Morbidity In Older Adults Research Articles

Understanding how to design an engaging hard martial arts programme to improve quality of life among older people: a preliminary study

Background/Aims Improvements to the quality of life of tai chi practitioners have been demonstrated in the literature; however, less is known about the possible effects on the quality of life of practitioners of harder styles of martial arts in older populations. The aim of this study was to identify what facets of a modified hard martial arts programme motivated participants to attend and therefore guide the design of future programmes. Methods A total of nine community-dwelling older adults with a mean age of 75 years (± 7.3 years) who participated in 12 weeks of modified hard martial arts training were asked if they had perceived any changes to their health or quality of life over the participation period. A self-reported survey instrument, the Positive and Negative Affect Schedule, was used to measure change pre- and post-intervention, and semi-structured interviews were used to explore participants' motivators for participating, perceived benefits and concerns. Results Five themes emerged which were: (1) a general feeling that quality of life had increased; (2) an increase in social interaction; (3) increased physical abilities; (4) the need to preserve a safe training environment; and (5) a sense of loss relating to the study ending. Positive and Negative Affect Schedule scores indicated clinically significant improvement but did not reach statistical significance. Conclusions These themes may have important implications when designing future hard martial arts programmes aimed at attracting older persons who prefer to engage in vigorous exercise. Implications for practice As populations around the world age, engaging older adults in activities that promote fitness and social inclusion becomes increasingly important to maintain health into older age. Providing diverse and non-mainstream niche opportunities to older adults such as this programme will maximise engagement and potentially reduce loneliness and physical morbidity in older adults.

Effects of Daylong Exposure to Indoor Overheating on Thermal and Cardiovascular Strain in Older Adults: A Randomized Crossover Trial.

Health agencies recommend that homes of heat-vulnerable occupants (e.g., older adults) be maintained below 24-28°C to prevent heat-related mortality and morbidity. However, there is limited experimental evidence to support these recommendations. To aid in the development of evidence-based guidance on safe indoor temperatures for temperate continental climates, we evaluated surrogate physiological outcomes linked with heat-related mortality and morbidity in older adults during simulated indoor overheating. Sixteen older adults [six women; median age: 72 y, interquartile range (IQR): 70-73 y; body mass index: ] from the Ottawa, Ontario, Canada, region (warm summer continental climate) completed four randomized, 8-h exposures to conditions experienced indoors during hot weather in continental climates (e.g., Ontario, Canada; 64 participant exposures). Ambient conditions simulated an air-conditioned environment (22°C; control), proposed indoor temperature upper limits (26°C), and temperatures experienced in homes without air-conditioning (31°C and 36°C). Core temperature (rectal) was monitored as the primary outcome; based on previous recommendations, between-condition differences were considered clinically meaningful. Compared with 22°C, core temperature was elevated to a meaningful extent in 31°C [; 95% confidence interval (CI): 0.5, 0.8] and 36°C (; 95% CI: 0.8, 1.1), but not 26°C (, 95% CI: 0.0, 0.3). Increasing ambient temperatures were also associated with elevated heart rate and reduced arterial blood pressure and heart rate variability at rest, as well as progressive impairments in cardiac and blood pressure responses to standing from supine. Core temperature and cardiovascular strain were not appreciably altered following 8-h exposure to 26°C but increased progressively in conditions above this threshold. These data support proposals for the establishment of a 26°C indoor temperature upper limit for protecting vulnerable occupants residing in temperate continental climates from indoor overheating. https://doi.org/10.1289/EHP13159.

Influenza vaccination before and during the COVID-19 pandemic in the elderly in South Korea

