Fall Episodes Research Articles

Fall assessment and intervention among community-dwelling older people in a primary health care center in Spain: a best practice implementation project.

The implementation of fall prevention programs in the community is complex. Although there is solid scientific evidence that supports the effectiveness of such programs, there are multiple barriers that should be addressed using multifaceted strategies. The aim of this project was to increase compliance with evidence-based recommendations regarding fall risk screening and preventive interventions among older adults in a primary health care setting. This project used a pre-/post-implementation clinical audit based on the JBI Evidence Implementation Framework. Eight audit criteria were derived from JBI evidence summaries. The sample size was 62 patients aged 70 years or older. Data collection methods included a review of medical records and a questionnaire. A baseline audit was conducted and five barriers to best practice were identified. Strategies were then developed to increase compliance with the evidence-based recommendations, guided by JBI's Getting Research into Practice (GRiP) analysis. A follow-up audit was conducted in July 2022 to evaluate changes in compliance with best practices. The baseline audit showed 0% compliance with best practice recommendations for seven out of eight audit criteria. Five barriers were identified: (1) absence of fall risk screening tools, (2) lack of fall prevention intervention protocols, (3) insufficient reporting of fall episodes in the records, (4) need for staff training, and (5) high staff turnover. Following the implementation of a fall risk assessment and intervention protocol, along with staff training, seven out of eight audit criteria increased from 0% to between 22.6% and 100%. This evidence-based implementation project improved nursing practice in relation to compliance with best practice interventions to prevent falls. http://links.lww.com/IJEBH/A229.

DOACs for Older adults with Atrial Fibrillation and Falls: Results from the prospective single-centre DOAFF study

IntroductionFalls are one of the most fearsome events in anticoagulated older adults. The evidence concerning safety of direct oral anticoagulants (DOACs) in falling elderly patients with atrial fibrillation (AF) is still limited. MethodsWe prospectively enrolled consecutive anticoagulant-naïve patients aged 65 years and older, starting anticoagulation with DOACs for AF. The study cohort was stratified in fallers vs. non-fallers, according to the occurrence of at least one fall during the 2-year follow-up and bleeding outcomes were evaluated. ResultsWe enrolled 524 consecutive patients. Mean age was 80.8 years and they were mostly women (54.0%). Among the study cohort, 148 patients (28.2%) presented at least one fall episode during the study period. After the adjustment for potential confounders, no difference was found between fallers and non-fallers for all the study outcomes: major bleeding [HR: 1.04 (95%CI: 0.58–1.85)], intracranial haemorrhage [HR: 1.63 (95%CI: 0.69–3.80)], clinically relevant non-major bleeding [HR: 1.21 (95%CI: 0.83–1.76)], and all-cause death [HR: 1.51 (95%CI: 0.85–2.69)]. The presence of a prior cerebrovascular event [HR: 2.27 (95%CI: 1.12–4.62); p-value: 0.02] and polypharmacy [HR: 1.60 (95%CI: 1.08–2.39); p-value: 0.02] were the main drivers for major and clinically relevant non-major bleedings, respectively. ConclusionsFalls in an anticoagulant-naïve population aged 65 years and over starting a DOAC for AF do not increase the bleeding risk. Thus, the presence of falls should not discourage clinicians from prescribing DOACs also in this subset of patients.

Effect of physical exercise on fall episodes in the elderly: a meta-analysis

Effect of physical exercise on fall episodes in the elderly: a meta-analysis

SHMAD: A Smart Health Care System to Monitor Alzheimer's Disease Patients.

