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1.
Artigo em Inglês | MEDLINE | ID: mdl-34208319

RESUMO

There is strong evidence that effective fall prevention elements exist, but the implementation into society remains difficult. The aim of the current study is to describe and evaluate the implementation of the fall prevention programme "Thuis Onbezorgd Mobiel" (TOM). This novel approach combines effective components into a multidisciplinary group-based programme for adults aged 65 years or older with an increased risk of falling. To investigate the impact on several health-related outcomes such as subjective health, quality of life, physical functioning, and falls, we applied a quasi-experimental pre-post design including a follow-up period. A total of 164 older adults subscribed to the programme: 80 were eligible to start and 73 completed it. The impact analysis revealed a significant improvement in subjective health, physical functioning, and quality of life directly after participating in the programme. The impact on subjective health and quality of life persisted six months after the programme. Important facilitators for the implementation of the programme were social contact and clear communication. Lack of a concrete follow-up was seen as an important barrier. The results of the current research help guide further implementation of effective fall prevention interventions in practice.


Assuntos
Acidentes por Quedas , Vida Independente , Acidentes por Quedas/prevenção & controle , Idoso , Terapia por Exercício , Humanos , Países Baixos , Qualidade de Vida
2.
Sensors (Basel) ; 21(13)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34202786

RESUMO

The high prevalence of falls and the enormous impact they have on the elderly population is a cause for concern. We aimed to develop a walking-monitor gait pattern (G-STRIDE) for older adults based on a 6-axis inertial measurement (IMU) with the application of pedestrian dead reckoning algorithms and tested its structural and clinical validity. A cross-sectional case-control study was conducted with 21 participants (11 fallers and 10 non-fallers). We measured gait using an IMU attached to the foot while participants walked around different grounds (indoor flooring, outdoor floor, asphalt, etc.). The G-STRIDE consisted of a portable inertial device that monitored the gait pattern and a mobile app for telematic clinical analysis. G-STRIDE made it possible to measure gait parameters under normal living conditions when walking without assessing the patient in the outpatient clinic. Moreover, we verified concurrent validity with convectional outcome measures using intraclass correlation coefficients (ICCs) and analyzed the differences between participants. G-STRIDE showed high estimation accuracy for the walking speed of the elderly and good concurrent validity compared to conventional measures (ICC = 0.69; p < 0.000). In conclusion, the developed inertial-based G-STRIDE can accurately classify older people with risk to fall with a significance as high as using traditional but more subjective clinical methods (gait speed, Timed Up and Go Test).


Assuntos
Acidentes por Quedas , Dispositivos Eletrônicos Vestíveis , Idoso , Estudos de Casos e Controles , Estudos Transversais , Marcha , Humanos , Projetos Piloto , Equilíbrio Postural , Estudos de Tempo e Movimento , Caminhada
3.
Sensors (Basel) ; 21(13)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34202820

RESUMO

Automatic fall detection systems ensure that elderly people get prompt assistance after experiencing a fall. Fall detection systems based on accelerometer measurements are widely used because of their portability and low cost. However, the ability of these systems to differentiate falls from Activities of Daily Living (ADL) is still not acceptable for everyday usage at a large scale. More work is still needed to raise the performance of these systems. In our research, we explored an essential but often neglected part of accelerometer-based fall detection systems-data segmentation. The aim of our work was to explore how different configurations of windows for data segmentation affect detection accuracy of a fall detection system and to find the best-performing configuration. For this purpose, we designed a testing environment for fall detection based on a Support Vector Machine (SVM) classifier and evaluated the influence of the number and duration of segmentation windows on the overall detection accuracy. Thereby, an event-centered approach for data segmentation was used, where windows are set relative to a potential fall event detected in the input data. Fall and ADL data records from three publicly available datasets were utilized for the test. We found that a configuration of three sequential windows (pre-impact, impact, and post-impact) provided the highest detection accuracy on all three datasets. The best results were obtained when either a 0.5 s or a 1 s long impact window was used, combined with pre- and post-impact windows of 3.5 s or 3.75 s.


