Racial/Ethnic Differences in the Longitudinal Effects of Fear of Falling on Falls.

INTRODUCTION: Recent evidence suggests that the effects of fear of falling on falls may differ by race/ethnicity. This study investigated whether race/ethnicity (white, black, and Hispanic) moderated the longitudinal effects of fear of falling on the incidence of falling and having a repeated fall among community-dwelling older adults. METHODS: We used data from 2011 to 2018 of the National Health and Aging Trends Study (NHATS). These included a total of 19,516 person-intervals from 5,113 respondents. Any self-reported fall in the past year was the outcome variable with baseline fear of falling as the predictor and race/ethnicity as the moderator. Covariates included self-reported sociodemographic information, probable depression, chronic conditions, functional impairment, pain, insomnia symptoms, the Clock Drawing Test, the Short Physical Performance Battery, and grip strength. RESULTS: Among respondents who had no experience of falling at baseline, baseline fear of falling increased the odds of having a new onset of fall at 1-year follow-up significantly among blacks, compared to whites (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.44-2.38). No significant difference was found for Hispanics. Among respondents who already fell at baseline, baseline fear of falling increased the odds of having a repeated fall at 1-year follow-up significantly among Hispanics, compared to whites (OR = 1.91, 95% CI = 1.06-3.44). No significant difference was found for blacks. CONCLUSIONS: Clear evidence of racial/ethnic differences was found in the relationship between fear of falling and falls among community-dwelling older adults in the USA. Special attention should be paid to black older adults with a fear of falling but have not fallen down recently and Hispanics with fear of falling and have fallen in the past year. Readily available educational programs should be actively advertised to older adults to reduce the fear of falling, and at the same time, culturally tailored educational programs should be developed for older adults from racial/ethnic minority backgrounds.

The Effects of the A Matter of Balance Program on Falls and Physical Risk of Falls, Tampa, Florida, 2013.

INTRODUCTION: This study investigated the effects of the A Matter of Balance (MOB) program on falls and physical risk factors of falling among community-dwelling older adults living in Tampa, Florida, in 2013. METHODS: A total of 110 adults (52 MOB, 58 comparison) were enrolled in this prospective cohort study. Data on falls, physical risk of falling, and other known risk factors of falling were collected at baseline and at the end of the program. Multivariate analysis of covariance with repeated measures and logistic regressions were used to investigate the effects of this program. RESULTS: Participants in the MOB group were less likely to have had a fall and had significant improvements in their physical risk of falling compared with adults in the comparison group. No significant effects of the MOB program on recurrent falls or the number of falls reported were found. CONCLUSION: This study contributes to our understanding of the MOB program and its effectiveness in reducing falls and the physical risk of falling among older adults. The findings support extended use of this program to reduce falls and physical risk of falling among older adults.

Predictors of falls among community-dwelling older adults with cancer: results from the health and retirement study.

PURPOSE: Cancer symptoms and the side effects of its treatment can increase the risk of falling among older adults with cancer. This study aimed to identify predictors of falling and recurrent falls among community-dwelling older adults with cancer over a 2-year period. METHODS: Data from the Health and Retirement Study were used (N = 1,630) in this study. The sample had a mean age of 75 years and was mostly female (53 %) and white (89 %). Descriptive analyses, correlation analyses, and logistic regressions were used to analyze the data. RESULTS: The results showed that functional limitations (OR = 1.13, 95 % CI = 1.03-1.24), the full-tandem stance (OR = 1.48, 95 % CI = 1.01-2.16), and self-reported difficulties with balance (OR = 1.50, 95 % CI = 1.23-1.83) at time 1 were significant predictors of falling at time 2. Only difficulties with self-reported balance (OR = 1.84, 95 % CI = 1.44-2.36) at time 1 were found to be a predictor of recurrent falls at time 2. CONCLUSIONS: The consequences of falling can complicate the course of cancer treatment. Measures of functional limitations and balance have the potential to be quick and useful clinical tools to detect falling among seniors with cancer living in communities.

Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults.