BackgroundInfluenza epidemics are a significant cause of mortality and morbidity in older adults; thus, vaccination is recommended. However, the coronavirus disease 2019 (COVID-19) pandemic could affect influenza vaccination. MethodsThe influenza vaccination rate was estimated from the Korea Community Health Survey data from 2011 to 2021 using Joinpoint regression. We used multiple logistic regression analysis from each two flu seasons data before (2017–18 and 2018–19 seasons) and during (2019–20 and 2020–21 seasons) the COVID-19 pandemic to identify older adults who were not been vaccinated during the COVID-19 pandemic. Additionally, we stratified changes in influenza vaccination according to the flu season, demographic and socioeconomic characteristics, and health status. ResultsThe annual percentage change in influenza non-vaccination rate from 2010–11 to 2018–19 seasons and from 2019–20 to 2020–21 seasons was -8.31% (confidence interval (CI), -9.60 to ‐7.00) and 11.41% (CI, -3.22 to 28.25), respectively. Compared to before COVID-19, in the 2019–20 and 2020–21 seasons, the odds ratio (OR) of non-vaccination was 0.87 (CI, 0.83–0.91) and 1.18 (95% CI, 1.13–1.24), respectively. The decrease in influenza vaccination among older individuals with higher education (OR, 1.24; CI, 1.11–1.39) was greater than that among those with lower education (OR, 1.09; CI, 0.98–1.22). Older individuals with the lowest income level or poor self-rated health showed reduced influenza vaccination. ConclusionsWe estimated the trends of influenza vaccination and identified subgroups with decreased vaccination rates during the COVID-19 pandemic among older adults in South Korea. Health policy decision-makers, practitioners, and researchers should consider the implications of COVID-19 on changes in influenza vaccination, particularly for older individuals at risk of influenza.

Older Adults with Epilepsy and COVID-19: Outcomes in a Multi-Hospital Health System

BackgroundCoronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy. MethodsThis retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS). ResultsWe identified 5384 older adults admitted with COVID-19 of whom 173 (3.21%) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p=0.007). Older adults with epilepsy were more likely to be ventilated (35.84% vs. 16.18%, p<0.001), less likely to be discharged home (21.39% vs. 43.12%, p<0.001), had longer median LOS (13 days vs. 8 days, p<0.001), and had higher in-hospital death (35.84% vs. 28.29%, p=0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95% CI 1.12-2.14, p=0.032), non-routine discharge disposition (aOR, 3.34; 95% CI 2.21-5.03, p<0.001), and longer LOS (46.46% 95% CI 34%-59%, p<0.001). ConclusionsIn models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.

Comparison of Risk Factors for Falls in the Old and the Oldest Old Admitted to the Emergency Department

Background: Falls can cause a wide range of consequences from a simple injury to life-threatening situations. As falls are a major cause of mortality and morbidity in older adults, it is important to identify risk factors. Our aim was to evaluate fall risk factors in geriatric patients presenting to the emergency department with fall and to evaluate the variability of fall risk factors in the group below and above 85 years of age (oldest old). Materials and Methods: A total of 132 geriatric patients admitted to the emergency department of a univer-sity hospital due to falls were retrospectively analysed. Demographic characteristics and chronic diseases of patients, number of drugs, previous fall history, unintentional weight loss, depressive symptoms, anaemia, urinary incontinence, fear of falling, orthostatic hypotension were recorded. Edmonton frail scale, clock-draw-ing test and geriatric depression scale score was also evaluated. Results: The mean age of our study population was 80.5 ±8.3. While 80 (60.6%) of the patients were below 85 years of age, 52 (39.4%) were aged 85 years and older. 62 (47%) of the patients were frail and orthostatic hypotension was found in 10 (7.6%) of the patients. Fear of falling was observed in 67 (50.8%) patients. Polypharmacy was present in 62 (47%) patients. Frequency of diabetes mellitus, frailty, fear of falling, walking aid usage and the need for a regular caregiver were significantly higher and clock-drawing test score was lower in the oldest old group (p&amp;lt;0.05, for all). Conclusions: Falls are common in older patients. Our study clearly revealed the frequency of fall risk factors in the geriatric population admitted to the emergency department. The frequency of frailty was higher in the oldest old (over 85 years old) who presented with falls, and fear of falling was found in these patients even if there was no previous history of falling. Necessary precautions should be taken considering the negative con-sequences of falls.

Type 2 diabetes mellitus plays a protective role against osteoporosis --mendelian randomization analysis

