Community-Dwelling Older Adults Research Articles

Associations between sociodemographic and clinical characteristics and adherence to self-management behaviours among community-dwelling older adults with mild cognitive impairment.

Self-management is vital for individuals with mild cognitive impairment (MCI) to enhance cognitive health and mitigate the risk of dementia. However, maintaining consistent engagement in self-management strategies can be challenging for older adults with MCI. This study aimed to explore the associations between sociodemographic and clinical characteristics and adherence to self-management behaviours among community-dwelling older adults with MCI. A cross-sectional study involving 467 community-dwelling older adults with MCI was conducted from July to November 2022 across Nanjing, Xuzhou, and Lianyungang in Jiangsu Province, China. Data on sociodemographic and clinical characteristics, as well as self-management behaviours for MCI, were collected. Multiple linear and binary logistic regressions were employed to identify factors influencing self-management behaviours. Among the four recommended self-management behaviours for MCI, participants adopted an average of 1.37 ± 1.202 behaviours. Physical exercise (n = 239; 51.2%) was the most prevalent behaviour, followed by modifiable risk factors management (n = 156; 33.4%), cognitive training (n = 144; 30.8%), and cognitive function monitoring (n = 103; 22.1%). Higher education level (B = 0.286, P < 0.001), urban employee medical insurance (B = 0.621, P < 0.001), and non-smoking status (B = 0.389, P = 0.002) positively correlated with aggregate MCI self-management behaviours, while older age (B = -0.295, P < 0.001) had a negative association. Marital status, monthly income, employment status, gender, residence, and family history of cognitive disorders were also found to be associated with specific self-management behaviours for MCI. Enhancing adherence to self-management among community-dwelling older adults with MCI is critical. Sociodemographic and clinical factors should be considered to pinpoint at-risk populations and accordingly tailor support strategies.

Effect of exercise referral schemes and self-management strategies on healthcare service utilisation among community-dwelling older adults: secondary analyses of two randomised controlled trials.

The objective of this study is to explore whether offering an integrated self-management strategy and exercise referral scheme intervention (ERS+SMS) or a stand-alone ERS intervention is more effective in reducing healthcare service utilisation among community-dwelling older adults over time compared with a stand-alone SMS/control intervention. Secondary analyses of two randomised controlled trials (RCTs) with linkage to Danish national health registries. Three Danish municipalities: Esbjerg, Slagelse and Odense. Danish community-dwelling older adults, aged 65 years or older, were included in the study. Participants originated from two completed RCTs: the Welfare Innovation in Primary Prevention (WIPP, n=115) and the SITLESS project (SITLESS, n=333). Participants in the two trials were randomly assigned to one of three intervention groups: ERS in combination with SMS (ERS+SMS), ERS alone or an SMS/control intervention. Annual number of days with contact to general practice (GP) and days hospitalised for all causes. No statistically significant between-group difference was observed in the annual number of days with contact with GP between participants randomised to ERS+SMS (p=0.759) or ERS only (p=0.156) compared with those randomised to the SMS/control group. In addition, no statistically significant between-group differences in days hospitalised were observed when comparing the ERS+SMS (p=0.222) or ERS only (p=0.060) group to the SMS/control group. Neither the integrated intervention (ERS+SMS) nor the ERS alone intervention was more effective in reducing healthcare service utilisation during a 2-year follow-up period compared with a stand-alone SMS/control intervention. A potential stabilising effect of ERS and/or SMS interventions on the general age-related increase in healthcare service utilisation cannot be ruled out but needs further exploration in future studies along with the exploration of the effects of long-term interventions. NCT04531852 : and : NCT02629666 : .