INTRODUCTION: A greater fear of falling predicts disability, falls, and mortality among older adults. Although poor sleep has been identified as a relevant risk factor for fear of falling among older adults, evidence is primarily shown in cross-sectional studies using isolated sleep characteristics. Less is known about whether prior fall experiences change the sleep health-fear of falling link among older adults. We investigated the longitudinal relationship between sleep health and the incidence of fear of falling among community-dwelling older adults and how the association differed between those with or without prior fall experiences. METHODS: Data were from individuals who completed the sleep module in the National Health and Aging Trends Study (2013-2014; n = 686). Fear of falling was assessed with a single item. Multidimensional sleep health was measured with self-reported sleep items based on the SATED model (ie, sleep satisfaction, daytime alertness, timing, efficiency, and duration). Covariates included sociodemographics, assistive device usage, health, risky behavior, and sleep medications. Multiple logistic regression was used to analyze the data. RESULTS: Poor sleep health was associated with the onset of fear of falling at 1-year follow-up (odds ratios=1.20, 95% confidence interval=1.02-1.41). Moreover, poor sleep health increased the odds of having fear of falling among individuals without prior falls experiences and elevated the already heightened risks of developing fear of falling among those who fell at baseline. CONCLUSIONS: Given that fear of falling and experiencing a fall each increase the risk of the other occurring in the future, improving sleep health may prevent older adults from stepping into the vicious cycle of fear of falling and falls.

Falls among community-dwelling older adults in the Philippines and Viet Nam: Results from nationally representative samples.

Falls are a significant public health issue globally. However, studies with nationally representative samples have yet to be done to understand falls among older adults in the Philippines and Viet Nam. Using a biopsychosocial perspective, this study investigated the prevalence of falls and their associated factors among community-dwelling older adults in these countries. Cross-sectional data were drawn from the baseline survey of the Longitudinal Study of Ageing and Health in the Philippines (2018, N = 4,606) and the Longitudinal Study of Ageing and Health in Viet Nam (2018, N = 4,378). The outcome variables were any falls in the past year. Independent variables included sociodemographic factors (age, sex, education, living in urban areas, living alone, social network size), biophysical factors (vision, chronic conditions, functional impairments, pain locations, insomnia symptoms, sleep medications, grip strength, walking speed, postural control), and psychological factors (depressive symptoms). Descriptive analysis and logistic regression analysis were used to analyze the data. The results showed that 17.7 % and 7.3 % of older Filipino and Vietnamese adults fell in the year before the study. Significant factors associated with the odds of any falls among Filipino older adults were having a higher level of education, living in urban areas, living with others, experiencing more functional impairments, reporting one or more pain locations, and having poor grip strength. In Viet Nam, having more chronic conditions, experiencing more functional impairments, and reporting two or more pain locations were found to be associated with higher odds of any falls. The population in the Philippines and Viet Nam is aging rapidly. Findings from this study are timely in identifying at-risk individuals and preparing for effective fall prevention strategies.

Sex differences in the risk factors of disability among community-dwelling older adults with hypertension: Longitudinal results from the Health, Aging, and Retirement in Thailand study (HART).

Background: Hypertension poses a serious health problem among Thai older adults which could subsequently lead to disability. However, little to no research has been conducted to understand modifiable risk factors of disability among community-dwelling older adults with hypertension in Thailand. In addition, sex is an important social determinant of health, but its role in disability among older adults with hypertension is less clear. Objectives: This study focused on community-dwelling older adults with hypertension in Thailand and investigated predictors of disability and examined sex differences in the risk factors that were associated with disability in this population. Methods: Longitudinal data were from the Health, Aging, and Retirement in Thailand (HART) survey (2015-2017; N = 916). The outcome variable was difficulty with the activity of daily living at follow-up. Potential risk factors included sociodemographic information, health behaviors/health status, and disability at baseline. Descriptive analysis and logistic regression analysis were employed to analyze the data. Results: Most of the participants were female and between aged 60 and 69 years old. Being in an older age group (OR = 1.78, 95% CI: 1.07-2.97, p < 0.05), having more chronic conditions (OR = 1.38, 95% CI: 1.10-1.73, p < 0.01), experiencing obesity (OR = 2.02, 95% CI: 1.11-3.69, p < 0.05), and having disability at baseline (OR = 2.42, 95% CI: 1.09-5.37, p < 0.05) significantly predicted disability at 2 year follow-up among community-dwelling Thai older adults with hypertension. The effects of these risk factors on disability at follow-up did not differ by sex. However, different risk factors of disability were observed across sexes. Conclusion: The situations of disability among older adults with hypertension in Thailand are likely to aggravate due to the rapid aging of the population. Our analysis provided useful information regarding significant predictors of disability and sex-specific risk factors of disability. Tailored promotion and prevention programs should be readily available to prevent disability among community-dwelling older adults with hypertension in Thailand.

Nutritional Status Predicts Injurious Falls Among Community-Dwelling Older Adults: Does Sex Matter?