In the digital era monitoring the patient's health status is more effective and consistent with smart healthcare systems. Smart health care facilitates secure and reliable maintenance of patient data. Sensors, machine learning algorithms, Internet of things, and wireless technology has led to the development of Artificial Intelligence-driven Internet of Things models. This research study proposes an Artificial Intelligence driven Internet of Things model to monitor Alzheimer's disease patient condition. The proposed Smart health care system to monitor and alert caregivers of Alzheimer's disease patients includes different modules to monitor the health parameters of the patients. This study implements the detection of fall episodes using an artificial intelligence model in Python. The fall detection model is implemented with data acquired from the IMU open dataset. The ensemble machine learning algorithm AdaBoost performs classification of the fall episode and daily life activity using the feature set of each data sample. The common machine learning classification algorithms are compared for their performance on the IMU fall dataset. AdaBoost ensemble classifier exhibits high performance compared to the other machine learning algorithms. The AdaBoost classifier shows 100% accuracy for the IMU dataset. This high accuracy is achieved as multiple weak learners in the ensemble model classify the data samples in the test data accurately. This study proposes a smart healthcare system for monitoring Alzheimer's disease patients. The proposed model can alert the caregiver in case of fall detection via mobile applications installed in smart devices.

Effects of the Anchor System on Postural Balance of Women Undergoing Breast Cancer Treatment: A Clinical, Randomized, Controlled, and Crossover Trial

ObjectiveInvestigate the effects of multisensory training with and without the anchor system on breast cancer survivors’ postural balance and self-efficacy of falls. DesignClinical randomized, controlled, and crossover trial. SettingTeaching, Research, and Assistance Center in Mastectomized Rehabilitation. ParticipantsEighty breast cancer survivors homogeneously distributed in the groups of adults and elderly affected, or not, by lymphedema. InterventionsParticipants were randomized to multisensory training with and without the anchor system involving 3 sessions per week for 12 weeks. After the 4-week washout period, the remaining therapeutic intervention was applied. Main Outcome MeasuresThe primary outcome was semi-static and dynamic balance as evaluated by baropodometry and Mini Balance Evaluation Systems Test, and the secondary outcome was self-efficacy of the fall episode as assessed by Falls Efficacy Scale - International in the pre-, post-immediate, and 4-week follow-up period. ResultsBoth therapeutic interventions caused positive and significant effects on postural balance and self-efficacy of falls in the immediate period. The multisensory training with the anchor system induced significant functional retention in the short term, related to the clinical effect of small to moderate variation. ConclusionsMultisensory training with the anchor system is convenient for postural balance and self-efficacy for falls, regardless of age and upper limb volume, for breast cancer survivors.

Sex, cognitive state and falls as factors associated with malnutrition: a cross-sectional study of institutionalized older adults living in a rural area of Portugal

BackgroundMalnutrition is an underestimated geriatric problem, with a high prevalence in institutionalized older adults. The identification of risk factors for malnutrition in elderly individuals must be a priority for governmental organizations worldwide.MethodsA total of 98 institutionalized seniors were enrolled in a cross-sectional study. For the assessment of risk factors, sociodemographic characteristics and health-related information were collected. The Mini-Nutritional Assessment Short-Form test was used to assess malnutrition in the sample population.ResultsA significantly greater proportion of women than men were malnourished or at risk of malnutrition. In addition, the comparative analysis revealed that comorbidity, arthritis, balance impairment, dementia and fall episodes with serious injuries were significantly more frequent in the older adults categorized as malnourished or at risk of malnutrition than in those categorized as well-nourished.ConclusionsMultivariable regression analysis revealed that being female, having a poor cognitive status and experiencing falls with injuries are the main independent factors influencing nutritional status in institutionalized older adults living in a rural area of Portugal.