Higher Magnesium Intake Is Associated With a Lower Risk of Frailty in Older Adults

ObjectivesMagnesium deficiency is common in older adults and has been associated with reduced muscle functionality and several age-related diseases. Evidence of its relationship with frailty is scarce. We aimed to explore the association of magnesium intake with incident frailty in the Seniors-ENRICA-1 cohort. DesignProspective longitudinal cohort study. Setting and ParticipantsThe ENRICA study is a population-based study (N = 13,105) that includes a representative sample of the noninstitutionalized Spanish population aged 18 years and older. For the present analyses, we used data from the community-dwelling participants aged 60 years and older at baseline (n = 2519). After exclusions, we included data from 1900 participants of the Seniors-ENRICA-1 cohort (mean age 68.7 ± 6.4 years; 51.7% women). MethodsFood consumption was assessed at baseline with a validated, computer-based, face-to-face dietary history (DH-ENRICA), from which magnesium intake was estimated. Frailty was defined as having 3 or more of Fried criteria: exhaustion, low physical activity, slow gait speed, weakness, and weight loss. Analyses were performed with logistic regression adjusted for potential confounders. ResultsDuring a mean follow-up of 3.5 years, 136 new cases (7.2%) of frailty occurred. Compared with the lowest sex-specific quartile of magnesium intake, the fully adjusted odds ratio (95% CI) for incident frailty across increasing quartiles of intake was 0.62 (0.36, 1.07), 0.53 (0.28, 0.98), and 0.43 (0.21, 0.86), respectively (P-trend = .016). Corresponding results for slow gait speed were 0.68 (0.47, 1.01), 0.58 (0.37, 0.89), and 0.52 (0.32-0.84), respectively (P-trend = .008). Other Fried criteria showed a similar tendency to reduced frailty incidence with increasing magnesium intake, without achieving statistical significance in the fully adjusted model. Conclusions and ImplicationsHigher magnesium intake was inversely and independently associated with lower frailty risk, especially of slow gait speed, in community-dwelling older adults, suggesting that adequate intake of this vital ion could help prevent unhealthy aging.

Benefits of an educational intervention on functional capacity in community-dwelling older adults with frailty phenotype: A randomized controlled trial

BackgroundThere is an urgent demand for nurses to expand their knowledge and skills in managing frailty in primary care. Frailty is a multifaceted condition that is prevalent among older adults and often leads to reduced functional capacity. Currently, there is a limited understanding of the effectiveness of educational interventions aimed at improving functional capacity among community-dwelling frail older adults in a primary care setting. ObjectiveThis study aimed to evaluate the impact of an educational program on functional capacity among pre-frail and frail older adults living in the community. DesignA 12-month, multicenter, randomized controlled trial. SettingsThe FRAGSALUD study was conducted across 14 healthcare centers situated within the regions of Cadiz and Malaga, Spain. ParticipantsA total of 199 frail/pre-frail community-dwelling older adults (74.2 ± 6.4 years). MethodsParticipants who met at least one Fried's criteria were assigned to either the control group (n = 90), which received usual healthcare assistance, or the intervention group (n = 109). The 6-month intervention comprised four group sessions and six telephone calls conducted by professional nurses, sport scientists, and nutritionists. This educational program focused on guidelines for physical activity, nutritional habits, cognition, and psychosocial well-being. Functional capacity was assessed using questionnaires for basic (Barthel Index) and instrumental (Lawton & Brody Scale) activities of daily living. All outcome measures were evaluated at baseline, immediately after the intervention (6-month), and six months after the intervention as a follow-up (12-month). Differences in functional capacity (Barthel Index and Lawton and Brody Scale scores) across the three time points were analyzed using Friedman's ANOVA, with Wilcoxon signed-rank test for pairwise comparisons. ResultsAt both 6-month and 12-month assessments, the control group showed a statistically significant decline in basic and instrumental activities of daily living compared to the intervention group, which maintained similar levels, preventing this age-related decline. ConclusionsThe educational intervention, designed for easy implementation within healthcare systems, especially for nurses, successfully maintained levels of functional capacity in basic and instrumental activities of daily living, while the control group experienced a decline in functional capacity during the 12-month follow-up. Thus, educational interventions are encouraged for preserving the functional independence of frail/pre-frail older adults living in the community. RegistrationThis trial was registered at ClinicalTrials.gov (Identifier: NCT05610605) and the first participant was registered in March 2022.Tweetable abstract: The FRAGSALUD educational intervention prevents the age-related decline in functional independence over 12 months in frail older adults.

