Impaired cognition predicts falls among women with and without HIV infection
Sharma A, Vance DE, Hoover DR, Shi Q, Yin MT, Holman S, Plankey MW, Tien PC, Weber KM, Floris-Moore M, Bolivar HH, Golub ET, McDonnell Holstad M, Rubin LH. J. Acquir. Immune Defic. Syndr. (LWW) 2020; ePub(ePub): ePub.
Johns Hopkins University School of Medicine, Baltimore, MD.
(Copyright © 2020, Lippincott Williams and Wilkins)
DOI 10.1097/QAI.0000000000002262 PMID 31913989
OBJECTIVE: To determine if domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared to HIV- women.
DESIGN: Cross-sectional data analysis from 825 HIV+ and 392 HIV- women in the Women’s Interagency HIV Study (WIHS) with NC testing within two years prior to falls surveys.
METHODS: NC impairment (T score <40) was assessed in seven domains: executive function, psychomotor speed, attention, learning, memory, fluency, and fine motor function. For domains associated with any fall within 6 months in simple logistic regression (p<.05), hierarchical regression models evaluated associations between NC impairment and odds of falling, adjusting for: (1) study site and HIV, (2) demographics, (3) comorbid conditions, (4) substance use/CNS active medications, and HIV-specific factors.
RESULTS: Median age was higher in HIV+ than HIV- women (51yrs vs. 48yrs); prevalence of falls was similar (19% HIV+, 16% HIV-). Overall, executive function (OR [odds ratio]=1.82, 95%CI [confidence interval] 1.21-2.74; P=0.004), psychomotor speed (OR=1.59, 95%CI 1.05-2.42, P=0.03), and fine motor (OR 1.70, 95%CI 1.11-2.61, P=0.02) impairments were associated with greater odds of falls in fully adjusted models. In fully adjusted models, associations of executive function, psychomotor speed, and fine motor were non-significant among HIV+ women; conversely, among HIV- women, associations with impaired executive and fine motor functions were strengthened, and remained significant.
CONCLUSIONS: Cognitive impairment was associated with falls among middle-aged HIV- but not HIV+ women. Additional studies should elucidate mechanisms by which domain-specific NC impairment impacts fall risk among older HIV+ and HIV- women, and how different factors modify relationships between cognition and falls.
Sarcopenia is associated with cognitive decline and falls but not hospitalization in community-dwelling oldest old in China: a cross-sectional study
Xu W, Chen T, Shan Q, Hu B, Zhao M, Deng X, Zuo J, Hu Y, Fan L. Med. Sci. Monit. 2020; 26: e919894.
Department of Geriatric Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China (mainland).
(Copyright © 2020, Medical Science International)
DOI 10.12659/MSM.919894 PMID 31980594
BACKGROUND The aim of this study was to investigate the association between sarcopenia and cognitive decline, falls, and hospitalization in a Chinese elderly population. MATERIAL AND METHODS This cross-sectional survey was conducted between November 2018 and May 2019, and enrolled only older adults aged 80 years or over (oldest old). We diagnosed sarcopenia using the Asian Working Group for Sarcopenia criteria. Demographic characteristics, disease history, smoking status, drinking status, cognitive function, falls, and hospitalization events in the previous 12 months were acquired by face-to-face interview. Cognitive status was evaluated by the Montreal Cognitive Assessment. Falls was ascertained by the question “Have you fallen down in the last 12 months?” Hospitalization was ascertained by the question “Have you received inpatient care in the past year?” RESULTS A total of 582 participants (aged 80-99 years and 42.3% male) were included. The prevalence of sarcopenia was 21.7% (95% confidence interval [CI]: 17.3-26.2%) and 33.3% (95% CI: 27.4-39.3%) for females and males, respectively. Among the study population, the prevalence of cognitive decline was 60.8%; the proportions of the oldest old who had falls or hospitalization in the past 12 months were 18.1% and 34.3%, respectively. Multivariate analyses showed that sarcopenia was significantly and independently associated with cognitive decline [odds ratio (OR)=1.96, 95% CI: 1.17-3.27] and falls (OR=2.00, 95% CI: 1.17-3.43) but not associated with hospitalization (OR=1.32, 95% CI: 0.83-2.08).