Assuntos
Acidentes por Quedas , Atividades Cotidianas , Acelerometria , Idoso , Algoritmos , Humanos , Monitorização Ambulatorial
4.
Adv Gerontol ; 34(2): 300-305, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34245515

RESUMO

The article presents characteristics of the dynamic component of postural balance and its features in elderly women with postural deficit. The assessment of the dynamic component of postural balance was performed on a computer stabilometric complex «Balance Manager¼ in women aged 60-74 with and without a history of falls. The most significant changes are manifested by an increase in the time of implementation and a decrease in the effectiveness of performing complex motor acts. In the factor structure of indicators of the dynamic component of postural balance in postural deficit, the leading factor is the factor that characterizes speed and power indicators in the implementation of complex motor acts. The study of the dynamic component of postural balance is recommended to be included in the comprehensive diagnosis of walking disorders in the elderly and in evaluating the effectiveness of treatment and rehabilitation measures.


Assuntos
Acidentes por Quedas , Equilíbrio Postural , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Humanos , Caminhada
5.
Clin Interv Aging ; 16: 1337-1346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285478

RESUMO

Purpose: Limited information exists on fall-related fractures in older adults with cerebrovascular disease. This study aimed to determine the characteristics of older adults with cerebrovascular disease who sustained fall-related fractures and identify the associated risk factors for perioperative complications. Patients and Methods: This was a cross-sectional study, which included patients with cerebrovascular disease who sustained fractures between Jan. 2017 and Dec. 2019. The collected data included demographics (age and gender), time and place of fracture occurrence, mechanism of injury, fracture location, type of cerebrovascular disease, complications, and comorbidities. Results: A total of 768 patients with 815 fractures were included; there were 253 males and 515 females, with an average age of 78.3 years. For either males or females, 80-84 years was the most commonly involved age group. Most (61.0%) patients had their fractures occurring at home and most fractures (70.7%) occurred during the daytime. Most were hip fractures and limb weakness; instability-related falls were the most common cause of fracture, making a proportion of 34.5%. Patients who suffered falls were mainly combining ischemic cerebrovascular disease. Most (85.9%) patients presented with at least one comorbid disease and the perioperative complication rate was 76.9% in total cases. Age≥80 (OR: 1.772, 95% CI: 1.236-2.540) and the number of comorbidities≥3 (OR: 1.606, 95% CI: 1.035-2.494) were found independently associated with complications, while the type of cerebrovascular disease, fracture location, and comorbidities of prior fragility fracture and respiratory disease were not significantly correlated with complications. Conclusion: Our findings highlighted that more focus on improved physical function explored in intervention setting and the importance of primary home prevention measures seems justified in China and maybe other countries as well. It is the first study that presented the epidemiological characteristics of older adults with cerebrovascular disease who later experienced a fracture.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Transtornos Cerebrovasculares/epidemiologia , Fraturas Ósseas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/complicações , China/epidemiologia , Estudos Transversais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Fatores de Risco
6.
Front Public Health ; 9: 566960, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34222159

RESUMO

Background: Housing is essential for healthy ageing, being a source of shelter, purpose, and identity. As people age, and with diminishing physical and mental capacity, they become increasingly dependent on external supports from others and from their environment. In this paper we look at changes in housing across later life, with a focus on the relationship between housing and women's care needs. Methods: Data from 12,432 women in the 1921-26 cohort of the Australian Longitudinal Study on Women's Health were used to examine the interaction between housing and aged care service use across later life. Results: We found that there were no differences in access to home and community care according to housing type, but women living in an apartment and those in a retirement village/hostel were more likely to have an aged care assessment and had a faster rate of admission to institutional residential aged care than women living in a house. The odds of having an aged care assessment were also higher if women were older at baseline, required help with daily activities, reported a fall, were admitted to hospital in the last 12 months, had been diagnosed or treated for a stroke in the last 3 years, or had multiple comorbidities. On average, women received few services in the 24 months prior to admission to institutional residential aged care, indicating a potential need to improve the reach of these services. Discussion: We find that coincident with changes in functional capacities and abilities, women make changes to their housing, sometimes moving from a house to an apartment, or to a village. For some, increasing needs in later life are associated with the need to move from the community into institutional residential aged care. However, before moving into care, many women will use community services and these may in turn delay the need to leave their homes and move to an institutional setting. We identify a need to increase the use of community services to delay the admission to institutional residential aged care.


