fall risk

跌倒风险
  • 文章类型: Journal Article
    跌倒问题对老年人的健康构成重大威胁。虽然他汀类药物可以引起肌病,这意味着它们可能会导致平衡问题并增加跌倒的风险,这还没有经过测试。我们的目的是评估他汀类药物的使用是否与较高的跌倒风险有关。
    进行了一项横断面调查研究和孟德尔随机化(MR)研究,以检查他汀类药物的使用是否与跌倒和平衡问题的风险增加有关。这项横断面研究包括来自美国人口(NHANES)的2,656名参与者,他们报告了过去一年中平衡和下降问题的信息以及他们使用他汀类药物的情况。使用单变量和多变量逻辑回归模型来研究他汀类药物使用与跌倒或经历平衡问题的可能性之间的关联。MR研究确定了五个单核苷酸多态性(SNP),可预测五个祖先群体中的他汀类药物使用:混合非洲或非洲,东亚,欧洲,西班牙裔,南亚。此外,预测跌倒风险的SNP是从英国生物银行人群获得的。进行了两个样本的MR分析,以检查遗传预测的他汀类药物使用是否会增加跌倒的风险。
    发现他汀类药物的使用与平衡和跌倒问题的可能性增加有关(平衡问题,或1.25,95CI1.02至1.55;下降问题,或1.27,95CI1.03-1.27)。亚组分析显示,65岁以下的患者在服用他汀类药物时更容易受到这些问题的影响(平衡问题,或3.42,95CI1.40至9.30;下降问题,或5.58,95CI2.04-15.40)。MR分析表明,他汀类药物的使用,作为基因代理,导致跌倒问题的风险增加(OR1.21,95%CI1.1-1.33)。
    我们的研究发现,在40岁以上的成年人中,他汀类药物的使用与平衡问题和跌倒风险增加之间存在关联。MR研究结果提示使用他汀类药物会增加跌倒风险.与65岁以上的参与者相比,65岁以下的参与者的风险更高。
    UNASSIGNED: The issue of falls poses a significant threat to the health of the elderly population. Although statins can cause myopathy, which implies that they may cause balance problems and increase the risk of falling, this has not been tested. Our objective was to assess whether the use of statins is linked to a higher risk of falls.
    UNASSIGNED: A cross-sectional survey study and Mendelian randomization (MR) study were conducted to examine whether the use of statins was associated with an increased risk of falling and balance problems. The cross-sectional study included 2,656 participants from the US population (NHANES) who reported information on balance and falling problems in the past year and their use of statins. Univariate and multivariate logistic regression models were used to investigate the association between statin use and the likelihood of falling or experiencing balance problems. The MR study identified five Single Nucleotide Polymorphisms (SNPs) that predict statin use across five ancestry groups: Admixed African or African, East Asian, European, Hispanic, and South Asian. Additionally, SNPs predicting the risk of falls were acquired from the UK Biobank population. A two-sample MR analysis was performed to examine whether genetically predicted statin use increased the risk of falls.
    UNASSIGNED: The use of statins was found to be associated with an increased likelihood of balance and falling problems (balance problem, OR 1.25, 95%CI 1.02 to 1.55; falling problem, OR 1.27, 95%CI 1.03-1.27). Subgroup analysis revealed that patients under the age of 65 were more susceptible to these issues when taking statins (balance problem, OR 3.42, 95%CI 1.40 to 9.30; falling problem, OR 5.58, 95%CI 2.04-15.40). The MR analysis indicated that the use of statins, as genetically proxied, resulted in an increased risk of falling problems (OR 1.21, 95% CI 1.1-1.33).
    UNASSIGNED: Our study found an association between the use of statins and an increased risk of balance problems and falls in adults over 40 years old, and the MR study result suggested statin use increased risk of falls. The risk was higher in participants under 65 years old compared to those over 65 years old.
