Abstract Falls constitute an important public health problem that impact the quality of life of an individual. Falls contribute to disability, especially among older adults and elderly individuals. ...Recurrent fallers are those who fall one or more times per year. The purpose of this article is to provide a detailed systemic qualitative review of the recent definition of falls, their mechanism, risk factors, classification; falls in neurodegenerative disorders; and their approach and management. Sources of literature were drawn from peer-reviewed original and systematic review articles published until January 2024 in the PubMed database using the following key words: falls, elderly, definition, management, etiology, neurodegenerative diseases, epilepsy and fall, dementia and fall, and prevention and diagnostic tests for postural instability and falls. This review summarizes the current understanding of falls and provides a pragmatic and clinically focused approach to their management. Falls are usually multifactorial. Neurodegenerative disorders such as cognitive decline and parkinsonism lead to increased risk of falling. There are several tools to assess the risk of early falls. A multidisciplinary approach is needed in the management of falls. The main goal is encouraging physical activity, home hazard modification, management of postural hypotension, and underlying neurodegenerative diseases.
ABSTRACT Objective to understand the meaning of care from the perspective of resident older adults, family members and professionals from Long-Term Care Institutions for Older Adults. Method a ...descriptive and exploratory study with a qualitative approach, developed with 14 resident older adults, 35 family members and 41 professionals from Long Term Care Institutions for Older Adults, located in the city of Florianópolis, Brazil. The data were collected between May 2017 and January 2018, being organized through the Atlas.ti software for the analysis of qualitative data and analyzed according to the content analysis method proposed by Bardin, in the light of the Theory of Social Representations. Results for the older adults, care was linked to three main dimensions: technical care related to the institution, family care, and self-care. The meaning of care from the perspective of family members was related to the moment experienced with the institutionalization of the aged family member, mainly characterized by the dimensions of affective care, when providing comfort and technical care. For the professionals, technical care was related to the affective character. Conclusion care could be understood in different ways, from different perspectives, but it also made it possible to identify points of synchrony among the participants.
RESUMEN Objetivo comprender el significado del cuidado desde la perspectiva de los adultos mayores residentes, familiares y profesionales de las Instituciones de Atención de Larga Estadía para el Adulto Mayor. Método estudio descriptivo y exploratorio, con abordaje cualitativo, desarrollado con 14 adultos mayores residentes, 35 familiares y 41 profesionales de Instituciones de Atención de Larga Estadía para Adultos Mayores, ubicadas en la ciudad de Florianópolis, Brasil. Los datos fueron recolectados entre mayo de 2017 y enero de 2018, la organización de los mismos se llevó a cabo a través del software de análisis de datos cualitativos Atlas.ti y el análisis mediante el método de análisis de contenido propuesto por Bardin, a la luz de la Teoría de las Representaciones Sociales. Resultados para el adulto mayor, la atención se vinculó a tres dimensiones principales: atención técnica relacionada con la institución, atención familiar y autocuidado. El significado del cuidado desde la perspectiva de los familiares se relacionó con el momento vivido a partir de la institucionalización del familiar anciano, caracterizado principalmente por las dimensiones del cuidado afectivo, al brindar confort y cuidado técnico. Para los profesionales, el cuidado técnico estaba vinculado con el carácter afectivo. Conclusión el cuidado pudo entenderse de diferentes formas, desde diferentes perspectivas, sin embargo, fue posible identificar puntos de sincronía entre los participantes.
RESUMO Objetivo compreender o significado do cuidado na perspectiva de idosos residentes, familiares e profissionais de Instituições de Longa Permanência para Idosos. Método estudo do tipo descritivo e exploratório, com abordagem qualitativa, desenvolvido com 14 idosos residentes, 35 familiares e 41 profissionais de Instituições de Longa Permanência para Idosos, localizadas na cidade de Florianópolis, Brasil. Os dados foram coletados entre maio de 2017 e janeiro de 2018, sendo organizados através do software para análise de dados qualitativos Atlas.ti e analisados segundo o método de análise de conteúdo proposto por Bardin, à luz da Teoria das Representações Sociais. Resultados para os idosos, o cuidado esteve vinculado a três dimensões principais: o cuidado técnico relacionado à instituição, o cuidado familiar e o cuidado de si. O significado de cuidado na perspectiva de familiares esteve relacionado ao momento vivido com a institucionalização do familiar idoso, caracterizado principalmente pelas dimensões do cuidado afetivo, ao prover conforto e cuidado técnico. Para os profissionais, o cuidado técnico esteve relacionado ao caráter afetivo. Conclusão o cuidado pôde ser compreendido de formas distintas, sob ópticas diferentes, mas que também possibilitou a identificação de pontos de sincronia entre os participantes.
As the world population ages and older adults comprise a growing proportion of current and potential Internet users, understanding the state of Internet use among older adults as well as the ways ...their use has evolved may clarify how best to support digital media use within this population. This article synthesizes the quantitative literature on Internet use among older adults, including trends in access, skills, and types of use, while exploring social inequalities in relation to each domain. We also review work on the relationship between health and Internet use, particularly relevant for older adults. We close with specific recommendations for future work, including a call for studies better representing the diversity of older adulthood and greater standardization of question design.