Activities-specific balance confidence scale in elderly in community nursing home

Background: To investigate the incidence of falls in elderly in nursing homes and to determine the differences in confidence indexes of daily living in the Activities-Specific Balance Confidence Scale (ABC) in elderly fallers or nonfallers. Methods: We conducted a perspective study with elderly (ages >75 years old) from January 1, 2018, to December 31, 2020, living in community nursing homes in Tongzhou district, Beijing. All the participants were able to walk independently, had not experienced any fall episodes, were capable of following commands, and they sufficiently cooperated with the process of the examination. A face-to-face visit or telephone interview was conducted with participants on a regular basis for 12 months. The falling incidence and the differences of ABC scale confidence indexes between fallers and nonfallers were investigated. Results: This study included 87 older adults (67 nonfall participants and 20 fall participants). Falls occurred at a rate of 23 per 100 people per year. The ABC scale index of the faller group was 37%, which indicated very low balance confidence and a high risk of falling. The ABC scale index of the nonfaller group was 80%, which indicated normal balance confidence and no risk of falling. There were significant differences in ABC scale indexes between the faller and nonfaller groups (37% vs. 80%, P = 0.005). There were significant differences in activities such as walking around the house, climbing up and down stairs, picking up slippers from floor, reaching on tiptoes, standing on a chair to reach, walking outside to a nearby car, getting in/out of a car, walking across a parking lot, walking up and down a ramp, walking in a crowded mall between two groups of people, walking in a crowd (risk of bumping into other people), going up an escalator without rail assistance, and walking on an icy sidewalk between the two groups (P < 0.05). Conclusion: Nursing homes have a high rate of falls among older adults. The ABC scale can assess balance confidence and the risk of falling in older adults. To reduce or prevent falls, health-care professionals should screen those who are at high risk of falling and enroll them in a fall prevention program.

Polypharmacy Predicts Onset and Transition of Frailty, Malnutrition, and Adverse Outcomes in Peritoneal Dialysis Patient.

Polypharmacy, frailty and malnutrition are known predictors of adverse outcomes in dialysis patients. Little has reported about their interaction and composite prognostic values. We aimed to describe the interaction between polypharmacy, frailty, nutrition, hospitalization, and survival in peritoneal dialysis patients. In this prospective cohort study, we recruited 573 peritoneal dialysis patients. Drug burden was measured by medication number and daily pill load. Frailty and nutrition were assessed by the validated Frailty Score (FQ) and Subjective Global Assessment (SGA) respectively. All patients were followed for two years. Primary outcome was all-cause mortality. Secondary outcomes were fall and fracture episodes, hospitalization, change in FQ and SGA. At baseline, each patient took 7.5 ± 2.6 medications with 15.5 ± 8.5 tablets per day. Medication number, but not daily pill load predicted baseline FQ (p = 0.004) and SGA (p = 0.03). Over 2 years, there were 69 fall and 1,606 hospitalization episodes. In addition, 148 (25.8%) patients died, while FQ and SGA changed by 0.73 ± 4.23 and -0.07 ± 1.06 respectively in survivors. Medication number (hospitalization: p = 0.02, survival: p = 0.005), FQ (hospitalization: p < 0.001; survival: p = 0.01) predicted hospitalization and survival. Medication number also predicted fall episodes (p = 0.02) and frailty progression (p = 0.002). Daily pill load did not predict any of these outcomes. Drug burden is high in peritoneal dialysis patients, and it carries important prognostic implication. Medication number but not pill load significantly predicted onset and progression of frailty, malnutrition, fall, hospitalization, and mortality.