BackgroundType 2 diabetes mellitus (DM2) and osteoporosis (OP) are currently the two most significant causes of mortality and morbidity in older adults, according to clinical evidence. The intrinsic link between them is yet unknown, despite reports of their coexistence. By utilizing the two-sample Mendelian randomization (MR) approach, we sought to evaluate the causal impact of DM2 on OP.MethodsThe aggregate data of the whole gene-wide association study (GWAS) were analyzed. A two-sample MR analysis was performed using single-nucleotide polymorphisms (SNPs), which are strongly associated with DM2, as instrumental variables (IVs) to evaluate the causal analysis of DM2 on OP risk with OR values, using inverse variance weighting, MR-egger regression, and weighted median methods, respectively.ResultA total of 38 single nucleotide polymorphisms were included as tool variables. According to the results of inverse variance-weighted (IVW), we found that there was a causal relationship between DM2 and OP, in which DM2 had a protective effect on OP. For each additional case of DM2, there is a 0.15% decrease in the odds of developing OP (OR = 0.9985;95%confidence interval:0.9974,0.9995; P value = 0.0056). There was no evidence that the observed causal effect between DM2 and the risk of OP was affected by genetic pleiotropy (P = 0.299). Using Cochran Q statistics and MR-Egger regression in the IVW approach, the heterogeneity was calculated; P > 0.05 shows that there is a significant amount of heterogeneity.ConclusionA causal link between DM2 and OP was established by MR analysis, which also revealed that DM2 decreased the occurrence of OP.

Integration of Oral Health into General Health Services for Older Adults.

The prevalence of oral diseases in the older adult population remains high worldwide and is expected to surge in the coming decade. The World Health Organization (WHO) has listed the oral health of older adults as one of its pivotal concerns. Oral health affects general health, and oral diseases increase mortality and morbidity in older adults. Integrating oral health into the general health service with a patient-centred approach can be an effective way to improve oral and systemic health for older adults simultaneously. This integration tackles the shared risk factors of both oral and noncommunicable diseases, aids in the early detection of systemic disease, strengthens health surveillance, enhances efficient data sharing, and allows for the better allocation of resources and the workforce in the healthcare system. However, the oral healthcare sector operates as an isolated field, with an emphasis on intervention rather than prevention, which presents a key challenge to the success of integration. Therefore, refocusing oral healthcare service on prevention is paramount. In addition, approaches taken in clinical practice implementation, interprofessional education and training, technology and innovation, research and evaluation, advocacy by national professional oral healthcare organizations, and policy making will ensure the efficient, effective, and long-term integration of oral and general health services. Integrating these services would foster the accessibility and affordability of oral healthcare services for older adults to improve their oral health and overall well-being in the coming decade. This review aims to discuss the merits and outline the challenges of integrating oral health into general health services for older adults and to propose the approaches that could be taken.

Development of the Home-Based Fall Prevention Knowledge (HFPK) questionnaire to assess home-based fall prevention knowledge levels among older adults in China

BackgroundFalls are one of the main reasons for mortality and morbidity in older adults. However, despite adoption of prevention strategies, the number of falls in older adults has not declined. This study aimed to develop a questionnaire to assess fall prevention knowledge and explore associated factors among Chinese community-dwelling older adults.MethodsThe Home-Based Fall Prevention Knowledge (HFPK) questionnaire was developed by Delphi expert consultation. We tested the internal consistency, reliability, and content validity of the HFPK. A total of 374 community-dwelling older adults participated in this study. The HFPK was used to assess their fall prevention knowledge.ResultsAfter being evaluated by 15 experts, the item content validity index ranged from 0.867 to 1, and the scale content validity index was 0.985, which met the criterion for content validity. Cronbach’s α coefficient was 0.933, which satisfied the reliability criterion. Stepwise linear regression analysis showed that fall prevention knowledge was significantly associated with having higher education, being female, having a higher monthly income, people who were public officials before retirement, and having fewer children (p < 0.05).ConclusionFall prevention knowledge should be improved among older males and those with lower education, lower monthly income, people who were not public officials before retirement, and more children.

Associations of long-term exposure to community noise and traffic air pollution with cause-specific morbidities in older adults

Associations of long-term exposure to community noise and traffic air pollution with cause-specific morbidities in older adults

Short-term effects of exposure to ultrafine particles and black carbon on cause-specific morbidities in older adults in New York State

Short-term effects of exposure to ultrafine particles and black carbon on cause-specific morbidities in older adults in New York State

A cross-sectional study of factors associated with life satisfaction in Thai elderly

