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2.
Medicine (Baltimore) ; 99(38): e22385, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957420

RESUMO

INTRODUCTION: Reduced bone mineral density and increased risk of falls are related with Alzheimer disease, and these increase likelihood of bone osteoporotic fractures causing serious complications such as disability, fear of falling, loss autonomy, decreased quality of life, and anticipated mortality in elderly patients. Gait and balance disturb are 2 factors to favor falls in elderly, and in patients with cognitive impairment, the risk of falls increases to double. Exercise and Mediterranean diet produce beneficial effects for aging, cognitive decline, and are widely recommended to reduce the effects of osteoporosis, fall risk, and related fragility fractures. The primary objective of this study is to evaluate the short and medium-term effects during 6 months, of a multicomponent physical exercise program with a Mediterranean diet on bone mineral density, fall risk, balance, and gait by a controlled clinical trial in patients with Alzheimer disease. METHODS: The study is a 6-month, randomized controlled parallel-group, single-blinded clinical trial. Institutionalized patients with Alzheimer disease will be included. The intervention group will perform a multicomponent physical exercise program in reduced groups, with a frequency of 3 sessions per week, associated with a Mediterranean diet. This program includes strength, balance, and aerobic resistance exercises, and in the main part of the session, also ludic exercises to improve agility, coordination, and balance. The control group will receive usual care. The outcomes to assess are the change of physical functions, such as gait and balance, and the change of bone mineral density by calcaneal quantitative ultrasound, during the study follow-up at 1, 3, and 6 months. This clinical trial will generate more and new evidence on the effects of a multicomponent physical exercise program and Mediterranean diet in patients with Alzheimer disease on risk of falls and osteoporotic fractures, the relation of these with bone mineral density, gait and balance, and the correlations between them. ETHICS AND DISSEMINATION: This study protocol has been approved by the Ethics Committee of the University of Salamanca. The results will be published in peer-reviewed journals and disseminated in national and international conferences, to the participants and their families, and the general public through the associations of people with AD. TRIAL REGISTRATION ID: ClínicalTrials.gov ID: NCT04439097.


Assuntos
Doença de Alzheimer/terapia , Densidade Óssea , Dieta Mediterrânea , Terapia por Exercício/métodos , Acidentes por Quedas/prevenção & controle , Feminino , Marcha , Humanos , Masculino , Equilíbrio Postural , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
4.
5.
Chirurgia (Bucur) ; 115(4): 530-536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876028

RESUMO

The enlarged number of powerful vehicles in our country led to an increased speed of travel and hence the high number of traffic accidents with severe consequences, even death. Along with polytrauma caused by occupational accidents, these types of traumas require complex and often multidisciplinary surgical therapy against the clock, which places the surgeon in front of situations that are not found in the everyday practice. Injuries involving damage to the thoracic-phreno-abdominal region fall into this specific category that we have chosen to discuss in the present work. We will further present three clinical cases of patients with thoraco-phreno-abdominal injuries produced by different mechanisms. A work-accident wound produced by an angle grinder, causing left thoracoabdominal injuries; a polytrauma caused by a road accident, with a thoraco-phreno abdominal wound produced by a piece of wood that penetrated obliquely through the right thorax, in the 5th and 6th intercostal spaces, crossed the right lower lung lobe, the diaphragm, the 7th liver segment, and stopped in the right posterior costal grid, and a polytrauma following a fall from a height, with a torn diaphragm and mesentery.


Assuntos
Traumatismos Abdominais/cirurgia , Traumatismo Múltiplo/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Acidentes por Quedas , Acidentes de Trânsito , Humanos , Traumatismo Múltiplo/complicações , Traumatismos Ocupacionais/complicações , Traumatismos Ocupacionais/cirurgia , Traumatismos Torácicos/complicações , Resultado do Tratamento , Ferimentos Penetrantes/complicações
6.
Cochrane Database Syst Rev ; 9: CD009233, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32885841