P26 Challenging Scenario: Scleroderma/Sjogren overlap with dysautonomia

Introduction/BackgroundScleroderma Overlap conditions are well defined and often behave differently than their limited or diffuse counterparts. The treatment for such patients is usually tailored around the organ system involvement and severity. We present a challenging case of Scleroderma/Sjogren overlap with refractory Raynaud's phenomenon who posed treatment challenges due to severe autonomic dysfunction.Description/Method76-year-old Caucasian lady, non-smoker, who presented in 1990’s with dry eyes, dry mouth and severe Raynaud's phenomenon with recurrent digital ulceration which became infected on multiple occasions. ANA was 1:400 with Extractable nuclear antigen Ro and La positive. Anti DsDNA was negative and C4 was low. Antiphospholipid antibodies and cryoglobulins are negative. She failed calcium channels blockers and phosphodiesterase 5 inhibitors and was intolerant to intravenous (IV) Iloprost which was tried on multiple occasions. IV latanoprost was tried as well. This treatment was complicated when she developed postural hypotension and multiple fall episodes during vasodilator use. This was attributed to autonomic dysfunction secondary to her Sjogren syndrome. She was initiated on Injection Fludrocortisone, however her hypotensive episodes continued. She received monthly intravenous immunoglobulins 20gm (over two days) infusion for a few months for autonomic dysfunction with some response. She eventually developed recurrent diarrhoea and abdominal pain and bloating which was attributed to small bowel overgrowth with rapid bowel transit on a gastric emptying scan. She had a blocked bile duct as well which was unblocked using Endoscopic Retrograde Cholangiopancreatography. Over the next 8 years, she continued struggling with refractory Raynaud’s, having failed IV regional guanethidine blocks and digital sympathectomy. Her postural hypotension decompensated on multiple occasions necessitating plasmapheresis which provided some benefit. In 2020, she was detected to have a PET avid slowly progressing left upper lobe lung lesion. She underwent left video assisted thoracoscopy surgery with upper lobectomy. Histology was suggestive of adenocarcinoma. In 2021, she had another fall episode due to an acute/subacute infarct of left pons. She continues having postural hypotension and requires regular plasmapheresis sessions to manage her symptoms. She is also presently on Bosentan for her raynaud’s phenomenon.Discussion/ResultsThis is a case of overlap of Sjogren syndrome with scleroderma features. Management of Refractory Raynaud’s as part of her scleroderma phenotype was challenging. This case gave us the opportunity to explore all the treatment options available for Raynaud’s phenomenon albeit with poor outcome. She also struggled with autonomic dysfunction leading to postural hypotension and gastrointestinal symptoms which can be seen in upto 50% of patients with Sjogren syndrome. Autonomic failure is often thought to be immune mediated in Sjogren syndrome. This makes way for the use of intravenous immunoglobulin and plasmapheresis to treat these conditions as was done in this case. Increased risk of lung carcinoma with scleroderma is well documented. Autonomic dysfunction can also present as paraneoplastic syndrome with lung carcinoma, however it is more common with small cell lung carcinoma and our patient was diagnosed with Adenocarcinoma. We would have to wait and see if the resection of the tumour has any demonstrable effect on her dysautonomia.Key learning points/ConclusionOverlap connective tissue diseases are often difficult to manage in view of extensive disease heterogeneity. Clinicians need to be aware of challenges in managing Difficult Raynaud’s with Autonomic dysfunction. Treating physicians need to be aware of the high risk of lung malignancy and regular close monitoring is required. This case-based conference gives us the opportunity to discuss further management approaches for her.

