Correction: Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

[This corrects the article DOI: 10.1371/journal.pone.0194967.].

Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

BACKGROUND: Despite the number of studies that have tried to demonstrate that there is an association between previous falls and the fear of falling, the relationship between these two variables remains a matter of controversy. OBJECTIVES: Our objective was to investigate whether the fear of falling is a cause of falls, a consequence, or both in community-dwelling adults aged ≥ 75 years old. METHODS: A descriptive, longitudinal, prospective study was performed. A total of 640 individuals were interviewed between 2009 and 2011. Sociodemographic data, health status, history of falls and fear of falling were assessed at baseline and at 24 months. RESULTS: The prevalence of falls at baseline was 25% as opposed to 35.2% at 24 months. The prevalence of the fear of falling was 41.5% at baseline. Logistic regression analysis showed a significant association between a history of falls and the fear of falling. Other factors associated with the fear of falling were female gender, comorbidity, depressive symptoms, and disability. In total, 41.7% of the subjects who had reported a fear of falling at baseline had suffered at least one fall 24 months later. Unadjusted Cox regression analysis revealed that the fear of falling was a risk factor for falls. According to the final model adjusted for other covariates, the only reliable predictor was female gender. The Cox model stratified by gender failed to show a crude association between fear of falling and falls. CONCLUSION: A previous history of falls in the previous year was a good predictor of the fear of falling; but the fear of falling was a predictor of falls during follow-up only in the unadjusted model, pointing to strong gender turns out as an effect modifier of the association of FOF and subsequent falls. Nursing staff working in elderly care should not only routinely assess patients' previous history of falls, but also evaluate their fear of falling and its associated factors.

Differences in fitness level between women aged 60 and over participating in three different supervised exercise programs and a sedentary group.

The aim of this study was to compare fitness levels in women aged 60 and over participating in a supervised exercise program (involving tai chi, recreational gymnastics, and/or aquatic fitness) with those in a sedentary group. An observational, descriptive, cross-sectional study was performed on a total of 171 women aged from 60 to 92 who attended public community clubs for older adults. The instruments used included the Senior Fitness Test, the Tinetti Balance Assessment Tool, the Katz Index, and the Lawton & Brody Activities of Daily Living Scale. Significant differences in fitness levels were observed when we compared the exercise groups with the sedentary group. Women with better fitness levels had a lower risk of suffering falls and greater autonomy in performing activities of daily living and instrumental activities of daily living. Agility and gait control were found to be independently associated with exercise groups.

[Effectiveness of physical exercise on fitness in frail older adults: A systematic review of randomised trials]. / El ejercicio físico y su efectividad sobre la condición física en personas mayores frágiles. Revisión sistemática de ensayos clínicos aleatorizados.

Performing exercise to maintain a good physical condition is crucial to improve and prevent frailty in older adults. The aim of this review was to assess the beneficial effects of physical exercise on fitness in frail older adults. A thorough literature search of randomised clinical trials (RCT) in the last 15 years was performed on different electronic databases. The methodological assessment of studies was obtained using the PEDro scale. Ten RCT were included, providing a final sample of 1,130 individuals. Scores on the PEDro scale ranged from 5 to 8/10. Multicomponent training programs seem to be the best strategy to improve fitness outcomes. Further studies should be performed in order to optimise the design of supervised exercise programs, and further research is needed in hospital and institutionalised settings.

[Frailty as a predictor of mortality in a cohort of people aged 75 years and older]. / La fragilidad como predictora de mortalidad en una cohorte de edad avanzada.

OBJECTIVE: To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012. METHODS: We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months). RESULTS: Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank=10.56; p=0.005). In addition to frailty (HR=4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR=2.87; 95%CI: 1.02-8.26). CONCLUSION: A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida.

[Association between Mini Nutritional Assessment and the Fried frailty index in older people living in the community]. / Asociación entre el Mini Nutritional Assessment y el índice de fragilidad de Fried en las personas mayores que viven en la comunidad.