RESUMO

BACKGROUND: Impairment of vision is associated with a decrease in activities of daily living. Avoidance of physical activity in older adults with visual impairment can lead to functional decline and is an important risk factor for falls. The rate of falls and fractures is higher in older people with visual impairment than in age-matched visually normal older people. Possible interventions to reduce activity restriction and prevent falls include environmental and behavioral interventions. OBJECTIVES: We aimed to assess the effectiveness and safety of environmental and behavioral interventions in reducing physical activity limitation, preventing falls and improving quality of life amongst visually impaired older people. SEARCH METHODS: We searched CENTRAL (including the Cochrane Eyes and Vision Trials Register) (Issue 2, 2020), Ovid MEDLINE, Embase and eight other databases to 4 February 2020, with no language restrictions. SELECTION CRITERIA: Eligible studies were randomized controlled trials (RCTs) and quasi-randomized controlled trials (Q-RCTs) that compared environmental interventions, behavioral interventions or both, versus control (usual care or no intervention); or that compared different types of environmental or behavioral interventions. Eligible study populations were older people (aged 60 and over) with irreversible visual impairment, living in their own homes or in residential settings. To be eligible for inclusion, studies must have included a measure of physical activity or falls, the two primary outcomes of interest. Secondary outcomes included fear of falling, and quality of life. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included six RCTs (686 participants) conducted in five countries (Australia, Hungary, New Zealand, UK, US) with follow-up periods ranging from two to 12 months. Participants in these trials included older adults (mean age 80 years) and were mostly female (69%), with visual impairments of varying severity and underlying causes. Participants mostly lived in their homes and were physically independent. We classified all trials as having high risk of bias for masking of participants, and three trials as having high or unclear risk of bias for all other domains. The included trials evaluated various intervention strategies (e.g. an exercise program versus home safety modifications). Heterogeneity of study characteristics, including interventions and outcomes, (e.g. different fall measures), precluded any meta-analysis. Two trials compared the home safety modification by occupational therapists versus social/home visits. One trial (28 participants) reported physical activity at six months and showed no evidence of a difference in mean estimates between groups (step counts: mean difference (MD) = 321, 95% confidence interval (CI) -1981 to 2623; average walking time (minutes): MD 1.70, 95% CI -24.03 to 27.43; telephone questionnaire for self-reported physical activity: MD -3.68 scores, 95% CI -20.6 to 13.24; low-certainty of evidence for each outcome). Two trials reported the proportion of participants who fell at six months (risk ratio (RR) 0.76, 95% CI 0.38 to 1.51; 28 participants) and 12 months (RR 0.59, 95% CI 0.43 to 0.80, 196 participants) with low-certainty of evidence for each outcome. One trial (28 participants) reported fear of falling at six months, using the Short Falls Efficacy Scale-International, and found no evidence of a difference in mean estimates between groups (MD 2.55 scores, 95% CI -0.51 to 5.61; low-certainty of evidence). This trial also reported quality of life at six months using 12-Item Short Form Health Survey, and showed no evidence of a difference in mean estimates between groups (MD -3.14 scores, 95% CI -10.86 to 4.58; low-certainty of evidence). Five trials compared a behavioral intervention (exercise) versus usual activity or social/home visits. One trial (59 participants) assessed self-reported physical activity at six months and showed no evidence of a difference between groups (MD 9.10 scores, 95% CI -13.85 to 32.5; low-certainty of evidence). Three trials investigated different fall measures at six or 12 months, and found no evidence of a difference in effect estimates (RRs for proportion of fallers ranged from 0.54 (95% CI 0.29 to 1.01; 41 participants); to 0.93 (95% CI 0.61 to 1.39; 120 participants); low-certainty of evidence for each outcome). Three trials assessed the fear of falling using Short Falls Efficacy Scale-International or the Illinois Fear of Falling Measure from two to 12 months, and found no evidence of a difference in mean estimates between groups (the estimates ranged from -0.88 score (95% CI -2.72 to 0.96, 114 participants) to 1.00 score (95% CI -0.13 to 2.13; 59 participants); low-certainty of evidence). One trial (59 participants) assessed the European Quality of Life scale at six months (MD -0.15 score, 95% CI -0.29 to -0.01), and found no evidence of a clinical difference between groups (low-certainty of evidence). AUTHORS' CONCLUSIONS: There is no evidence of effect for most of the environmental or behavioral interventions studied for reducing physical activity limitation and preventing falls in visually impaired older people. The certainty of evidence is generally low due to poor methodological quality and heterogeneous outcome measurements. Researchers should form a consensus to adopt standard ways of measuring physical activity and falls reliably in older people with visual impairments. Fall prevention trials should plan to use objectively measured or self-reported physical activity as outcome measures of reduced activity limitation. Future research should evaluate the acceptability and applicability of interventions, and use validated questionnaires to assess the adherence to rehabilitative strategies and performance during activities of daily living.


