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Objectives To compare the fall characteristics of individuals with and without Parkinson's disease ( PD) through the analysis of real-life falls captured on video. Design Observational cohort study. Setting Two long-term care facilities in British Columbia, Canada. Participants Individuals living in long-term care (N = 306; 16 with PD). Measurements Falls captured on video and analyzed (N = 906; 71 in participants with PD). Generalized estimating equation models were used to examine differences in fall characteristics between participants with and without PD. Results Individuals with PD were 1.3 times as likely as those without PD to fall because of incorrect weight shifting (95% confidence interval ( CI) = 1.03-1.65). Secondary steps during the fall event were 1.5 times as likely to be short in individuals with PD as in those without (95% CI = 1.23-1.78). Individuals with PD were also 1.6 times as likely to attempt to recover balance by reaching to grasp an external object (95% CI = 1.13-2.15) and 5.0 times as likely to secure grasp of the object (95% CI = 1.23-20.0). Conclusion Along with greater likelihood for individuals with PD to fall because of incorrect weight shifting, differences between groups were found in reactive stepping responses. This first detailed evidence of the characteristics of falls in PD should help to inform fall and injury prevention approaches for clinicians and rehabilitation professionals working with individuals with PD. [ABSTRACT FROM AUTHOR]

Objectives To develop mortality risk prediction models for older adults with chronic kidney disease ( CKD) that include comorbidities and measures of health status and use not associated with particular comorbid conditions (nondisease-specific measures). Design Retrospective cohort study. Setting Kaiser Permanente Northwest ( KPNW) Health Maintenance Organization. Participants Individuals with severe CKD (estimated glomerular filtration rate <30 mL/min per 1.73 m2; N = 4,054; n = 1,915 aged 65-79, n = 2,139 aged ≥80) who received care at KPNW between 2000 and 2008. Measurements Cox proportional hazards analysis was used to examine the association between selected participant characteristics and all-cause mortality and to generate age group-specific risk prediction models. Predicted and observed risks were evaluated according to quintile. Predictors from the Cox models were translated into a points-based system. Internal validation was used to provide best estimates of how these models might perform in an external population. Results The risk prediction models used 16 characteristics to identify participants with the highest risk of mortality at 2 years for adults aged 65 to 79 and 80 and older. Predicted and observed risks agreed within 5% for each quintile; a 4 to 5 times difference in 2-year predicted mortality risk was observed between the highest and lowest quintiles. The c-statistics for each model (0.68-0.69) indicated effective discrimination without evidence of significant overfit (slope shrinkage 0.06-0.09). Models for each age group performed similarly for mortality prediction at 6 months and 2 years in terms of discrimination and calibration. Conclusion When validated, these risk prediction models may be helpful in supporting discussions about prognosis and treatment decisions sensitive to prognosis in older adults with CKD in real-world clinical settings. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether implementation of symptom-triggered administration of a benzodiazepine protocol reduces the severity (total cumulative dose), duration, and complications of alcohol withdrawal syndrome ( AWS). Design Retrospective health record review. Setting Tertiary care center in Vancouver, Canada. Participants Individuals aged 70 and older admitted to the Acute Care for Elders and Acute Medicine Unit wards with diagnostic codes for AWS from 2008 to 2012. Measurements Median duration and cumulative dose of benzodiazepine treatment, number of severe AWS complications, severe benzodiazepine-associated adverse effects, and need for adjunct therapy. Results Thirty-three participants in the preprotocol group and 30 in the protocol-implemented group met the inclusion criteria. Median duration of benzodiazepine treatment decreased from 96 hours (interquartile range ( IQR) 72-120 hours) in the preprotocol period to 48 hours ( IQR 0-108 hours; P = .04), and median cumulative benzodiazepine dose administered decreased from 9 mg ( IQR 5-19.8 mg) to 3 mg ( IQR 0-10 mg; P = .001). Statistically significantly lower incidence of severe AWS complications ( P = .007) and adjunct therapy use ( P = .02) was seen in the protocol-implemented group. Conclusion A symptom-triggered protocol for dosing of benzodiazepine therapy in the management of AWS in individuals aged 70 and older significantly reduced the total duration of benzodiazepine use, cumulative benzodiazepine dose, and use of adjunctive medications in the treatment of AWS. [ABSTRACT FROM AUTHOR]