IntroductionAging raises wide-ranging issues within social, economic, welfare, and health care systems. Life satisfaction is regarded as an indicator of the quality of life which, in turn, is associated with mortality and morbidity in older adults.ObjectivesLife Satisfaction is a dimension of happiness and well-being which represents the quality of life in both literacy and every aspect of a person. The purpose of the article is to assess the level of life satisfaction and the factors associated with life satisfaction in old age.MethodsThis research was conducted in a cross-sectional study using 36 items from Satisfaction and Well-being of Elderly (Thai semi-structured in-depth interviews) tools to collect data. The population used in this study was Thai people over 60 and used multistage probability sampling, were held with 2000 elderly individuals from 13 health regions of Thailand.Results Of the 2000 samples, the overall life satisfaction was moderate (54.1%). Upon data analysis, ten categories were extracted. However, there are 7 factors that significantly influence the level of life satisfaction of the Thai elderly at p &lt; 0.05: Age, Occupation, Recreational activities, Revenue, Education level, Religious activities, and Social Support. Moreover, when tested with Pearson Correlation found that the relationship between and Thai brief screening for depression (2Q) was low correlated (r -0.121, P=0.000).ConclusionsAging should be foreseen and forethought to increase life satisfaction. The following can be effective in increasing life satisfaction in the elderly: Placing greater emphasis on spiritualism in life, employment of the elderly, and promoting positive leisure in the elderly.DisclosureNo significant relationships.

Functional status recovery trajectories in hospitalised older adults with pneumonia.

Background and objectivesPneumonia is associated with significant mortality and morbidity in older adults. We investigated changes in functional status over 6 months after pneumonia hospitalisation by frailty status.Methods and measurementsThis single-centre prospective cohort study enrolled 201 patients (mean age 79.4, 37.3% women) who were hospitalised with pneumonia. A deficit-accumulation frailty index (range: 0–1; robust <0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, severely frail ≥0.45) was calculated on admission. Functional status, defined as self-reported ability to perform 21 activities and physical tasks independently, was measured by telephone at 1, 3 and 6 months after discharge. Group-based trajectory model was used to identify functional trajectories. We examined the probability of each trajectory based on frailty levels.ResultsOn admission, 51 (25.4%) were robust, 43 (21.4%) pre-frail, 40 (20.0%) mild-to-moderately frail and 67 (33.3%) severely frail patients. Four trajectories were identified: excellent (14.4%), good (25.4%), poor (28.9%) and very poor (31.3%). The trajectory was more strongly correlated with frailty level on admission than pneumonia severity. The most common trajectory was excellent trajectory (59.9%) in robust patients, good trajectory (74.4%) in pre-frail patients, poor trajectory (85.0%) in mild-to-moderately frail patients and very poor trajectory (89.6%) in severely frail patients. The risk of poor or very poor trajectory from robust to severely frail patients was 11.8%, 25.6%, 92.5% and 100%, respectively.ConclusionsFrailty was a strong determinant of lack of functional recovery over 6 months after pneumonia hospitalisation in older adults. Our results call for hospital-based and post-acute care interventions for frail patients.

Geroscience-guided repurposing of FDA-approved drugs to target aging: A proposed process and prioritization.

Common chronic diseases represent the greatest driver of rising healthcare costs, as well as declining function, independence, and quality of life. Geroscience‐guided approaches seek to delay the onset and progression of multiple chronic conditions by targeting fundamental biological pathways of aging. This approach is more likely to improve overall health and function in old age than treating individual diseases, by addressing aging the largest and mostly ignored risk factor for the leading causes of morbidity in older adults. Nevertheless, challenges in repurposing existing and moving newly discovered interventions from the bench to clinical care have impeded the progress of this potentially transformational paradigm shift. In this article, we propose the creation of a standardized process for evaluating FDA‐approved medications for their geroscience potential. Criteria for systematically evaluating the existing literature that spans from animal models to human studies will permit the prioritization of efforts and financial investments for translating geroscience and allow immediate progress on the design of the next Targeting Aging with MEtformin (TAME)‐like study involving such candidate gerotherapeutics.

Interface of Law and Psychiatric Problems in the Elderly.

Interface of Law and Psychiatric Problems in the Elderly.