Use of the walking and turning test to accurately discriminate between independently ambulatory community-dwelling older Thai adults with and without a history of falls: a retrospective diagnostic study

ObjectivesThis study developed and investigated the possibility of using the walking and turning test (WTT) to indicate fall risk in community-dwelling older adults.DesignRetrospective diagnostic study.SettingThe study was carried out in...

Comparing 30 Versus 60min Cognitively Loaded Physical Exercise on Cognitive Function and Physical Health in Community-Dwelling Older Adults With Mild Cognitive Impairment: A Double-Blind Randomized Controlled Trial.

Mild cognitive impairment (MCI) is characterized by a mild decline in cognitive function and represents a risk stage for dementia in community-dwelling older adults. Exercise and dual-task training have been used to improve physical health, psychosocial health, and cognitive and learning functions in various subjects. However, the optimal time for these interventions has yet to be clearly identified. This study investigated the effects of cognitively loaded physical exercise (CLPE) on cognitive function and physical health in community-dwelling older adults with mild cognitive impairment and compared the differences according to exercise time. Fifty-one community-dwelling aged 60years or older with MCI were randomly assigned to 30-min CLPE (30CLPE, n=17), 60-min CLPE (60CLPE, n=17), and control (n=17) groups. The CLPE program consisted of a twice-weekly exercise program for 8weeks. During the exercise, a dual task was performed to assess cognitive load. The control group performed a typical exercise program at a dementia center during the same period. The Korean version of the Montreal Cognitive Assessment was used to evaluate cognitive function, and various physical health factors were assessed using the handgrip dynamometer and pinch gauge, Senior Fitness Test, dynamic and static balance abilities, and gait variables. After the intervention, both the 30CLPE and 60CLPE groups showed significant improvements in cognitive function, upper limb strength, senior fitness, balance, and gait (p<0.05), while the control group showed no significant changes in any of the variables (p>0.05). In between-group comparisons, both CLPE groups showed significantly improved cognitive and physical functions compared to the control group (p<0.05). However, there was no significant difference between the 30 CLPE and 60 CLPE groups (p>0.05). The results of this study demonstrate that cognitively loaded physical exercise is effective in improving cognitive and physical function in individuals with MCI. Both the 30-min and 60-min sessions resulted in significant improvements, with no statistically significant differences observed between the two durations. This suggests that persistence and consistency of exercise may be more important than the duration of individual sessions. Clinical Trials.gov: KCT0009053.

Effectiveness of a resilience-building nursing intervention on psychological well-being in Arab community-dwelling older adults

BackgroundPsychological resilience plays a crucial role in the well-being of community-dwelling older adults. This study aimed to evaluate the effectiveness of a resilience-building nursing intervention on enhancing psychological well-being in this population. MethodsA randomized controlled trial was conducted with 84 community-dwelling older adults in Abha, Saudi Arabia. Participants were randomly assigned to either the intervention group (resilience-building nursing intervention) or the control group (standard care). Psychological resilience and quality of life were assessed using validated scales at baseline, post-intervention, and follow-up. ResultsThe intervention group showed significant improvements in psychological resilience (mean difference: +3.2, p = 0.001) and quality of life (mean difference: +5.4, p = 0.002) at follow-up compared to the control group. Factors influencing resilience included age, gender, socioeconomic status, health status, intervention exposure, community engagement, and living arrangements. ConclusionThe resilience-building nursing intervention effectively enhanced psychological well-being among community-dwelling older adults. Integrating such interventions into routine nursing care can promote holistic well-being and enable older adults to thrive within their communities.

Prediction models for cognitive frailty in community-dwelling older adults: A scoping review

ObjectivesThis review investigates the current status of cognitive frailty risk prediction models for community-dwelling older adults, aiming to explore the shortcomings and provide insights for model optimisation. MethodsWe adhered to the PRISMA guidelines for scoping review and followed the Joanna Briggs Institute Manual for Evidence Synthesis. ResultsThis article includes a total of 10 studies, revealing a prevalence of cognitive frailty ranging from 4.8 % to 39.6 %. The methods used for model construction included both logistic regression and machine learning. The predictors varied across the models, with age, education level, gender, and physical activity level being the most frequently cited factors. ConclusionsWhile most models showed good applicability, all models displayed a high risk of bias. Future endeavors should concentrate on leveraging existing tools to ensure standardization in development and conducting rigorous evaluations of prediction models for cognitive frailty in community-dwelling older adults.

