MEDICATION USE AND FALLS IN OLDER ADULTS: A PHARMACOEPIDEMIOLOGIC APPROACH

More than one-third of community-dwelling older adults fall each year. Falling is classified as a geriatric syndrome which has multiple contributing factors and an interaction between chronic predisposing diseases and impairments and acute precipitating insults. One potentially modifiable risk factor is medication use. While previous research has been conducted on medication-related falls, there are several gaps remaining in the literature, including the lack evidence on dose-response relationships across wide ranges of medication classes and falls as well as the frequent inability to address confounding by indication. Therefore, the overall purpose of this project was to determine—in a large, representative sample of community-dwelling older adults—associations between antihypertensive, anticholinergic, and antidepressant use and recurrent falls. First, we found no increased risk of recurrent falls in antihypertensive users compared to non-users, or those taking higher doses or for longer durations. Only those using a loop diuretic were found to have a modest increased risk of recurrent falls. In conclusion, antihypertensive use overall was not associated with recurrent falls after adjusting for important confounders. Loop diuretic use may be associated with recurrent falls and needs further study. Second, we found no statistically significant increased risk of recurrent falls in anticholinergic users, or those taking higher doses or for longer durations. In conclusion, increased point estimates suggest an association of anticholinergic use with recurrent falls, but the associations did not reach statistical significance. Future studies are needed to examine other measures of anticholinergic burden, and their associations with other outcomes such as cognitive function. Third, we found a statistically significant increased risk of recurrent falls in antidepressant users. An increased risk was also seen among those taking SSRIs, those with short duration of use, and those taking moderate doses. Among those with a history of falls/fracture at baseline, we found an increase in risk for any antidepressant use, but no increased risk was found in those without a history of falls/fracture. Taken together, the findings from this proposal will provide clinicians and researchers with clinically-relevant information on potential harmful outcomes associated with chronic medication therapy among older adults

Extraction of Stride Events From Gait Accelerometry During Treadmill Walking

Objective: evaluating stride events can be valuable for understanding the changes in walking due to aging and neurological diseases. However, creating the time series necessary for this analysis can be cumbersome. In particular, finding heel contact and toe-off events which define the gait cycles accurately are difficult. Method: we proposed a method to extract stride cycle events from tri-axial accelerometry signals. We validated our method via data collected from 14 healthy controls, 10 participants with Parkinson's disease, and 11 participants with peripheral neuropathy. All participants walked at self-selected comfortable and reduced speeds on a computer-controlled treadmill. Gait accelerometry signals were captured via a tri-axial accelerometer positioned over the L3 segment of the lumbar spine. Motion capture data were also collected and served as the comparison method. Results: our analysis of the accelerometry data showed that the proposed methodology was able to accurately extract heel and toe-contact events from both feet. We used t-tests, analysis of variance (ANOVA) and mixed models to summarize results and make comparisons. Mean gait cycle intervals were the same as those derived from motion capture, and cycle-to-cycle variability measures were within 1.5%. Subject group differences could be similarly identified using measures with the two methods. Conclusions: a simple tri-axial accelerometer accompanied by a signal processing algorithm can be used to capture stride events. Clinical impact: the proposed algorithm enables the assessment of stride events during treadmill walking, and is the first step toward the assessment of stride events using tri-axial accelerometers in real-life settings

Criteria for Clinically Relevant Weakness and Low Lean Mass and Their Longitudinal Association With Incident Mobility Impairment and Mortality: The Foundation for the National Institutes of Health (FNIH) Sarcopenia Project