Assuntos
Acidentes por Quedas/prevenção & controle , Vida Independente , Atividade Motora , Pessoas com Deficiência Visual/reabilitação , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Viés , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Oral Health Prev Dent ; 18(1): 707-712, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32895653

RESUMO

PURPOSE: Investigate dental trauma among adolescents aged 15-19 years and associated factors. METHODS: The study was conducted in Recife, Brazil and the sample comprised 1485 adolescents of both sexes. The data was collected by clinical examination and interviews were conducted in-between classes by a single trained assessor. Two questionnaires (AUDIT and ASSIT 2.0) were used to investigate the involvement of adolescents with alcohol, tobacco and illicit drugs. The classification proposed by Andreasen was used to identify dental injuries. The sample size was calculated using 95% interval level. Pearson's chi-square test and Fisher's exact test were used to confirm the association between the variables. RESULTS: The prevalence of dental injuries was 17.8%. The main causes of trauma were playing with others (20.8%) and falls (25.4%). A statistically significant percentage of adolescents reported using illicit drugs (13.9%), 15.9% used tobacco and 56.8% used alcoholic beverages. However, no statistically significant difference between the consumption of this drugs and dental injuries (p >0.005) was found. CONCLUSION: The prevalence of dental trauma in adolescents was high, with no association with drugs use.


Assuntos
Acidentes por Quedas , Traumatismos Dentários , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Inquéritos e Questionários , Adulto Jovem
9.
Med Clin North Am ; 104(5): 791-806, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773046

RESUMO

A large body of research has addressed the assessment and management of fall risk among community-dwelling older adults. Persons with dementia are at higher risk for falls and fall-related injuries, yet less is known about effective strategies for reducing falls and injuries among those with dementia. Falls and dementia are regularly considered to be discrete conditions and are often managed separately. Increasing evidence shows that these conditions frequently co-occur, and one may precede the other. This article explores the relationship between falls and dementia, including the importance of rehabilitation strategies for reducing fall risk in these individuals.


Assuntos
Acidentes por Quedas , Demência , Avaliação Geriátrica/métodos , Medição de Risco/métodos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Causalidade , Demência/diagnóstico , Demência/epidemiologia , Humanos , Vida Independente/psicologia , Atenção Primária à Saúde/métodos
10.
Rev Saude Publica ; 54: 76, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32813869

RESUMO

OBJECTIVE To estimate the trends of fall-related hospitalization, mortality, and lethality among older adults in Brazil and regions. METHODS This is a descriptive study based on data from the Hospital Information System of the Brazilian Unified Health System. We included records of every older adult, aged 60 years or older, hospitalized for accidental fall from January, 1998 to November, 2015 in all Brazilian regions. We selected the codes E885, E886, E880, E884, E884 from the International Classification of Diseases, 9th revision, and W01, W03, W10, W17, W18 from the 10th revision, and calculated fall-related hospitalization and mortality rates per 100,000 inhabitants, as well as lethality. To estimate trends, we applied the Prais-Winsten regression for time series analysis. RESULTS During the period, 1,192,829 fall-related hospitalizations occurred, among which 54,673 had a fatal outcome; lethality was 4.5%. Hospitalization rates showed upward trends, with seasonality, in Brazil (11%), and in the Northeast (44%), Midwest (13%), and South regions (14%). The North showed a decreasing hospitalization rate (48%), and the Southeast a stationary one (3%). CONCLUSIONS In Brazil, fall-related hospitalizations, mortality, and lethality among older adults showed an upward trend from 1998 to 2015, with seasonal peaks in the second and third quarters. Considering we are in plain demographic transition, to improve hospital healthcare and encourage falls prevention programs among older adults is essential.