Assuntos
Habitação , Aposentadoria , Acidentes por Quedas , Idoso , Austrália/epidemiologia , Feminino , Humanos , Estudos Longitudinais
7.
Sensors (Basel) ; 21(14)2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34300378

RESUMO

In this study, algorithms to detect post-falls were evaluated using the cross-dataset according to feature vectors (time-series and discrete data), classifiers (ANN and SVM), and four different processing conditions (normalization, equalization, increase in the number of training data, and additional training with external data). Three-axis acceleration and angular velocity data were obtained from 30 healthy male subjects by attaching an IMU to the middle of the left and right anterior superior iliac spines (ASIS). Internal and external tests were performed using our lab dataset and SisFall public dataset, respectively. The results showed that ANN and SVM were suitable for the time-series and discrete data, respectively. The classification performance generally decreased, and thus, specific feature vectors from the raw data were necessary when untrained motions were tested using a public dataset. Normalization made SVM and ANN more and less effective, respectively. Equalization increased the sensitivity, even though it did not improve the overall performance. The increase in the number of training data also improved the classification performance. Machine learning was vulnerable to untrained motions, and data of various movements were needed for the training.


Assuntos
Acidentes por Quedas , Redes Neurais de Computação , Algoritmos , Humanos , Aprendizado de Máquina , Masculino , Máquina de Vetores de Suporte
8.
Sensors (Basel) ; 21(14)2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34300399

RESUMO

Loss-of-balance (LOB) events, such as trips and slips, are frequent among community-dwelling older adults and are an indicator of increased fall risk. In a preliminary study, eight community-dwelling older adults with a history of falls were asked to perform everyday tasks in the real world while donning a set of three inertial measurement sensors (IMUs) and report LOB events via a voice-recording device. Over 290 h of real-world kinematic data were collected and used to build and evaluate classification models to detect the occurrence of LOB events. Spatiotemporal gait metrics were calculated, and time stamps for when LOB events occurred were identified. Using these data and machine learning approaches, we built classifiers to detect LOB events. Through a leave-one-participant-out validation scheme, performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPR). The best model achieved an AUROC ≥0.87 for every held-out participant and an AUPR 4-20 times the incidence rate of LOB events. Such models could be used to filter large datasets prior to manual classification by a trained healthcare provider. In this context, the models filtered out at least 65.7% of the data, while detecting ≥87.0% of events on average. Based on the demonstrated discriminative ability to separate LOBs and normal walking segments, such models could be applied retrospectively to track the occurrence of LOBs over an extended period of time.


Assuntos
Acidentes por Quedas , Dispositivos Eletrônicos Vestíveis , Acidentes por Quedas/prevenção & controle , Idoso , Marcha , Humanos , Estudos Retrospectivos , Caminhada
9.
Sensors (Basel) ; 21(14)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34300509