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  • 文章类型: Journal Article
    患有帕金森病(PD)的人通常在自愿步骤之前表现出减少的预期姿势调整(APAs),影响他们的稳定性。APA阶段中对跌倒风险有重要影响的具体子阶段仍不清楚。
    我们分析了压力中心(CoP)轨迹参数,包括持续时间,长度,和速度,整个步态开始。这项检查涵盖了两个姿势阶段,称为预期姿势调整(APA)(APA1、APA2a、APA2b),和随后的运动阶段(LOC)。参与者被指示开始一个步骤,然后停止(开始一个步骤)。此外,我们使用统一帕金森病评定量表(UPDRS)对临床疾病的严重程度进行评估,并在非用药期间使用Tinetti步态和平衡评分对跌倒风险进行评估.
    在测量CoP轨迹时,在110名参与者中有18名观察到步态(FOG)冻结。Ramer-Douglas-Peucker算法成功识别了105名参与者(95.5%)的CoP位移轨迹,而其余5例由于FOG而无法识别。Tinetti平衡和步态评分显示与左旋多巴等效日剂量显著相关,UPDRS总分,疾病持续时间,APA2a(s)和LOC(s)中的持续时间,长度为APA1(cm)和APA2b(cm),APA1(X)中外侧速度(cm/s),APA2a(X)(cm/s),APA2b(X)(cm/s)和LOC(X)(cm/s),APA2a(Z)(cm/s)和APA2b(Z)(cm/s)的前后速度。多元线性回归显示,仅APA2a和UPDRS总分的持续时间与Tinetti步态和平衡评分独立相关。进一步的中介分析表明,APA2a中的持续时间是UPDRS总分与Tinetti平衡和步态评分之间的中介(Sobel检验,p=0.047)。
    APA2子阶段持续时间介导PD中疾病严重程度与跌倒风险之间的联系,表明较长的APA2a持续时间可能表明步态启动期间控制降低,从而增加跌倒风险。
    UNASSIGNED: People with Parkinson\'s Disease (PD) often show reduced anticipatory postural adjustments (APAs) before voluntary steps, impacting their stability. The specific subphase within the APA stage contributing significantly to fall risk remains unclear.
    UNASSIGNED: We analyzed center of pressure (CoP) trajectory parameters, including duration, length, and velocity, throughout gait initiation. This examination encompassed both the postural phase, referred to as anticipatory postural adjustment (APA) (APA1, APA2a, APA2b), and the subsequent locomotor phases (LOC). Participants were instructed to initiate a step and then stop (initiating a single step). Furthermore, we conducted assessments of clinical disease severity using the Unified Parkinson\'s Disease Rating Scale (UPDRS) and evaluated fall risk using Tinetti gait and balance scores during off-medication periods.
    UNASSIGNED: Freezing of gait (FOG) was observed in 18 out of 110 participants during the measurement of CoP trajectories. The Ramer-Douglas-Peucker algorithm successfully identified CoP displacement trajectories in 105 participants (95.5%), while the remaining 5 cases could not be identified due to FOG. Tinetti balance and gait score showed significant associations with levodopa equivalent daily dose, UPDRS total score, disease duration, duration (s) in APA2a (s) and LOC (s), length in APA1 (cm) and APA2b (cm), mediolateral velocity in APA1 (X) (cm/s), APA2a (X) (cm/s), APA2b (X) (cm/s) and LOC (X) (cm/s), and anterior-posterior velocity in APA2a (Z) (cm/s) and APA2b (Z) (cm/s). Multiple linear regression revealed that only duration (s) in APA2a and UPDRS total score was independently associated with Tinetti gait and balance score. Further mediation analysis showed that the duration (s) in APA2a served as a mediator between UPDRS total score and Tinetti balance and gait score (Sobel test, p = 0.047).
    UNASSIGNED: APA2 subphase duration mediates the link between disease severity and fall risk in PD, suggesting that longer APA2a duration may indicate reduced control during gait initiation, thereby increasing fall risk.
