Effect of a home-based exercise program on subsequent falls among community-dwelling older adults with cognitive frailty: A sub-group analysis of a randomized controlled trial.

Objectives: Cognitive frailty is characterized by concurrent physical frailty and mild cognitive impairment and is associated with increased risk of falls. Exercise is an evidence-based strategy to prevent falls, but whether exercise reduces falls in people with cognitive frailty is unknown. We examined the effects of home-based exercise on subsequent falls among community-dwelling older adults with cognitive frailty who have previously fallen.

Perceived Health Status and Capability after Hip Fracture: Secondary Outcomes from an Randomized Controlled Trial.

Introduction: Hip fractures can have a significant impact on the lives of older people and their families. We conducted a pragmatic randomized controlled trial of post-discharge comprehensive geriatric care (CGC) for community-dwelling older adults after a surgically repaired hip fracture. The objective of this study was to conduct a secondary analysis to compare changes in health status and perceived capability from baseline to 12 months after randomization with: the EuroQol 5-Dimension (EQ-5D-5L) (1) utility score and (2) visual analog scale (VAS); and (3) well-being as measured by participants' perceptions of their ability (or capability) toward completing life activities using the ICEpop Capability Measure for Older People (ICECAP-O).

Comprehensive Geriatric Care to Improve Mobility after Hip Fracture: An RCT.

Background: Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care.

Objective: To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months.

Methods: A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada.

Action Seniors! Cost-Effectiveness Analysis of a Secondary Falls Prevention Strategy Among Community-Dwelling Older Fallers.

Background: The Otago Exercise Program (OEP) has demonstrated cost-effectiveness for the primary prevention of falls in a general community setting. The cost-effectiveness of exercise as a secondary falls prevention (ie, preventing falls among those who have already fallen) strategy remains unknown. The primary objective was to estimate the cost-effectiveness (incremental cost-effectiveness/utility ratio) of the OEP from a healthcare system perspective.

Older Adults' Sedentary Behavior and Physical Activity After Hip Fracture: Results From an Outpatient Rehabilitation Randomized Controlled Trial.

Background And Purpose: Prolonged sedentary time and limited physical activity can result in deleterious effects on health and mobility, especially for older adults with fall-related hip fracture. Therefore, the purpose of this study was to examine the effect of a multidisciplinary clinic on sedentary behavior and physical activity (prespecified secondary outcomes) and provide descriptions of activity patterns over 1 year for men and women.

Methods: We conducted a parallel-group, single-blinded randomized controlled trial comparing a multidisciplinary clinic and usual care (intervention) with usual care (control).

Incontinence and Nocturia in Older Adults After Hip Fracture: Analysis of a Secondary Outcome for a Parallel Group, Randomized Controlled Trial.

To test the effect of a follow-up clinic on urinary incontinence (UI) and nocturia among older adults with hip fracture. Fifty-three older adults (≥65 years) 3 to 12 months following hip fracture were enrolled and randomized to receive usual care plus the intervention (B4), or usual care (UC) only. The B4 group received management by health professionals, with need-based referrals.

Reflections on Hip Fracture Recovery From Older Adults Enrolled in a Clinical Trial.

This study describes patients' perspectives on recovery during participation in a randomized controlled trial that tested a postoperative hip fracture management program (B4 Clinic), compared with usual care, on mobility. Semistructured qualitative interviews were conducted with 50 older adults with hip fracture (from both groups) twice over 12 months. A total of 32 women (64%) and 18 men (36%) participated in the study with a mean age at baseline of 82 (range = 65-98) years.

Equivalent Fall Risk in Elderly Patients on Hemodialysis and Peritoneal Dialysis.

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Background: Accidental falls are common in the hemodialysis (HD) population. The high fall rate has been attributed to a combination of aging, kidney disease-related morbidity, and HD treatment-related hazards. We hypothesized that patients maintained on peritoneal dialysis (PD) would have fewer falls than those on chronic HD.

Sedentary Behavior and Physical Activity Patterns in Older Adults After Hip Fracture: A Call to Action.

Objectives: To characterize patterns of sedentary behavior and physical activity in older adults recovering from hip fracture and to determine characteristics associated with activity.

