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Can cognitive enhancers reduce the risk of falls in older people with Mild Cognitive Impairment? A protocol for a randomised controlled double blind trial
Manuel Montero-Odasso, Jennie L Wells, Michael J Borrie, Mark Speechley
BMC Neurology , 2009, DOI: 10.1186/1471-2377-9-42
Abstract: Double blinded randomized controlled trial with 6 months follow-up in 140 older individuals with Mild Cognitive Impairment (MCI). Participants will be randomized to the intervention group, receiving donepezil, and to the control group, receiving placebo. A block randomization by four and stratification based on fall history will be performed. Primary outcomes are improvements in gait velocity and reduction in gait variability. Secondary outcomes are changes in the balance confidence, balance sway, attention, executive function, and number of falls.By characterizing and understanding the effects of cognitive enhancers on fall risk in older adults with cognitive impairments, we will be able to pave the way for a new approach to fall prevention in this population. This RCT study will provide, for the first time, information regarding the effect of a medication designed to augment cognitive functioning have on the risk of falls in older adults with Mild Cognitive Impairment. We expect a significant reduction in the risk of falls in this vulnerable population as a function of the reduced gait variability achieved by treatment with cognitive enhancers. This study may contribute to a new approach to prevent and treat fall risk in seniors in early stages of dementia.The protocol for this study is registered with the Clinical Trials Registry, identifier number: NCT00934531 http://www.clinicaltrials.gov webciteAn important goal of geriatric medicine is to reduce the gap between life expectancy and disability-free life expectancy. A substantial portion of this gap is caused by two major geriatric syndromes: cognitive impairment and mobility limitation, which ultimately manifest as dementia and falls, respectively. Interestingly, these manifestations often coexist in elderly people: falling is a common geriatric syndrome affecting about a third of older adults each year, and dementia has a prevalence of 8% of Canadians aged 65 and 35% in people over age 85 [1-3]. This interrela
Causality of accidental falls in the elderly
Danielli Gavi?o Mallmann, Darleni Rosa Tambara, Karina Silveira de Almeida Hammerschmidt, Beatriz Franchini
Revista de Enfermagem UFPE On Line , 2009,
Abstract: Objective: to identify the predisposing factors in the literature falls in the elderly. Methods: this was about a review in databases Scientific Electronic Library Online (SciELO) and Google Scholar (Google Scholar) and the library collection of UNIPAMPA, using the descriptors: falls and falls in the elderly. Inclusion criteria were: 1) Publication of the period 2000-2009, 2) publication which deals expressly falls in the elderly, and the exclusion criteria: 1) Publications International, 2) Subjects of falls in older people focused on specificity. Results: we found 16 articles on the subject proposed the review, which were used for preparing the same, and two books on the subject. The inadequate environment presents itself as one of the most significant factors in the occurrence of falls, in addition to changes resulting from age and use of medications. Conclusion: falls interfere with the quality of life to undermine the day-day limit of the elderly when the outputs of some activities of daily living. There are prevention methods that can be used to avoid the drop, as the organization's environment.