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  • 文章类型: Journal Article
    这项研究系统地研究了在不同重量条件和负载位置下,被动臂支撑外骨骼(ASE)对负载保持任务中静态姿势平衡的影响,以及这种影响与外骨骼支撑力轮廓之间的关系。使用3(外骨骼干预)×3(重量条件)×3(负载位置)受试者内设计,研究发现,与不佩戴外骨骼和停用支撑相比,在所有情况下佩戴带支撑力的ASE显著减少了17.84%和15.19%的姿势摇摆。分别。这些改进与主观评估是一致的。稳定性优势随重量和负载位置而变化,反映外骨骼的支撑力轮廓。总的来说,研究表明,ASE的支撑力可以增强静态姿势平衡,有效性取决于重量条件和负载位置。这凸显了被动ASE在工作环境中提高稳定性和降低跌倒风险的潜力。
    This study systematically investigated the influence of a passive arm-support exoskeleton (ASE) on static postural balance in load-holding tasks under different weight conditions and load locations, and the relationship between such influence and the exoskeleton\'s supportive force profile. Using a 3 (exoskeleton interventions) ×3 (weight conditions) ×3 (load locations) within-subjects design, the research found that wearing ASE with supportive force significantly reduced postural sway by 17.84% and 15.19% across all conditions compared to without wearing the exoskeleton and with deactivated support, respectively. These improvements were consistent with subjective assessments. The stability benefits varied with the weight and load location, reflecting the exoskeleton\'s supportive force profile. Overall, the study suggests that the supportive force from the ASE can enhance static postural balance, with effectiveness dependent on weight conditions and load locations. This highlights the potential of passive ASEs for improving stability and reducing fall risks in work environments.
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  • 文章类型: Journal Article
    目的:ESPEN和EASO最近制定了关于节育性肥胖(SO)的共识标准,采用骨骼肌质量与重量(SMM/W)的比率。新的证据表明,根据体重指数(SMM/BMI)调整骨骼肌质量可以提高健康结果的预测准确性。我们旨在验证ESPEN/EASO标准,并探讨SMM/BMI调整在预测中国西部老年人跌倒中的潜在益处。
    方法:我们进行了多中心,横断面研究,包括社区居住的老年人。使用标准的ESPEN/EASO共识标准(SOESPEN)和调整SMM/BMI的修改版本(SOESPEN-M)确定SO的诊断。SOESPEN协会,SOESPEN-M,并分析了它们与跌倒的成分。
    结果:在1353名参与者中,SO的患病率为13.2%(SOESPEN)和11.4%(SOESPEN-M),随着年龄和较高的BMI水平而增加。在BMI正常的参与者中,4.2%和6.2%被发现有SOESPEN和SOESPEN-M,分别。SMM/W和SMM/BMI与跌倒风险呈负相关(分别为p=0.042和p=0.021)。在调整混杂因素后,只有SOESPEN与跌倒显着相关(优势比[OR]1.61,95%置信区间[CI]1.08至2.40),而SOESPEN-M的关联没有达到显著性(OR1.55,95%CI0.99~2.43).
    结论:这项研究在中国西部社区居住的老年人中验证了ESPEN/EASO标准(SOESPEN)及其修改版本(SOESPEN-M)。SMM/BMI调整似乎提供了对SO患病率的较低估计,只有SOESPEN显示与跌倒有显著关联。
    OBJECTIVE: The ESPEN and the EASO recently developed consensus criteria for sarcopenic obesity (SO), employing the skeletal muscle mass to weight (SMM/W) ratio. Emerging evidence suggests that adjusting skeletal muscle mass for body mass index (SMM/BMI) could enhance the predictive accuracy for health outcomes. We aimed to validate the ESPEN/EASO criteria and explore the potential benefits of the SMM/BMI adjustment in predicting falls among older adults in Western China.
    METHODS: We conducted a multicenter, cross-sectional study and included community-dwelling older adults. The diagnosis of SO was determined using the standard ESPEN/EASO consensus criteria (SOESPEN) and a modified version adjusting SMM/BMI (SOESPEN-M). The associations of SOESPEN, SOESPEN-M, and their components with falls were analyzed.
