Influence of lower extremity strength of healthy older adults on the outcome of an induced trip

OBJECTIVES: To determine whether decreased lower extremity strength contributes to trip-related falls in older adults. DESIGN: A cross-sectional sample of older adults were safety-harnessed and tripped while walking using a concealed, mechanical obstacle. Lower extremity strength was compared between trip outcome groups. SETTING: A biomechanics research laboratory. PARTICIPANTS: Seventy-nine healthy, community-dwelling adults aged 65 and older (50 women). MEASUREMENTS: Ankle, knee, and hip flexion and extension strength were measured isometrically and isokinetically. Measured strengths were subjected to a factor analysis. Strength factor scores were compared between those who recovered from the trip and those who fell by three previously identified mechanisms: during-step, after-step, and elevating-response falls. RESULTS: Seven common factors, one associated with each direction of exertion at each joint and one with the time rate of moment increase, explained 88% of the variance in measured strength. The during-step (n=5) fallers were significantly stronger in the ankle extension (plantarflexion), knee flexion, overall extension, and total strength factors than those who successfully recovered using a similar, lowering strategy (n=26). The elevating-response faller (n=1) was stronger in the plantarflexion and overall extension factors than most of those who recovered using a similar, elevating strategy (n=11). Two of three after-step fallers were among the weakest subjects tested. CONCLUSION: Weak older adults and the strongest older adults may be at greater risk of falling from a trip, although by different mechanisms. High strength may increase the likelihood of a during-step or elevating-response fall; decreased strength may increase the likelihood of an after-step fall.     

骨质疏松性骨折的临床特点及康复对策

目的：分析研究骨质疏松性骨折患者的临床特点，并提出相应的防治措施及康复对策。方法：对1997年2月～2003年2月人住我院康复医学科的骨质疏松骨折患者202例在性别、年龄、骨质疏松类型及程度、骨折原因、部位、次数、病程、治疗方法、并发症及预后等临床方面进行综合分析。结果：研究对象中原发性骨质疏松169例(83．66％)，继发性33例(16．34％)；骨质疏松程度：2．0S～3．0S 72例(35．64％)，3．0S～4．0S75例(37．13％)，大于4．0S55例(27．23％，)；自发性骨质疏松18例(8．9l％)，跌倒致骨折184例(91．09％)；单次骨折158例(78．22％)，多次骨折44例(21．78％)；骨折后手术治疗171例(84．65％)，保守治疗3l例(15．35％)；并发感染或压疮172例(85．15％)：平均住院天数50．30天；ADL评分(B1)≥75分182例(90．10％)(轻度功能缺陷)；50-70分13例(6．44％)(中度功能缺陷)；25-45分5例(2．47％)(重度功能缺陷)；≤20分2例(0．99％)(极重度功能缺陷)。结论：骨质疏松性骨折发生率与年龄，骨质疏松程度呈正相关性分布，跌倒是骨折最危险因素。     

Fear of falling and its predictors among community-living older adults in Korea

Objectives: To explore the prevalence and predicting factors of fear of falling (FOF) among community-living older adults in Korea.

Methods: Secondary data analysis of the 2011 Korean National Elderly Living Conditions and Welfare Desire Survey was used. Logistic regression analysis was conducted to examine the predictors of FOF.

Results: In total, 75.6% of older adults with normal cognition have FOF. Factors associated with an increased risk of FOF in older adults are previous experience with falling (OR = 3.734, 95% CI = 2.996–4.655), limitations in the performance of exercise involving lower extremities (OR = 2.428, 95% CI = 2.063–2.858), being female (OR = 2.335, 95% CI = 2.023–2.694), having more than three chronic diseases (OR = 1.994, 95% CI = 1.625–2.446), limitations in instrumental activities of daily living (IADLs) (OR = 1.745, 95% CI = 1.230–2.477), limitations in the performance of exercise involving upper extremities (OR = 1.646, 95% CI = 1.357–1.997), living without a spouse (OR = 1.626, 95% CI = 1.357–1.948), having poor self-rated health (OR = 1.571, 95% CI = 1.356–1.821), limitations in muscle strength (OR = 1.455, 95% CI = 1.150–1.841), age (≥75 years) (OR = 1.320, 95% CI = 1.150–1.516), lower levels of education (0-6 years) (OR = 1.231, 95% CI = 1.075-1.409), and life satisfaction (OR = 1.104, 95% CI = 1.065–1.114).

Conclusion: A multidimensional construct of general characteristics, physical, and psychosocial variables act as risk factors for FOF. Preventive intervention should be developed to decrease the FOF among Korean older adults.     

Home environmental and health‐related factors among home fallers and recurrent fallers in community dwelling older Korean women

The purpose of the study was to determine home environmental and health‐related factors among home fallers and recurrent fallers in community dwelling older Korean women. The study population included 438 older women aged 65 years and over. Measures included a checklist of home environments and health‐related items. Risk indicators for accidental falls and recurrent falling were analysed using logistic regression. Logistic regression analysis revealed that chronic disease (odds ratio (OR) = 2.02, P = 0.007), poor night light (OR = 1.97, P = 0.032) and obstacle of door sill (OR = 1.76, P = 0.021) were predictors of accidental falls, and physical inactivity (OR = 2.34, P = 0.018) and slippery floor in the bathroom (OR = 0.41, P = 0.034) were predictors of recurrent falling. The findings have implications for strategies and suggest the need to modify home environmental context in systematic and consistent ways and the need to maintain physical activities to prevent falls and recurrent falling.     

