Risk factors for incident falls in older men and women:The English longitudinal study of ageing

Background: falls are a major cause of disability and death in older people, particularly women. Cross-sectional surveys suggest that some risk factors associated with a history of falls may be sex-specific, but whether risk factors for incident falls differ between the sexes is unclear. We investigated whether risk factors for incident falls differ between men and women.Methods: participants were 3298 people aged ≥60 who took part in the Waves 4-6 surveys of the English Longitudinal Study of Ageing. At Wave 4, they provided information about sociodemographic, lifestyle, behavioural and medical factors and had their physical and cognitive function assessed. Data on incident falls during the four-year follow-up period was collected from them at Waves 5 and 6. Poisson regression with robust variance estimation was used to derive relative risks (RR) for the association between baseline characteristics and incident falls.Results: in multivariable-adjusted models that also controlled for history of falls, older age was the only factor associated with increased risk of incident falls in both sexes. Some factors were only predictive of falls in one sex, namely more depressive symptoms (RR (95% CI) 1.03 (1.01,1.06)), incontinence (1.12 (1.00,1.24)) and never having married in women (1.26 (1.03,1.53)), and greater comorbidity (1.04 (1.00,1.08)), higher levels of pain (1.10 (1.04,1.17) and poorer balance, as indicated by inability to attempt a full-tandem stand, (1.23 (1.04,1.47)) in men. Of these, only the relationships between pain, balance and comorbidity and falls risk differed significantly by sex.Conclusions: there were some differences between the sexes in risk factors for incident falls. Our observation that associations between pain, balance and comorbidity and incident falls risk varied by sex needs further investigation in other cohorts. <br/

Risk factors for falls in older adults in a South African Urban Community

Background: Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries. Methods: A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa. Logistic regression models were fitted to determine the association between (1) falls and (2) recurrent falls occurring during follow-up and their potential socio-demographic, self-reported medical conditions and physical assessment predictors. Results: Prevalence rates of 26.4 % for falls and 11 % for recurrent falls at baseline and 21.9 % for falls and 6.3 % for recurrent falls during follow-up. In both prospective analyses of falls and recurrent falls, history of previous falls, dizziness/vertigo, ethnicity (white or mixed ancestry vs black African) were significant predictors. However, poor cognitive score was a significant predictor in the falls analysis, and marital status (unmarried vs married) and increased time to perform the timed Up and Go test in the recurrent fall analysis but not in both. Other than the timed Up and Go test in recurrent falls analysis, physical assessment test outcomes were not significant predictors of falls. Conclusion: Our study provides simple criteria based on demographic characteristics, medical and physical assessments to identify older persons at increased risk of falls. History taking remains an important part of medical practice in the determination of a risk of falls in older patients. Physical assessment using tools validated in developed country populations may not produce results needed to predict a risk of falls in a different setting

Лапаротомия в системе лечения перитонитов

ПЕРИТОНИТ /ХИРБРЮШИНЫ БОЛЕЗНИ /ХИРЛАПАРОТОМИЯХИРУРГИЧЕСКИЕ ОПЕРАЦИИ /МЕТОДЫРЕЛАПАРОТОМИ

Physiological and cognitive mediators for the association between self-reported depressed mood and impaired choice stepping reaction time in older people

Background. The aim of the study was to use path analysis to test a theoretical model proposing that the relationship between self-reported depressed mood and choice stepping reaction time (CSRT) is mediated by psychoactive medication use, physiological performance, and cognitive ability. Methods. A total of 280 retirement village residents, aged 62–95 years, undertook tests of CSRT, which required them to step onto one of four panels that were illuminated in a random order. Depressed mood was assessed using the 30-item Geriatric Depression Scale (GDS). The participants were also tested on physiological and cognitive performance, including quadriceps strength, balance, complex attention (Trail Making Test [TMT] B), simple reaction time, reported level of exercise, and use of psychoactive medications. Results. A total of 51 participants (18%) showed mild to severe depression. Those with higher GDS scores had significantly increased CSRT and worse performance on all physiological and cognitive parameters. CSRT was also significantly associated with all other measures. The final path analysis model revealed an association between self-reported depression and CSRT that was mediated by two paths, one through quadriceps strength and the other through TMT B with both mediating variables then influencing CSRT via simple reaction time and balance. Conclusions. The findings suggest that self-reported depressed mood is related to slowed performance on a CSRT task and that this relationship is explained by underlying physiological and cognitive impairments.7 page(s

Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study

Objectives This study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia. Methods One hundred and seventy-seven older people with dementia (Mini-Mental State Examination 11–23; Addenbrooke's Cognitive Examination-Revised <83) residing in the community or low level care facility completed baseline neuropsychological, physical and functional assessments. Of these, 134 participants agreed to reassessment of the above measures one year later. Results Overall, many neuropsychological, physical and functional performance measures declined significantly over the one year study period. Baseline gait speed was significantly associated with decline in verbal fluency (B(109) = 2.893, p = 0.046), specifically phonemic/letter fluency (B(109) = 2.812, p = 0.004) while controlling for age, education, dementia drug use and baseline cognitive performance. There was also a trend for an association between baseline gait speed and decline in clock drawing performance (B(107) = 0.601, p = 0.071). Conclusions Older people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition

Depressive symptomatology as a risk factor for falls in older people : systematic review and meta-analysis

Objectives: To conduct a systematic literature review and meta-analysis to evaluate studies that have addressed depressive symptoms as a risk factor for falls in older people. Design: Systematic review with meta-analysis. Setting :Community and residential care. Participants: Individuals aged 60 and older. Measurements: Depressive symptoms, incidence of falls. Results: Twenty-five prospective studies with a total of 21,455 participants met inclusion criteria for the systematic review. Twenty studies met criteria for the meta-analyses. Recruitment of participants was conducted randomly or by approaching groups with identified healthcare needs. Eleven measures were used to assess depressive symptoms, and length of follow-up for falls ranged from 90 days to 8 years. Reporting of antidepressant use was variable across studies. The pooled effect of 14 studies reporting odds ratios (ORs) indicated that a higher level of depressive symptoms at baseline resulted in a greater likelihood of falling during follow-up (OR = 1.46, 95% confidence interval (CI) = 1.27-1.67, P &lt;.001, I2 = 77.2%). In six studies reporting relative risks (RRs) or hazard ratios, a higher level of depressive symptoms at baseline resulted in a greater likelihood of falling during follow-up (RR = 1.52, 95% CI = 1.19-1.84, P &lt;.001). There was no difference between community samples and those with identified healthcare needs with respect to depressive symptoms being a risk factor for falls. Conclusion: Depressive symptoms were found to be consistently associated with falls in older people, despite the use of different measures of depressive symptoms and falls and varying length of follow-up and statistical methods. Clinicians should consider management of depression when implementing fall prevention initiatives, and further research on factors mediating depressive symptoms and fall risk in older people is needed.13 page(s

Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning

Depressive symptoms and antidepressant use are associated with greater fall risk in older people. This prospective study investigated interactions between depressive symptoms, antidepressant use and physical and cognitive function measures in relation to injurious or multiple falls in a large sample of community-living older people. Four-hundred and eighty-eight community-dwelling older people aged 70 years and over, underwent a comprehensive psychological, cognitive and physiological assessment and were prospectively monitored for falls over a 12-month follow up period. Substantial depressive symptoms were defined by a Geriatric Depression Scale (GDS) (15-item) score ≥5 and fallers were defined as people who had at least one injurious or two non-injurious falls during follow-up. In univariate analyses, the presence of depressive symptoms (RR = 1.50; 95% CI = 1.06–2.11), antidepressant use (RR = 1.56; 95% CI = 1.08–2.27), high physiological fall risk (RR = 1.61; 95% CI = 1.20–2.15) and poorer executive functioning (RR = 1.40; 95% CI = 1.05–1.88) were significant risk factors for falls. Multivariate models revealed that depressive symptomatology and antidepressant use were independent of each other, and independent of the presence of a high physiological fall risk and poorer executive functioning in the prediction of falls. Fall risk increased with the number of risk factors present: i.e. by 55% in participants with any two risk factors (RR = 1.55; 95% CI = 1.17–2.04) and by 144% in participants with three or four risk factors (RR = 2.44; 95% CI = 1.75–3.43). The study findings indicate that higher depressive symptoms and antidepressant use predict falls over 12-months, independent of reduced executive and physical functioning. Treatment of depressive symptoms using non-pharmacological approaches should be considered as part of fall prevention programs, especially in populations at high risk of falls.6 page(s