    RESULTS: Among the 1353 participants, the prevalence of SO was 13.2 % (SOESPEN) and 11.4 % (SOESPEN-M), which increased with age and higher BMI levels. Within participants with a normal BMI, 4.2 % and 6.2 % were found to have SOESPEN and SOESPEN-M, respectively. SMM/W and SMM/BMI negatively correlated with fall risk (p=0.042 and p=0.021, respectively). Upon adjusting for confounders, only SOESPEN was significantly associated with falls (odds ratios [OR] 1.61, 95 % confidence interval [CI] 1.08 to 2.40), whereas the association for SOESPEN-M did not achieve significance (OR 1.55, 95 % CI 0.99 to 2.43).
    CONCLUSIONS: This research validated the ESPEN/EASO criteria (SOESPEN) and their modified version (SOESPEN-M) among community-dwelling older adults in Western China. The SMM/BMI adjustment appears to offer a lower estimate of SO prevalence, with only SOESPEN showing a significant association with falls.
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  • 文章类型: Journal Article
    瀑布,尤其是老年人,在美国是一个普遍和日益严重的医疗保健问题。经历跌倒的人面临更高的发病率和死亡率风险,以及与管理任何由此造成的伤害相关的大量费用。急救人员经常回应与跌倒有关的911电话,这些病例中有很大一部分没有导致医院或医疗机构转移。因此,许多跌倒受害者在没有采取任何预防措施的情况下接受治疗。这篇评论的目的是探索当前研究,以检查紧急医疗服务人员是否可以有效地预防跌倒。虽然早期的研究提出了相互矛盾的发现,最近的研究表明,预防策略的潜力不仅仅是转诊。
    Falls, particularly among the elderly, are a prevalent and growing healthcare issue in the United States. Individuals who experience falls face heightened morbidity and mortality risks, along with substantial expenses associated with managing any resulting injuries. First responders frequently respond to 911 calls related to falls, with a significant portion of these cases not resulting in hospital or healthcare facility transfers. As such, many fall victims receive treatment without any preventive measures being implemented. The purpose of this review is to explore the current studies that examine whether Emergency Medical Service personnel can effectively act in fall prevention. While earlier studies present conflicting findings, recent research indicates the potential for preventive strategies that go beyond mere referrals.
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  • 文章类型: Journal Article
    成人癌症幸存者意外跌倒是一个健康问题。瀑布给癌症幸存者带来经济负担和有害后果。这篇综述旨在综合已发表的研究结果,以探讨癌症幸存者中跌倒与癌症诊断和治疗之间的关系。
    使用四个数据库进行了范围审查(Medline,EMBASE,CINAHL,和Scopus)为2001-2021年。在删除重复项后,鉴定出总共425份摘要。完成了2022-2023年的第二次搜索,确定了80篇摘要。抽象筛选,全文回顾,并进行了数据提取。从全文中提取研究特征和关键发现。提出了描述性数字摘要,并进行了叙事分析。
    共有42篇文章被纳入范围审查中,这些研究表明(1)癌症幸存者中跌倒的患病率增加,(2)存在癌症特异性跌倒危险因素,(3)缺乏癌症特异性跌倒预测工具,和(4)很少有跌倒预防干预措施作为癌症幸存者常规护理的一部分。年轻的癌症幸存者人数不足。癌症幸存者应该意识到他们跌倒的风险,卫生专业人员应确保跌倒预防是日常护理的一部分。
    瀑布与癌症生存有关,随着越来越多的人与癌症一起生活,跌倒变得越来越重要。存在与癌症幸存者相关的癌症特异性跌倒风险因素,这可能导致跌倒风险增加。然而,在癌症幸存者的标准治疗中,可能无法解决跌倒预防问题.这篇评论表明,需要癌症特异性跌倒风险工具,预防跌倒应该是肿瘤治疗的一部分。
    UNASSIGNED: Accidental falls among adult cancer survivors are a health concern. Falls impose economic burdens and detrimental consequences to cancer survivors. This review aimed to synthesize findings from published research to explore the relationship between falls and cancer diagnosis and treatment among cancer survivors.