Assuntos
Acidentes por Quedas/mortalidade , Hospitalização/estatística & dados numéricos , Acidentes por Quedas/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estações do Ano , Índice de Gravidade de Doença
11.
Medicine (Baltimore) ; 99(34): e21506, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846760

RESUMO

BACKGROUND: Vitamin D supplement is one of the current possible interventions to reduce fall and fracture. Despite having several studies on vitamin D supplement and fall and fracture reductions, the results are still inconclusive. We conducted a meta-analysis to examine the effect of vitamin D supplement in different forms and patient settings on fall and fracture. METHODS: A systematic literature research was conducted in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) to compare the effects of vitamin D supplements on fall and fracture outcomes. Random-effect models were used to compute the weighted mean difference for continuous variables and the risk ratio for binary variables. RESULTS: Forty-seven RCTs with 58,424 participants were identified reporting on fall outcome. Twenty-four of 47 studies with 40,102 subjects also reported fracture outcome. Major populations were elderly women with age less than 80 years. Overall, vitamin D supplement demonstrated a significant effect on fall reduction, RR = 0.948 (95% CI 0.914-0.984; P = .004, I = 41.52). By subgroup analyses, only vitamin D with calcium supplement significantly reduce fall incidence, RR = 0.881 (95% CI 0.821-0.945; P < .001, I = 49.19). Vitamin D3 supplement decreased incidence of fall but this occurred only when vitamin D3 was supplemented with calcium. Regarding fracture outcome, vitamin D supplement failed to show fracture lowering benefit, RR = 0.949 (95% CI 0.846-1.064; P = .37, I = 37.92). Vitamin D along with calcium supplement could significantly lower fracture rates, RR = 0.859 (95% CI 0.741-0.996; P = .045, I = 25.48). CONCLUSIONS: The use of vitamin D supplement, especially vitamin D3 could reduce incidence of fall. Only vitamin D with calcium supplement showed benefit in fracture reduction.


Assuntos
Acidentes por Quedas/prevenção & controle , Conservadores da Densidade Óssea/uso terapêutico , Fraturas Ósseas/prevenção & controle , Vitamina D/uso terapêutico , Suplementos Nutricionais , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
J Orthop Trauma ; 34(9): e343-e348, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815849

RESUMO

OBJECTIVES: To compare orthopaedic trauma volume and mechanism of injury before and during statewide social distancing and stay-at-home directives. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: One thousand one hundred thirteen patients sustaining orthopaedic trauma injuries between March 17 and April 30 of years 2018, 2019, and 2020. INTERVENTION: Statewide social distancing and stay-at-home directives. MAIN OUTCOME MEASUREMENTS: Number of consults, mechanism of injury frequency, and type of injury frequency. RESULTS: During the COVID-19 pandemic, orthopaedic trauma consult number decreased. Injuries due to gunshot wounds increased and those due to automobile versus pedestrian accidents decreased. Time-to-presentation increased and length of stay decreased. Operative consults remained unchanged. CONCLUSIONS: Orthopaedic trauma injuries continued to occur during the COVID-19 pandemic at an overall decreased rate, however, with a different distribution in mechanism and type of injury. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/prevenção & controle , Fraturas Ósseas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Centros de Traumatologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Adulto Jovem
13.
Yakugaku Zasshi ; 140(8): 1041-1049, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32741862

