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Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study.

ABSTRACT: Older people are continuing to fall despite fall prevention guidelines targeting known falls' risk factors. Multisite pain is a potential novel falls' risk factor requiring further exploration. This study hypothesises that: (1) an increasing number of pain sites and widespread pain predicts self-reported falls and falls recorded in primary and secondary healthcare records; (2) those relationships are independent of known falls' risk factors and putative confounders. This prospective cohort study linked data from self-completed questionnaires, primary care electronic health records, secondary care admission statistics and national mortality data. Between 2002-2005, self-completion questionnaires were mailed to community-dwelling individuals aged 50 years and older registered with one of eight general practices in North Staffordshire, UK(n = 26,129) yielding 18,497 respondents. 11,375 respondents entered the study; 4386 completed six year follow-up. Self-reported falls were extracted from three and six year follow-up questionnaires. Falls requiring healthcare were extracted from routinely collected primary and secondary healthcare data. Increasing number of pain sites increased odds of future 3 year (odds ratio 1.12 (95% confidence interval: 1.01-1.24)) and 6 year self-reported fall (odds ratio 1.02 (1.00-1.03)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.01 (1.00-1.03)). The presence of widespread pain increased odds of future 3 year (odds ratio 1.27 (0.92-1.75)) and 6 year fall (odds ratio 1.43(1.06-1.95)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.27(0.98-1.65)). Multisite pain was not associated with future fall requiring secondary care admission. Multisite pain must be included as a falls' risk factor in guidelines to ensure clinicians identify their older patients at risk of falls and employ timely implementation of current falls prevention strategies.

SUBMITTER: Welsh VK

PROVIDER: S-EPMC6905547 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study.

Welsh Victoria K VK Mallen Christian D CD Ogollah Reuben R Wilkie Ross R McBeth John J

PloS one 20191211 12

Older people are continuing to fall despite fall prevention guidelines targeting known falls' risk factors. Multisite pain is a potential novel falls' risk factor requiring further exploration. This study hypothesises that: (1) an increasing number of pain sites and widespread pain predicts self-reported falls and falls recorded in primary and secondary healthcare records; (2) those relationships are independent of known falls' risk factors and putative confounders. This prospective cohort study ...[more]

PMID: 31826023

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Project description:OBJECTIVES:To determine the prevalence of falls, fear of falling (FoF), and activity limitation due to FoF in a nationally representative study of older adults with self-reported vision impairment (VI). DESIGN:Cross-sectional analysis of panel survey data. SETTING:National Health and Aging Trends Study, a nationally representative survey administered annually from 2011 to 2016 to U.S. Medicare beneficiaries aged 65 and older. PARTICIPANTS:Respondents (N=11,558) who contributed 36,229 participant observations. MEASUREMENTS:We performed logistic regression to calculate the unadjusted and adjusted prevalence of self-reported history of more than 1 fall in the past year, any fall in the past month, FoF, and activity limitation due to FoF in participants with and without self-reported VI. RESULTS:The weighted proportion of participants reporting VI was 8.6% (95% confidence interval (CI)=8.0-9.2%). The unadjusted prevalence of more than 1 fall in the past year was 27.6% (95% CI=25.5-29.7%) in participants with self-reported VI and 13.2% (95% CI=12.7-13.7%) in those without self-reported VI. In respondents with self-reported VI, the prevalence of FoF was 48.3% (95% CI=46.1-50.6%) and of FoF limiting activity was 50.8% (95%CI 47.3-54.2%), and in those without self-reported VI, the prevalence of FoF was 26.7% (95% CI=25.9-27.5%) and of FoF limiting activity was 33.9% (95% CI=32.4-35.4%). The prevalence of all fall and fall-related outcomes remained significantly higher among those with self-reported VI after adjusting for sociodemographics and potential confounders. CONCLUSION:The prevalence of falls, FoF, and activity limitation due to FoF is high in older adults with self-reported VI. This is the first study to provide nationally representative data on the prevalence of fall-related outcomes in older Americans with self-reported VI. These findings demonstrate the need to treat avoidable VI and to develop interventions to prevent falls and fall-related outcomes in this population. J Am Geriatr Soc 67:239-245, 2019.