Risk of overactive bladder associated with cholinesterase inhibitors in dementia

Although cholinesterase inhibitors (ChEIs) are the primary treatment for dementia, they are associated with overactive bladder (OAB), necessitating antimuscarinic use. Limited data exist regarding the risk of OAB across individual ChEIs in dementia. This study evaluated the risk of OAB associated with individual ChEIs in older adults with dementia. This was a new user retrospective cohort study using Medicare claims data involving Parts A, B, and D claims dataset from 2013 to 2015. The study included older adults (aged 65 and older) with a diagnosis of dementia using donepezil, galantamine, or rivastigmine. New ChEI claims were identified with a 6-month baseline washout period. Patients with OAB diagnosis or any antimuscarinic or mirabegron use in the baseline period were excluded. The primary outcome of interest was OAB diagnosis or prescription of antimuscarinics or mirabegron within 6 months of ChEI initiation. Multivariable cox proportional hazards regression with propensity scores (PS) as covariates and inverse probability of treatment weighting generated using generalized boosted models was used to assess the risk of OAB among donepezil, galantamine, and rivastigmine users. The study included 524,975 older adults with dementia who were incident users of ChEIs (donepezil 80.72%, rivastigmine 16.41%, galantamine 2.87%). Overall, OAB diagnosis/antimuscarinic/mirabegron prescription was observed in 5.07% of the cohort within 6 months of ChEIs prescription. The Cox regression model with PS as covariate approach found that donepezil use increased the risk of OAB compared to rivastigmine (aHR, 1.13; 95% CI, 1.08-1.28; p < 0.0001). However, there was no differential risk of OAB between galantamine and rivastigmine. The findings were consistent with the generalized boosted models. The study found that the risk of OAB varies across individual ChEIs with an increased risk of OAB with donepezil compared to rivastigmine. The study findings suggest the need to understand and manage medication-related morbidity in older adults with dementia.

Persistent eosinopenia is associated with in-hospital mortality among older patients: unexpected prognostic value of a revisited biomarker

IntroductionInfection is one of the major causes of mortality and morbidity in older adults. Available biomarkers are not associated with prognosis in older patients. This study aimed to analyze the value of eosinopenia (eosinophil count< 100/mm3) as a prognosis marker among older patients with suspected or confirmed bacterial infection.MethodsA retrospective study was performed from 1 January to 31 December 2018 among patients in a geriatrics ward suffering from a bacterial infection treated with antibiotics. Biomarker data including the eosinophil count, neutrophil count and C-reactive protein (CRP) were collected within 4 days after patient diagnosis. Persistent eosinopenia was defined as a consistent eosinophil count< 100/mm3 between Day 2 and Day 4. The association of biomarkers with 30-day hospital mortality in a multivariate analysis was assessed and their predictive ability using the area under the ROC curve (AUC) was compared.ResultsOur study included 197 patients with a mean age of 90 ± 6 years. A total of 36 patients (18%) died during their stay in hospital. The patients who died were more likely to have persistent eosinopenia in comparison to survivors (78% versus 34%, p < 0.001). In the multivariate analysis, persistent eosinopenia was associated with in-hospital mortality with an adjusted HR of 8.90 (95%CI 3.46–22.9). The AUC for eosinophil count, CRP and neutrophil count between Day 2 and Day 4 were 0.7650, 0.7130, and 0.698, respectively.ConclusionPersistent eosinopenia within 4 days of diagnosis of bacterial infection appeared to be a predictor of in-hospital mortality in older patients.

Swallowing difficulty in the older adults: presbyphagia or dysphagia with sarcopenia?

Oropharyngeal dysphagia is an important cause of mortality and morbidity in older adults. It has been reported in the literature that 11-68% of older adults experience swallowing difficulties. This study aimed to investigate the presence of dysphagia in older adults, whether this dysphagia is related to age (presbyphagia) or sarcopenia by comparing it with adults. Two hundred twenty-five patients were included in this cross-sectional study. The participants were divided into two groups by age as 'adults' and 'older adults'. Sarcopenia, dysphagia and malnutrition evaluations were performed. Older adult and adult groups were compared in terms of malnutrition, dysphagia and sarcopenia. The number of patients with dysphagia was significantly higher (P = 0.007) in the older adults. In older adults, all sarcopenic evaluation parameters were found significantly lower than adults (P < 0.05). The number of older adults with malnutrition was significantly lower in patients with normal swallowing (P < 0.05). The swallowing difficulty can be detected in older adults even if it does not cause any complaint. While most swallowing disorders may be due to age-related changes, about a third may be accompanied by sarcopenia.