Objectives To report 25 hydroxyvitamin D (25 OHD) concentrations, an indicator of vitamin D status, in older adults living in residential care 1 year after a protocol of weekly 20,000 IU of vitamin D was started. Design Cross-sectional. Setting Five residential care facilities in British Columbia, Canada. Participants Residents aged 65 and older from five facilities (N = 236). Measurements Participants provided a blood sample. Demographic and health information was obtained from the medical record. Results Mean 25 OHD was 102 nmol/L (95% confidence interval ( CI) = 98-106 nmol/L). Three percent of residents had a 25 OHD concentration of less than 40 nmol/L, 6% <50 nmol/L, and 19% <75 nmol/L. In those who received 20,000 IU/wk or more for 6 months or longer (n = 147), mean 25 OHD was 112 nmol/L (95% CI = 108-117 nmol/L), and none had a 25 OHD level of less than 50 nmol/L. Hypercalcemia (>2.6 mmol/L), a potential consequence of too much vitamin D, was present in 14%, although 25 OHD levels did not differ in those with and without hypercalcemia (108 vs 101 nmol/L; P = .17). Conclusion Twelve months after implementation of a 20,000- IU/wk vitamin D protocol for older adults in residential care, mean 25 OHD concentrations were high, and there was no evidence of poor vitamin D status. Given the absence of demonstrated benefit of high 25 OHD concentrations to the residential care population, dosages less than 20,000 IU/wk of vitamin D are recommended. [ABSTRACT FROM AUTHOR]

Objectives To explore how wheelchair-related factors, mobility, and participation are associated in a sample of long-term care residents who use wheelchairs as their primary means of mobility. Design Cross-sectional survey. Setting Eleven residential care facilities in the lower mainland of British Columbia, Canada. Participants One hundred forty-six self-responding residents and 118 proxy respondents: mean age 84 (range 60-103). Most were female (69%), and a small proportion (9%) drove a power wheelchair. Measurements The Nursing Home Life Space Diameter Assessment was used to measure resident mobility, and the Late Life Function and Disability Instrument: Disability Component was used to measure participation frequency in daily activities. Results Path analysis indicated that wheelchair-related factors were associated with participation frequency directly and indirectly through their relationship with mobility. The final model explained 46% of the variance in resident mobility and 53% of the variance in resident participation frequency. Wheelchair skills, which include the ability to transfer in and out of and propel a wheelchair, were important predictors of life-space mobility and frequency of participation, and life space mobility was a significant predictor of frequency of participation. Depression was associated with poorer wheelchair skills and mobility and less-frequent participation. Counterintuitively, perceived environmental barriers were positively associated with frequency of participation. Conclusion The findings suggest that, by addressing wheelchair-related factors, resident's mobility and participation may be improved, but the efficacy of this approach needs to be confirmed experimentally. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of medical Primary Integrated Interdisciplinary Elder Care at Home ( PIECH) on acute hospital use and mortality in a frail elderly population. Design Comparison of acute hospital care use for the year before entering the practice (pre-entry) with the most-recent 12-month period ( May 1, 2010- April 30, 2011, postentry) for active and discharged patients. Setting Community. Participants All 248 frail elderly adults enrolled in the practice for at least 12 months who were living in the community and not in nursing homes in Victoria, British Columbia. Intervention Primary geriatric care provided by a physician, nurse, and physiotherapist in participants' homes. Measurements Acute hospital admissions, emergency department ( ED) contacts that did not lead to admission, reason for leaving practice, and site of death. Results There was a 39.7% (116 vs 70; P = .004) reduction in hospital admissions, 37.6% (1,700 vs 1,061; P = .04) reduction in hospital days, and 20% (120 vs 95; P = .20) reduction in ED contacts after entering the practice. Fifty participants were discharged from the practice, 64% (n = 32) of whom died, 20% (n = 10) moved, and 16% (n = 8) were admitted to nursing homes. Fifteen (46.9%) deaths occurred at home. Conclusion Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the feasibility of a follow-up hip fracture clinic which could be used to promote mobility in older adults following hip fracture and hip fracture fixation. Researchers evaluated the use of the clinic with 110 subjects. They found that the clinic led to improved mobility and concluded that the clinic was feasible.