Project description:BackgroundLittle is known about associations between performance-based measurements and self-reported scales, nor about ceiling effects or sensitivity to change to evaluate effects in the target population for self-managed exercise interventions. This study aimed to explore the feasibility of using performance-based outcomes for gait speed, functional leg strength and balance, and self-reported outcomes of falls-efficacy and functional ability in two self-managed falls prevention exercise interventions for community dwelling older adults.MethodsIndependent living, community-dwelling older adults (n = 67) exercised with one of two self-managed falls prevention exercise programmes, a digital programme (DP) or a paper booklet (PB) in a 4-month participant preference trial. Pre- and post-assessments, by blinded assessors, included Short Physical Performance Battery (SPPB) and 30s Chair stand test (30s CST). Participants completed self-reported questionnaires: Activities-specific and Balance Confidence scale (ABC), Iconographical Falls Efficacy Scale (Icon-FES), Late-Life Function and Disability Instrument Function Component (LLFDI-FC). In addition, improvement in balance and leg strength was also self-rated at post-assessment. Participants' mean age was 76 ± 4 years and 72% were women.ResultsCeiling effects were evident for the balance sub-component of the SPPB, and also indicated for ABC and Icon-FES in this high functioning population. In SPPB, gait speed, 30s CST, and LLFDI-FC, 21-56% of participants did not change their scores beyond the Minimal Clinically Important Difference (MCID). At pre-assessment all performance-based tests correlated significantly with the self-reported scales, however, no such significant correlations were seen with change-scores. Improvement of performance-based functional leg strength with substantial effect sizes and significant correlations with self-reported exercise time was shown. There were no differences in outcomes between the exercise programmes except that DP users reported improved change of leg strength to a higher degree than PB users.ConclusionThe LLFDI-FC and sit-to-stand tests were feasible and sensitive to change in this specific population. The balance sub-component of SPPB and self-reported measures ABC and Icon-FES indicated ceiling effects and might not be suitable as outcome measures for use in a high functioning older population. Development and evaluation of new outcome measures are needed for self-managed fall-preventive interventions with high functioning community-dwelling older adults.

Project description:BackgroundFalls are a major public health concern in older adults, and the proportion of older adults that has been diagnosed with cancer is growing. Yet, while falls, peripheral neuropathy, and postural instability are more common in aging cancer survivors, it is unclear how these factors interact.Research questionOur objective was to examine how components of sway related to self-reported neuropathy and falls.MethodsPostural sway during static stance was recorded with an inertial sensor (APDM Opal), placed on the lumbar spine region in 434 older female cancer survivors (mean age 63) and 49 healthy older female control subjects (mean age 63). Measures of sway were resolved into principal components that were compared between women with and women without self-reported falls in the previous 6 months and between those with and without self-reported symptoms of peripheral neuropathy.ResultsCancer survivors had worse sway than healthy control subjects in components related to sway magnitude and mediolateral frequency of sway, but no difference in the component related to resultant / AP sway jerk and frequency. Cancer survivors who reported neuropathy were more likely to have higher resultant / AP sway frequencies and jerk than asymptomatic survivors, while survivors who reported a fall were more likely to have lower frequencies of mediolateral sway than non-fallers. Falls were more strongly associated with mediolateral sway in survivors with more severe neuropathy; whereas falls were more strongly associated with resultant / AP sway frequency in survivors with less severe neuropathy SIGNIFICANCE: Postural stability, falls, and neuropathy have complex interactions that can vary across components of postural sway. While the frequency of mediolateral sway was associated with falls across our entire cohort, neuropathy influenced the associations between specific characteristics of sway and falls, which may have implications for fall prevention interventions.

Dataset Information

Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study.

Publications

Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study.

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