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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.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
J Nurs Adm ; 50(9): 442-448, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826513

RESUMO

OBJECTIVE: The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making. BACKGROUND: The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment. METHODS: Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked. RESULTS: Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention. CONCLUSIONS: Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.


Assuntos
Acidentes por Quedas/prevenção & controle , Atitude do Pessoal de Saúde , Tomada de Decisões , Enfermeiras e Enfermeiros/psicologia , Adulto , Competência Clínica , Feminino , Humanos , Entrevistas como Assunto , Masculino , Enfermeiras Administradoras
12.
Medicine (Baltimore) ; 99(28): e21228, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664177

RESUMO

BACKGROUND: Recent years have witnessed wide applications of exergames to balance training among the older adults. However, research concerning balance training with the use of Kinect for Xbox has remained scarce. While previous studies have shown the positive effects of exergames on improving balance and preventing falling among the older adults, there has been a paucity of empirical evidence supporting the superiority of Kinect exercise to conventional exercise over balance training among the older adults. Therefore, this study aimed to compare the feasibility, safety, and effectiveness of Kinect exercise against conventional exercise over balance training among the community older adults. METHOD: A total of 20 participants were randomly assigned to the Kinect Exercise Group (N = 10) or the Conventional Exercise Group (N = 10) for a 5-week balance training (45 minutes a time, 2 times a week). Assessor blinding was employed to assess the participants' performance before and after the treatment, including 30-Second Chair Stand Test (30-sec CST), Timed Up and Go (TUG), Functional Reach Test (FRT), and One-Leg Stance Test (OLST) respectively with eyes open and closed. Subjective feeling of the intensity of pain and side effects were recorded throughout the investigation period. Nonparametric statistics was used for data analysis. RESULTS: Within-group comparison between the pre-test and post-test indicated that significant differences existed in all of the 5 tests (30-sec CST, TUG, FRT, OLST with eyes open, and OLST with eyes closed) in the Kinect exercise group. To the Conventional exercise group, however, significant differences were only observed in 30-sec CST, FRT and OLST with eyes open. With regard to between-group comparison, significant differences were only found in FRT. CONCLUSION: Such results indicated that both treatments were helpful in improving the participants' balance performance, that Kinect exercise was more effective in terms of overall balance ability, and that Kinect exercise was particularly beneficial to functional reach enhancement in comparison with traditional exercise. Kinect exercise could be a feasible, safe, and effective alternative for dynamic balance training among older adults.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Jogos de Vídeo , Idoso , Estudos de Viabilidade , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento
13.
PLoS One ; 15(7): e0235734, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667956

RESUMO

OBJECTIVE: The objective of this randomized controlled trial was to examine dynamic balance changes (reach distance) in middle-aged adults using the Y Balance Test (YBT) following 8 weeks of home-based exercise program adapted from the Otago Exercise Program (OEP). METHODS: Fifty-two healthy middle-aged adults with mean age of 54.4±5.4 years and body mass index of 27.7±5.7 kg/m2 were randomly assigned into either the exercise group (a modification of the Otago Exercise Program, that consisted of home-based balance and strength exercises) or the non-exercise group (continuation of usual lifestyle) by having the participants select a paper from a sealed envelope. The YBT was used to measure participants' dynamic balance in the right and left anterior (RA, LA), posteromedial (RPM, LPM), and posterolateral (RPL, LPL) directions. RESULTS: The outcome in this trial was reach distance (cm). There was a significant group by time interaction in terms of reach distance for all directions (p<0.05, η2 ranged from 0.06 to 0.20). In the exercise group, results of the repeated measures analysis of variance (ANOVA) showed significant improvements in the reach distance in all the directions (p<0.001). In contrast, the non-exercise group had significant difference only in the left posterolateral direction (p = 0.009). Participants in the exercise group achieved significantly greater reach distance (cm) (95% confidence interval (CI)) for RA[(2.8, 0.4 to 5.2), p = 0.023]; LA[(3.2, 0.9 to 5.6), p = 0.008]; RPM[(4.0, 1.0 to 7.9), p = 0.046]; LPM[(5.8,1.3 to 10.3), p = 0.013]; RPL[(7.6, 2.6 to 12.6), p = 0.003]; and LPL[(4.2, 0.3 to 8.2), p = 0.035]. CONCLUSION: The modified version of OEP appears to be effective in improving parameters of dynamic balance in the middle-aged adult population. The improvements in YBT reach distance in the exercise group are indicative of the significance of performing balance and strength exercises regularly for this population.