Effect of a home-based exercise program on subsequent falls among community-dwelling older adults with cognitive frailty: A sub-group analysis of a randomized controlled trial

ObjectivesCognitive frailty is characterized by concurrent physical frailty and mild cognitive impairment and is associated with increased risk of falls. Exercise is an evidence-based strategy to prevent falls, but whether exercise reduces falls in people with cognitive frailty is unknown. We examined the effects of home-based exercise on subsequent falls among community-dwelling older adults with cognitive frailty who have previously fallen. Study designA sub-group analysis of a 12-month, single-blind, randomized controlled trial among 344 adults aged 70 years or more who had fallen within the past 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or usual care (n = 172). In this sub-analysis, we included 192 participants with cognitive frailty (home-based exercise = 93; usual care = 99) with Short Physical Performance Battery scores ≤9/12 and Montreal Cognitive Assessment scores <26/30. Main outcome measuresOur primary analysis examined the effect of exercise on self-reported falls rate over 12 months. Secondary analyses investigated the intervention's effects on scores on the Short Physical Performance Battery and the Montreal Cognitive Assessment. We also explored whether greater than or equal to mean average monthly adherence (i.e., ≥45.5 %) moderated treatment effects. ResultsAt 12 months, falls rates were 35 % lower in the home-based exercise group compared with the usual care group (IRR = 0.65; p = 0.042). Score on the Short Physical Performance Battery significantly improved among home-based exercise participants with greater than or equal to mean adherence vs. those with less than mean adherence (estimated mean difference: 0.94; p = 0.022). ConclusionsExercise is a promising strategy for reducing subsequent falls in people with cognitive frailty. Greater exercise adherence improved physical function in this population.ClinicalTrials.gov identifier: NCT01029171

Frailty prevalence and associated factors in community dwelling older adults: An examination of the frailty care model

BackgroundAge-related changes put older adults at risk for frailty. The Frailty Care Model was created to inform the care of older adults with or at risk for frailty. The purpose was to test the Frailty Care Model. MethodsThis was a cross-sectional study to identify associations between factors in the Frailty Care Model, and frailty components in older adults’ strength, fatigue, ability to ambulate, and weight loss over the last year. Comparisons across frailty groups used Pearson's chi-square tests or Fisher's exact tests. ANOVA tests and Kruskal-Wallis tests were used. Multivariable ordinal regression models were fit. ResultsOdds of frailty increased by 137% for those who lived alone, 20% for those who were depressed, and 433% for those who were classified as “at risk for malnutrition”. ConclusionsThis study was the first to test the Frailty Care Model with a focus on modifiable factors that predict frailty.

From insight to action: Exploring knowledge and practices about periodic medical check-up among community dwelling older adults in Egypt

BackgroundPeriodic Medical Checkup (PMC) is a preventive practice that is a superior strategy to promote health and reduce community morbidity and mortality. AimIdentify the PMC knowledge and practice levels and determine the association between knowledge and practices about the PMC among community-dwelling older adults in Egypt. MethodsThe study is a cross-sectional survey adopting a descriptive correlation design. It was conducted over three months, from the beginning of December 2023 to the beginning of March 2024. A total of 250 older adults were allocated for this study. ResultsLow rates of knowledge and practice of PMC were found among the study participants, and there was a statistically significant association between the two variables. (r = 0.707, P < 0.001). ConclusionThis study supported our hypotheses by demonstrating a positive association between knowledge and practices about the PMC; the higher knowledge scores were associated with higher practices of PMC.

The effect of sociodemographic characteristics and polypharmacy on loneliness and social isolation in community-dwelling older adults

The aim of this study was to assess the impact of sociodemographic factors and polypharmacy on loneliness and social isolation in older adults. This cross-sectional study included 370 older adults with and without polypharmacy. The data were gathered via the Personal Information Form, Loneliness Scale for Elderly, and Lubben Social Network Scale-Revised. A multivariate ANOVA (MANOVA) was conducted to assess the impact of independent variables on the combined dependent variables. Loneliness and social isolation were found higher in older adults with polypharmacy. In addition, loneliness and social isolation are more common in women, individuals with low educational attainment, single individuals, individuals with low income, individuals living in rural areas, individuals with poor family relationships, individuals not living with their families and individuals with chronic diseases. It is thought that the findings of this study will be guiding for all health professionals working in the field of elderly health in interventions to be planned for the elderly population.