RESUMO

Sedative hypnotics are among the classes of drugs reported to influence falls. However, the effects of the sedative hypnotic drugs, suvorexant and ramelteon, on falls are not well known. Therefore, we conducted this retrospective case-control study to examine the association of the use of these two sedative hypnotics with the risk of falls. Conducted at the Sapporo Medical University Hospital in Japan, our study included 360 patients with fall incidents and 819 randomly selected control patients. Patients in the fall group were significantly older with a lower body mass index, and had a history of falls, disabilities in activities of daily living, cognitive impairment, and delirium. Monovariate analysis revealed that patients in the fall group frequently used ramelteon [odds ratio (OR) 2.38, 95% confidence interval (CI): 1.49-3.81, p<0.001], but rarely used suvorexant (OR 0.66, 95% CI: 0.29-1.39, p=0.317), compared with control patients. Furthermore, multivariate analysis revealed that ramelteon use did not increase the risk of falls (adjusted OR 1.43, 95% CI: 0.82-2.48, p=0.207), whereas suvorexant use significantly decreased the risk of falls (adjusted OR 0.32, 95% CI: 0.13-0.76, p=0.009). Although ramelteon tends to be used in patients at a high risk of falls, it may not increase the risk of falls. In contrast, the use of suvorexant may reduce the risk of falls.


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Azepinas , Hipnóticos e Sedativos , Indenos , Triazóis , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
PLoS One ; 15(8): e0236886, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790749

RESUMO

Falls pose a serious problem in elderly and clinical populations. Most often, they lead to a loss of mobility and independence. They might also be an indirect cause of death. The aim of this study was to determine an objective predictor of the fear of falling and falls in elderly subjects (ESs) and Parkinson's disease (PD) subjects. Thirty-two ESs were examined in this study, of whom sixteen were diagnosed with PD. The testing procedures comprised force plate measurements (limit of stability test-LOS test) and clinical tests (Berg Balance Scale, Functional Reach Test, Timed Up and Go test, Tinetti test). The Falls Efficacy Scale International (FES-I) was used to evaluate the fear of falling. The range of the maximum forward lean was normalized to the length from the ankle joint to the head of the first metatarsal bone and was named the functional forward stability indicator (FFSI). The FFSI, derived from the LOS test, allowed us to demonstrate the real deficit in functional stability and individual safety margins. Moreover, the FFSI was highly correlated with the FES-I score and almost all clinical test results in elderly subjects (r>0,6; p<0.05). In PD subjects, the FFSI was poorly correlated with the fear of falling, the BBS score and the FR distance; however, a high correlation with the Tinetii test (r>0,6, p<0.05) was noted. The PD subjects presented a different balance strategy when close to their stability limits, which was also reflected in the lower values of sample entropy (t = (-2.40); p<0.05; d = 0.87). The FFSI might be a good predictor of the fear of falling in the group of elderly people. Additionally, the FFSI allows us to show real balance deficits both in PD subjects and in their healthy peers without the need for a reference group and norms. In conclusion, it is postulated that the popular clinical assessments of postural balance in PD subjects should be accompanied by reliable posturography measurements.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Doença de Parkinson/diagnóstico , Idoso , Antropometria , Entropia , Medo/psicologia , Feminino , Idoso Fragilizado , Humanos , Masculino , Doença de Parkinson/patologia , Equilíbrio Postural , Índice de Gravidade de Doença
15.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 203-213, jul.-ago. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193507

RESUMO

ANTECEDENTES: Las caídas son la segunda causa mundial de muerte por lesiones accidentales. La mayor tasa de mortalidad se produce en los adultos mayores. OBJETIVO: Evaluar si la práctica del método Pilates es efectiva para reducir las caídas y el riesgo de caída en el adulto mayor. MÉTODOS: Revisión sistemática de artículos originales publicados desde el inicio hasta octubre de 2018. Bases de datos consultadas: Medline, PubMed, Google Scholar, Web of Knowledge, OVID y ScienceDirect. Se incluyeron estudios experimentales y cuasi-experimentales en los que los participantes fueron adultos mayores y recibieron una intervención basada en el método Pilates, y en los que se evaluaron los efectos sobre las caídas, el riesgo o el miedo a las caídas. La síntesis fue descriptiva y se evaluó la calidad de los estudios incluidos con las escalas PEDro y Otawa. RESULTADOS: Seis estudios cumplieron los criterios de elegibilidad. Cinco fueron estudios clínicos aleatorizados y el restante un estudio de intervención. Un total de 216 participantes fueron incluidos. Dos estudios evaluaron el efecto sobre las caídas con resultados inconcluyentes. En general los efectos sobre el equilibrio asociado con el riesgo de caídas fueron positivos. El efecto sobre el miedo a la caída, valorado por un estudio, también dedujo resultados positivos derivados de la práctica de Pilates. CONCLUSIONES: La práctica de ejercicio basado en el método Pilates es efectiva para mejorar las habilidades de equilibrio estático y dinámico, así como la fuerza muscular en adultos mayores (predictores de caídas). Existe escasez de estudios orientados a evaluar específicamente la reducción del número de caídas y del miedo a caer. La implementación de ensayos clínicos con poder adecuado queda justificada para resolver el efecto del método Pilates sobre las caídas en el adulto mayor