    UNASSIGNED: A scoping review was conducted using four databases (Medline, EMBASE, CINAHL, and Scopus) for the years 2001-2021. A total of 425 abstracts were identified after removing duplicates. A second search for the years 2022-2023 was completed where 80 abstracts were identified. Abstract screening, full-text review, and data extraction were conducted. Study characteristics and key findings were extracted from full texts. Descriptive numerical summaries were presented, and narrative analyses were performed.
    UNASSIGNED: A total of 42 articles were included in the scoping review which demonstrated (1) an increased prevalence of falls among cancer survivors, (2) the presence of cancer-specific fall risk factors, (3) a lack of cancer-specific fall prediction tools, and (4) few fall prevention interventions as part of usual care among cancer survivors. Younger cancer survivors were underrepresented. Cancer survivors should be aware of their risk of falls, and health professionals should ensure that fall prevention is part of usual care.
    Falls are associated with cancer survivorship and as there are more people living with and beyond cancer, falls are becoming more significant.There are cancer-specific fall risk factors relevant to cancer survivors which can contribute to increased fall risk.However, fall prevention may not be addressed in standard care for cancer survivors.This review suggests cancer-specific fall risk tools are needed, and that fall prevention should be part of oncologic care.
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  • 文章类型: Journal Article
    背景:跌倒在一系列临床队列中很常见,其中常规风险评估通常仅包括主观视觉观察。通常,观察性评估包括在实验室内的脚本步行方案中评估个体的步态,以识别可能增加跌倒风险的缺陷,但是微妙的缺陷可能(不容易)观察到。因此,客观方法(例如,惯性测量单元,IMU)可用于量化高分辨率步态特征,通过捕捉细微的缺陷,实现更明智的跌倒风险评估。然而,仅基于IMU的步态仪器是有限的,未能考虑参与者在环境中的行为和细节(例如,障碍)。基于视频的眼睛跟踪眼镜可以为跌倒风险提供额外的洞察力,阐明人们如何根据头部和眼睛的运动来穿越环境。记录头部和眼睛运动可以提供对视觉注意力对环境刺激的分配如何影响障碍物周围的成功导航的见解。然而,手动审查视频数据以评估头部和眼睛的运动是耗时和主观的。需要一种自动化方法,但目前还不存在。本文提出了一种基于深度学习的物体检测算法(VARFA),用于步行过程中的仪器视觉和视频数据,补充仪表步态。
    方法:该方法自动标记在步态实验室中捕获的视频数据,以评估视觉注意力和环境细节。所提出的算法使用YoloV8模型进行训练,并使用基于实验室的新数据集。
    结果:VARFA取得了出色的评估指标(0.93mAP50),识别,和定位静态对象(例如,步行路径中的障碍物),平均准确率为93%。同样,基于U-NET的航迹/路径分割模型取得了良好的指标(IoU0.82),表明预测的轨迹(即,步行路径)与实际轨道紧密对齐,有82%的重叠。值得注意的是,这两个模型都实现了这些指标,同时以实时速度处理,展示务实应用的效率和有效性。
    结论:仪器化方法通过评估视觉上的注意力分配(即,导航过程中关于某人何时何地出席的信息),提高这一领域仪器的广度。将VARFA用于仪器视觉可用于通过提供行为和背景数据来补充仪器来更好地告知跌倒风险评估,例如,步态任务期间的IMU数据。这可能值得注意(例如,个性化)康复影响广泛的临床队列,其中步态差和跌倒风险增加是常见的。
    BACKGROUND: Falls are common in a range of clinical cohorts, where routine risk assessment often comprises subjective visual observation only. Typically, observational assessment involves evaluation of an individual\'s gait during scripted walking protocols within a lab to identify deficits that potentially increase fall risk, but subtle deficits may not be (readily) observable. Therefore, objective approaches (e.g., inertial measurement units, IMUs) are useful for quantifying high resolution gait characteristics, enabling more informed fall risk assessment by capturing subtle deficits. However, IMU-based gait instrumentation alone is limited, failing to consider participant behaviour and details within the environment (e.g., obstacles). Video-based eye-tracking glasses may provide additional insight to fall risk, clarifying how people traverse environments based on head and eye movements. Recording head and eye movements can provide insights into how the allocation of visual attention to environmental stimuli influences successful navigation around obstacles. Yet, manual review of video data to evaluate head and eye movements is time-consuming and subjective. An automated approach is needed but none currently exists. This paper proposes a deep learning-based object detection algorithm (VARFA) to instrument vision and video data during walks, complementing instrumented gait.