RESUMO

Assessment of health and physical function using smartphones (mHealth) has enormous potential due to the ubiquity of smartphones and their potential to provide low cost, scalable access to care as well as frequent, objective measurements, outside of clinical environments. Validation of the algorithms and outcome measures used by mHealth apps is of paramount importance, as poorly validated apps have been found to be harmful to patients. Falls are a complex, common and costly problem in the older adult population. Deficits in balance and postural control are strongly associated with falls risk. Assessment of balance and falls risk using a validated smartphone app may lessen the need for clinical assessments which can be expensive, requiring non-portable equipment and specialist expertise. This study reports results for the real-world deployment of a smartphone app for self-directed, unsupervised assessment of balance and falls risk. The app relies on a previously validated algorithm for assessment of balance and falls risk; the outcome measures employed were trained prior to deployment on an independent data set. Results for a sample of 594 smartphone assessments from 147 unique phones show a strong association between self-reported falls history and the falls risk and balance impairment scores produced by the app, suggesting they may be clinically useful outcome measures. In addition, analysis of the quantitative balance features produced seems to suggest that unsupervised, self-directed assessment of balance in the home is feasible.


Assuntos
Aplicativos Móveis , Telemedicina , Acidentes por Quedas , Idoso , Humanos , Aprendizado de Máquina , Equilíbrio Postural , Smartphone
10.
Sr Care Pharm ; 36(8): 363-364, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34311813

RESUMO

The July issue of The Senior Care Pharmacist featured two excellent articles about the essential role of pharmacists in reducing falls and falls-risk factors among older people. It is up to senior care pharmacists to contribute to a rational and balanced discussion of pharmacotherapy options, which are best achieved through a multidisciplinary approach where the pharmacist?s unique and important input can be integrated into the treatment plan.


Assuntos
Acidentes por Quedas , Farmacêuticos , Acidentes por Quedas/prevenção & controle , Idoso , Humanos , Fatores de Risco
11.
Artigo em Inglês | MEDLINE | ID: mdl-34199566

RESUMO

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as "the composite of all physical and mental attributes on which an individual can draw". Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial.


Assuntos
Dieta Saudável , Fragilidade , Acidentes por Quedas , Idoso , Exercício Físico , Humanos , Organização Mundial da Saúde
12.
Artigo em Inglês | MEDLINE | ID: mdl-34199765

RESUMO

Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). DPN causes a decrease in proprioception, which could reduce balance ability. We investigated the association of impaired vibration sense, based on vibration perception threshold (VPT), with assessments of balance and other factors affecting balance impairment and fear of falling in patients with type 2 DM. Sixty-three patients with DM aged >50 years were categorized as having normal vibration sense (NVS; n = 34) or impaired vibration sense (IVS; n = 29) according to a VPT value of 8.9 µm. The following parameters were evaluated for all patients: postural steadiness through the fall index using posturography, functional balance through the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and fear of falling through the Falls Efficacy Scale-International (FES-I). The IVS group showed a significantly greater balance impairment in fall index, BBS, and TUG, as well as greater fear of falling on the FES-I than the NVS group. The linear regression analysis showed that the fall index was associated only with the VPT, whereas BBS, TUG, and FES-I were associated with the VPT, age, and/or lower extremity muscle strength. VPT, age, and/or muscle strength were identified as predictors of balance and fear of falling in patients with type 2 DM. Therefore, along with age and lower extremity strength, the VPT can be useful for balance assessment in patients with type 2 DM.


Assuntos
Diabetes Mellitus Tipo 2 , Acidentes por Quedas , Medo , Humanos , Percepção , Equilíbrio Postural , Estudos de Tempo e Movimento , Vibração
13.
BMC Geriatr ; 21(1): 405, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193074