Trajectories of Obesity Indices and Their Association with Pain in community-dwelling older adults: Findings from the English Longitudinal Study of Ageing

BackgroundThe prevalence of pain has increased with the increase of obesity, and finding indicators to predict pain risk has become an urgent need. BMI, WC, and WHtR have the potential to be excellent predictors. However, the association of these obesity indicators with various pains remains unclear. MethodsThis longitudinal cohort study included 2,155 pain-free participants (mean age = 68.5 years, standard deviation [SD] = 8.6) from the English Longitudinal Study of Ageing (ELSA). BMI, WC, and WHtR were measured during nurse visits at waves 0, 2, and 4. The Group-Based Trajectory Model (GBTM) was used to identify optimal trajectories for BMI, WC, and WHtR. Self-reported pain at four anatomical sites (lower back, hip, knee and total pain) was assessed at Waves 4 to 9. Cox proportional hazards models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obesity indices and pain risk. ResultsOver a median follow-up period of 7.49 years, we observed 1,059 incident cases of all-cause pain. After adjusting for confounders, participants in the High-Stable WC group had a 30% higher risk of experiencing pain (HR: 1.30, 95% CI: 1.05–1.60, P = 0.014), while those in the High-Stable WHtR group had a 29% higher risk (HR: 1.29, 95% CI: 1.06–1.56, P = 0.010) compared to the Low-Stable group. High-stable trajectories for BMI, WC, and WHtR were also associated with an elevated risk of back, hip, and knee pain. ConclusionThis study identifies long-term obesity indices as significant predictors of pain, suggesting the importance of monitoring these measures for effective clinical risk assessments. Further research is needed to explore the underlying mechanisms of these associations.

Sleep efficiency in community-dwelling persons living with dementia: exploratory analysis using machine learning.

Sleep disturbances lead to negative health outcomes and caregiver burden, particularly in community settings. This study aimed to investigate a predictive model for sleep efficiency and its associated features in older adults living with dementia in their own homes. This was an exploratory, observational study. A total of 69 older adults diagnosed with dementia were included in this study. Data were collected via actigraphy for sleep and physical activity for 14 days, a sweat patch for cytokines for 2-3 days, and a survey of diseases, medications, psychological and behavioral symptoms, functional status, and demographics at baseline. Using 730 days of actigraphy, sweat patches, and baseline data, the best prediction model for sleep efficiency was selected and further investigated to explore its associated top 10 features using machine learning analysis. The CatBoost model was selected as the best predictive model for sleep efficiency. In order of importance, the most important features were sleep regularity, number of medications, dementia medication, daytime activity count, instrumental activities of daily living, neuropsychiatric inventory, hypnotics, occupation, tumor necrosis factor-alpha, and waking hour lux. This study established the best sleep efficiency predictive model among community-dwelling older adults with dementia and its associated features using machine learning and various sources, such as the Internet of Things. This study highlights the importance of individualized sleep interventions for community-dwelling older adults with dementia based on associated features.

Chronic Musculoskeletal Pain is Associated With Depressive Symptoms in Community-Dwelling Older Adults Independent of Physical Activity. Experimental Aging Research

