Emergency department presentations and 30-day mortality in patients from residential aged care facilities.

Objective To describe patterns of emergency department (ED) presentations and predictors of 30-day mortality in patients referred from a residential aged care facility (RACF). Methods A retrospective analysis of linked state-wide emergency, inpatient and death data from 136 public ED hospitals in New South Wales, Australia. Data were collected from the NSW Emergency Department Data Collection database, the NSW Admitted Patient Data Collection database and the NSW Registry of Births, Deaths and Marriages.

Mild and marked executive dysfunction and falls in people with Parkinson's disease.

Background: Executive dysfunction and risk of falling are hallmarks of Parkinson's disease (PD). However, it is unclear how executive dysfunction predisposes people with PD to falling.

Objectives: To: (i) identify sensorimotor, balance, and cardiovascular risk factors for falls that discriminate between those with normal executive function and those with mild and marked executive dysfunction in people with PD and (ii) determine whether mild and marked executive dysfunction are significant risk factors for falls when adjusting for PD duration and severity and freezing of gait (FOG).

Sensorimotor, Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study.

Objective: To determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations.

Design: We pooled data from 5 studies for this observational analysis of prospective falls.

Setting: Community or low-level care facility.

Falls in Parkinson's Disease Subtypes: Risk Factors, Locations and Circumstances.

People with Parkinson's disease (PD) can be classified into those with postural instability and gait difficulty (PIGD subtype) and those manifesting tremor as the main symptoms (non-PIGD subtype). In a prospective cohort study of 113 people with PD we aimed to contrast fall rates and circumstances as well as a range of disease-related, clinical, and functional measures between the PD subtypes. Compared with non-PIGD participants, PIGD participants were significantly more likely to suffer more falls overall as well as more falls due to freezing of gait, balance-related falls and falls at home.

Making Decisions About Long-Term Institutional Care Placement Among People With Dementia and Their Caregivers: Systematic Review of Qualitative Studies.

Background And Objectives: People with dementia become increasingly dependent on others for care as cognition declines. Decision making about placement of people with dementia into long-term institutional care can be emotionally complex. The objective of this review is to describe experiences and perspectives of people with dementia and their family caregivers in making decisions about institutional care placement.

Factors to Consider in the Selection of Dopamine Agonists for Older Persons with Parkinson's Disease.

Dopamine agonists (DAs) are frequently used in the management of Parkinson's disease (PD), a complex multisystem disorder influenced substantially by age-related factors. Over 80% of PD patients present after age 60 years and may have clinical features exacerbated by age-related comorbidities or decline in physiological compensatory mechanisms. Pharmacotherapy for motor symptoms in older persons is more likely to involve exclusive use of levodopa combined with a peripheral decarboxylase inhibitor throughout the course of the illness.

Head and trunk stability during gait before and after levodopa intake in Parkinson's disease subtypes.

Introduction: People with Parkinson's disease (PD) can be classified into tremor dominant (TD) and postural instability and gait difficulty (PIGD) subtypes; the latter group having more impaired gait and increased fall risk. While there is some evidence that anti-parkinsonian medication, levodopa, might not improve balance and gait control or reduce fall risk in the PIGD subtype, it is unclear whether the levodopa dosage intake affects gait stability. To address these issues, this study used accelerometry to compare gait stability: (i) during before and after levodopa intake between non-PIGD and PIGD subtypes; (ii) between individuals who took less or >750 mg of levodopa/day.

Health care providers' perceptions of family caregivers' involvement in consultations within a geriatric hospital setting.

This study explored health professionals' (HPs') experiences of interacting with family care-givers (FCs), and the strategies they employ during these interactions. Qualitative methods involved audio-taped and transcribed in-depth semi-structured interviews with 21 HPs (doctors, nurses) from the geriatric wards of two tertiary hospitals. Framework methods were used to analyze data.

Association Between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-Analysis.

Background: Evaluating effect of acute or chronic use of antihypertensives on risk of falls in older adults.

Methods: Data sources: Systematic search of primary research articles in CINAHL, Cochrane, EBM, EMBASE, and MEDLINE databases from January 1 2007 to June 1 2017. Study selection: Research studies of cohort, case-control, case-crossover, cross-sectional, or randomized controlled trial (RCT) design examining association between antihypertensives and falls in people older than 60 years were evaluated.

Medicine information exchange networks among healthcare professionals and prescribing in geriatric medicine wards.

Aims: Effective transfer of information is vital for rational drug therapy. This is particularly important for older patients, who have a high prevalence of polypharmacy and are managed by multidisciplinary teams. We aimed to assess medicine information exchange (MIE) networks in geriatric medicine wards and whether they are associated with prescribing patterns.

The validity of three fall risk screening tools in an acute geriatric inpatient population.

Aim: We examined the validity of the Ontario Modified STRATIFY (OM) (St Thomas's Risk Assessment Tool in Falling Elderly Inpatients), The Northern Hospital Modified STRATIFY (TNH) and STRATIFY in predicting falls in an acute aged care unit.

