5–9% and fractures in 3–14%.     

老年人跌倒的公共卫生研究进展

  目的  了解中国社区老年人跌倒及跌倒后受伤情况,为采取相应的干预措施提供参考依据。  方法  收集老年期重点疾病预防和干预项目（PINDEC）2018年7 — 10月北京、上海、湖北、四川、云南、广西6个地区共21084名 ≥ 60岁社区老年人的追踪随访数据,分析过去1年老年人的跌倒情况以及跌倒后受伤情况。  结果  中国21084名社区老年人中,过去1年发生跌倒者2979人,经复杂加权后跌倒发生率为14.7 %,不同性别、年龄、文化程度、婚姻状态、职业、工作状况和居住地社区老年人跌倒发生率差异均有统计学意义（均P < 0.001）;过去1年发生跌倒的2979名社区老年人中,因跌倒受伤者2252例,经复杂加权后跌倒后受伤比例为79.5 %,不同性别、年龄、文化程度、职业、工作状况和居住地社区老年人跌倒后受伤比例差异均有统计学意义（均P < 0.01）;因跌倒而受伤的2252名社区老年人中,受伤类型为擦伤/挫伤、手/胳膊骨折、股骨头骨折、髋部骨折、头部受伤和其他类型伤者分别为1472、242、101、89、167和416例,经复杂加权后比例分别为70.1 %、10.0 %、4.6 %、2.4 %、7.0 %和15.3 %。  结论  中国社区老年人中跌倒发生率较高,且跌倒后受伤比例亦较高,擦伤/挫伤是最主要的受伤类型。     

Citrus fruit intake and bladder cancer risk: a meta-analysis of observational studies

Epidemiological studies have investigated the association between citrus fruit and bladder cancer risk; however, the results are inconsistent. To assess these issues, we conducted a meta-analysis of currently available studies. We identified relevant articles by searching the MEDLINE and EMBASE databases. We calculated the summary relative risk (RR) with 95% confidence interval (95% CI) using a random effect model. We included eight case–control studies and six cohort studies in the meta-analysis. There was a significant inverse association between citrus fruit intake and bladder cancer risk in all pooled studies (RR: 0.85; 95% CI, 0.76–0.94) and case–control studies (RR: 0.77; 95% CI, 0.64–0.92), but not in the cohort studies (RR: 0.96; 95% CI, 0.87–1.07). Our results suggest that citrus fruit intake is related to decreased bladder cancer risk. Subsequent well-designed, large prospective studies are needed to obtain better understanding of this relationship.