Showing papers by "Kim Delbaere published in 2022"

World guidelines for falls prevention and management for older adults: a global initiative

Abstract: Abstract Background falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. Objectives to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. Methods a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. Recommendations all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. Conclusions the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Risk factors for falls in community-dwelling older people with mild cognitive impairment: a prospective one-year study

Abstract: Objective Mild cognitive impairment (MCI) is considered an intermediate stage between normal cognitive function and dementia. Fall risk is increased in this group, but there is limited literature exploring specific fall risk factors that may be addressed in fall prevention strategies. The aim of this study was to examine risk factors for falls in older people with MCI, focusing on cognitive, psychological and physical factors. Methods Participants (n = 266, 45% women) were community-dwelling older people aged 70–90 years who met the criteria for MCI. Cognitive, psychological, sensorimotor and physical assessments, physical activity levels, medication use, general health and disability were ascertained at baseline. Falls were monitored prospectively for 12 months. Results During follow-up, 106 (40%) participants reported one or more falls. Poorer visual contrast sensitivity, increased postural sway, lower levels of weekly walking activity, higher levels of depressive symptoms and psychotropic medication use were significantly associated with faller status (≥1 falls) in univariable analyses. Of these factors, poor visual contrast sensitivity, increased postural sway and psychotropic medication use were found to be significant independent predictors of falls in multivariable analysis while controlling for age and sex. No measures of cognitive function were associated with falls. Conclusions Poor visual contrast sensitivity, impaired balance and psychotropic medication use predicted falls in community-dwelling people with MCI. These risk factors may be amenable to intervention, so these factors could be carefully considered in fall prevention programs for this population.

Effect of eHealth-delivered exercise programmes on balance in people aged 65 years and over living in the community: a systematic review and meta-analysis of randomised controlled trials

Abstract: Introduction Exercise that challenges balance is proven to prevent falls in community-dwelling older people, yet widespread implementation and uptake of effective programmes is low. This systematic review and meta-analysis synthesised the evidence and evaluated the effect of eHealth-delivered exercise programmes compared with control on balance in community-dwelling people aged ≥65 years. Methods Nine databases including MEDLINE, CINAHL and Embase, were searched from inception to January 2022 to identify randomised controlled trials evaluating eHealth-delivered exercise programmes for community-dwelling people aged ≥65 years, published in English that included a balance outcome. Primary outcomes were static and dynamic balance. Secondary outcomes included fall risk and fear of falling. We calculated standardised mean differences (SMDs, Hedges’ g) with 95% CIs from random effects meta-analyses. Results We identified 14 eligible studies that included 1180 participants. Methodological quality ranged from 3 to 8 (mean, 5). The pooled effect indicated that eHealth-delivered exercise programmes have a medium significant effect on static balance (11 studies; SMD=0.62, 95% CI 0.27 to 0.72) with very low-quality evidence. There was small statistically significant effect on dynamic balance (14 studies; SMD=0.42, 95% CI 0.11 to 0.73) with very low-quality evidence, and fall risk (5 studies; SMD=0.32, 95% CI 0.00 to 0.64) with moderate-quality evidence. No significant effect of eHealth programmes on fear of falling was found (four studies; SMD=0.10, 95% CI −0.05 to 0.24; high-quality evidence). Conclusion This review provides preliminary evidence that eHealth-delivered exercise programmes improved balance and reduced fall risk in people aged ≥65 years. There is still uncertainty regarding the effect of eHealth delivered exercise programmes on fear of falling. PROSPERO registration number CRD42018115098.