Methods: Data were collected prospectively from 217 people presenting consecutively and falls identified during hospitalisation.

Results: Sensitivities of OM (80.

Gait as a biomarker? Accelerometers reveal that reduced movement quality while walking is associated with Parkinson's disease, ageing and fall risk.

Humans are living longer but morbidity has also increased; threatening to create a serious global burden. Our approach is to monitor gait for early warning signs of morbidity. Here we present highlights from a series of experiments into gait as a potential biomarker for Parkinson's disease (PD), ageing and fall risk.

Exercise for falls prevention in Parkinson disease: a randomized controlled trial.

Objective: To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors, i.e., poor balance, reduced leg muscle strength, and freezing of gait, in people with Parkinson disease.

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area.

Objective: To contrast long-term population-based trends in general practice (GP) presentations and acute inpatient admissions from the emergency department (ED) in the elderly population within the Greater Sydney Area.

Methods: This was a retrospective analysis of population-based ED presentation data over 11 years, between January 2001 and December 2011, conducted within the Greater Sydney Area in Australia. De-identified data were obtained from the New South Wales Emergency Department Data Collection database on all patients presenting to 30 public hospital EDs located within the Greater Sydney Area.

Demand for emergency department services in the elderly: an 11 year analysis of the Greater Sydney Area.

Objective: To describe trends in population-based rates of ED presentations in the Greater Sydney Area (GSA) and compare these between the elderly and non-elderly age groups.

Methods: This was a retrospective study using ED presentation data from all public hospitals in the GSA and population data from the Australian Bureau of Statistics between 2001 and 2011. Age-specific ED presentation rates stratified by age group (<65 years, 65-79 years and ≥80 years of age) were presented and compared using negative binomial regression and generalised linear regression models.

Postural sway approaches center of mass stability limits in Parkinson's disease.

Background: Although Parkinson's disease (PD) is a well recognised risk factor for falls, how this disease and its therapy affect postural stability and leaning balance remains unclear. The aim of this study was to examine the effects of PD and levodopa on postural sway and leaning balance.

Methods: Performances of 28 PD participants {median [inter-quartile range (IQR)] duration of PD: 10 (6-13) years, median (IQR) UPDRS motor score "off": 22 (14-31) "on" and "off" levodopa were compared with 28 age- and gender-matched healthy controls on two measures of controlled leaning balance [ratio of anterior-posterior (AP) sway to maximal balance range (MBR) and coordinated stability].

The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial.

This randomized controlled trial with blinded assessment aimed to determine the effect of a 6-month minimally supervised exercise program on fall risk factors in people with Parkinson's disease (PD). Forty-eight participants with PD who had fallen or were at risk of falling were randomized into exercise or control groups. The exercise group attended a monthly exercise class and exercised at home three times weekly.

Clinical and physiological assessments for elucidating falls risk in Parkinson's disease.

The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 +/- 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation.

Acceleration patterns of the head and pelvis during gait in older people with Parkinson's disease: a comparison of fallers and nonfallers.

Background: Falls are common in older people with Parkinson's disease (PD) and are likely to be related to gait disturbances associated with the condition. Although several studies have evaluated differences in basic gait parameters in people with PD, none have directly evaluated the stability of the upper body during gait.

Methods: Temporospatial gait parameters and acceleration patterns at the head and pelvis were measured in three groups of older people: 33 controls without PD (mean age 67 +/- 4 years), 33 older people with PD and no history of falls (mean age 63 +/- 4 years), and 33 older people with PD and a history of falls (mean age 67 +/- 2 years).

Exercise therapy for prevention of falls in people with Parkinson's disease: a protocol for a randomised controlled trial and economic evaluation.

Background: People with Parkinson's disease are twice as likely to be recurrent fallers compared to other older people. As these falls have devastating consequences, there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson's disease. The main objective of this randomised controlled trial is to determine whether fall rates can be reduced in people with Parkinson's disease using exercise targeting three potentially remediable risk factors for falls (reduced balance, reduced leg muscle strength and freezing of gait).

Walking speed, cadence and step length are selected to optimize the stability of head and pelvis accelerations.

The aim of this study was to evaluate the hypothesis that an individual's preferred or usual walking speed, step length and cadence optimize the stability of head and pelvic accelerations in vertical (V), anterior-posterior (AP) and medio-lateral (ML) planes when walking. Acceleration patterns of the head and pelvis were recorded in ten healthy young adults as they walked on a level surface in three separate experiments: (1) walking at five different speeds, ranging from very slow to very fast; (2) walking in time to a metronome set at five different cadences, ranging from 33 to 167% of subjects' usual cadence; and (3) walking at five different step lengths varying from very short to very long while keeping in time with a metronome set at cadences 67, 100 and 125% of usual cadence. The results indicated that acceleration patterns in the V and AP planes were most stable when subjects walked at their usual cadence and step length.