Background. This analysis sought to determine the associations of the Foundation for the National Institutes of Health Sarcopenia Project criteria for weakness and low lean mass with likelihood for mobility impairment (gait speed ≤ 0.8 m/s) and mortality. Providing validity for these criteria is essential for research and clinical evaluation. Methods. Among 4,411 men and 1,869 women pooled from 6 cohort studies, 3-year likelihood for incident mobility impairment and mortality over 10 years were determined for individuals with weakness, low lean mass, and for those having both. Weakness was defined as low grip strength (<26kg men and <16kg women) and low grip strength-to-body mass index (BMI; kg/m2) ratio (<1.00 men and <0.56 women). Low lean mass (dual-energy x-ray absorptiometry) was categorized as low appendicular lean mass (ALM; <19.75kg men and <15.02kg women) and low ALM-to-BMI ratio (<0.789 men and <0.512 women). Results. Low grip strength (men: odds ratio [OR] = 2.31, 95% confidence interval [CI] = 1.34–3.99; women: OR = 1.99, 95% CI 1.23–3.21), low grip strength-to-BMI ratio (men: OR = 3.28, 95% CI 1.92–5.59; women: OR = 2.54, 95% CI 1.10–5.83) and low ALM-to-BMI ratio (men: OR = 1.58, 95% CI 1.12–2.25; women: OR = 1.81, 95% CI 1.14–2.87), but not low ALM, were associated with increased likelihood for incident mobility impairment. Weakness increased likelihood of mobility impairment regardless of low lean mass. Mortality risk patterns were inconsistent. Conclusions. These findings support our cut-points for low grip strength and low ALM-to-BMI ratio as candidate criteria for clinically relevant weakness and low lean mass. Further validation in other populations and for alternate relevant outcomes is needed

Maximum quasilikelihood estimation for a simplified NEAR(1) model

As alternatives to maximum likelihood estimation, conditional least squares (CLS) and maximum quasilikelihood estimation, with asymptotic properties, are investigated using a simplified NEAR(1) model. The maximum quasilikelihood estimator seems to perform better than the CLS estimator in simulations.Exponential Autoregressive Conditional least squares Consistency Asymptotic normality SNEAR

Religion, Spirituality, and Health Status in Geriatric Outpatients

BACKGROUND Religion and spirituality remain important social and psychological factors in the lives of older adults, and there is continued interest in examining the effects of religion and spirituality on health status. The purpose of this study was to examine the interaction of religion and spirituality with self-reported health status in a community-dwelling geriatric population. METHODS We performed a cross-sectional analysis of 277 geriatric outpatients participating in a cohort study in the Kansas City area. Patients underwent a home assessment of multiple health status and functional indicators by trained research assistants. A previously validated 5-item measure of religiosity and 12-item spirituality instrument were embedded during the final data collection. Univariate and multivariate analyses were performed to determine the relationship between each factor and self-reported health status. RESULTS In univariate analyses, physical functioning (P <.01), quality of life (P <.01), race (P <.01), depression (P <.01), age (P = .01), and spirituality (P <.01) were all associated with self-reported health status, but religiosity was not (P = .12). In a model adjusted for all covariates, however, spirituality remained independently associated with self-appraised good health (P = .01). CONCLUSIONS Geriatric outpatients who report greater spirituality, but not greater religiosity, are more likely to appraise their health as good. Spirituality may be an important explanatory factor of subjective health status in older adults

Diabetes Mellitus is Associated with Poor Bone Microarchitecture in Older Adults Residing in Long-Term Care Facilities

Objectives. Both diabetes mellitus (DM) and osteoporosis are very common in older adults who reside in long-term care (LTC) facilities. Nevertheless, few studies have examined the relationship between diabetes and bone quality in this population. The purpose of this study is to determine if bone mineral density (BMD) or trabecular bone score (TBS) is a better measure of bone quality and skeletal health, in LTC residents with and without a history of DM. Methodology. In this longitudinal cohort study, we examined baseline BMD (lumbar spine, total hip, and femoral neck), TBS, DM, and functional status in 511 LTC residents who were enrolled in two ongoing randomized placebo-controlled osteoporosis clinical trials. Results. On average, participants were older than 80 years and majority were prefrail or frail. Women with DM had greater lumbar spine BMD (1.106 vs 1.017, adjusted difference ± standard error = 0.084 ± 0.023 g/cm2, p=0.0003) and femoral neck BMD (0.695 vs 0.651, 0.027 ± 0.013 g/cm2, p=0.0463), but lesser lumbar spine TBS (1.211 vs 1.266, −0.036 ± 0.016, p=0.0299) compared to women without DM. Total hip BMD was also higher based on descriptive statistics (0.780 vs 0.734, p=0.6255) in diabetic women, although the difference was not statistically significant. Men had similar but attenuated findings. Conclusions. Among LTC residents, those with DM have greater BMD but lower bone quality measured by TBS. TBS should be considered in assessing older patients with DM. However, further studies are required to confirm the findings with respect to fractures