BACKGROUND: Falls are the second leading cause of death by accidental injury worldwide. The highest death rate is in older adults. OBJECTIVE: To assess whether practicing the Pilates Method is effective in reducing falls and the risk of falling. METHODS: A systematic review of original articles published from inception until October 2018. Databases consulted: Medline, PubMed, Google Scholar, Web of Knowledge, OVID, and ScienceDirect. We included experimental and quasi-experimental studies in which the participants were older adults and had undergone an intervention based on the Pilates Method, and in which the effects on falls, risk, and fear of falling were assessed. The synthesis was descriptive, and the quality of the studies included was assessed with the PEDro and Ottawa scales. RESULTS: Six studies met the eligibility criteria. Five were randomised trials and one was an intervention study. A total of 216 participants were included. Two studies assessed the effect on falls with inconclusive results. Overall, the effects on balance associated with risk of falling were positive. The effect on fear of falling, assessed by one study, also concluded positive results from the practice of Pilates. CONCLUSIONS: Exercising based on the Pilates method is effective in improving static and dynamic balance skills and muscle strength in older adults (predictors of falls). There are few studies that specifically assess reduction in number of falls and fear of falling. The implementation of clinical trials of adequate power is justified to establish the effect of the Pilates method on falls in older adults


Assuntos
Humanos , Idoso , Técnicas de Exercício e de Movimento/métodos , Acidentes por Quedas/prevenção & controle , Medo/psicologia , Acidentes por Quedas/mortalidade , Técnica Delfos
16.
PLoS One ; 15(8): e0238116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857793

RESUMO

INTRODUCTION: Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions. METHODS: This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis. RESULTS: Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) "circumstances surrounding the falls" (e.g. when falls occurred, the home is a 'safe space') and 2) "suggestions and preferences for fall prevention strategies/interventions" (e.g. fall prevention involves all, fall prevention training available as needed). CONCLUSION: Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.


Assuntos
Acidentes por Quedas/prevenção & controle , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Cadeiras de Rodas/psicologia , Adulto , Idoso , Pessoas com Deficiência , Feminino , Grupos Focais , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Preferência do Paciente , Medicina de Precisão , Adulto Jovem
17.
J Am Acad Orthop Surg ; 28(17): 707-716, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32833389

RESUMO

INTRODUCTION: Traumatic spinal cord injury (SCI) is a life-altering event. Motor vehicle accidents and falls are common causes of traumatic SCI, and SCI outcomes may be affected by patients' ages and injury sites. This study aimed to investigate the factors associated with unfavorable in-hospital outcomes, focusing on the impact of patients' ages and SCI lesion sites. METHODS: Data of 25,988 patients hospitalized with traumatic SCI in the US National Inpatient Sample (NIS) database from 2005 to 2014 were extracted and analyzed. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with SCI outcomes, including in-hospital deaths, adverse discharge, and prolonged hospital stays. RESULTS: Multivariate analysis revealed that the oldest ages (>65 years) were significantly associated with increased in-hospital mortality compared with the youngest ages at all lesion sites (cervical, odds ratio [OR]: 5.474, 95% confidence interval [CI]: 4.465 to 6.709; thoracic, OR: 5.940, 95% CI: 3.881 to 9.091; and lumbosacral, OR: 6.254, 95% CI: 2.920 to 13.394). Older ages were also significantly associated with increased adverse outcomes at all sites (cervical, OR: 2.460, 95% CI: 2.180 to 2.777; thoracic, OR: 2.347, 95% CI: 1.900 to 2.900; and lumbosacral, OR: 2.743, 95% CI: 2.133 to 3.527). Intermediate ages (35 to 64) were also significantly associated with increased in-hospital death and adverse discharge at cervical and thoracic SCIs, but not at lumbosacral sites. DISCUSSION: For hospitalized patients with traumatic SCI, older age independently predicts worse in-hospital outcomes, with greatest effects seen in patients aged 65 years and older. Study findings suggest that extra vigilance and targeted management strategies are warranted in managing SCI patients aged 65 years and older during hospitalization.