Self-reported health and life satisfaction in older emergency department patients: sociodemographic, disease-related and care-specific associated factors

BackgroundSelf-reported health (SRH) and life satisfaction (LS) are patient-reported outcomes (PROs) that independently predict mortality and morbidity in older adults. Emergency department (ED) visits due to serious health problems or accidents might pose critical life events for patients. This study aimed (a) to characterize older patients’ SRH and LS during the distinct event of an ED stay, and (b) to analyze concomitant associations of PROs with ED patients’ sociodemographic, disease-specific and care-related variables.MethodsStudy personnel recruited mostly older ED patients from three disease groups during a two-year period (2017–2019) in eight EDs in central Berlin, Germany, in the context of the health services research network EMANet. Cross-sectional data from the baseline patient survey and associated secondary data from hospital information systems were analyzed. Multilevel linear regression models with random intercept were applied to assess concomitant associations with SRH (scale: 0 (worst) to 100 (best)) and LS (scale: 0 (not at all satisfied) to 10 (completely satisfied)) as outcomes, including sensitivity analyses.ResultsThe final sample comprised N = 1435 participants. Mean age was 65.18 (SD: 16.72) and 50.9% were male. Mean ratings of SRH were 50.10 (SD: 23.62) while mean LS scores amounted to 7.15 (SD: 2.50). Better SRH and higher LS were found in patients with cardiac symptoms (SRH: β = 4.35, p = .036; LS: β = 0.53, p = .006). Worse SRH and lower LS were associated with being in need of nursing care (SRH: β = − 7.52, p < .001; LS: β = − 0.59, p = .003) and being unemployed (SRH: β = − 8.54, p = .002; LS: β = − 1.27, p < .001). Sex, age, number of close social contacts, and hospital stays in the previous 6 months were additionally related to the outcomes. Sensitivity analyses largely supported results of the main sample.ConclusionsSRH and LS were associated with different sociodemographic and disease-related variables in older ED patients. Nursing care dependency and unemployment emerged as significant factors relating to both outcomes. Being able to identify especially vulnerable patients in the ED setting might facilitate patient-centered care and prevent negative health outcomes. However, further longitudinal research needs to analyze trajectories in both outcomes and suitable intervention possibilities in the ED setting.Trial registrationEMANet sub-studies were registered separately: German Clinical Trials Register (EMAAge: DRKS00014273, registration date: May 16, 2018; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014273; EMACROSS: DRKS00011930, registration date: April 25, 2017; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011930); ClinicalTrials.gov (EMASPOT: NCT03188861, registration date: June 16, 2017; https://clinicaltrials.gov/ct2/show/NCT03188861?term=NCT03188861&draw=2&rank=1).

COVID-19-associated cardiovascular morbidity in older adults: a position paper from the Italian Society of Cardiovascular Researches

COVID-19-associated cardiovascular morbidity in older adults: a position paper from the Italian Society of Cardiovascular Researches

Fall Patterns Are Independent Risk Factors for Mortality After Hip Fracture in Older Adults

Abstract Hip fracture is becoming a major health problem with high mortality and morbidity in older adults. However, whether specific fall patterns could act as independent risk factors for predicting mortality after hip fracture remains unknown. We aimed to investigate whether fall patterns can serve as an independent risk factor for mortality after hip fracture. Electronic medical records (EMR) of individuals who visited emergency room or admitted to the Severance hospital, Seoul, Korea, between January 2005 to December 2019 were reviewed to categorize fall patterns. Fall patterns were categorized upon review of explanatory description in EMR, using modified classification based on motion analysis of video-captured falls in a prior study. Among 1,991 study subjects (mean age 77 years, 71% women), 211 patients died (10.6%; median survival 296 days). Fall location was divided into home (67.4%) and outdoor (32.6%) with mortality rate of 11.9% and 8.0% (p=0.009), respectively. Fall patterns were specified by “cause of fall” (6 categories; slip [29.6%], trip or stumble [17.5%], etc.) and by “activity at time of fall” (6 categories; walking [54.8%], getting up or rising [14.1%], etc). Among the combinations of both causes and activities, individuals who sustained hip fracture during “incorrect weight shift while sitting down or lowering”(hazard ratio [HR] 3.35, p=0.003), “collapsed during unclassified activity”(HR 2.37, p=0.006), “incorrect weight shift while getting up or rising”(HR 2.13, p=0.003), and “slipped while walking”(HR 1.83, p=0.004) had increased mortality after hip fracture compared to those with outdoor falls, after adjustment for age, sex, and Charlson comorbidity index. Specific fall patterns in individuals who sustained hip fracture predicted excess mortality in older adults, independent of age, sex, and comorbidities. Acknowledgement: We thank Doori Cho of the the SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform) team (4-2018-1215) for the data acquisition process. Conflict of Interest: SB, NH, and YR have nothing to declare.