RESUMO

BACKGROUND: Body movement-controlled video games involving physical motion and visual attention may have the potential to train both abilities simultaneously. Our purpose was to determine the associations between performance in these games and visual attention, balance and mobility in a group of older adults. The long-term goal is to identify the optimal type of interactive games with regards to training potential. METHODS: Fifty healthy adults aged 65+ years participated in this cross-sectional study. Visual attention was measured with static and dynamic versions of a useful field of view (UFV) and a multiple object tracking (MOT) test. Balance was measured with a force plate in bi-pedal quiet stance test (QST) and one-legged stance (OLST). Gait variability and walking speed were assessed with the Five Meter Walk Test (5MWT). Four Microsoft™ Xbox® 360 Kinect™ interactive video games were chosen based on the apparent levels of visual attention demand. RESULTS: Visual attention (UFV and MOT) was significantly associated with performance in Xbox® Kinect™ games that appeared to have a high visual attention demand (p < 0.05), while there was minimal or no significant association with games with apparent low visual attention demand. Balance and mobility show correlations with visual attention, and with Xbox games. CONCLUSION: The results suggest that there are relationships between visual attention, balance, mobility and Xbox® Kinect™ game performance. Since different Xbox® games were associated with different balance, mobility and visual attention scores, a variety of such games, rather than a single game, may be most effective for training for falls prevention.


Assuntos
Jogos de Vídeo , Acidentes por Quedas , Idoso , Estudos Transversais , Humanos , Movimento , Equilíbrio Postural
14.
BMC Geriatr ; 21(1): 402, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193084

RESUMO

BACKGROUND: Falls are the leading cause of fatal and non-fatal injuries in older adults, and attention to falls prevention is imperative. Prognostic models identifying high-risk individuals could guide fall-preventive interventions in the rapidly growing older population. We aimed to develop a prognostic prediction model on falls rate in community-dwelling older adults. METHODS: Design: prospective cohort study with 12 months follow-up and participants recruited from June 14, 2018, to July 18, 2019. SETTING: general population. SUBJECTS: community-dwelling older adults aged 75+ years, without dementia or acute illness, and able to stand unsupported for one minute. OUTCOME: fall rate for 12 months. STATISTICAL METHODS: candidate predictors were physical and cognitive tests along with self-report questionnaires. We developed a Poisson model using least absolute shrinkage and selection operator penalization, leave-one-out cross-validation, and bootstrap resampling with 1000 iterations. RESULTS: Sample size at study start and end was 241 and 198 (82%), respectively. The number of fallers was 87 (36%), and the fall rate was 0.94 falls per person-year. Predictors included in the final model were educational level, dizziness, alcohol consumption, prior falls, self-perceived falls risk, disability, and depressive symptoms. Mean absolute error (95% CI) was 0.88 falls (0.71-1.16). CONCLUSION: We developed a falls prediction model for community-dwelling older adults in a general population setting. The model was developed by selecting predictors from among physical and cognitive tests along with self-report questionnaires. The final model included only the questionnaire-based predictors, and its predictions had an average imprecision of less than one fall, thereby making it appropriate for clinical practice. Future external validation is needed. TRIAL REGISTRATION: Clinicaltrials.gov ( NCT03608709 ).


Assuntos
Acidentes por Quedas , Vida Independente , Idoso , Tontura , Humanos , Prognóstico , Estudos Prospectivos
15.
Rev Bras Enferm ; 74Suppl 2(Suppl 2): e20200904, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34231780

RESUMO

OBJECTIVE: to identify scientific productions on nursing care related to fall risk prevention among hospitalized elderly people. METHODS: an integrative literature review from 2015 to 2019 in the PubMed/MEDLINE, Scopus, Web of Science, LILACS, BDENF, SciELO and CINAHL databases, in Portuguese, English and Spanish. The keywords were elderly, hospitalization, accidents due to falls, nursing care. RESULTS: thirty-three publications were analyzed. The synthesis of the studies resulted in the categories: Clinical nursing assessments to prevent falls among hospitalized elderly people; Fall risk factors for elderly people; Fall risk prevention strategies for elderly people. FINAL CONSIDERATIONS: it was found that the scientific knowledge produced on nursing care related to fall risk prevention for hospitalized elderly people evidences the clinical assessment, risk factors and strategies such as nursing care, contributing to foster self-care behavior and promotion security for elderly people.