    METHODS: The approach automatically labels video data captured in a gait lab to assess visual attention and details of the environment. The proposed algorithm uses a YoloV8 model trained on with a novel lab-based dataset.
    RESULTS: VARFA achieved excellent evaluation metrics (0.93 mAP50), identifying, and localizing static objects (e.g., obstacles in the walking path) with an average accuracy of 93%. Similarly, a U-NET based track/path segmentation model achieved good metrics (IoU 0.82), suggesting that the predicted tracks (i.e., walking paths) align closely with the actual track, with an overlap of 82%. Notably, both models achieved these metrics while processing at real-time speeds, demonstrating efficiency and effectiveness for pragmatic applications.
    CONCLUSIONS: The instrumented approach improves the efficiency and accuracy of fall risk assessment by evaluating the visual allocation of attention (i.e., information about when and where a person is attending) during navigation, improving the breadth of instrumentation in this area. Use of VARFA to instrument vision could be used to better inform fall risk assessment by providing behaviour and context data to complement instrumented e.g., IMU data during gait tasks. That may have notable (e.g., personalized) rehabilitation implications across a wide range of clinical cohorts where poor gait and increased fall risk are common.
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  • 文章类型: Journal Article
    随着年龄的增长,走路不绊倒需要更大的认知需求。因此,解决和纳入认知负荷方面的培训干预措施可能是有益的.这项研究的目的是比较半沉浸式虚拟现实跑步机训练(VRTT)和常规跑步机训练(CTT)对老年人的障碍清除和绊倒危险。使用脚踏惯性测量单元(IMU)和Zeno压力走道测量了障碍物间隙参数。所有数据均通过自定义Matlab脚本进行处理和分析。两种训练干预后,前肢的障碍台阶平均高度均降低(p=.003)。在两种训练干预措施之后,障碍前和障碍后距离平均值都有其他显着变化。此外,人口统计学之间存在显著的相关性,认知,以及职能流动评估和依赖措施的变化。研究结果表明,VRTT和CTT干预措施都可以降低老年人的出行风险。虽然通过不同的方法。
    With increased age, walking without tripping requires greater cognitive demand. Therefore, it may be beneficial for training interventions to address and incorporate aspects of cognitive load. The purpose of this study was to compare a semi-immersive virtual reality treadmill training (VRTT) and conventional treadmill training (CTT) on obstacle clearance and trip hazard in older adults. Obstacle clearance parameters were measured with foot-mounted inertial measurement units (IMUs) and a Zeno pressure walkway. All data were processed and analyzed through custom Matlab scripts. Obstacle step height mean decreased (p = .003) in the lead limb following both training interventions. Additional significant changes were found in pre- and post-obstacle distance mean following both training interventions. Furthermore, significant correlations were found between demographic, cognitive, and functional mobility assessments and changes in dependent measures. The findings suggest that both the VRTT and CTT interventions may provide a reduction in trip risk in older adults, although through different methods.