Dementia Incidence, APOE Genotype, and Risk Factors for Cognitive Decline in Aboriginal Australians

Abstract: Background and Objectives Aboriginal Australians are disproportionately affected by dementia, with incidence in remote populations approximately double that of non-Indigenous populations. This study aimed to identify dementia incidence and risk factors in Aboriginal Australians residing in urban areas, which are currently unknown. Methods A population-based cohort of Aboriginal Australians ≥60 years of age was assessed at baseline and 6-year follow-up. Life-course risk factors (baseline) were examined for incident dementia or mild cognitive impairment (MCI) through logistic regression analyses; adjustments were made for age. APOE genotyping was available for 86 people. Results Data were included from 155 participants 60 to 86 years of age (mean 65.70 years, SD 5.65 years; 59 male). There were 16 incident dementia cases (age-standardized rate 35.97/1,000 person-years, 95% confidence interval [CI] 18.34–53.60) and 36 combined incident MCI and dementia cases. Older age (odds ratio [OR] 2.29, 95% CI 1.42–3.70), male sex (OR 4.14, 95% CI 1.60–10.77), unskilled work history (OR 5.09, 95% CI 1.95–13.26), polypharmacy (OR 3.11, 95% CI 1.17–8.28), and past smoking (OR 0.24, 95% CI 0.08–0.75) were associated with incident MCI/dementia in the final model. APOE ε4 allele frequency was 24%; heterozygous or homozygous ε4 was associated with incident MCI/dementia (bivariate OR 3.96, 95% CI 1.25–12.50). Discussion These findings provide evidence for higher dementia incidence in Aboriginal Australians from urban areas, where the majority of Aboriginal people reside. This study also sheds light on sociodemographic, health, and genetic factors associated with incident MCI/dementia at older ages in this population, which is critical for targeted prevention strategies.

Longitudinal Impact of Vision Impairment on Concern About Falling in People With Age-Related Macular Degeneration

Abstract: Purpose To explore the longitudinal impact of central vision loss on concern about falling (CF), over a 12-month period, in people with age-related macular degeneration (AMD). Methods Participants included 60 community-dwelling older people (age, 79.7 ± 6.4 years) with central vision impairment due to AMD. Binocular high-contrast visual acuity, contrast sensitivity, and visual fields were assessed at baseline and at 12 months. CF was assessed at both time points using the Falls Efficacy Scale–International (FES-I). Sensorimotor function (sit to stand, knee extension, postural sway, and walking speed) and neuropsychological function (reaction time, symptoms of anxiety and depression) were also assessed at both time points using validated instruments. Falls data were collected using monthly diaries during the 12 months. Results CF increased by a small but significant amount over the 12-month follow-up (2.1 units; P = 0.01), with increasing prevalence of high levels of CF (FES-I score ≥ 23), from 48% at baseline to 65% at 12 months. Linear mixed models showed that reduced contrast sensitivity was significantly associated with increased concern about falling (P = 0.004), whereas declines in both visual acuity and contrast sensitivity during the follow-up period were associated with increases in CF over the 12-month follow-up (P = 0.041 and P = 0.054, respectively), independent of age, gender, falls history, or number of comorbidities. Conclusions Higher levels of CF are common in older people with AMD, and levels increase over time; this increase is associated with declines in both visual acuity and contrast sensitivity. These findings highlight the need for regular assessment of both visual acuity and contrast sensitivity to identify those at greatest risk of developing higher CF. Translational Relevance Routine assessment of visual acuity and contrast sensitivity in older people with AMD will assist in identifying those at risk of developing high CF.

Correlates of gait speed among older adults from six countries: Findings from the COSMIC collaboration.

Abstract: BACKGROUND Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates, across Australia, Asia, and African countries. METHODS We used data from six population-based cohorts of adults 65+ from six countries and three continents (N=6472), with samples ranging from 231 to 1913. All cohorts are members of the Cohort Studies of Memory in an International Consortium (COSMIC) collaboration. We investigated whether clinical (BMI, hypertension, stroke, APOE status), psychological (cognition, mood, general health) and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models controlled for age, sex, and education, and were sex-stratified. RESULTS Age- and sex-standardized usual gait speed means ranged from 0.61-1.06 m/s and rapid gait speed means ranged from 1.16-1.64 m/s. Lower body mass index and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely non-significant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex except physical activity, where greater intensity was associated with usual gait among men but not women. CONCLUSIONS This study is among the first to describe usual and rapid gait speeds across older adults in Africa, Asia, and Australia.