Assuntos
Bases de Dados Factuais , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/mortalidade , Traumatismos da Medula Espinal/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Fatores Etários , Idoso , Vértebra Cervical Áxis , Feminino , Mortalidade Hospitalar , Humanos , Pacientes Internados , Tempo de Internação , Modelos Logísticos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Vértebras Torácicas , Estados Unidos , Adulto Jovem
19.
Vasc Health Risk Manag ; 16: 307-316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764951

RESUMO

Purpose: This study was conducted to investigate the relationships between arterial stiffness, frailty and fall-related injuries among community-dwelling older adults. Materials and Methods: A cross-sectional study of a random sample of older adults aged 60 years and older was conducted. Main study parameters: arterial stiffness was measured by the determining the cardio-ankle vascular index (CAVI); Frailty status was defined using a 7-item frailty screening scale, developed in Russia. This questionnaire included question about falls and fall-related injuries. Orthostatic test and anthropometric tests were done. Medical history (comorbidity, medications), the Osteoporosis Self-assessment Tool (OST), nutritional, physical, cognitive and functional status were evaluated. Results: The study population included 163 people aged 60-89 years. The average predicted value of CAVI in women aged 60-69 was 9.13 ± 0.13, in men, 9.49 ± 0.05; in women aged 70-79, it was 9.49 ± 0.16, in men, 9.73 ±0.11; in women aged 80 and older it was 10.04 ±0.18, in men, 10.24 ±0.10 units. The CAVI above the predicted value was associated with fall-related injuries even after adjustment for age, sex, use of ß-blockers (BBs), history of stroke, and region of residence with the odds ratio 3.52 (95% CI: 1.03 -12.04). Conclusion: Our study revealed an independent association between arterial stiffness and fall-related injuries in older adults over 60 years. The findings suggest that clinicians, especially geriatricians, should pay attention to arterial stiffness of patients with fall-related injuries. Similarly, the patients with CAVI above age-predicted value should be evaluated for risk of falls for prevention of fall-related injuries.


Assuntos
Acidentes por Quedas , Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Rigidez Vascular , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Feminino , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
20.
N Z Med J ; 133(1519): 24-31, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32777792

RESUMO

AIMS: Falls are common in 80-plus year-olds and there is evidence available in terms of risk factors and prevention measures. We aimed to review falls risk factor assessment and secondary prevention strategies in patients in this age group presenting acutely to services other than older adult health services at Waitemata District Health Board. METHODS: We retrospectively reviewed electronic hospital records of those >80 years presenting to acute services with a primary or secondary diagnosis of a fall, or fall-related injury. Admission characteristics, risk factor identification and subsequent referrals for falls prevention were recorded. Six-month outcomes including readmissions and mortality were assessed. RESULTS: One hundred and thirty-eight discharge summaries were reviewed (71% female, median age 89). Thirty-one percent had a previous fall-related hospital admission in the six months prior. There was high prevalence of psychoactive medications (51%) and falls-related cardiovascular drugs (78%) at discharge. No patients were referred for falls prevention programmes or geriatric assessment at discharge. At six months 19% had died and 44% had been readmitted. CONCLUSIONS: There are inadequate falls prevention referrals, indicating a quality of care gap. The older age group presenting to acute services have high rates of polypharmacy, hospitalisations and death.


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Medição de Risco/métodos , Prevenção Secundária , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
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