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  • 文章类型: Journal Article
    背景:老年患者的跌倒可导致严重的健康并发症和增加的医疗保健费用。跌倒风险增加药物(FRID)是一组可能诱发跌倒或增加跌倒倾向的药物(即,跌倒风险)。开药是指从不适当的药物中撤出的过程,在医疗保健专业人员的监督下,以管理多重药房和改善结果为目标。
    目的:本研究旨在根据评估结果评估去处方干预的有效性。Review,最小化,优化,和重新评估(ARMOR)工具在降低老年患者跌倒风险方面的作用,并评估取消FRIDs处方的成本-效果。
    方法:这是一个开放标签,平行组随机对照学术试验。目前正在服用5种或更多处方药的60-80岁个人,包括至少1个FRID,将被招募。人口统计数据,医疗条件,药物清单,直立性低血压,和秋季历史细节将被收集。跌倒关注将使用跌倒功效量表进行评估,和跌倒风险将通过定时UpandGo测试和Tinetti以性能为导向的移动性评估工具进行评估。在这项研究中,所有主治医师将采用基于资历的分层随机化方法进行随机化.随机医师将使用ARMOR工具对FRID患者进行处方。参与者将保持日记,每月进行电话随访,以监测跌倒和不良事件。将进行身体评估,以评估跌倒风险每3个月一年。使用世界卫生组织的核心指标对处方药的合理性进行评价。
    结果:该研究于2023年10月获得了印度医学研究理事会的资助-安全和合理使用药物。该研究计划于2024年4月开始,并于2026年结束。将通过跌倒频率和跌倒风险评分的变化来衡量功效。成本效益分析还将包括增量成本效益比计算。将记录与取消处方相关的不良事件。
    结论:该试验将为ARMOR工具在减少服用FRIDs的老年人群跌倒方面的有效性提供重要见解。此外,它将提供有关取消处方做法的成本效益的宝贵信息,对改善老年患者的福祉和优化医疗资源分配具有重要意义。这项研究的结果将与医疗保健专业人员有关,政策制定者,研究人员专注于老年护理和跌倒预防策略。
    背景:临床试验注册-印度CTRI/2023/12/060516;https://ctri。nic.在/临床试验/pubview2。php。
    PRR1-10.2196/55638。
    BACKGROUND: Falls in older patients can lead to serious health complications and increased health care costs. Fall risk-increasing drugs (FRIDs) are a group of drugs that may induce falls or increase the tendency to fall (ie, fall risk). Deprescribing is the process of withdrawal from an inappropriate medication, supervised by a health care professional, with the goal of managing polypharmacy and improving outcomes.
    OBJECTIVE: This study aims to assess the effectiveness of a deprescribing intervention based on the Assess, Review, Minimize, Optimize, and Reassess (ARMOR) tool in reducing the risk of falls in older patients and evaluate the cost-effectiveness of deprescribing FRIDs.
    METHODS: This is an open-label, parallel-group randomized controlled academic trial. Individuals aged 60-80 years who are currently taking 5 or more prescribed drugs, including at least 1 FRID, will be recruited. Demographic data, medical conditions, medication lists, orthostatic hypotension, and fall history details will be collected. Fall concern will be assessed using the Fall Efficacy Scale, and fall risk will be assessed by the Timed Up and Go test and Tinetti Performance-Oriented Mobility Assessment tool. In this study, all treating physicians will be randomized using a stratified randomization method based on seniority. Randomized physicians will do deprescribing with the ARMOR tool for patients on FRIDs. Participants will maintain diaries, and monthly phone follow-ups will be undertaken to monitor falls and adverse events. Physical assessments will be performed to evaluate fall risk every 3 months for a year. The rationality of prescription drugs will be evaluated using the World Health Organization\'s core indicators.
    RESULTS: The study received a grant from the Indian Council of Medical Research-Safe and Rational Use of Medicine in October 2023. The study is scheduled to commence in April 2024 and conclude by 2026. Efficacy will be measured by fall frequency and changes in fall risk scores. Cost-effectiveness analysis will also include the incremental cost-effectiveness ratio calculation. Adverse events related to deprescription will be recorded.
    CONCLUSIONS: This trial will provide essential insights into the efficacy of the ARMOR tool in reducing falls among the geriatric population who are taking FRIDs. Additionally, it will provide valuable information on the cost-effectiveness of deprescribing practices, offering significant implications for improving the well-being of older patients and optimizing health care resource allocation. The findings from this study will be pertinent for health care professionals, policy makers, and researchers focused on geriatric care and fall prevention strategies.
