Physiological and Cognitive Determinants of Gait Variability of Asian Population: The Yishun Study.

INTRODUCTION: Gait variability is associated with frailty, dementia, and falls. Studies on the association of physiological and cognitive factors with gait variability have seldom included middle-aged adults, even though these adults already experienced loss of muscular strength and postural stability. This study aimed a) to examine and compare the trend of gait variability in men and women, across the adult age spectrum, and b) to identify and compare the contributions of physiological and cognitive factors to gait variability. METHODS: This was a population-based cross-sectional study at a single center. A random sample of 507 community-dwelling, well-functioning adults aged 21-90 years were studied. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status. Physiological factors examined included visual contrast sensitivity (VCS), postural sway, hand reaction time, handgrip strength (HGS), knee extensor strength, and gait variability (coefficient of variation [CoV]). Multivariable regression models were used to examine the association between physiological and cognitive performance with gait CoV. RESULTS: Women walked with greater stride width CoV (p < 0.01) and double support time (DST) CoV (p < 0.01) than men. The stride width (p = 0.01) and DST variability (p = 0.03) were significantly higher in older men as compared to men in younger age-groups. Gait speed accounted for most of the gait CoV variances and attenuated the effects of physiological performance and/or attention cognition on most gait variability, except for CoV of DST and stride width. Adults with better VCS (ß = -0.19), faster hand reaction (ß = 0.12), and greater HGS (ß = -0.15) had lower variability in step length. CONCLUSION: The trends of stride width CoV and DST CoV across adult age spectrum were different between men and women. Greater stride width variability was partly attributed to greater HGS, possibly to better control lateral stability during walking. Physiological factors outweigh cognition in regulating most of the gait CoV in this study. They are modifiable and potential targets for healthy aging program.

An integrative care bundle to prevent surgical site infections among surgical hip patients: A retrospective cohort study.

BACKGROUND: Surgical site infections (SSIs) following hip fracture surgeries have profound clinical and economic implications. The study aims to analyze the effect of an integrative SSI prevention care bundle on the SSI incidence among surgical hip patients. The study also aims to examine the association between SSI and mortality, readmission, duration of hospitalization, and hospital cost. METHODS: A retrospective cohort study was carried out to assess the incidence of SSI in an acute hip unit in Singapore from January 2015 to September 2017. Patients who developed SSI fell into the exposure group, whereas patients without SSI fell into the nonexposure group. A comparison of the incidence of mortality, readmission, length of stay, and inpatient bill size was conducted between the 2 groups. RESULTS: Among 758 hip surgeries performed during the study period, 14 (1.8%) SSIs were documented. Compared with patients with no SSI, patients with SSI were 4.27times more likely to be readmitted within 30days, had 2.47times longer length of stay, and 2.15times the inpatient bill size. CONCLUSIONS: An integrative care bundle that capitalizes on the expertise of a multidisciplinary team has promoted shared responsibility and proven to be effective in preventing SSIs while contributing to better patient outcomes within the unit.