Assuntos
Acidentes por Quedas , Cuidados de Enfermagem , Acidentes por Quedas/prevenção & controle , Idoso , Hospitalização , Humanos , Fatores de Risco
16.
BMJ ; 374: n1585, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257088

RESUMO

OBJECTIVE: To examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital. DESIGN: Cluster randomised controlled trial. SETTING: 110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors. PARTICIPANTS: 2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term). INTERVENTION: Clinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing. MAIN OUTCOME MEASURE: Primary outcome was first drug related hospital admission within 12 months. RESULTS: 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237 v 263 first falls) and for death was 0.90 (0.71 to 1.13; 172 v 203 deaths). CONCLUSIONS: Inappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02986425.


Assuntos
Hospitalização/estatística & dados numéricos , Prescrição Inadequada/prevenção & controle , Multimorbidade , Polimedicação , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Europa (Continente) , Humanos , Prescrição Inadequada/efeitos adversos
17.
Arq Neuropsiquiatr ; 79(5): 376-383, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34161525

RESUMO

BACKGROUND: The link between sarcopenia and cognitive impairment has not yet been thoroughly evaluated, especially among older adults. OBJECTIVE: To evaluate the relationship between probable sarcopenia and cognitive impairment among community-dwelling older adults in two Brazilian cities. METHODS: Probable sarcopenia was assessed using the EWGSOP2 (2018) criteria. Thus, participants were classified as probably having sarcopenia if they had SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs and Falls) ≥4 points and low grip strength. Cognitive function was evaluated through the Mini-Mental State Examination (MMSE), verbal fluency (VF) and clock drawing test (CDT). RESULTS: In a sample of 529 older adults (mean age 80.8±4.9 years; mean education 4.2±3.67 years; 70.1% women), 27.3% of the participants had SARC-F≥4, 38.3% had low grip strength and 13.6% were classified as probable sarcopenia cases. After adjusting for possible confounders (age, sex, education, depression, diabetes, hypertension, leisure-time physical activity and obesity), probable sarcopenia was found to be associated with impairment in the MMSE (OR 2.52; 95%CI 1.42‒4.47; p=0.002) and in VF (OR 2.17; 95%CI 1.17‒4.01; p=0.014). Low grip strength was found to be associated with impairment in the MMSE (OR 1.83; 95%CI 1.18‒2.82; p=0.006) and in the CDT (OR 1.79; 95%CI 1.18‒2.73; p=0.006). SARC-F scores were found to be associated with impairment in the MMSE (OR 1.90; 95%CI 1.18‒3.06; p=0.008). CONCLUSION: The results suggested that probable sarcopenia and its components present a significant association with cognitive deficits among community-dwelling older adults. Future longitudinal studies will further explore the causal relationship.


Assuntos
Disfunção Cognitiva , Sarcopenia , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Masculino
18.
Artigo em Inglês | MEDLINE | ID: mdl-34071578

RESUMO

Accidents due to falls from height are one of the main causes of death in workplaces. Fall arrest systems (FAS) are designed to arrest the fall safely without injuring the accident victim. Their main mission is to restrain the body so as to prevent it from hitting the ground, generating forces and accelerations in the arrest process that are not harmful. A lack of empirical evidence and scant technical information provided by manufacturers regarding minimum clearance distance (MCD) below anchorage makes it necessary to study the safety distances required in the use of Energy Absorber Lanyards (EAL). This paper aims to determine the MCD below anchorage to arrest a fall using an EAL without hitting the ground. The real deformation of EAL when stopping a fall is studied. Ten EAL models distributed internationally by six manufacturers were chosen. Dynamic behavior tests were performed on the samples. Using image processing the total elongation of the equipment (elastic plus plastic) is obtained. The main conclusions are that maximum plastic elongation could be reduced by 29%. The method described in EN 355: 2002 underestimates elongation by up to 70% for some equipment 20% of EAL's exceed the maximum arrest force (Fm) allowed in EN 355. The MCD data provided by manufacturers is not reliable. The data provided by manufacturers are incomplete. It is recommended that quality control for EAL's be strengthened to ensure that products launched onto the market meet the requirement of EN355. The findings of this study recommended increasing MCD distance longer than that calculated according to EN355, at less than 1 m.