    BACKGROUND: Clinical Trials Registry - India CTRI/2023/12/060516; https://ctri.nic.in/Clinicaltrials/pubview2.php.
    UNASSIGNED: PRR1-10.2196/55638.
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  • 文章类型: Journal Article
    背景:老年人在日常环境中导航时难以保持左右平衡。在这种情况下失去平衡会导致跌倒。我们需要更好地了解老年人如何适应横向平衡以适应环境施加的任务限制。
    目的:老年人在不断变窄的小路中行走时如何调整中外侧平衡,这些调整的稳定性含义是什么?
    方法:18位年龄较大(71.6±6.0岁)的健康成年人和20位年龄较小(21.7±2.6岁)的健康成年人穿越了25m长的路径,逐渐从45cm缩小到5cm。参与者在选择时切换到相邻的路径。我们将参与者的横向质心动态和横向稳定边际(MoSL)量化为路径变窄。我们将横向不稳定概率(PoIL)量化为参与者在行走时采取横向不稳定(MoSL<0)步骤的概率。我们还提取了参与者切换路径的这些结果。
    结果:随着路径变窄,所有参与者表现出逐渐变小的平均MoSL和越来越大的PoIL.然而,它们的MoSL变异性在最窄和最宽的路段都最大。老年人在路径宽度上始终表现出更大的平均值和更多的可变MoSL。一起考虑,随着路径变窄,这些导致了可比的或稍大的PoIL。老年人更快离开狭窄的道路,平均而言,比年轻。当他们这样做的时候,老年人表现出显著更大的平均水平和更多的变化MoSL,但有点小PoIL比年轻。
    结论:我们的结果直接挑战了主要的解释,即平均MoSL越大表明“稳定性越大”,我们认为这与它的推导背后的原则不一致。相比之下,分析一步一步的步态动力学,与估计PoIL一起,可以正确量化不稳定风险。此外,使用这些方法发现的适应性策略为减少老年人跌倒的未来干预措施提供了潜在目标.
    BACKGROUND: Older adults have difficulty maintaining side-to-side balance while navigating daily environments. Losing balance in such circumstances can lead to falls. We need to better understand how older adults adapt lateral balance to navigate environment-imposed task constraints.
    OBJECTIVE: How do older adults adjust mediolateral balance while walking along continually-narrowing paths, and what are the stability implications of these adjustments?
    METHODS: Eighteen older (71.6±6.0 years) and twenty younger (21.7±2.6 years) healthy adults traversed 25 m-long paths that gradually narrowed from 45 cm to 5 cm. Participants switched onto an adjacent path when they chose. We quantified participants\' lateral center-of-mass dynamics and lateral Margins of Stability (MoSL) as paths narrowed. We quantified lateral Probability of Instability (PoIL) as the probability that participants would take a laterally unstable (MoSL<0) step as they walked. We also extracted these outcomes where participants switched paths.
    RESULTS: As paths narrowed, all participants exhibited progressively smaller average MoSL and increasingly larger PoIL. However, their MoSL variability was largest at both the narrowest and widest path sections. Older adults exhibited consistently both larger average and more variable MoSL across path widths. Taken into account together, these resulted in either comparable or somewhat larger PoIL as paths narrowed. Older adults left the narrowing paths sooner, on average, than younger. As they did so, older adults exhibited significantly larger average and more variable MoSL, but somewhat smaller PoIL than younger.
    CONCLUSIONS: Our results directly challenge the predominant interpretation that larger average MoSL indicate \"greater stability\", which we argue is inconsistent with the principles underlying its derivation. In contrast, analyzing step-to-step gait dynamics, together with estimating PoIL allows one to properly quantify instability risk. Furthermore, the adaptive strategies uncovered using these methods suggest potential targets for future interventions to reduce falls in older adults.
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