Medication as a risk factor for falls in older women in Brazil  [cached]
Rozenfeld Suely,Camacho Luiz Antonio Bastos,Veras Renato Peixoto
Revista Panamericana de Salud Pública , 2003,
Abstract: OBJECTIVE: To assess the prevalence of falls and their association with the use of medications among elderly women in the city of Rio de Janeiro, Brazil. Falls among the elderly are likely to gain additional public health importance in Brazil and many other developing countries given the rapid growth of the elderly populations in those nations. METHODS: A cross-sectional study was carried out with women who were participating in the educational, cultural, and medical care activities of the Open University of the Third Age (OUTA), a group that works to promote the welfare of elderly people in the city of Rio de Janeiro. The women in the study were all 60 years old or older, were able to walk, had no cognitive impairment, and were living in the community (rather than living in a facility exclusively for older persons). A questionnaire was used that asked about falls within the 12 months prior to the interview, medications used in the previous 15 days, current and past health problems, and demographic characteristics. Women who were interviewed face-to-face also had their blood pressure checked. Two outcome variables were defined: (1) "fallers," who had suffered one or more falls (contrasted with "nonfallers") and (2) "recurrent fallers," who had had two or more falls (contrasted with those who had had one or no falls, called "nonrecurrent fallers"). RESULTS: A total of 634 women were interviewed face-to-face at the OUTA facilities. Among these in-person interviewees, 23.3% reported one fall in the previous year, and 14.0% reported two or more falls in that period. Considering both prescribed drugs and over-the-counter drugs, only 9.1% of these women were not using any medications, 52.7% were using 1 to 4 medications, 34.4% were using 5 to 10, and 3.8% were using 11 to 17 medications. In comparison to nonusers, users of diuretics who also suffered from musculoskeletal disease were 1.6 times as likely to report having suffered a single fall in the preceding year, after adjusting for cardiovascular disease. Recurrent falls were reported 2.0 times as often among beta-blocker users as among nonusers, after adjusting for cardiovascular disease. The risk of recurrent falls among users of anxiolytics/sedatives who had postural hypotension was 4.9 times as high as among nonusers. CONCLUSIONS: Our data indicate an association between single falls and recurrent falls and several groups of medications. Some falls could be avoided through the more rational use of drugs, and measures should be developed and implemented to encourage this.
Level of physical activity and accidental falls in elderly: a systematic review
Priscila Carneiro Valim-Rogatto,Gustavo Puggina Rogatto,áurea Christina de Paula Corrêa,Ana Cristina Passarella Brêtas
Revista Brasileira de Cineantropometria e Desempenho Humano , 2009,
Abstract: The aim of this study was to analyze studies evaluating the association between the level of physical activity and the occurrence of accidental falls in the elderly. A systematic literature review of the LILACS and MEDLINE databases was conducted. As inclusion criteria, complete scientific articles investigating subjects older than 60 years, published in Portuguese, English or Spanish, were selected. Twenty-nine articles were retrieved, five from LILACS (1982 to 2007), two from MEDLINE (1966 to 1996), and 22 from MEDLINE (from 1997 to 2007). Ten (35%) articles were selected based on the inclusion criteria and 19 (65%) were excluded. A cross-sectional design was the most frequent type of study (60%). The studies identified suggest an association between the level of physical activity and factors related to the occurrence of falls such as functional disability, quality of life and independence to perform daily activities. Falls were found to restrict physical activity in some studies. In view of the heterogeneity of the studies in terms of methods and assessments, it was not possible to determine whether a better level of physical activity is able to decrease the incidence of falls in the elderly.
The Association between Seasonal Variation in Vitamin D, Postural Sway, and Falls Risk: An Observational Cohort Study  [PDF]
Marie-Louise Bird,Keith D. Hill,Iain Robertson,Madeleine J. Ball,Jane K. Pittaway,Andrew D. Williams
Journal of Aging Research , 2013, DOI: 10.1155/2013/751310