The association of poor nutritional status with falls-related injuries other than fractures is unclear. Although there are sex differences in poor nutritional status and the rate of falls-related injuries, whether the impacts of poor nutritional status on falls-related injuries differ by sex is unclear. We investigated whether baseline poor nutritional status predicted injurious falls, fall-related minor injuries, and fractures at 3-year follow-up and whether these relationships differed by sex among community-dwelling older adults (N = 3257). We found that being at risk of malnutrition at baseline significantly predicted injurious falls but not minor injuries and fractures at follow-up. Compared to older males at risk of malnutrition at baseline, females at risk of malnutrition were significantly more likely to have injurious falls and minor injuries later. Being at risk of malnutrition predicted injurious falls, especially among older females. Regular nutritional screenings among older females should be implemented to provide prompt interventions against falls.

Gardening as a potential activity to reduce falls in older adults.

This study examines whether participation in gardening predicts reduced fall risk and performance on balance and gait-speed measures in older adults. Data on adults age 65 and older (N = 3,237) from the Health and Retirement Study and Consumption and Activities Mail Survey were analyzed. Participants who spent 1 hr or more gardening in the past week were defined as gardeners, resulting in a total of 1,585 gardeners and 1,652 nongardeners. Independent t tests, chi square, and regression analyses were conducted to examine the relationship between gardening and health outcomes. Findings indicate that gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardeners. Significantly fewer gardeners than nongardeners reported a fall in the past 2 yr. The findings suggest that gardening may be a potential activity to incorporate into future fall-prevention programs.

Data Privacy, Regulations and Legal Issues on COVID-19 Tracking Apps: A Scoping Review.

It cannot be deniable that smartphone apps have grown exponentially and are playing a crucial role in the response to the COVID-19 pandemic in many countries. This paper aims to investigate data privacy, regulations and legal issues on COVID-19 tracking apps. A literature search will be followed the PRISMA guidelines extension for a scoping review. The search will be conducted on PubMed and Google Scholar. A total of 38 articles from 7,626 articles were reviewed. Mostly articles report on data privacy. Not many articles report on regulations and legal issues. However, there are many challenges on COVID-19 applications such as security risks, privacy issues, political, ethical, and legal risks, and standardization issues.

The Wellness Center in Public Hospitals in Thailand: A Qualitative Assessment Using RE-AIM Model.

Non-communicable diseases (NCDs) become one of serious health issues globally including Thailand. The Wellness Center was introduced by the Ministry of Public Health (MOPH) in public hospitals since 2018 for both healthy people and people who at risk for NCDs. It incorporates risk evaluation, health assessment, health behaviors changing, health promotion and prevention, and health record system to follow participant's health status. This study aimed to evaluate the Wellness Centers in three public hospitals in Thailand using RE-AIM framework. Findings indicated that the Wellness Centers successful reached its target groups. Although sample size was small, the findings provided a positive outcome. Besides, the average weight and Body Mass Index (BMI) had reduced significantly after participants attending both services of Wellness Centers. However, there were some challenges from this program such as financial sustainability, performance indicator, and data system.

Multidimensional sleep health is associated with physical frailty in a national sample of Taiwanese community-dwelling older adults: Sex matters.

OBJECTIVES: Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty both across and within sex groups. DESIGN: Data were from the Taiwan Longitudinal Study on Aging (2011), a survey with a nationally representative sample of Taiwanese older adults (N = 2,015). Frailty was defined using the Fried criteria. Self-reported sleep during the past month was used to conceptualize the five sleep health dimensions in the SATED model. Their relationship was estimated using logistic regression analysis adjusting for sociodemographic characteristics (age, sex, education), health status (comorbidity, cognitive function, pain, depressive symptoms [excluding items overlapping with frailty and sleep]), and health risk behaviors (drinking, smoking, lack of exercise). RESULTS: Having a better sleep health composite score was significantly related to lower odds of being frail in both sexes adjusting for sociodemographic characteristics. This association remained significant among women but not among men after adding health and risk behaviors to the models. Satisfaction and alertness in both sexes and duration among women were significantly associated with frailty adjusting for sociodemographic characteristics. Only alertness among men was significantly related to frailty in the model with all covariates. CONCLUSIONS: Our findings show that having better sleep health across multiple dimensions is related to a lower risk of being frail, with differential risks for women and men.

Work-family balance self-efficacy and work-family balance during the pandemic: A longitudinal study of working informal caregivers of older adults.