Methods: Community-dwelling, Canadian adults (65 years+) who sustained hip fracture wore an accelerometer at the waist for seven days and provided information on quality of life, falls self-efficacy, cognitive functioning, and mobility.

Results: There were 53 older adults (mean age [SD] 79.

Accidental falls and risk of mortality among older adults on chronic peritoneal dialysis.

Background And Objectives: More than 40% of elderly hemodialysis patients experience one or more accidental falls within a 1-year period. Such falls are associated with higher mortality. The objectives of this study were to assess whether falls are also common in elderly patients established on peritoneal dialysis and evaluate if patients with falls have a higher risk of mortality than patients who do not experience a fall.

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy.

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Background: Older in-center hemodialysis patients have a high burden of functional disability. However, little is known about patients on home chronic peritoneal dialysis (PD). As patients opting for home dialysis are expected to play a greater role in their own dialysis care, we hypothesized that a relatively low number of PD patients would require help with basic self-care tasks (ADL) and instrumental activities of daily living (IADL).

Post-discharge management following hip fracture--get you back to B4: a parallel group, randomized controlled trial study protocol.

Background: Fall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence) to improve outcomes.

The intersection of geriatrics and chronic kidney disease: frailty and disability among older adults with kidney disease.

Older adults (aged >or=65 years) comprise the largest segment of the CKD population, and impaired kidney function is linked with unsuccessful aging. Individuals across the spectrum of kidney disease have clinical features of the frailty phenotype, suggesting that frailty is not confined to old age among vulnerable populations. This manifests as a high prevalence of impaired physical performance, emergent geriatric syndromes, disability, and risk of death.

Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial.

Objectives: To primarily ascertain the effect of the Otago Exercise Program (OEP) on physiological falls risk, functional mobility, and executive functioning after 6 months in older adults with a recent history of falls and to ascertain the effect of the OEP on falls during a 1-year follow-up period.

Design: Randomized controlled trial.

Setting: Dedicated falls clinics.

Visual impairment in elderly patients receiving long-term hemodialysis.

Background: Visual impairments are associated with low quality of life, impairment of daily activities, and accidental falls. As dialysis patients are increasingly older and more disabled, we sought to assess visual impairments within an elderly dialysis population. Based on data from the general population, we hypothesized that more than 30% of dialysis patients 65 years or older would have visual impairment manifested by loss of visual acuity, depth perception, or contrast sensitivity.

Geriatric comorbidities, such as falls, confer an independent mortality risk to elderly dialysis patients.

Background: As the number of patients aged >/=65 years starting haemodialysis (HD) continues to increase, more patients are at risk of falls, functional decline and cognitive impairment. In an earlier prospective cohort study, we showed that 44% of elderly HD patients had more than one fall within a 1-year period. The objective of this study was to assess whether falls remained predictive of increased mortality risk even after controlling for age, comorbidity, dialysis vintage and laboratory variables.

Falls and fall-related injuries in older dialysis patients.

Dialysis patients are increasingly older and more disabled. In community-dwelling seniors without kidney disease, falls commonly predict hospitalization, the onset of frailty, and the need for institutional care. Effective fall prevention strategies are available.

Utility of the mean cumulative function in the analysis of fall events.

Background: Falls are the most common cause of injury among elderly people; half of those people fall recurrently. The objective of these simulation studies was to describe the Mean Cumulative Function (MCF) and to evaluate the utility of the MCF in detecting differences between groups experiencing different patterns of event intensities.

Methods: We specified 250 participants per group with a maximum follow-up time of 365 days.

Causes of death in older peritoneal dialysis patients--can we depend on registry reports?

Objectives: Despite significant improvements in renal management the mortality associated with dialysis care remains high. Many renal registries report mortality statistics on an annual basis. The objectives of this study were (1) to establish the accuracy of the registered cause of death (CoD) against that determined by a panel of physicians; and (2) to test the feasibility of using the HEMO study CoD classification system in patients on peritoneal dialysis (PD).

Prevalence of falls among seniors maintained on hemodialysis.

Background: Increasing numbers of seniors are starting renal replacement therapy. Many may experience a loss of functional independence including mobility impairment. Seniors on dialysis commonly have multiple comorbidities that are associated with an increased risk for falls in the general population.