Gerontology
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Multicenter Study
Caregiver fear of falling and functional ability among seniors residing in long-term care facilities.
Consistent with fear-avoidance models of falling and pain, past research has demonstrated that, among adults living in the community, excessive fear of falling and fear of pain result in activity restriction and predict functional outcomes including falls (possibly because self-imposed activity restriction, due to fear of pain or falling, can lead to muscular decline and deconditioning). Among seniors with dementia, who rely on others for their care, decisions concerning activity restrictions are made by caregivers. As such, caregivers' fear about the possibility of care recipient falls and pain is important to examine. ⋯ This is the first study to apply a modified fear-avoidance model of falls and pain to seniors with dementia who reside in LTC facilities. Our results demonstrate the importance of considering caregiver fears concerning falls and pain, when developing programs designed to optimize the use of physical restrictions (to prevent falls and minimize functional decline) in LTC facilities.
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The use of falls risk screening tools may aid in targeting fall prevention interventions in older individuals most likely to benefit. ⋯ Clinical tests of neuromuscular function can predict risk of falls in frail older people. When feasibility and validity were considered, the CWS was the best test for use as a screening tool in frail older people, however, these preliminary results require confirmation in further research.
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Both age and dementia have been shown to have an effect on nociception and pain processing. The question arises whether mild cognitive impairment (MCI), which is thought to be a transitional stage between normal ageing and dementia, is also associated with alterations in pain processing. ⋯ The pain response system appeared to be quite unaltered in MCI patients compared to cognitively unimpaired individuals of the same age. Only the sympathetic responsiveness qualified as an indicator of early aging effects as well as of pathophysiology associated with MCI, which both seemed to affect the pain system independently from each other.
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Hip fracture patients are reported to have an increased mortality rate compared to the general population. In order to be able to reduce the morbidity and mortality after a hip fracture, our efforts to identify the patients at risk already upon admission to the hospital need to be increased. For such a risk assessment, robust, validated, and reproducible criteria are mandatory. ⋯ The combined use of the ASA classification for assessing physical health and the SPMSQ for assessing cognitive function effectively identified hip fracture patients with an increased mortality rate. We present a predictive model including age, gender, ASA, and SPMSQ that can be used to assess the mortality risk after hip fracture surgery.
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Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functioning and therefore may increase the incidence of falls in older people. ⋯ Sleep disturbances were common and associated with a variety of psychological, physiological, health and lifestyle factors. Long daytime naps and short night-time sleep periods were associated with an increased risk of falls.