ABSTRACT Background Prevalence of chronic musculoskeletal pain and depressive symptoms in adults is high; however, whether there is an association between these conditions in older adults is unknown. Objective The aim of this study was to investigate the association of depressive symptoms with chronic musculoskeletal pain, and specifically with chronic LBP and knee osteoarthritis (OA), in community-dwelling older adults. In addition, we explored whether physical activity can mitigate these associations. Methods A cross-sectional study design. A cross-sectional study design. Participants recruited were older adults (age ≥60 years) living in the community. Chronic musculoskeletal pain was assessed by specific questions regarding the presence of chronic LBP and knee OA. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. Multivariable regression model adjusted for potential confounders (i.e., age, sex, economic status, body composition, and physical activity) was used to investigate the association between chronic musculoskeletal pain and depressive symptoms. Separate analyses were also conducted for older adults with LBP and with knee OA. Results A total of 509 (69% women) older adults were recruited. The regression analysis showed that musculoskeletal pain was associated with higher depressive symptoms ( β = 2.52, 95% CI: 0.50 to 4.54; p-value < .05) compared with older adults without chronic musculoskeletal pain. Similarly, in the fully adjusted model, which included physical activity, LBP was associated with higher depressive symptoms ( β = 2.80, 95% CI: 0.82 to 4.79; p-value < .01). The association between knee OA and depressive symptoms was not statistically significant after adjusting for physical activity ( β = 2.00, 95% CI: −0.13 to 4.13; p-value = .06). Conclusion Older adults with chronic musculoskeletal pain have higher depressive symptoms scores, when compared to those without musculoskeletal pain. Physical activity does not seem to influence this association.

Correlation between fall experience and life functions among community-dwelling older adults in Japan

PurposeThis study investigated the correlation between the risk of falls and life functions, including motor function, cognitive function, and urinary disorders, among older adults residing in small cities in the metropolitan areas of Japan and evaluated the contents of fall prevention instructions. MethodsSixty-nine older adults residing at home participated in this case-control study conducted between September and October 2019. The survey items included questions pertaining to the history of falls; grip strength; the 30-s Chair Stand Test (CS-30), Functional Reach Test (FRT), and Timed Up and Go Test (TUG) scores; mental and cognitive functions [Test Your Memory-Japanese version test (TYM-J)]; living conditions; and urination status [Core Lower Urinary Tract Symptom Score (CLSS)]. ResultsParticipants with a history of falls had significantly lower CS-30 and FRT scores, and significantly higher TUG scores and CLSS than those with no history of falls. Grip strength bore significant correlations with the CS-30 and TUG scores. The CS-30 scores were correlated with the FRT and TUG scores. The FRT scores were correlated with the TUG and French State Activity Index (FAI) scores. The TUG scores were correlated with the TYM-J and FAI scores. The CLSS showed no significant correlations with the remaining items. The FRT scores and CLSS exerted a significant effect on the risk of experiencing falls. ConclusionBoth balancing ability and micturition status affect fall risk and should be considered in treatment strategies for urinary disorders in fall prevention programs for older adults.

Weight Loss and Number of Present Teeth in Community-Dwelling Japanese Older Adults: A Cross-Sectional Study in Niigata.

Weight loss is a critical health issue among the older population. This study aimed to explore the association between weight loss and oral health in older adults. We used cross-sectional data from the Uonuma Chronic Kidney Disease Cohort Study. The binary logistic regression models were fitted to estimate the relationship between weight loss and independent variables including the number of teeth present. The participants included 1656 females and 1625 males. There were 1217 females (73.4%) and 1236 males (76.0%) with normal BMI (18.5 ≤ BMI < 25) in the previous year. Weight loss was determined over a 12-month period. Individuals with normal BMI in previous year, and those with weight loss (≥ 5%) or those whom maintained a stable weight were further analysed. The regression analysis (model 3, fully adjusted) showed that females with 0 and 1-10 teeth present had a higher likelihood of losing weight (OR = 4.07; 95% CI = 1.85-8.93, OR = 2.33; 95% CI = 1.24-4.39) compared with those with 20 or more teeth. Current smokers had a higher likelihood of losing weight (OR = 3.15; 95% CI = 1.01-9.76) than lifelong abstainers. Among males, both current and previous smokers showed a higher likelihood of losing weight (OR = 4.94; 95%CI = 1.76-13.8, OR = 3.35; 95% CI = 1.29-8.68) than those who never smoked. This study indicates that the number of teeth and smoking are both linked to weight loss in females. However, in males, the association between the number of teeth and weight loss may be compromised due to the high prevalence of smoking in this group.

Increased risk of falls in older adults with hearing loss and slow gait: results from the Otassha Study.

