A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension： a cross-sectional study

Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.

Balance training in the intervention of fall risk in elderly with diabetic peripheral neuropathy: A review

Diabetic peripheral neuropathy(DPN)was the most common complications of elderly diabetic,which could contribute to an increased risk of falling.Despite the increased prevalence of elderly diabetic,high risk of falls and serious consequences of falls in elderly with DPN,It is necessary to adopt means of reducing the risk of falls in elderly with DPN.Impaired balance in the elderly with DPN was the most important risk factor of increasing falls.This review will introduce the epidemiology of falls in elderly with DPN,analysis the reasons for high risk of falls in elderly with DPN,provide a review of the development of balance training in the intervention of fall risk in elderly with DPN and offer recommendations to medical personnels on how to provide an efficient balance training for elderly with DPN.

Relationship between fall risks and activities of daily living in older individuals

Objective:To investigate the relationship between fall risks and maintaining activities of daily living in individuals aged 65 and over.Methods:This study is cross-sectional.It was conducted with 233 individuals who were aged 65 and over in Family Health Centers located in the eastern part of Turkey between February and June 2018.Results:The mean older individuals’DENN Fall Risks Assessment Scale score was 11.73±7.13,and 62.2%of the participants were in the high-risk group.Barthel Index of Activities of Daily Living(ADL)mean score was 68.03±25.36,and 45.1%of the participants were in the moderately dependent group.There was a statistically significant,negative correlationship between Barthel Index of ADL score and age and DENN Fall Risks Assessment Scale score.In addition,there was a statistically significant,positive relationship between the DENN Fall Risks Assessment Scale score and age(p<0.01).Conclusions:This study found that level of dependency and fall risks increased with the increase in age.Effective global and multidisciplinary interventions are needed to decrease older individuals’dependency levels and fall risks today when the number of older individuals is increasing.

Effects of a multimodal exercise protocol on functional outcomes,epigenetic modulation and brain-derived neurotrophic factor levels in institutionalized older adults:a quasi-experimental pilot study

Epigenetic changes have been shown to be associated with both aging process and aging-related diseases.There is evidence regarding the benefits of physical activity on the functionality,cognition,and quality of life of institutionalized older adults,however,the molecular mechanisms involved are not elucidated.The purpose of this pilot study was to investigate the effects of a multimodal exercise intervention on functional outcomes,cognitive performance,quality of life(QOL),epigenetic markers and brain-derived neurotrophic factor(BDNF)levels among institutionalized older adult individuals.Participants(n=8)without dementia who were aged 73.38±11.28 years and predominantly female(87.5%)were included in this quasi-experimental pilot study.A multimodal exercise protocol(cardiovascular capacity,strength,balance/agility andflexibility,perception and cognition)consisted of twice weekly sessions(60 minutes each)over 8 weeks.Balance(Berg Scale),mobility(Timed Up and Go test),functional capacity(Six-Minute Walk test),cognitive function(Mini-Mental State Examination)and QOL(the World Health Organization Quality of Life-BREF Scale questionnaire)were evaluated before and after the intervention.Blood sample(15 mL)was also collected before and after intervention for analysis of biomarkers global histone H3 acetylation and brain-derived neurotrophic factor levels.Significant improvements were observed in cognitive function,balance,mobility,functional capacity and QOL after the intervention.In addition,a tendency toward an increase in global histone H3 acetylation levels was observed,while brain-derived neurotrophic factor level remained unchanged.This study provided evidence that an 8-week multimodal exercise protocol has a significant effect on ameliorating functional outcomes and QOL in institutionalized older adult individuals.In addition,it was also able to promote cognitive improvement,which seems to be partially related to histone hyperacetylation status.The Ethics Research Committee of Centro Universitário Metodista-IPA,Brazil approved the current study on June 6,2019(approval No.3.376.078).