0852 Narcolepsy Type 1 in a Pediatric Patient with Temporal Lobe Epilepsy

Abstract Introduction Narcolepsy type-1 is clinically characterized by irrepressible daytime sleepiness and REM-sleep dissociation, including cataplexy. Cataplexy usually manifests as episodes of brief, symmetrical sudden loss of muscle tone with retained consciousness. It may be difficult to distinguish from seizure activity as they may share overlapping features. We discuss a pediatric patient with temporal lobe epilepsy with co-occuring Narcolepsy Type 1. Report of Cases: A 17-year-old boy with obesity and a history of focal epilepsy secondary to intracranial hemorrhage in the neonatal period status-post right parieto-occipital resection at age 11, presented with worsening fall episodes and feeling of imbalance Following surgery, his seizures improved, but he was having excessive sleepiness. At age 13, he started experiencing episodes of slurred speech, feeling of imbalance, “body heaviness and tongue heaviness” with occasional falls. He denied loss of consciousness, body shaking, stiffening, or incontinence. At age 17, he presented to medical attention due to increasing frequency of such episodes. Physical exam was significant for BMI 42.7 kg/m , Mallampati 4, tonsils 3+ bilaterally, and homonymous hemianopia. Epworth Sleepiness Scale: 22/24. Video EEG was negative for epileptiform discharges despite occurrence of above-mentioned episodes increasing the clinical suspicion of Narcolepsy. Polysomnography revealed sleep latency of 0 minutes, REM latency of 2.6 minutes, and mild OSA. Toxicology screen was negative. MSLT showed mean sleep latency of 1.2 minutes with 3 SOREMPs. CSF orexin could not be obtained due to technical constraints. He was diagnosed with Narcolepsy type-1 and started on Venlafaxine and Methylphenidate with resultant improvement in both daytime sleepiness, and the severity and frequency of cataplexy. However, his feeling of imbalance persisted, prompting repeat video EEG which demonstrated left temporal lobe seizure activity. Anti-epileptic regimen was optimized with improvement in sensation of imbalance. Conclusion Temporal lobe epilepsy and Narcolepsy Type-1 can have overlapping features that make it difficult to distinguish between the two. While exceedingly rare, the two entities may co-occur. Diagnostic and therapeutic management require coordination between Sleep Medicine and Neurology. While PSG, MSLT, and CSF Orexin can clarify the diagnosis of narcolepsy, neurologic work up should be pursued if symptoms are not completely attributable to Narcolepsy. Support (If Any)

Delayed tension gastrothorax caused necrosis of stomach and re-expansion pulmonary edema: a case report

BackgroundTraumatic tension gastrothorax is a rare and potentially fatal condition occurring in patients with congenital or acquired diaphragmatic defects. Traumatic tension gastrothorax leads to acute and severe respiratory distress. Delayed tension gastrothorax that develops late during injury can be more severe.Case presentationAn 84-year-old woman was brought to our facility with cardiac arrest and returned to spontaneous circulation after 2 min of cardiopulmonary resuscitation. Computed tomography showed diaphragmatic injury and tension gastrothorax due to trauma because of a fall episode few days earlier. Emergency thoracotomy and laparotomy was performed, because nasogastric tube insertion failed. There was a partially necrotic stomach in the chest cavity. The stomach was retracted from the thoracic cavity into the abdominal cavity and placed in its proper position. There was a 5 cm tear of the diaphragm. The tear was sutured and closed and then the necrotic area of the stomach was resected. Although the surgery relieved the intrathoracic compression, it resulted in re-expansion pulmonary edema immediately after surgery and hypoxemia. The patient was unable to overcome the hypoxemic state and eventually died.ConclusionsDelayed tension gastrothorax can lead not only to obstructive shock due to intrathoracic compression but also to more severe organ ischemia and re-expansion pulmonary edema due to insufflation.

Case Report: Posterolateral Epidural Supra-C2-Root Approach (PESCA) for Biopsy of a Retro-Odontoid Lesions in Same Sitting After Occipitocervical Fixation and Decompression in a Case of Crowned Dens Syndrome With Brainstem Compression and Displacement

Background‘Crowned dens syndrome' (CDS) is a special form of calcium pyrophosphate dihydrate deposition disease which is characterized radiologically by a halo-like or crown-like distribution in the periodontoid region and clinically by cervical pain. Herein, we will describe our experience of posterolateral epidural supra-C2-root approach (PESCA) for biopsy of retro-odontoid lesions in one surgical session after occipitocervical fixation and decompression in a patient with CDS and massive brainstem compression.Case PresentationA 70-year-old woman presented to our department with a 4-week history of progressive walking impairment, neck pain, neck rigidity, fever, dizziness, slight palsy of the left hand, and multiple fall episodes. Magnetic resonance imaging (MRI) of the craniovertebral junction (CVJ) and cervical spine revealed a lesion of the odontoid process and the retro-odontoid region with mainly solid components, as well as small cystic components, and brainstem compression and displacement. In first step, fusion surgery of the CVJ C0–C4 was performed with occiptocervical decompression. After fusion and decompression the lower lateral part of the C1 arc and the lateral superior part of the left side of the C2 arc were removed. The entry point was located directly above the superior part of the C2 root. A biopsy of the lateral portions of the lesions was obtained by bioptic forceps under microscope guidance. Pathologic examination of the mass revealed deposition of birefringent crystals compatible with calcium pyrophosphate. In addition to the clinical symptoms (especially neck pain), the diagnosis of CDS was made. Non-steroidal inflammatory drugs (NSAIDs) and colchicine (and later magnesium) were started. At follow-up examination 6 months after surgery, an MRI scan of the cervical spine revealed regression of the pannus and the cyst with replacement of the brainstem, clinical improvement of walking, and increased strength of the left hand.ConclusionsThis study demonstrates that PESCA can be used to obtain tissue for pathological analysis in one surgical sitting after fusion and decompression and that fusion, decompression, and PESCA (in the same session) together with subsequent conservative management could be a good alternative for the treatment of CDS.