Assuntos
Acidentes por Quedas/prevenção & controle , Exercício Físico , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Endocrine ; 69(2): 237-240, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32632722

RESUMO

Coronavirus 2019 disease (COVID-19) mostly adversely affects the elderly, a population at higher risk for low serum 25-hydroxyvitamin D (25(OH)D) levels. In this viewpoint, we highlight the well-known musculoskeletal properties of vitamin D, which are particularly relevant in the context of COVID-19, suggesting further potential benefits through extra-skeletal effects. Maintaining optimal 25(OH)D is crucial to prevent falls, frailty and fractures in elderly patients, with low activity levels due to lockdown, or who are relatively immobilized during hospitalization and after discharge for prolonged periods of time. Hypovitaminosis D is also associated with susceptibility to respiratory infections, admissions to the intensive care unit, and mortality. We underscore the importance of achieving desirable serum 25(OH)D in COVID-19 elderly patients, to ensure beneficial musculoskeletal effects and possibly respiratory effects of vitamin D, in the context of COVID-19.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Infecções por Coronavirus/complicações , Fraturas Ósseas/prevenção & controle , Pneumonia Viral/complicações , Deficiência de Vitamina D/complicações , Vitamina D/uso terapêutico , Acidentes por Quedas/prevenção & controle , Idoso , Humanos , Pandemias , Deficiência de Vitamina D/prevenção & controle
15.
N Engl J Med ; 383(2): 129-140, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32640131

RESUMO

BACKGROUND: Injuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined. METHODS: We conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group. RESULTS: The demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups. CONCLUSIONS: A multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.).


Assuntos
Acidentes por Quedas/prevenção & controle , Lesões Acidentais/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Acidentes por Quedas/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Lesões Acidentais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Vida Independente , Masculino , Medicina de Precisão , Medição de Risco , Fatores de Risco
16.
Cuad. psicol. deporte ; 20(3): 75-81, jul. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-193542

RESUMO

This study determined the effects of a 4-week individualized multicomponent exercise program (Vivifrail) on physical frailty and functional disability in older adults living in nursing homes.Fourteen institutionalized older adults (aged 81.7 ± 9.7 years) volunteered to completed 4 weeks of the individualized Vivifrail exercise program (5 days a week) according to their initial level: A, disability; B, frailty; C, pre-frailty and D, robust. Training sessions were directed by strength and conditioning trainers. Eleven participants completed the pre and post evaluations with very high levels of attendance (96% of the training sessions). Functional capacity (SPPB scores) significantly improved in all the participants (+48.2%, p < 0.001) and tests: sit-to-stand (24.1% faster, p = 0.003), gait speed 4 m (9.8% faster, p = 0.033) and 6 m (7.2% faster, p = 0.017) and Up and Go (11.2% faster, p = 0.004). Disability and sarcopenia decreased significantly (SARC-F, p = 0.026; Lawton index, p = 0.013). People with initial levels of disability (A), frailty (B) and pre-fragility (C) shown the greatest improvements. Six of the nine participants who started with physical frailty or pre-frailty status (66.7%) reversed this condition after the intervention. In addition, 33% of participants with disability, who were unable to perform the functional tests (sit-stand and walk), became able to complete them after the intervention. These important benefits found in such a shorter period of time (4 weeks) could be related to three key elements: individualization of the program, daily frequency and face-to-face coaching motivation by physical conditioning professionals