A protocol for a randomized clinical trial of interactive video dance: potential for effects on cognitive function

<p>Abstract</p> <p>Background</p> <p>Physical exercise has the potential to affect cognitive function, but most evidence to date focuses on cognitive effects of fitness training. Cognitive exercise also may influence cognitive function, but many cognitive training paradigms have failed to provide carry-over to daily cognitive function. Video games provide a broader, more contextual approach to cognitive training that may induce cognitive gains and have carry over to daily function. Most video games do not involve physical exercise, but some novel forms of interactive video games combine physical activity and cognitive challenge.</p> <p>Methods/Design</p> <p>This paper describes a randomized clinical trial in 168 postmenopausal sedentary overweight women that compares an interactive video dance game with brisk walking and delayed entry controls. The primary endpoint is adherence to activity at six months. Additional endpoints include aspects of physical and mental health. We focus this report primarily on the rationale and plans for assessment of multiple cognitive functions.</p> <p>Discussion</p> <p>This randomized clinical trial may provide new information about the cognitive effects of interactive videodance. It is also the first trial to examine physical and cognitive effects in older women. Interactive video games may offer novel strategies to promote physical activity and health across the life span.</p> <p>The study is IRB approved and the number is: PRO08080012</p> <p>ClinicalTrials.gov Identifier: NCT01443455</p

A generalized equation approach for hyoid bone displacement and penetration–aspiration scale analysis

Abstract Swallowing physiology includes numerous biomechanical events including displacement of the hyoid bone, which is a crucial component of airway protection and opening of the proximal esophagus. The objective of this study was to evaluate the potential relations between the trajectory of hyoid bone movement and the risk of airway penetration and aspiration during a videofluoroscopic swallowing study. Two hundred sixty-five patients were involved in this study, producing a total of 1433 swallows of various volumes consisting of thin liquid, nectar-thick liquid, and solids during a fluoroscopic exam. The anterior and posterior landmarks of the body of the hyoid bone were manually marked in each frame of each fluoroscopic video. Generalized estimation equations were applied to evaluate the relationship between penetration–aspiration scores and mathematical features extracted from the hyoid bone trajectories, while also considering the influence of other independent variables such as age, bolus volume, and viscosity. Our results indicated that penetration–aspiration scores showed a significant relation to age. The maximum anterior (horizontal) displacement of the anterior hyoid bone landmark was significantly associated with the penetration–aspiration scores. Differences in the displacement of the hyoid bone are useful observations in airway protection. Article highlights (1) In this work, the potential relations between the trajectory of hyoid bone movement and the risk of airway penetration and aspiration during a videofluoroscopic swallowing study were evaluated. (2) We extracted features from the hyoid bone trajectories and applied generalized estimation equations to investigate their relationship to penetration–aspiration scales. (3) The results showed that the maximum anterior (horizontal) displacement of the anterior hyoid bone landmark was significantly associated with the penetration–aspiration scales

Analysis of the pen pressure and grip force signal during basic drawing tasks: The timing and speed changes impact drawing characteristics

International audienceWriting is a complex fine and trained motor skill, involving complex biomechanical and cognitive processes. In this paper, we propose the study of writing kinetics using three angles: the pen-tip normal force, the total grip force signal and eventually writing quality assessment. In order to collect writing kinetics data, we designed a sensor collecting these characteristics simultaneously. Ten healthy right-handed adults were recruited and were asked to perform four tasks: first, they were instructed to draw circles at a speed they considered comfortable; they then were instructed to draw circles at a speed they regarded as fast; afterwards, they repeated the comfortable task compelled to follow the rhythm of a metronome; and eventually they performed the fast task under the same timing constraints. Statistical differences between the tasks were computed, and while pen-tip normal force and total grip force signal were not impacted by the changes introduced in each task, writing quality features were affected by both the speed changes and timing constraint changes. This verifies the already-studied speed-accuracy trade-off and suggest the existence of a timing constraints-accuracy trade-off