CONCLUSIONS Our results showed that sarcopenia was significantly and independently associated with cognitive decline and falls, but not associated with hospitalization, in the community-dwelling oldest old.
Gait, cognition and falls over 5 years, and motoric cognitive risk in New Zealand octogenarians: Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ
Lord S, Moyes S, Teh R, Port W, Muru-Lanning M, Bacon CJ, Wilkinson T, Kerse N. BMC Geriatr. 2020; 20(1): e43.
Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Tamaki Campus, Auckland, New Zealand.
(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group – BMC)
DOI 10.1186/s12877-020-1420-8 PMID 32024482
BACKGROUND: Understanding falls risk in advanced age is critical with people over 80 a rapidly growing demographic. Slow gait and cognitive complaint are established risk factors and together comprise the Motoric Cognitive Risk Syndrome (MCR). This study examined trajectories of gait and cognition and their association with falls over 5 years, and documented MCR in Māori and non-Māori of advanced age living in New Zealand.
METHOD: Falls frequency was ascertained retrospectively at annual assessments. 3 m gait speed was measured and cognition was assessed using the Modified Mini-Mental Status Examination (3MS). Frequency of MCR was reported. Gait and cognition trajectories were modelled and clusters identified from Latent Class Analysis. Generalised linear models examined association between changes in gait, cognition, MCR and falls.
RESULTS: At baseline, 138 of 408 Māori (34%) and 205 of 512 non-Māori (40%) had fallen. Mean (SD) gait speed (m/s) for Māori was 0.66 (0.29) and 0.82 (0.26) for non-Māori. Respective 3MS scores were 86.2 (15.6) and 91.6 (10.4). Ten (4.3%) Maori participants met MCR criteria, compared with 7 (1.9%) non-Māori participants. Māori men were more likely to fall (OR 1.56; 95% CI 1.0-2.43 (P = 0.04) whilst for non-Māori slow gait increased falls risk (OR 0.40; 95% CI 0.24-0.68(P < 0.001). Non-Māori with MCR were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06-5.68 (P = 0.03).
CONCLUSIONS: Māori and non-Māori of advanced age show a mostly stable pattern of gait and cognition over time. Risk factors for falls differ for Māori, and do not include gait and cognition.
Exploring enablers and barriers to accessing health services after a fall among people with intellectual disability
Ho P, Bulsara C, Patman S, Downs J, Hill AM. J. Appl. Res. Intellect. Disabil. 2020; ePub(ePub): ePub.
School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
(Copyright © 2020, John Wiley and Sons)
DOI 10.1111/jar.12704 PMID 32039539
BACKGROUND: Adults with intellectual disability experience high rates of falls making falls prevention an important health need. The purpose of the study was to seek perspectives of older adults with intellectual disability and their caregivers to (a) explore the experiences of older adults with intellectual disability when seeking healthcare services after a fall and (b) identify enablers and barriers when taking up evidence-based falls recommendations.
METHOD: A qualitative exploratory study was undertaken as part of a prospective observational cohort study. Semi-structured interviews were conducted with a purposeful sample. Data were analysed thematically using Colaizzi’s method.
RESULTS: Seventeen interviews were conducted (n = 21). Emergent themes demonstrated that participants had limited knowledge about falls prevention. Enablers included individualizing falls prevention strategies. Barriers included not being offered access to established falls prevention pathways.
CONCLUSION: There is an urgent need to develop high-quality falls prevention services for older adults with intellectual disability.
accidental falls; barriers and enablers; intellectual disability; referral and consultation