Abstract: Introduction. Low serum vitamin D levels are associated with increased postural sway. Vitamin D varies seasonally. This study investigates whether postural sway varies seasonally and is associated with serum vitamin D and falls. Methods. In a longitudinal observational study, eighty-eight independently mobile community-dwelling older adults (69.7 7.6 years) were evaluated on five occasions over one year, measuring postural sway (force platform), vitamin D levels, fall incidence, and causes and adverse outcomes. Mixed-methods Poisson regression was used to determine associations between measures. Results. Postural sway did not vary over the year. Vitamin D levels varied seasonally ( ), peaking in summer. Incidence of falls ( ) and injurious falls ( ) were lower in spring, with the highest fall rate at the end of autumn. Postural sway was not related to vitamin D ( ) or fall rates, but it was associated with fall injuries (IRR 1.59 (CI 1.14 to 2.24, ). Conclusions. Postural sway remained stable across the year while vitamin D varied seasonally. Participants with high values for postural sway demonstrated higher rates of injurious falls. This study provides important evidence for clinicians and researchers providing interventions measuring balance outcomes across seasons. 1. Introduction Balance impairment is an important fall-risk factor [1], and increases in range of postural sway in the mediolateral direction in older adults are associated with increased fall-risk and rates [2]. Postural sway has been shown in older adults to be strongly related to other measures of balance [3]. Multivariate analysis reveals serum vitamin D levels as an independent variable associated with postural sway [4]. In individuals with suboptimal levels of vitamin D, balance and strength improve after supplementation [5], in particular postural sway [6]. Epidemiological studies have shown that vitamin D levels show seasonal variation [7, 8]. Lowest levels of serum vitamin D are recorded towards the end of winter, approximately four weeks after the shortest day of the year [8]. Overall, vitamin D supplementation did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; seven trials; 9324 participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03; 13 trials; 26, 747 participants) but may do so in people with lower vitamin D levels before treatment [9]. Older adults are at risk for lower levels of serum vitamin D because of age-related changes in UVB absorption and skin capacity to synthesize vitamin D, reduction in activation in the kidneys, and reduced expression of
Reliability of voluntary step execution behavior under single and dual task conditions
Itshak Melzer, Irena Shtilman, Noah Rosenblatt, Lars IE Oddsson
Journal of NeuroEngineering and Rehabilitation , 2007, DOI: 10.1186/1743-0003-4-16
Abstract: Twenty-four healthy adults (21–63 years old) and 16 elderly adults (66–87 years) performed a voluntary rapid step execution following a tap on their heel while standing on a force platform under single and dual task conditions on three separate occasions. The first two tests were performed 30–60 minutes apart and the third test was performed a week later. Variables analyzed from the ground reaction force data included onset latency of step initiation (initiation phase), preparation and swing phases, foot-off and foot-contact times.Intraclass correlation coefficients (ICC(2,1)) were good to excellent across all parameters and test conditions for the pooled population and for elderly (0.74–0.92 and 0.62–0.88, respectively) except for the swing phase duration where lower values were seen (0.54–0.60 and 0.32–0.64 respectively). Values were similar under single and dual task conditions.A voluntary step execution test, performed under single and dual task conditions especially foot-off and foot-contact times, is a reliable outcome measure that may be a useful tool to asses dynamic balance function for diagnostic purposes as well as clinical intervention trials.Postural control plays a fundamental role for our ability to maintain balance during various activities of daily living especially those that include elements of independent standing and gait. Age-related deterioration of the postural control system can lead to balance impairment and limitations of mobility causing disability that may contribute to falls. Falls are the leading cause of injury-related visits to emergency departments and the primary etiology of accidental deaths in persons over the age of 65 years [1-4]. Nearly 30% of elderly individuals over 65 and almost 50% of elderly individuals over 80 fall at least once every year [3]. Various postural responses including rapid execution of a step may prevent a fall from occurring [5]. Protective stepping [6], a perturbation-triggered automatic response that is
Postural Stability: Effect of Age  [PDF]
Borah D,Singh U,Wadhwa S,Bhattacharjee M
Indian Journal of Physical Medicine and Rehabilitation , 2007,
Abstract: The number of elderly persons is increasing in our society as a result of increase in life expectancy. Falls in elderly population is a major cause of morbidity and mortality. Falls in such persons can occur without any evident disease or postural difficulty. Postural instability has been documented in such persons. This may be a reflection of normal aging process. This instability becomes more obvious in conditions demanding higher degree of postural adjustments. In challenging conditions this instability may result infalls with varying degree of consequences. Proper preventive strategies can help in minimizing such fall and its consequences.