Association between daily activities and fall in older adults: an analysis of longitudinal ageing study in India (2017\u201318)

BackgroundDeclining functionality affects an individual’s musculoskeletal integrity increasing the risk of fall and disability. Individuals with severe functional limitations are 5 times more likely to experience a fall. Thus, this paper investigated the association between functional decline and falls in older adults.MethodsThis study uses secondary data from the Longitudinal Aging Study in India (2017–18). A total of 31,477 people over the age of 60 are included in the study. Descriptive statistics and bivariate analysis were performed to determine the association between activities of daily living (ADL), instrumental activities of daily living (IADL) and fall. Adjusted odds ratio was used to determine the association of ADL and IADL with fall while controlling for age, gender, balance and gait impairments.ResultsThe study reported 6352 fall episodes in 3270 participants aged 60 and above, over a period of 2 years. More than 30% of participants reported difficulty in ADL and IADL. Age and gender adjusted odds of fall were higher in participants with difficulty in more than 4 ADLs (AOR:1.32; CI:1.08 – 1.67) and in more than 2 IADL (AOR: 1.39; CI:1.02 – 1.89). Similarly, the odds of fall were higher for difficulty in ADL (AOR:1.31; CI:1.11 – 1.73) and IADL (AOR of 1.18; CI:1.07 – 1.29) controlling for gait and balance impairment. Difficulty in pushing-pulling objects (AOR: 1.30; CI: 1.15 – 1.46 & AOR: 1.40; CI: 1.21–1.61) and getting up from the chair (AOR: 1.12; CI:1.01–1.26 & AOR: 1.27; CI: 0.99 – 1.26) was significantly associated with fall when adjusted for age, gender and balance and gait parameters.ConclusionsThis study provides the new insights into the association of fall and risk of functional decline, especially difficulty in pushing and pulling objects and getting up from a chair, can be incorporated in the primary screening of fall risk assessment.

Are we missing parameters to early detect risk factors of falling in older adults?

Falls in older adults constitutes a major health problem and a burden for public health systems worldwide. Despite the high prevalence of falls in older people over the past decades, a fall episode is preventable when early assessment is performed to identify the modifiable risk factors. Unfortunately, health care providers lack technical knowledge to do that, and many non-instrumented clinical tests used to detect those factors also lack responsiveness. To counteract those issues and perform a comprehensive assessment, the care provider already has access to valid, sensitive and affordable tools to measure physical markers of motor deterioration, such as body balance, temporospatial gait parameters, muscle strength and power. They all demand little investment and training, with promising results for early diagnostic and intervention. We hypothesize that majoring the knowledge and the investment on those low-cost missing parameters could change the current numbers and minimize the impact of a fall episode for both the individual and the public health care system.

A Review on Aging, Sarcopenia, Falls, and Resistance Training in Community-Dwelling Older Adults.