The 16-item Physical Resilience Instrument for Older Adults (PRIFOR) has good clinimetric properties; however, a shortened PRIFOR would greatly enhance physical resilience measurements in clinical ...settings. The current analysis aimed to reduce the number of PRIFOR while maintaining its clinimetric properties, emphasizing on its factor structure and convergent validity. A longitudinal study was conducted among 863 patients aged 65 years or older. Four PRIFOR items with high factor loadings were selected to generate the short version of PRIFOR (PRIFOR-4). The PRIFOR-4 was found to have a unidimensional structure (comparative fit index = 0.999; Tucker-Lewis index = 0.998 in the confirmatory factor analysis results) with good convergent validity with various external measures (absolute r = 0.109–0.597; p-values<0.01). Because the PRIFOR-4 contains only four items, the completion time for the respondents reduced three fourths from the original PRIFOR, which may have a marked reduction in the response burden. The PRIFOR-4 is thus an easy-to-use measurement that saves time for healthcare professionals in clinical practice.
Falls in older adults are the result of a complex interaction between intrinsic, extrinsic, and behavioral factors. Although it is difficult to separate these factors, some studies indicate that ...environmental risk factors are present in approximately 40% of falls, but there is still a gap in these real factors.
To verify the association between environmental risk factors for falls in older adult Brazilians.
Prospective cohort study, being one of the arms of a larger study “Prevalence of falls in the older adults: Intrinsic, extrinsic and behavioral factors”. The study aimed to follow up with 400 patients, both sexes, aged over 60 years and from different regions of Brazil, who had access to the online questionnaire through a link and agreed to participate in the research. The questionnaire had items related to environmental factors in older adults falls. The environmental assessment was carried out using the Home Fast Brazil self-application instrument. An analysis was performed with the Shapiro-Wilk test, which showed that the data were non-parametric, and thus the data were presented descriptively by the median and interquartile range and the environmental data with nominal variables. significance level p<0.05 was adopted.
405 individuals were evaluated, 39.5% (n=160) (p<0.446) characterized as fallers, so the sample of fallers consisted of 39% (n=113) female (p< 0.882), an aged median of 67 (63-73) years. It was observed that falls have a higher incidence with tripping 100% (n=67) (p<0.01), slipping 100% (n=43) (p<0.01), loss of balance 100%(n=37) (p< 0.01), acute pain 100% (n=2) (p<0.01), leg weakness 100% (n=2) (p<0.01), dizziness 100% (n=4) (p<0.01), knees buckled 100% (n=5) (p<0.01). Of the individuals who reported falls, the reasons were 45.83% (n=88) due to the bathroom being slippery when wet (p <0.03), even if they had adaptations in their home such as a toilet of adequate size 38.15% (n=145) (p<0.04) and grab bar in the bathroom in 47.91% (n=46) (p<0.04).
We found that the incidence of falls was due to the bathroom being slippery due to the wet floor and that most have adaptations in their homes due to the fear of falling. This makes us reflect that even with adaptations, it gives a false sense of security.
With the knowledge of environmental risk factors such as wet bathrooms, it is necessary to supervise the hygiene of these older adults.
Older adults have physical and metabolic characteristics, and there are many differences in nutritional outcomes from middle-aged adults. In addition, there are many factors that cause malnutrition ...peculiar to the older adults, which are not seen in middle-aged adults, and it is easy for them to lose weight and become malnourished. Therefore, nutritional management needs to take into account the age of each subject. Uniform nutritional management can even cause poor health outcomes. The concept of frailty, especially phenotype frailty, and sarcopenia, which have been advocated with the aging of the population and the extension of life expectancy around the world, is very important in considering the extension of healthy life expectancy. In other words, in the super-aged society, frailty and sarcopenia have been emphasized as factors of functional decline, physical dysfunction, and the need for long-term care in addition to the well-known diseases such as cardiovascular disease, malignant tumors, and infectious disease. In fact, these two conditions are strongly associated with the increased risk of new disease development, falls, fractures, disability, hospitalization and death in the older adults. These two conditions are primarily associated with malnutrition and decreased dietary protein intake, and may recover to robustness again with appropriate interventions such as nutritional therapy. Therefore, undernutrition measures are more important for prevention of frailty and sarcopenia than measures for obesity against metabolic syndrome in the older adults, especially in the late-stage older people.
•Cognitive reserve could attenuate the risk of MCI associated with (pre)frailty.•Older adults with low cognitive reserve and (pre)frailty had higher risk of MCI.•Cognitive reserve could attenuate the ...risk of incident MCI.
We aimed to identify the effect of lifespan cognitive reserve and (pre)frailty on mild cognitive impairment (MCI) among older adults.
A total of 4420 older adults aged above 60 with intact cognition recruited in 2011/2012 were followed up in 2015 from the China Health and Retirement Longitudinal Study (CHARLS). The assessment of MCI was based on executive function, episodic memory, and visual-spatial ability. (Pre)frailty was assessed by the validated version of the Fried physical frailty phenotype scale. The lifespan cognitive reserve consisted of the highest educational level, occupational complexity, and participation in leisure activities. Modified Poisson regression models were used to identify the risk of MCI in relation to (pre)frailty and lifespan cognitive reserve index. We examined the interactions of (pre)frailty and lifespan cognitive reserve index on both additive and multiplicative scales.
Baseline (pre)frailty significantly increased the risk of MCI after 3–4 years of follow-up, and high cognitive reserve protected individuals from the risk of MCI. There was an additive interaction between (pre)frailty and the low lifespan cognitive reserve (the relative excess interaction risk=1.08, 95 % CI= 0.25–1,91), but no multiplicative interaction (RR=0.95, 95 % CI= 0.67–1.37). The risk of MCI was larger among older adults with comorbid (pre)frailty and low cognitive reserve than those with each condition alone.
Cognitive reserve attenuates the risk of MCI associated with (pre)frailty. This finding implicates the urgency for identifying and managing MCI among frail older adults who accumulate low cognitive reserve in the life course.
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