Assuntos
Acidentes por Quedas , Equipamentos de Proteção , Acidentes por Quedas/prevenção & controle , Cinética , Aplicação da Lei , Fenômenos Mecânicos
19.
Artigo em Inglês | MEDLINE | ID: mdl-34072495

RESUMO

Falls account for a high proportion of the safety accidents experienced by hospitalized children. This study aims to analyze the contents and effects of fall prevention programs for pediatric inpatients to develop more adaptable fall prevention programs. A literature search was performed using PubMed (including Medline), Science Direct, CINAHL, Embase, and Cochrane. We included articles published from the inception of each of the databases up to 31 March 2019. A total of 1725 results were reviewed according to the inclusion and exclusion criteria, and nine studies were selected. Data were analyzed using descriptive statistics and the Comprehensive Meta-Analysis program. Four of the nine studies divided their participants into a high-risk fall group and a low-or medium-risk fall group, and all studies used a high-risk sign/sticker as a common protocol guideline for its high-risk fall group. The odds ratio of 0.95 (95% Cl 0.550-1.640) for the fall prevention program in seven studies was not statistically significant. To develop a standardized fall prevention program in the future, randomized control trial studies that can objectively measure the fall rate reduction effect of the integrated fall prevention program need to be expanded.


Assuntos
Acidentes por Quedas , Pacientes Internados , Acidentes por Quedas/prevenção & controle , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Arch Osteoporos ; 16(1): 99, 2021 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-34148132

RESUMO

There is limited evidence from 11 randomised controlled trials on the effect of rehabilitation interventions which incorporate outdoor mobility on ambulatory ability and/or self-efficacy after hip fracture. Outdoor mobility should be central (not peripheral) to future intervention studies targeting improvements in ambulatory ability. PURPOSE: Determine the extent to which outdoor mobility is incorporated into rehabilitation interventions after hip fracture. Synthesise the evidence for the effectiveness of these interventions on ambulatory ability and falls-related self-efficacy. METHODS: Systematic search of MEDLINE, Embase, PsychInfo, CINAHL, PEDro and OpenGrey for published and unpublished randomised controlled trials (RCTs) of community-based rehabilitation interventions incorporating outdoor mobility after hip fracture from database inception to January 2021. Exclusion of protocols, pilot/feasibility studies, secondary analyses of RCTs, nonrandomised and non-English language studies. Duplicate screening for eligibility, risk of bias, and data extraction sample. Random effects meta-analysis. Statistical heterogeneity with inconsistency-value (I2). RESULTS: RCTs (n = 11) provided limited detail on target or achieved outdoor mobility intervention components. There was conflicting evidence from 2 RCTs for the effect on outdoor walking ability at 1-3 months (risk difference 0.19; 95% confidence intervals (CI): 0.21, 0.58; I2 = 92%), no effect on walking endurance at intervention end (standardised mean difference 0.05; 95% CI: - 0.26, 0.35; I2 = 36%); and suggestive (CI crosses null) of a small effect on self-efficacy at 1-3 months (standardised mean difference 0.25; 95% CI: - 0.29, 0.78; I2 = 87%) compared with routine care/sham intervention. CONCLUSION: It was not possible to attribute any benefit observed to an outdoor mobility intervention component due to poor reporting of target or achieved outdoor mobility and/or quality of the underlying evidence. Given the low proportion of patients recovering outdoor mobility after hip fracture, future research on interventions with outdoor mobility as a central component is warranted. TRIAL REGISTRATION: PROSPERO registration: CRD42021236541.


Assuntos
Acidentes por Quedas , Fraturas do Quadril , Humanos , Autoeficácia , Caminhada
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