As aging continues to grow in our society, sarcopenia and associated fall risk is considered a public health problem since falling is the third cause of chronic disability. Falls are negatively related to functionality and independence and positively associated with morbidity and mortality. The cost of treatment of secondary injuries related to falls is high. For example, one in ten fall incidents leads to bone fractures and several other comorbidities. As demonstrated by several experimental studies, adopting a more active lifestyle is critical for reducing the number of fall episodes and their consequences. Therefore, it is essential to debate the proven physical exercise methods to reduce falls and fall-related effects. Since muscle mass, muscle strength, bone density, and cartilage function may play significant roles in daily activities, resistance training may positively and significantly affect the elderly. This narrative review aimed to examine current evidence on existing resistance training using resistance machines and bodyweight or low-cost equipment for the elderly and how they are related to falls and fall-related consequences. We provide theoretical links between aging, sarcopenia, and falls linking to resistance training and offer practical suggestions to exercise professionals seeking to promote regular physical exercise to promote quality of life in this population. Exercise programs focusing on strength may significantly influence muscle mass and muscle strength, minimizing functional decline and risk of falling. Resistance training programs should be customized to each elderly according to age, sex, and other fundamental and individual aspects. This narrative review provides evidence to support recommendations for practical resistance training in the elderly related to intensity and volume. A properly designed resistance training program with adequate instructions and technique is safe for the elderly. It should include an individualized approach based on existing equipment (i.e., body weight, resistance machines). Existing literature shows that exercise performance towards 2–3 sets of 1–2 exercises per major muscle group, performing 5–8 repetitions or achieving intensities of 50–80% of 1RM, 2–3 times per week should be recommended, followed by training principles such as periodization and progression. Bearing this in mind, health and exercise professionals should combine efforts focusing on efficient strategies to reduce falls among the elderly and promote higher experiences of well-being at advanced stages in life.

The relationship between height of vertical jumps, functionality and fall episodes in patients with chronic obstructive pulmonary disease: A case-control study.

This study aimed to compare the height of jumps and functional parameters in patients with chronic obstructive pulmonary disease (COPD) to those in healthy people, in addition to assessing the relationship among variables in patients with COPD. Twenty patients with COPD (forced expiratory volume [FEV1] % of predicted: 39.98±11.69%; age: 62.95±8.06years) and 16 healthy people (FEV1% of predicted: 97.44±14.45%; age: 59.94±6.43years) were evaluated, and all participants performed the Squat Jump (SJ) and Counter Movement Jump (CMJ) tests to assess rapid force considering the jumping height. Functional capacity was assessed using the self-selected walking speed tests, walking speed in 10m, walking test in 6min, balance on one leg, sitting and standing, timed up and go, and a stair-climbing test. In addition, the questionnaires on recall of falls, Falls Efficacy Scale-International (concern with falling), International Physical Activity Questionnaires, and Saint George Respiratory Questionnaire were administered. The height of the jumps showed no difference between the groups, but the COPD group performed worse in most functional tests and was more afraid of falling. The number of falls was correlated with height in the SJ (r=-0.51) and CMJ (r=-0.62) jumps (p<0.05), and with the performance in different functional tests. We suggest that interventions targeting rapid force may bring improvements in functional mobility and physical fitness as well as reducing fall episodes in patients with COPD.

Strategies to reduce PM2.5 and O3 together during late summer and early fall in San Joaquin Valley, California