Age-related hearing loss (ARHL) and impaired gait both independently heighten the risk of accidental falls among older adults. However, the combined impact of these factors remains unclear. We analyzed the data of 786 community-dwelling Japanese older adults. Hearing was evaluated at frequencies of 1.0 and 4.0kHz, with participants categorized into ARHL (> 25dB) and non-ARHL groups. Gait was also assessed, defining slow gait (SG) as speeds one standard deviation below the age- and sex-specific mean. Participants were divided into four groups based on their ARHL and SG statuses and were monitored annually for 8years to track falls and related injuries. Throughout the follow-up, incidents included 328 single falls (9.6/100 person-years), 117 multiple falls (2.8/100 person-years), 249 minor injuries from falls (6.7/100 person-years), and 55 fractures due to falls (1.3/100 person-years). Cox proportional hazard regression models showed that participants without ARHL but with SG faced a significantly increased risk of frequent falls. Furthermore, ARHL combined with SG significantly raised the risk of both single and frequent falls, and increased the incidence of both minor and severe fall-related injuries, including fractures. In contrast, no significant association was found between ARHL alone and fall-related incidents. These findings suggest that the previously reported risk associated with hearing loss in fall incidents predominantly relates to gait impairment. The co-occurrence of ARHL and SG significantly escalates the risk of falls and related injuries, highlighting the critical need for routine gait monitoring.

Patterns of referral to interprofessional services among frail older adults presenting to emergency departments in Canada.

Geriatric Emergency Department (ED) Guidelines recommend optimizing transitions of care for older patients with complex needs. In this study, we investigated referral patterns to interprofessional services, including occupational therapy, physiotherapy, dietician, social work, home care, and specialized geriatric services, among older adults presenting to the ED with high-risk characteristics. We recruited community-dwelling older adults presenting to 10 EDs across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. To observe processes of care in the ED, we deployed a two-stage high-risk case-finding and focused comprehensive assessment process based on the interRAI ED-Screener and ED Contact Assessment to identify and characterize older adults at high risk. We analyzed the secondary data using descriptive statistics and logistic regression. We screened 5265 individuals with the ED Screener, further assessed 1479 with the ED Contact Assessment, and analyzed data from a subset of 1055 community-dwelling older adults assessed with the ED Contact Assessment. Participants in our study sample had a mean age of 83 years, 58% were female, and many had a complex burden of cognitive and functional impairment and social needs. Over half of this high-needs sample were referred to general home care services (62.7%), occupational therapy (59.3%), and physiotherapy services (55.2%), while 16% were referred to specialized geriatric services. We also found a significant positive association between interprofessional referrals and the Assessment Urgency Algorithm and Institutional Risk Scale. The most important determinants of referral to interprofessional services were hospital province, functional, clinical, and social burden and support measures. The referral patterns identified suggest that patient needs and risk intensity did not always guide referral patterns in the Canadian EDs investigated. We suggest that EDs critically examine the appropriateness of their documentation and referral systems for supporting person-centered care provision.

Prevalence and Risk Factors of Self-Reported Sarcopenia and Its Association With Multimorbidity in Community-Dwelling Older Adults: A Cross-Sectional Study.

This cross-sectional study aimed to identify the impact of multimorbidity on self-reported sarcopenia and compare the differences in the prevalence and associated factors of sarcopenia in community-dwelling older adults with and without multimorbidity. We enrolled 876 community-dwelling older adults in South Korea. Multimorbidity was defined as the coexistence of two or more chronic diseases, and sarcopenia was evaluated using the Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falling Questionnaire. Binomial logistic regression analyses were performed. Our study revealed that the prevalence of sarcopenia was significantly higher (43.5%) in older adults with multimorbidity than in those without multimorbidity (20.8%). This finding underscores the significant impact of multimorbidity on sarcopenia. We also found that poor perceived health status was the strongest predictor of sarcopenia in older adults with multimorbidity, while oldest-old age (≥ 85 years) was the strongest predictor of sarcopenia in those without multimorbidity. Large prospective cohort studies using objective sarcopenia screening tools are needed to demonstrate the synergistic effects of multimorbidity and sarcopenia on health outcomes among community-dwelling older adults.