A mental health-informed, online health promotion programme targeting physical activity and healthy eating for adults aged 60+ years: study protocol for the MovingTogether randomised controlled trial

Abstract: The COVID-19 pandemic and associated social distancing regulations have led to an increased risk of social isolation and physical inactivity, particularly among older adults. The benefits of physical activity for reducing fall risk and improving mood and mental functioning have been well documented. The aim of this trial is to investigate the effect of the MovingTogether programme on psychological distress (primary outcome) and physical activity, social capital, cognition, concern about falling, loneliness, physical functioning, quality of life and physical activity enjoyment (secondary outcomes).A randomised controlled trial with a waitlist control will be conducted, recruiting 80 adults aged 60+ years with access to Facebook and a computer or tablet and not currently meeting the aerobic physical activity guidelines. Randomisation will be completed using REDCap. The intervention group (n = 40) will join a private Facebook group where allied health facilitators will provide targeted healthy lifestyle education throughout the 10-week programme with weekly telehealth group calls. Intervention participants will also be provided access to tailored strength and aerobic exercise guidance and an evidence-based eHealth balance exercise programme. Psychological distress and secondary outcomes will be assessed at baseline, 11 weeks (post-intervention) and 16 weeks (1-month follow-up). Linear mixed models will be applied for each outcome measure as per an intention-to-treat approach to determine the between-group differences. Secondary analyses are planned in people with greater adherence and those with higher psychological distress.COVID-19 has highlighted the need for scalable, effective and novel methods to improve and protect the health of older adults. The integration of an evidence-based fall prevention programme with a mental health-informed online health promotion programme may help to improve mental and physical health outcomes among older adults.Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001322820p. Registered on 29 September 2021.

Abstract 12373: Process Evaluation of a Vanguard Phase of a Trial for a Smartphone- App Based Model Of Care

Abstract: Background: Home-based monitoring and timely intervention of patients with acute coronary syndrome (ACS) and heart failure (HF) can improve patient outcomes. TeleClinical Care (TCC-Cardiac) is a smartphone app-based model of care designed to improve community-based care. We conducted a process evaluation within a multi-centre RCT to elucidate barriers and facilitators to implementation. Methods Patients were enrolled during their hospital stay and provided with an app and Bluetooth observation monitors. Patients were encouraged to engage with the app regularly (i.e. exercise program, record their observations). Data were monitored by a dedicated Remote Monitoring Solution team (RMS), and information was made available to the care team. Interviews were conducted with patients at 6 months, and with 3 RMS members, 2 HF nurses and 1 cardiologist. Results Of the 35 enrolled patients, 27 (77%) had a diagnosis of ACS and 8 (23%) of HF. Patient engagement with the app was good overall, with adherence tailing off over time, demonstrated by median (IQI) patient self-BP recordings of 93.3% (90-100%) at 1-month compared to 70% (43-90%) at 6-months. Older patients had higher levels of adoption (>50%), with a median age amongst high adopters of 67-years (IQI 40-82) compared to 63-years (IQI 50-87) for medium adopters (50-70%) and 44-years (IQI 33-53) amongst low adopters (<50%) (p=0.0184) (Fig 1). Interviews revealed good acceptance of Telehealth and remote monitoring. Higher motivation and health and tech literacy facilitated adherence. 21% of participants meeting inclusion criteria but not enrolled did not possess a smartphone. GPs did not engage. Other health professionals identified the time requirements of supporting less tech-literate patients and responding to alerts as potential barriers to adoption. However, most valued the potential for early detection and prevention of deterioration of this cohort of patients. Conclusion TCC-cardiac was generally considered an acceptable and viable model of care by patients and health professionals. Adherence was best amongst older patients with the highest potential to benefit. Designing strategies to overcome barriers to adherence in younger patients and GPs, combined with adequate tech support is recommended.

The effects of active classroom breaks on moderate to vigorous physical activity, behaviour and performance in a Northern NSW primary school: a quasi-experimental study.