Deficits in postural control in individuals with COPD - emerging evidence for an important secondary impairment
Maria K Beauchamp, Dina Brooks, Roger S Goldstein
Multidisciplinary Respiratory Medicine , 2010, DOI: 10.1186/2049-6958-5-6-417
Abstract: Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder characterized by progressive airflow limitation [1]. It is one of the most important causes of death in North America and Europe, and is projected to rank third in 2020 in the global burden of disease [2,3]. While treatment of COPD has traditionally focused on lung function, systemic effects of the disease are gaining increased attention. Although reductions in peripheral muscle performance, functional mobility and exercise capacity have been well demonstrated [4,5], emerging evidence suggests that individuals with COPD also demonstrate important deficits in balance control [6-11].The ability to maintain balance is critical for mobility, avoidance of falls and functional independence in daily living. Balance impairment has been associated with an increased risk of falls and a resulting increase in mortality rate among older adults [12-14]. A large cross-sectional study reported that COPD was second only to osteoarthritis in its association with the number of falls in elderly women [15]. In a recent prospective study, individuals with COPD were found to have a projected annual fall rate of 1.2 falls per person - a substantially higher rate than that previously reported for older adults (incidence rate of 0.24) [16,17]. Furthermore, in this study fallers with COPD showed a greater decline in health-related quality of life scores after 6 months compared to non-fallers [16]. Given the devastating consequences of falls in older adults, an understanding of the balance deficits present in individuals with COPD is essential to guide the development of balance training and fall prevention programs for this population. Therefore, the purpose of this article is to: 1) provide a brief overview of balance control and its assessment; 2) review relevant literature describing balance impairment in individuals with COPD; and 3) highlight important areas for future research.Successful maintenance of balance, or
Right prefrontal cortex is activated for perceiving postural limits: a functional near-infrared spectroscopy study  [PDF]
Noriyuki Kamata, Yoshimi Matsuo, Ayako Matsuya, Satoru Inoue, Kazuo Abe
Health (Health) , 2009, DOI: 10.4236/health.2009.13039
Abstract: The purpose of this study was to investigate neuronal mechanisms active during the percep-tion of forward postural limits in a standing po-sition and to specify fall-related brain activity using optical functional near-infrared spectros-copy. The study group included six right-handed, healthy female volunteers (range: 19, 20 years). The optical imaging device comprised 16 opto-des designed to provide 24-channel recording of changes in hemoglobin oxygenation. We meas-ured the changes of oxygenated hemoglobin levels in the frontal region when subjects per-ceived reachability in a standing position. Com- pared with those in other regions, the oxygen-ated hemoglobin levels in the right frontal region compatible with the right prefrontal cortex sig-nificantly increased. This result suggests that brain activities in the right prefrontal cortex are related to perception of reachability. Overesti-mation of postural limits has been reported as one of the risk factor for falling. This overesti-mation might be induced by dysfunction in the prefrontal cortex, resulting in a failure to inhibit a motor program that would have caused a loss of balance in reaching. Activation of the right prefrontal cortex may be a key factor for pre-venting accidental falls in the elderly and in pa-tients with neurological disorders.
Mild cognitive impairment  [PDF]
Pavlovi? Dragan M.,Pavlovi? Aleksandra M.
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0908434p
Abstract: Mild cognitive impairment (MCI) is a syndrome that spans the area between normal ageing and dementia. It is classified into amnestic and non-amnestic types, both with two subtypes: single domain and multiple domains. Prevalence of MCI depends on criteria and population and can vary from 0.1 to 42% persons of older age. In contrast to dementia, cognitive deterioration is less severe and activities of daily living are preserved. Most impaired higher cognitive functions in MCI are memory, executive functions, language, visuospatial functions, attention etc. Also there are depression, apathy or psychomotor agitation, and signs of psychosis. Aetiology of MCI is multiple, mostly neurodegenerative, vascular, psychiatric, internistic, neurological, traumatic and iatrogenic. Persons with amnestic MCI are at a higher risk of converting to Alzheimer's disease, while those with a single non-memory domain are at risk of developing frontotemporal dementia. Some MCI patients also progress to other dementia types, vascular among others. In contrast, some patients have a stationary course, some improve, while others even normalize. Every suspicion of MCI warrants a detailed clinical exploration to discover underlying aetiology, laboratory analyses, neuroimaging methods and some cases require a detailed neuropsychological assessment. At the present time there is no efficacious therapy for cognitive decline in MCI or the one that could postpone conversion to dementia. The treatment of curable causes, application of preventive measures and risk factor control are reasonable measures in the absence of specific therapy.
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