PM2.5 and O3 controls are traditionally considered separately because PM2.5 is usually high in winter while O3 is generally high in summer. In this study, we explore the opportunity of controlling the two pollutants simultaneously through a better understanding of their intra-seasonal correlation and chemical-coupling behaviors under different meteorological conditions during the late summer and early fall (August–September) episodes in the San Joaquin Valley (SJV), California. A correlation analysis is first used to identify the temporal correlations between O3 and PM2.5 and their underlying physical and chemical drivers. Sensitivity analysis is then applied to determine the chemical coupling between PM2.5 and O3 and subsequent multipollutant control opportunities under two contrasting meteorological conditions using the Community Multi-Scale Air Quality (CMAQ) model. We find that O3 and PM2.5 are positively correlated on the daily timescale because both are sensitive to atmospheric stagnation. However, O3 and PM2.5 are negatively correlated on the hourly timescale determined by the negative correlation between hourly NO3− and O3, which is mainly due to the opposite effects of T and RH on the diurnal variations of NO3− and O3. Reducing NOx on average lead to O3 increase, but it can facilitate reducing O3 at higher O3 (>75 ppb) locations under the more stagnant conditions. NOx emission control could become beneficial for both O3 and PM2.5 when the NOx emissions in 2005 are further reduced by 15% under the more stagnant meteorological conditions and by 30% under the more ventilated meteorological conditions.

Screening Gait Performance, Falls, and Physical Activity among Benedictine and Trappist Monks.

Background and Objective:Physical performance in older men has been reported in analyses with veterans and in disease-based cohort research. Studies examining gait performance among older monks, however, are narrow. The purpose of this study was to analyze the impact of a recent fall on gait ability in a cohort of Benedictine and Trappist monks in 4 US monastic communities. The second aim was to analyze physical activity and a recent fall as predictive markers of 2 constructs of gait performance.Methods:In this cross-sectional study, 53 Benedictine and Trappist monks over 60 (x = 74.7 ± 7.6; range: 61-94 years) completed a basic sociodemographic and fall history profile, the Timed Up and Go (TUG) Test, Dynamic Gait Index (DGI) and the Physical Activity Scale for the Elderly (PASE).Results:Demographic profiles revealed that 10% of participants had fallen over the past 3 months; in addition, those who had fallen were more likely to limit activities because of fear of falling (P = .005). Monks who had fallen over the past 3 months demonstrated significantly poorer TUG (12.6 ± 2.1 vs 10.5 ± 1.8; P = .01) and DGI (17.2 ± 5.3 vs 22.3 ± 2.3; P < .001) scores. There was a significant association between physical activity and both the TUG (–0.55; P < .001) and DGI (64; P < .001). Multiple regression models demonstrated that physical activity and a fall in the past 3 months predicted 24% of the variance in the TUG (P < .001) and 46% of the variance in the DGI (P < .001).Conclusions:Gait performance is linked to a recent fall episode among older monks. Predictive determinants of functional mobility (TUG) and superimposing tasks on the gait cycle (DGI) include recent fall history and physical activity. Appropriate health promotion activities can be aligned with these lifestyle attributes in monastic communities.

Risk factors for future falls among community-dwelling older adults without a fall in the previous year: A prospective one-year longitudinal study

IntroductionOne of the main risk factor for falls is a history of falls itself. Henceforth, preventing a fall is an important strategy for the prevention of new ones. The objective of the present study was to determine whether personal self-perception questions and functional tests might represent risk factors for a fall during the year following a year without any falls among independent community-dwelling older adults, considering a period of 12 prospective months. MethodsA total of 101 community-dwelling older adults without a fall in the previous year underwent an initial evaluation (sample characterization, self-perception questionnaire and functional tests) and monthly monitoring of prospective fall episodes by telephone contact. We determined the association between the occurrence of prospective falls (dependent variable) and personal questions and functional tests (independent variables) with multiple binary logistic regression adjusted for confounding variables. ResultsOnly age (p = 0.005) and self-perception of general health (p = 0.019) showed association with the occurrence of prospective falls. ConclusionOur results showed that the only factors bearing an association with the occurrence of prospective falls were age and general health self-perception, which demonstrates the importance of administrating self-perception measures in clinical practice or in epidemiological studies for the prevention of a fall during the year following a year without any falls in older adults.

Relationship Between Lower Limb Muscle Strength and Future Falls Among Community-Dwelling Older Adults With No History of Falls: A Prospective 1-Year Study.

Objective: To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method: Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results: there was no association between lower limb PT and future falls (p > .05). Conclusion: Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.