En este estudio se determinaron los efectos de un programa de ejercicio multicomponente individualizado de 4 semanas (Vivifrail) sobre la fragilidad física y la discapacidad funcional en adultos mayores que viven en hogares de ancianos. Catorce personas institucionalizadas (edad 81,7 ± 9,7 años) se ofrecieron voluntarios para completar 4 semanas del programa de ejercicio individualizado Vivifrail (5 días a la semana) de acuerdo con su nivel inicial: A, discapacidad; B, fragilidad; C, pre-fragilidad y D, robusto. Los entrenamientos fueron dirigidos por educadores físico-deportivos titulados. Once participantes completaron las 4 semanas con niveles muy altos de asistencia (96%). La capacidad funcional (puntuación del SPPB) mejoró en todos los participantes (+46,6%, p < 0,001, ES = 0,79) y tests: levantarse de la silla (45,6% faster, p = 0,003, ES = 1,43), velocidad de marcha 4 m (19,3% faster, p = 0,033, ES = 0,38) y test Timed Up-and-Go (23,2% faster, p = 0,004, ES = 0,35). La discapacidad y sarcopenia disminuyeron significativamente (SARC-F, p = 0,026, ES = 0,59; Lawton index, p = 0,013, ES = 0,87). Las personas que empezaron con niveles de discapacidad (A), fragilidad (B) y pre-fragilidad (C) mostraron mejores resultados. Seis de los nueve participantes que comenzaron con fragilidad física o pre-fragilidad (66,7%) revirtieron esta condición tras la intervención. Además, el 33% de los participantes que fueron incapaces de realizar las pruebas funcionales (sentarse, levantase y caminar) al inicio, pudieron completarlas tras la intervención. Estos importantes beneficios en tan poco tiempo (4 semanas) podrían estar relacionados con tres elementos clave: individualización del programa, frecuencia diaria y motivación del entrenamiento dirigido


Neste estudo, foram determinados os efeitos de um programa individualizado de exercícios multicomponentes de quatro semanas (Vivifrail) sobre a fragilidade física e a incapacidade funcional em idosos residentes em casas de repouso. Quatorze indivíduos institucionalizados (idade 81,7 ± 9,7 anos) se voluntariaram para completar 4 semanas do programa de exercícios individualizado Vivifrail (5 dias por semana), de acordo com seu nível inicial: A, incapacidade; B, fragilidade; C, pré-fragilidade e D, robusto. Os treinamentos foram conduzidos por educadores físicos e esportivos certificados. Onze participantes completaram as 4 semanas com níveis muito altos de participação (96%). A capacidade funcional (escore SPPB) melhorou em todos os participantes (+46,6%, p < 0,001, ES = 0,79) e testes: levantar da cadeira (45,6% faster, p = 0,003, ES = 1,43), velocidade de caminhada 4m (19.3% faster, p = 0,033, ES = 0,38) e 6 m (19,3% faster, p = 0,033, ES = 0,38) e teste Timed Up and Go (23,2% faster, p = 0,004, ES = 0,35). Incapacidade e sarcopenia diminuíram significativamente (SARC-F, p = 0,026, ES = 0,59; Lawton index, p = 0,013, ES = 0,87). Pessoas que iniciaram com níveis de incapacidade (A), fragilidade (B) e pré-fragilidade (C) apresentaram melhores resultados. Seis dos nove participantes que iniciaram com a condição física ou pré-fragilidade (66,7%) reverteram essa condição após a intervenção. Além disso, 33% dos participantes que não conseguiram realizar os testes funcionais (sentar, levantar e andar) na linha de base, conseguiram concluí-los após a intervenção. Esses importantes benefícios em tão pouco tempo (4 semanas) podem estar relacionados a três elementos principais: individualização do programa, frequência diária e motivação do treinamento direcionado


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Idoso Fragilizado , Atenção Primária à Saúde , Terapia por Exercício/métodos , Casas de Saúde , Idoso Fragilizado/psicologia , Terapia por Exercício/psicologia , Acidentes por Quedas/prevenção & controle , Desempenho Físico Funcional
17.
Stud Health Technol Inform ; 270: 257-261, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570386

RESUMO

Classification systems are widely used in medicine for knowledge representation. The hierarchical relationships between concepts in a classification system can be exploited in prediction models by looking for the optimal predictive granularity level. In this study, we used the Anatomical Therapeutic Chemical (ATC) classification system to cluster medications in the context of predicting medication-related falls in older persons. We compared the performance of fall risk prediction by describing medications at varying granularity levels of the ATC classification system. We found that the level of abstraction significantly affects the predictive performance in terms of both discrimination (measured by the receiver operating characteristic curve AUC-ROC) and calibration. An implication of these findings to the researchers is that data representation at different granularity levels can influence the predictive performance. The optimal granularity level can be determined by experimentation.