基于半结构化访谈的家庭病床与家庭照护病床“二床合一”可行性研究及政策建议

目的：调查上海市中心城区的老年人对于家庭病床、家庭照护床位及“二床合一”的需求、存在的困难及老年人获益情况并进行分析,全方面了解“二床合一”的可行性。方法：2022年1—12月,选取在上海市黄浦区老西门街道社区卫生服务中心接受家庭病床服务的老年人2名,在老西门街道登记家庭照护床位服务的老年人2名,以及接受“二床合一”服务的老年人3名作为研究对象,采用半结构化访谈对研究对象进行面对面访谈。结果：接受家庭病床服务的老年人对于家庭照护服务不了解,接受家庭照护床位服务的老年人不了解家庭病床服务内容和申请途径,接受“二床合一”服务的老年人能够充分了解和利用两种服务的优势,并能够根据自身支付能力和需求精准组合服务套餐。结论：“二床合一”服务能够使“医”与“养”精准互动,具有满足老年人居家养老服务需求的趋势。     

Using machine learning-based analytics of daily activities to identify modifiable risk factors for falling in Parkinson’s disease

BackgroundAlthough risk factors that lead to falling in Parkinson's disease (PD) have been previously studied, the established predictors are mostly non-modifiable. A novel method for fall risk assessment may provide more insight into preventable high-risk activities to reduce future falls.ObjectivesTo explore the prediction of falling in PD patients using a machine learning-based approach.Method305 PD patients, with or without a history of falls within the past month, were recruited. Data including clinical demographics, medications, and balance confidence, scaled by the 16-item Activities-Specific Balance Confidence Scale (ABC-16), were entered into the supervised machine learning models using XGBoost to explore the prediction of fallers/recurrent fallers in two separate models.Results99 (32%) patients were fallers and 58 (19%) were recurrent fallers. The accuracy of the model to predict falls was 72% (p = 0.001). The most important factors were item 7 (sweeping the floor), item 5 (reaching on tiptoes), and item 12 (walking in a crowded mall) in the ABC-16 scale, followed by disease stage and duration. When recurrent falls were analysed, the models had higher accuracy (81%, p = 0.02). The strongest predictors of recurrent falls were item 12, 5, and 10 (walking across parking lot), followed by disease stage and current age.ConclusionOur machine learning-based study demonstrated that predictors of falling combined demographics of PD with environmental factors, including high-risk activities that require cognitive attention and changes in vertical and lateral orientations. This enables physicians to focus on modifiable factors and appropriately implement fall prevention strategies for individual patients.     

The association between bladder dysfunction,balance and falls in women with multiple sclerosis: The specific contribution of fear of falling

BackgroundBladder dysfunction is the most common autonomic disturbance in people with MS (PwMS). Only a few studies have examined the relationship between bladder dysfunction and falls in PwMS. Bladder dysfunction has been deemed only a secondary outcome measure, and classified by a gross measure providing a limited perspective of this disturbing symptom. Furthermore, no study to date has focused on the relationship between bladder dysfunction and balance performance in PwMS.Research questionDetermine the relationship between bladder dysfunction with balance, falls and fear of falling in women with MS.MethodsThe study was observational, including 44 women with MS, mean age 46.3 (SD = 5.7), all with at least a mild bladder dysfunction. Outcome measures included the Urinary Incontinence Quality of Life Scale (I-QoL), Bladder Control Scale (BLCS), Timed Up and Go Test (TUG), Four Square Step Test (FSST), Falls Efficacy Scale International (FES-I), Falls status, and posturography.ResultsParticipants performed the TUG in 14.1 s (S.D. = 11.1), and the FSST in 20.5 s (S.D. = 22.4). A relatively large proportion (68.2 %) of women was classified as fallers. However, no differences were found between those classified as fallers (n = 30) or non-fallers (n = 14) in terms of the I-QoL and the BLCS, controlling for age, EDSS and number of vaginal deliveries. Significant correlations scores were found between the I-QoL, BLCS and FES-I (rho ∼0.47), while controlling for age, EDSS and number of vaginal deliveries. No associations were demonstrated between the bladder dysfunction outcome scores and either the TUG and/or FSST.SignificanceWomen afflicted with MS and suffering from bladder dysfunction tend to fall and present with more balance difficulties compared with disability-matched PwMS. Nevertheless, once bladder dysfunction is detected, the perceived severity of the condition is not associated with balance and prevalence of falling, but rather on fear of falling.     

急诊待床入院患者焦虑状况调查与分析

目的 探讨急诊待床入院患者焦虑现状及其影响因素.方法 采用便利抽样的方法选择2016年6月14日至2016年8月13日在某三甲医院急诊待床入院的106例患者,在其入院时采用焦虑自评量表(self-rating anxiety scale,SAS)及筛查问卷对其进行调查.结果 106例患者焦虑发生率为25.47%,SAS标准分为(43.18±9.57)分,焦虑得分与婚姻状况、文化程度及职业有关 .结论 对于急诊待床入院患者,在进行急诊常规诊疗的同时,应重视其不良情绪,尤其对于离异丧偶、文化程度低、职业为农民或无业的患者,应避免因焦虑等不良情绪而加重患者病情.     

双重任务训练对养老院老年人步态与平衡功能的影响

目的 探讨双重任务训练对养老院老年人步态与平衡改善的效果。 方法 将养老院30例老年人按照随机数字表法分为观察组与对照组各15人。对照组按常规进行回春医疗保健操训练，观察组在常规训练基础上开展双重任务训练。于干预前和干预6周后进行步态参数测试及平衡测试。 结果 干预后，观察组步速、步长、双重任务步长、起立行走试验用时和双重任务起立行走试验用时、平衡功能评分显著优于对照组（P＜0.05，P＜0.01），两组双重任务步速及ABC平衡信心评分差异无统计学意义（均P＞0.05）。 结论 双重任务训练可改善养老院老年人的步态及综合平衡能力，但对其害怕跌倒心理的改善作用不显著。