The measures against the coronavirus disease (COVID-19) pandemic, such as lockdown, pose a major challenge to those who manage work and caregiving demands. Drawing on social cognitive theory, which emphasizes the critical role of self-referent thought and human agency in overcoming obstacles and striving toward goals, the present longitudinal study (prepandemic, during lockdown, and postlockdown) investigated work-family balance self-efficacy (WFBSE) and work-family balance (WFB) among working informal caregivers of older adults (i.e., those who manage paid work and informal eldercare) during the COVID-19 pandemic (N = 132). As hypothesized, prepandemic WFBSE was positively associated with the level of WFB during lockdown. Prepandemic WFBSE also mitigated the relationship between perceived work demands and WFB as well as the relationship between perceived difficulty to use technology for caregiving and WFB during lockdown. Prepandemic WFBSE, however, did not buffer the relationship between perceived caregiving demands and WFB and the relationship between perceived difficulty to use technology for work and WFB. We also observed that WFB during lockdown was associated with increased postlockdown WFBSE. Collectively, our research reiterates the relevance and utility of self-efficacy in the crisis context and provides empirical evidence for the proposition that positive changes may occur in the face of adversity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal effects of nocturnal insomnia symptom subtypes and nonrestorative sleep on the incidence of depression among community-dwelling older adults: results from the Health and Retirement Study.

OBJECTIVE: The relationships between different insomnia symptom subtypes and the onset of depression among older adults are inconsistent. It may be that each subtype has a distinct temporal effect on depression not easily captured by the different follow-up intervals used in past studies. We systemically investigated the temporal effects by examining the links between subtypes and the onset of depression at different follow-up intervals among community-dwelling older adults. METHODS: We used the 2006 wave of the Health and Retirement Study as baseline (n = 9151). The outcome was the onset of depression at 2-year (2008 wave), 4-year (2010 wave), and 6-year (2012 wave) follow-ups. The independent variables were difficulty with falling asleep (initial insomnia), waking up during the night (middle insomnia), waking up too early and being unable to fall asleep again (late insomnia), and nonrestorative sleep at baseline. Factors known to be related to depression among older adults were included as covariates. RESULTS: Our findings showed that each insomnia symptom subtype had distinct temporal effects on the onset of depression. It appeared that the effects of initial insomnia may take longer to emerge than indicated in previous studies. Middle insomnia and late insomnia had weak relationships with depression. Nonrestorative sleep predicted the onset of depression at every follow-up period. CONCLUSIONS: We found that documenting the temporal effects of insomnia symptom subtypes helps both to classify individuals' insomnia symptoms and predict the onset of depression. We recommend taking temporal effects of insomnia symptom subtypes into account in future investigations and clinical practice.

A 2-Year Longitudinal Relationship Between Work-Family Conflict and Health Among Older Workers: Can Gardening Help?

With the graying workforce worldwide, identifying factors that facilitate older workers' health is critically important. We examined whether gardening mitigates the relationship of work-family conflict with disability, chronic conditions, depressive symptoms, and self-rated health among older workers. We drew a subsample of older workers aged 55 years and above from the Health and Retirement Study (N = 1,598). Our results indicate that the relationships of work-to-family conflict at baseline with disability and with poorer self-rated health at a 2-year follow-up were stronger for those who gardened less than those who gardened more. No significant interaction was found between family-to-work conflict and gardening in predicting the health outcomes. This study is the first to show that gardening may have a protective effect against the adverse impact of work-to-family conflict on older workers' health.

The bidirectional relationships between effort-reward imbalance and sleep problems among older workers.

BACKGROUND: Sleep problems are common among working individuals. A growing body of research has documented that effort-reward imbalance (ERI) predicts poor sleep outcomes. OBJECTIVE: Extending this literature, we investigated the bidirectional relationship between ERI and sleep problems; for each direction, we tested predictor's baseline level and its changes over time. DATA: We drew a subsample of older workers aged 55 years and older from the Health and Retirement Study (N=860). DESIGN: We examined whether baseline ERI and ERI changes predict sleep problems at follow-up. In parallel, we examined whether baseline sleep problems and sleep problem changes predict ERI at follow-up. RESULTS: For the ERI-to-sleep-problems direction, baseline ERI predicted the experience of any sleep problems at follow-up. The odds of experiencing sleep problems at follow-up was higher among respondents who consistently perceived ERI over the 4-year compared with those who remain balanced. For the sleep-problems-to-ERI direction, baseline sleep problems predicted ERI at follow-up. Older workers who repeatedly reported sleep problems over the 4-year period had the greatest odds to perceive ERI at follow-up. CONCLUSION: ERI and sleep problems are reciprocally related among older workers. Both ERI and sleep problems change over time, hence considering their dynamic nature may provide additional insights.

Prevalence and Correlates of Falls Among Centenarians: Results from the Five-Country Oldest Old Project (5-COOP).