Hourly Rounding and Fall Prevention among the Elderly in Long Term Care: A change Process

Long term care facilities have a rising rate of falls and fall related injuries with increasing cost and more hospitalization.Hourly rounding®is an evidenced based intervention that is proactive for nursing staff to be able to identify patient’s needs.This helps with positive fall prevention out­come.This project focused on process improvement efforts for 10 weeks and examining the education and implementation of an evidenced-based hourly rounding program that assisted in reducing the number of falls in the pilot unit.The implementation of the intervention took place in a long-term care facility located in Dallas,Georgia.The hourly rounding tools used in this project were the Studer Group hourly rounding log and competency checklist with permission.Twenty staff members were in­cluded in the sample,age 18 years and 60 years.The unit has 41 residents who were included in the pilot case study design.Staff members were first educated regarding hourly rounding and documentation on the hourly rounding log was done two days before implementation and the pre and post fall rate was retrieved from the facilities fall database.Competency checklist was completed prior to implementation and post implementa­tion to evaluate staff understanding of the main tenets of the 4 P’s(potty,pain,possession,and position).For this project,descriptive statistics was used to help determine fall rates.Minitab was used to analyzed data and to determine if it was clinically significant.In the ten weeks following the hourly rounding implementation,participants performed hourly rounding by incorporating it to each resident’s daily routine and documented their rounds on the log sheet.The results indicated that it is statistically signifi­cant and with a P-values=-<0.0001 and t-value=-5.81.

Experimental Field Study of Movement Charateristics of Rock Blocks Falling down a Slope

The downslope movement of detached rock blocks along steep slopes is an important process endangering the safety of infrastructure along the foot of a slope and on the valley bottom,but only limited knowledge is available on the influence of various factors on the velocity and distance of movement of such blocks.We discuss the influence of the mass and shape of the rock blocks,the steepness of the slope,and the thickness of the overburden on the slope,on the distance of movement of rock blocks which was observed in 256 field experiments with differently shaped blocks from 3 different positions on the slope with a height of 176 m.The statistical evaluation of the results of the field tests shows that the slope condition of gradient and overburden is the main factor,the form of rock masses is the second factor,and the mass is the third of the influencing factors.It is the maximum average acceleration for movement of rock masses when the mass of rock masses is 15≤m27 kg,the form of rock masses is flake,the condition of gradient is on average 59.6° and the overburden is basic exposed bedrock and a small quantity of gravel-soil in the experiment condition.It is the minimum average acceleration for movement of rock masses when the mass of rock masses is 9.5≤m15 kg,the form of rock masses is rectangular,the condition of gradient is on average 39° and the overburden is gravel-soil and cinder.Then,the foundation for impact energy is provided and the new feasible methods to prevent potential unstable rock masses are put forward.

The correlation between white matter hyperintensity and balance disorder and fall risk:An observational, prospective cohort study

Objective: The presence of an association between white matter hyperintensity (WMH) and the risk of falls in older people is uncertain, with little supporting prospective evidence available at present. We aimed to determine whether WMH was associated with dysfunctions of balance and gait, and other sensorimotor factors leading to falls, and the independent factors related to falls in older Chinese people. The protective effect of exercise against falls was also addressed. Methods: In a representative sample of hospital-based individuals aged 50 years and older in China, the patients' history of falls, magnetic resonance imaging data, scores on the 9-item Berg Balance Scale (BBS-9) test and timed up-and-go test (TUGT), and sensorimotor measures of computerized dynamic posturography (CDP) were analyzed. Incident falls were recorded prospectively over a 12-month period. Using regression modeling, the association between the risk of falls and baseline WMH was estimated. Results: Only individuals with severe WMH were at an increased risk of falls, and CDP was more sensitive than BBS-9 in detecting WMH-related balance and gait dysfunction. However, WMH was not an independent predictor of falls. Taller height and overweight or obese body habitus were identified as novel protective factors for falls. Female, fall history, and increased TUGT score were identified as independent risk factors for falls in older Chinese people.