Assuntos
Acidentes por Quedas/prevenção & controle , Classificação , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Curva ROC , Reprodutibilidade dos Testes
18.
Rev Lat Am Enfermagem ; 28: e3268, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32491125

RESUMO

OBJECTIVE: determine the psychometric properties of the safety practices and behaviors dimension of the Scale of Practices and Behaviors of Institutionalized Elderly People to Prevent Falls in a sample of elderly people with cognitive decline. METHOD: methodological study, with a quantitative approach, to assess the psychometric properties of the mentioned scale in a sample with 102 elderly people with cognitive decline who lived in two long-term care institutions for the public in this age group. Internal consistency evaluation was carried out by calculating the Cronbach's alpha coefficient; interobserver reliability was expressed by Cohen's kappa coefficient; and temporal stability, by obtaining Spearman correlation. Compliance with all ethical procedures was observed. RESULTS: the dimension of safety practices and behaviors showed α = 0.895 for its 11 items. Seven out of the 11 items reached good to excellent agreement among the experts for interobserver reliability. Kappa index values indicated that the instrument is valid and reliable. Safety practices and behaviors were influenced by institutionalization time, being at least 85 years old, and gait skills. CONCLUSION: the results pointed out that the instrument has good reproducibility and is valid and reliable, which allows its use in clinical practice in elderly people with cognitive decline as well as in research.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica , Escalas de Graduação Psiquiátrica/normas , Idoso , Idoso de 80 Anos ou mais , Comportamento , Feminino , Psiquiatria Geriátrica , Humanos , Institucionalização , Masculino , Variações Dependentes do Observador , Psicometria/métodos , Reprodutibilidade dos Testes
19.
Rev Lat Am Enfermagem ; 28: e3272, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32491126

RESUMO

OBJECTIVE: to analyze the experience of the patient during hospitalization, focusing on the co-production of care related to patient safety protocols. METHOD: qualitative study, whose data were collected through the triangulation of multiple sources: document analysis, observation of 10 professionals in the provision of care and 24 interviews with patient-families from 12 clinical and surgical inpatient units of a hospital. Thematic analysis was carried out, based on the concept of co-production. RESULTS: safety protocols according to the experience of the patient portrayed the role of patient-families as co-producers of safe care. It was found an alignment between perceptions of the patients, institutional definitions and basic national and international patient safety protocols. However, these protocols are not always followed by professionals. CONCLUSION: co-production was perceived in the protocols for safe surgery and prevention of injuries resulting from falls. In patient identification, hand hygiene and medication process, it was found that co-production depends on the proactive behavior of patient-families, as it is not encouraged by professionals. The research contributes with subsidies to leverage the participation of the patient as an agent of their safety, highlighting the co-production of health care as a valuable resource for advancing patient safety.


Assuntos
Família , Hospitalização/estatística & dados numéricos , Segurança do Paciente/normas , Assistência Centrada no Paciente/normas , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Brasil , Protocolos Clínicos , Feminino , Higiene das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
20.
Rev Bras Epidemiol ; 23: e200055, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520105

RESUMO

OBJECTIVE: The aim of this study was to verify the association between types of dependence for basic and instrumental activities of daily living and the occurrence of falls in the elderly. METHODS: A cross-sectional, population-based study using data from 23,815 elderly people drawn from the National Health Survey (NHS) in 2013. The NHS, conducted by the Brazilian Institute of Geography and Statistics (IBGE) and the Ministry of Health, presents data collected in 81,767 households in more than 1,600 municipalities. The association between the independent variable (ADL disabilities) and the dependent variable (history of falls) was performed through multiple and crude analyses, regression. RESULTS: There was a greater association between using the toilet and transfers (ABVD) and falls, and between shopping and taking care of finances (IADL) and falls. In addition, the association between Basic Activities of Daily Living and falls was greater for up to four activities, and the Instrumental Activities of Daily Living for up to three activities. CONCLUSION: Thus, the results obtained in the NHS reinforce the planning of preventive strategies considering the functional dependence.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Atividades Cotidianas , Pessoas com Deficiência/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos
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