Abstract: ISSUE ADDRESSED Approximately 77% of NSW children aged 5 to 15 years do not meet physical activity guidelines and many spend a considerable amount of time sitting (1). Active breaks at primary school are feasible, may increase daily moderate to vigorous physical activity (MVPA) and decrease off-task behaviour without adversely affecting cognitive function and learning. METHODS In this quasi-experimental study, 101 primary school children in six intervention classrooms participated in three ten-minute active breaks per day for six-weeks during class time, while five control classrooms were run as usual (n=89). Physical activity levels were measured using wrist-worn Actigraph wGT3X-BT accelerometers and analysed using a random forest model. Students' off-task behaviour, wellbeing, cognitive function, and maths performance were also measured. School staff completed a brief feedback survey. RESULTS Children in the intervention group engaged in 15.4 and 10.9 minutes more MVPA per day at 3 and 6 weeks respectively (p<0.001). Participation significantly increased the proportion of children who met the Australian 24-Hour Movement Guidelines (p<0.001). At pre, middle and end of intervention, 44.4%, 60.8% and 55.1% of intervention children and 46.5%, 45.9% and 45.8% of controls met the guidelines. Significantly fewer students engaged in off-task behaviour in the intervention classes at mid and weeks of intervention (-1.4 students, p=0.003). No significant intervention effects were found for wellbeing, cognitive and maths performance. CONCLUSIONS Active classroom breaks are an effective way to increase physical activity among primary school children while reducing off-task classroom behaviour. SO WHAT?: Primary school students' health would benefit from active breaks with no detrimental effects on wellbeing, maths and cognitive performance.

Responsiveness of Daily Life Gait Quality Characteristics over One Year in Older Adults Who Experienced a Fall or Engaged in Balance Exercise

Abstract: Gait quality characteristics obtained from daily-life accelerometry are clinically relevant for fall risk in older adults but it is unknown whether these characteristics are responsive to changes in gait quality. We aimed to test whether accelerometry-based daily-life gait quality characteristics are reliable and responsive to changes over one year in older adults who experienced a fall or an exercise intervention. One-week trunk acceleration data were collected from 522 participants (65–97 years), at baseline and after one year. We calculated median values of walking speed, regularity (sample entropy), stability (logarithmic rate of divergence per stride), and a gait quality composite score, across all 10-s gait epochs derived from one-week gait episodes. Intraclass correlation coefficients (ICC) and limits of agreement (LOA) were determined for 198 participants who did not fall nor participated in an exercise intervention during follow-up. For responsiveness to change, we determined the number of participants who fell (n = 209) or participated in an exercise intervention (n = 115) that showed a change beyond the LOA. ICCs for agreement between baseline and follow-up exceeded 0.70 for all gait quality characteristics except for vertical gait stability (ICC = 0.69, 95% CI [0.62, 0.75]) and walking speed (ICC = 0.68, 95% CI [0.62, 0.74]). Only walking speed, vertical and mediolateral gait stability changed significantly in the exercisers over one year but effect sizes were below 0.2. The characteristic associated with most fallers beyond the LOA was mediolateral sample entropy (4.8% of fallers). For the exercisers, this was gait stability in three directions and the gait quality composite score (2.6% of exercisers). The gait quality characteristics obtained by median values over one week of trunk accelerometry were not responsive to presumed changes in gait quality after a fall or an exercise intervention in older people. This is likely due to large (within subjects) differences in gait behaviour that participants show in daily life.

The rising cost of falls – Health researchers are calling for action

Abstract: Falls are a major health issue, especially for people aged 65 years and over. One in three older adults living in the community falls each year and half of these people will fall again within a year. The consequences of falls can be severe. Over 133,000 Australians aged 65 and over were hospitalised due to falls in 2019– 2020. Falls contribute to 77% of injury hospitalisations and 71% of injury deaths for this age group (Figure 1). Falls are now the leading cause of injuryrelated deaths across all age groups in Australia with an agestandardised rate of 15.4/100,000, ahead of suicide (12.5/100,000) and transport (5/100,000).1 Australia is ageing at an unprecedented rate. The 2021 Census counted 4.4 million people aged 65 and over compared to 4.6 million people aged under 14, or 17% and 18% of the population respectively. In 2011, these proportions were 14% vs 19% respectively. The last 10 years clearly illustrate that we have experienced a decade of an ageing population. This historic demographic transition from predominantly young to increasingly ageing populations brings many benefits, but will also have important implications for our health system. The number of people aged over 65 years is expected to grow by 55% by 2040, outstripping the expected 30% allages population increase.2