Association between frequency of going out and mild cognitive impairment in community-dwelling older adults: a pilot study in frailty prevention groups.

BACKGROUND: Clarifying the role of physical limitations in the relationship between frequency of going out and mild cognitive impairment (MCI) may be useful in supporting early detection and prevention of MCI. However, few studies have explored relatively active populations that are continuously active throughout the year. This study aimed to determine the relationship between frequency of going out and MCI among non-homebound older adults who participated in group activities to prevent frailty. METHODS: This prospective cohort study used frequency of going out as the exposure and MCI as the outcome. The Touch Panel-type Dementia Assessment Scale and questionnaires about daily life were completed by 153 community-dwelling older adults aged ≥65 years participating in frailty prevention groups in a rural town. The baseline survey was conducted from December 2017 to March 2018 and analysed cross-sectionally. Follow-up surveys were conducted at 1- and 2-years and analysed longitudinally. RESULTS: Univariate and binomial logistic regression analyses at baseline showed no association between MCI and frequency of going out in older adults with physical limitations. However, there was a significant association in older adults without physical limitations. A binomial logistic regression analysis of the frequency of going out at baseline and cognitive function at the 2-year follow-up showed no association between MCI and frequency of going out in older adults with physical limitations, but there was a significant association in those without physical limitations. CONCLUSION: Our results suggest that frequency of going out may not be a useful indicator of MCI in older adults with physical limitations, although low frequency of going out may be an indicator of MCI in older adults without physical limitations.

In-Hospital Fall Risk Prediction by Objective Measurement of Lower Extremity Function in a High-Risk Population.

OBJECTIVES: Limited data exist regarding association between physical performance and in-hospital falls. This study was performed to investigate the association between physical performance and in-hospital falls in a high-risk population. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: The study population consisted of 1200 consecutive patients with a median age of 74 years (50.8% men) admitted to a ward with high incidence rates of falls, primarily in the departments of geriatrics and neurology, in a university hospital between January 2019 and December 2021. METHODS: Short Physical Performance Battery (SPPB) was measured after treatment in the acute phase. As the primary end point of the study, the incidence of in-hospital falls was examined prospectively based on data from mandatory standardized incident report forms and electronic patient records. RESULTS: SPPB assessment was performed at a median of 3 days after admission, and the study population had a median SPPB score of 3 points. Falls occurred in 101 patients (8.4%) over a median hospital stay of 15 days. SPPB score showed a significant inverse association with the incidence of in-hospital falls after adjusting for possible confounders (adjusted odds ratio for each 1-point decrease in SPPB: 1.19, 95% CI 1.10-1.28; P < .001), and an SPPB score ≤6 was significantly associated with increased risk of in-hospital falls. Inclusion of SPPB with previously identified risk factors significantly increased the area under the curve for in-hospital falls (0.683 vs. 0.740, P = .003). CONCLUSION AND IMPLICATIONS: This study demonstrated an inverse association of SPPB score with risk of in-hospital falls in a high-risk population and showed that SPPB assessment is useful for accurate risk stratification in a hospital setting.

The Relationship Between Fear-Avoidance Beliefs, Disability, and Physical Capacity in Patients with Chronic Low Back Pain.

Objective: The objective of this study was to document the multi-dimensional profile of patients referring with chronic low back pain (CLBP) and determine the relationship among fear-avoidance belief and disability and physical capacity in the Pakistani population. Methods: A cross-sectional survey was conducted at the Physiotherapy Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences. Consecutive sampling was used among the population of CLBP, and objective measures were fear-avoidance beliefs (FABQ-total) and Roland Morris questionnaire (RMDQ) and pain. Each participant performed a physical capacity test, which included a 6-minute walk test (6MWT), abdominal muscular endurance (AME), hand grip strength (HGS), and Functional reach test (FRT). Result: Of the 136 participants, 70(51.5%) were males. The mean and SD of the tests performed were: 6MWT (487.97±51.46), AME (9.31±4.68), FRT (35.14±2.79), HGS (33.31±14.55), VAS (5.51±1.27), RMDQ (18.25±2.17), FABQ-total (48.18±5.31). Multivariate regression revealed that symptom duration, FRT, AME, HGS, VAS, RMDQ were all found to be associated with fear-avoidance belief, accounting for 60% (adjusted R2 = 0.60) of variability. Likewise, only 6-MWT, FRT, FABQ-total were the significant predictors of disability (adjusted R2=0.282). Conclusion: It has been demonstrated that sub-maximal exercise capacity, strength, endurance, pain and flexibility are the contributing factors for the change in disability and fear-avoidance beliefs among the individuals with CLBP. The findings of this study could have inference for increasing productivity both at individual and organizational levels by formulating effective strategies to manage CLBP.

Functional Performances on Admission Predict In-Hospital Falls, Injurious Falls, and Fractures in Older Patients: A Prospective Study.

Falls are common among older inpatients and remain a great challenge for hospitals. Despite the relevance of physical impairments to falls, the prognostic value of performance-based functional measures for in-hospital falls and injurious falls remains unknown. This study aimed to determine the predictive ability and accuracy of various functional tests administered at or close to admission in a geriatric hospital to identify in-hospital fallers and injurious fallers. In this prospective study, conducted in a geriatric hospital in Geneva, Switzerland, 807 inpatients (mean age 85.0 years) were subjected to a battery of functional tests administered by physiotherapists within 3 days (interquartile range 1 to 6) of admission, including Short Physical Performance Battery (SPPB), simplified Tinetti, and Timed Up and Go tests. Patients were prospectively followed up for falls and injurious falls until discharge using mandatory standardized incident report forms and electronic patients' records. During a median length of hospital stay of 23 days (interquartile range 14 to 36), 329 falls occurred in 189 (23.4%) patients, including 161 injurious falls of which 24 were serious. In-hospital fallers displayed significantly poorer functional performances at admission on all tests compared with non-fallers (p < 0.001 for all). In multivariate analysis controlling for age, sex, previous falls, and fall as cause of admission, poorer functional performances on all functional tests predicted in-hospital falls and injurious falls (p < 0.001 for all). The SPPB only significantly predicted serious injurious falls (adjusted odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.60-0.96) and fractures (adjusted OR = 0.76; 95% CI 0.59-0.98). In conclusion, poor functional performances, as assessed by SPPB, are independent predictors of in-hospital falls, injurious falls, and fractures in patients admitted to a geriatric hospital. These findings should help to design preventive strategies for in-hospital falls and support the adoption of objective performance-based functional measures into routine hospital practice. © 2018 American Society for Bone and Mineral Research.