BACKGROUND AND OBJECTIVE: To assess the association between Mini Nutritional Assessment (MNA) and the Fried frailty index in older people living in the community. MATERIAL AND METHOD: Cross-sectional study of individuals aged 75 and over living in the community. VARIABLES: nutritional status measured by Mini Nutritional Assessment Short Form (MNA-SF) and MNA, and frailty measured by Fried's frailty criteria. RESULTS: The sample consisted of 640 individuals with a mean age of 81.3±5.0 years; 39.7% were men. According to the MNA-SF, 76.9% of patients were well nourished, 19.8% were at risk of malnutrition and 1.9% were malnourished, while percentages were 78.1, 19.6 and 2.3%, respectively, according to the MNA. According to Fried criteria, 43.4% were not frail, 47% were pre-frail and 9.6% were frail. The largest proportion of frail subjects were at risk of malnutrition. The higher the score of MNA components, the higher was the frailty index. Likewise, there was a significant association between the 5 frailty criteria and the categories of MNA and MNA-SF. The area under the ROC curve for the MNA-SF was 0.75 while for the MNA it was 0.80. CONCLUSIONS: The results presented show a clear association between Mini Nutritional Assessment and Fried's criteria. They also suggest that the "nutritional risk" MNA category is the one most strongly associated with the Fried's frailty index.

[Prevalence and factors associated with suspected mistreatment in a geriatric unit in a hospital emergency area]. / Prevalencia y factores asociados a sospecha de malos tratos en la unidad geriátrica del área de urgencias del hospital.

OBJECTIVE: To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area. METHODS: Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency. RESULTS: Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone. CONCLUSIONS: Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly.

Prevalence of frailty and factors associated with frailty in the elderly population of Lleida, Spain: the FRALLE survey.

The aim of this study was to assess the prevalence of frailty and to identify factors associated with frailty in older people living in the community through a cross-sectional study of community-dwelling persons age 75 and older. A total of 640 individuals were interviewed using the FRALLE survey between 2009 and 2010. This survey measures frailty through the five Fried criteria, and through questions on sociodemographics, health habits, health status, social relations and data on health-related quality of life. The mean age of the participants was 81.3 ± 5.0; 39.7% were men. The prevalence of frailty was 9.6% (95% confidence interval (CI): 7.6-11.5) and that of pre-frailty was 47% (95% CI: 42.7-51.2). After the logistic regression, age (over 85 years) (odds ratio (OR): 3.61; 95% CI: 1.65-7.91; p<0.001), depressive symptoms (OR: 3.13; 95% CI: 1.37-7.13; p=0.0006), comorbidity (OR: 5.20; 95% CI: 1.78-15.16; p=0.0002), cognitive impairment (OR: 3.22; 95% CI: 1.48-7.02; p=0.0003), poor social ties (OR: 0.57; 95% CI: 0.43-0.77; p<0.001) and poor physical health (OR: 0.98; 95% CI: 0.97-0.98; p<0.001) were significantly associated with frailty. There is great variability in the prevalence of frailty depending on the study considered. The lack of homogeneity in the measurement of the five criteria, the age of participants and the degree of dependence could explain the differences observed. Here, the factors associated with frailty were age, comorbidity, cognitive impairment and depressive symptoms, while the diversity of social interaction and health-related physical function were protective factors.

High rates of malnutrition in older adults receiving different levels of health care in Lleida, Catalonia: an assessment of contributory factors.

The aim of this study was to define the factors associated with the presence or risk of malnutrition in older adults (>65 years of age) attending health care centers in Lleida, Catalonia, using a cross-sectional study approach. Nutritional parameters assessed included the Mini Nutritional Assessment Scale, sociodemographic and psychosocial factors, functional and cognitive status, swallowing and oral problems, texture and route of administration of the diet, changes in dietary intake, and presence of digestive disorders. A total of 398 individuals (184 men) with an average age of 77 years were included in the assessment. Poor nutritional status was recorded in 58% of the individuals. Factors independently associated with unsatisfactory nutritional status included weight loss, functional dependence, cognitive impairment, loneliness, living without a partner, history of heart disease, lung disease, and the presence of acute vomiting.