BACKGROUND: Many studies have been conducted to investigate risk factors of falls in older people, but little is known about falls among centenarians. We analyzed the cross-sectional data from the Five-Country Oldest Old Project (5-COOP) to investigate the prevalence and correlates of falls among centenarians. METHODS: Data collection was carried out in 2011-2014 in Japan, France, Switzerland, Sweden, and Denmark. The sample consisted of 1,165 centenarians who were at least 100 years old in 2011. The outcome variable was falls in the past 6 months. Demographics, chronic conditions, pain, visual impairment, global cognitive function, dizziness and syncope, number of medications, functional limitation (ie, dressing, bathing, toileting, transferring, incontinence, and feeding), mobility difficulty, poor strength, and assistive device usage were included in the analysis. RESULTS: The prevalence of falls within the last 6 months was 33.7%, ranging from 21.6% (Japan) to 40.9% (France). Being male, experiencing dizziness, syncope, incontinence, and using assistive devices indoors were associated with an increased risk of falls among centenarians. Significant cross-country differences in the relationships between some risk factors (ie, gender, difficulty with bathing, toileting, transferring, and feeding, and using assistive devices for walking indoors and outdoors) and falls were observed. Subsample analysis using data from each country also showed that factors related to falls were different. CONCLUSIONS: The prevalence of falls among centenarians is high and fall-related factors may be different than those for their younger counterparts. Given that centenarians is an emerging population, more studies investigating risk factors are needed to better understand falls among centenarians.

Going Online to Stay Connected: Online Social Participation Buffers the Relationship Between Pain and Depression.

OBJECTIVES: Maintaining offline social participation (i.e., face-to-face social interaction) is key for healthy aging, but older adults who experience pain tend to restrict their social activity outside of the home. The onset of pain may set off a downward spiral where lowered social participation increases the risk of depression and vice versa. This study thus assesses whether online social participation (i.e., the use of online social network sites) moderates the effect of pain on depression, possibly functioning as a compensatory mechanism for reduced offline social participation for those in pain. METHOD: Logistic regression models with a lagged dependent variable were used with panel data from the National Health and Aging Trends Study. An interaction term was included to assess the moderating effect of online social participation. RESULTS: We find that online social participation buffers the detrimental effect of pain on depression. However, the effect of pain on online social participation was not statistically significant. DISCUSSION: Findings show that online social participation can alleviate the negative effects of pain on mental well-being, and suggest that online social participation can supplement attempts to maintain offline social participation in later life, especially for those whose social activity may be limited by pain.

Examination of the Psychometric Properties of the Geriatric Fear of Falling Measure Among Community-Dwelling Older Adults in the United States.

This current study investigated the construct validity and reliability of the Geriatric Fear of Falling Measure (GFFM) among community-dwelling older adults in the United States. Eighty-eight participants were assessed on the GFFM together with demographics, falls, and fear of falling and falls-efficacy measures at baseline and an 8-week follow-up visit. Cronbach's alpha, regression analyses, and correlation analyses were used to examine the psychometric properties of the GFFM. The results showed that the GFFM demonstrated good construct validity and reliability among community-dwelling older adults in the United States. Our findings provide evidence for the validity and reliability of the GFFM. Further study with a larger and diverse sample is needed to determine whether the GFFM has potential as a quick screening tool of fear of falling in clinical settings.

Longitudinal relationship between sleep deficiency and pain symptoms among community-dwelling older adults in Japan and Singapore.

The association of sleep with pain is well documented among adult populations. Even though both sleep problems and pain are prevalent in older adults, the longitudinal and bidirectional relationship between sleep deficiency (i.e. insufficient and poor sleep) and pain is less well established. This study investigated the association between sleep deficiency and pain among community-dwelling adults aged 65 years and older across a 2- to 3-year period. We analyzed cross-country data from the Nihon University Japanese Longitudinal Study of Aging (N = 2888) and the Panel on Health and Aging of Singaporean Elderly (N = 2111). Sleep deficiency was operationalized as self-reported short sleep duration (<6 hours), frequent restlessness during the night, and/or non-restorative sleep. Pain was characterized in terms of any pain, multiple pain locations, and pain-related disability. Demographics, smoking, nap duration, depressive symptoms, chronic conditions, and body mass index were included as covariates. Baseline sleep deficiency was associated with any pain, multiple pain locations, and pain-related disability among older adults at follow-up, although differences by country of residence were observed. In Singaporeans, sleep deficiency predicted the new onset of any pain, and any pain also predicted the new emergence of sleep deficiency. Improving sleep of older adults may improve pain-related symptoms and help intervene on the vicious cycle of pain and sleep deficiency.